1) There is a perception that the salaries of American physicians are too high, making them a frequent target to cut.
My take: When expressed in GDP per capita, American physicians are indeed compensated at a higher rate compared to other countries. However, context is needed. New American physicians graduate with a mortgage-sized $150,000 debt. In Canada and Europe, medical education is heavily subsidized. Furthermore, American physicians pay significantly more in malpractice insurance. When these points are factored in, the contrast in salaries aren’t as stark. I will not take any suggestion to reduce the salaries of American physicians seriously, unless it is accompanied with proposals to reduce the burden of malpractice insurance and subsidizing medical education.
As an aside, I would also be curious to see how the salaries of American CEOs and lawyers compare with those abroad. Are they also compensated at a higher rate when compared to Canada and Europe? If so, where is the outrage against American attorney’s salaries?
2) The Boston Globe’s Steve Bailey writes: “Massachusetts did what no other state was willing to do because it got tired of access being held hostage to cost. But broadening coverage without slowing costs will not work. In the end, it will break the bank.”
My take: Thanks for stating the obvious Steve. Promising universal coverage is an easy political sell. Obviously, everyone wants health care for all. Implementation however, tells a different story. Massachusetts is finding out that costs will increase with universal coverage, no matter how they dress it up. As the public slowly realizes that universal coverage will be on their dime, I would be curious to see if the enthusiasm lasts.
By promising universal coverage up front, leaders are going for the political slam dunk. This is a mistake. Without paying attention to what’s really ailing our health care system, like runaway costs and primary care infrastructure, they will find out that the easy way out is going to lead to a hard road ahead.
Hillary and Obama are in danger of falling into the Massachusetts trap. But with the Democratic primary so closely contested, don’t bet on any deviation from their misguided universal coverage rhetoric.
Related posts:
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- Did the Massachusetts health plan just get bailed out?
- Before you think about cutting physician salaries
- NY Times hearts Massachusetts
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- Physician salaries are not keeping up with inflation
- How to solve Massachusetts’ health budget shortfall
{ 12 comments }
The correct comparison is to other professionals. And yes, American professionals have a substantially higher wage ratio to the average worker compared to other countries. Dentists, etc. all make more here than in most countries.
Agreed. However, many would take greater exception to the primary care/subspecalist pay disparity. If no changes would/could be made, resdistribution is not only right, but necessary. With exceptions, and I wont name specialities to avoid battles, some groups of docs could use a 10% slice for transference to the FPs, Peds, etc, of the world. It is obscene to think that there is a differential of 200-300K between these groups. Not right. Period. I am not a primary care doc btw.
What do you think about the idea to force people to buy health insurance (like we force people to buy car insurance)? Employers with more than a certain number of employees (like say, 10) would be forced. Those who could not afford it (based on strict criteria) would get subsidies or medicaid/medicare. The insurance for say a healthy 25 year old could be the cheap kind that only covers bigtime problems. I know it is not perfect but the idea seems to have some merit. And yes, I think medical education should be more subsidised as well – espeically if you go into primary care or other underserved fields.
I agree income for docs in US is generally higher but recently GPs in England seem to have seen a impressive surge in compensation according to this article
http://news.bbc.co.uk/1/hi/health/6157219.stm
GPs getting $200,000
If so will the brain drain of the 60’s(or whenever it was that the newly born NHS lead to a exodus of docs to the west) be reversed?
Kevinmd, agree with you completely on both points. To ERP: Forcing insurance or universal coverage is flawed unless you tackle the other issues. More covered people just means more healthcare costs and with primary care crashing in the U.S. it means BIG increased specialty costs.
I don’t think much at all of forcing people to buy health insurance–it has no comparison to car insurance:
1. We only require people to buy automotive liability–not collision. We are requiring them to cover the risk to which they put others by operating a car, not their own risk. They are perfectly free to self-insure for their own risk. They should be for health insurance also.
2. People have the option of not owning a car.
3. Automotive liability is not nearly as expensive.
The only moral case that can be made for mandatory health coverage is for emergency care only. By existing, you are putting the nearest ER at risk, but for non-emergency care providers are free to deny you care and so it just can’t be morally justified. It probably makes more sense to collective that limited risk through the tax system.
People have the right to not buy health insurance just as surely as they have the right to live and die without health care if that is what they want.
People should have to freedom to choose how they want to pay for their health care–prepayment via a plan or pay as expenses arise. All the political debate notwithstanding, this is a private choice and not the public’s business.
Much of the push to complete the partial collectivization is predicated on the oft proclaimed belief that the uninsured are the source of the cost problem. The data says otherwise.
Anon 1:03: I don’t agree. A specialist making 250k more than a FP doc is probably making 400+. I cannot think of many fields in which physicians make 400k and it isn’t vastly more stressful than family practice. You are talking about fields where people are constantly on call, have awful family lives and live in the hospital. Quite frankly, the neurosurgeons around here do deserve to make double what the FPs make, because their lifestyles are sure as hell a lot more than twice as bad and stressful. And there was that whole working 100 hours a week for 7 years thing in residency.
From a more practical standpoint, with a trend towards increasing NP independence and use in primary care the idea that FP salaries are going to shoot up is ridiculous unless they go to a NP-management model. Each increase in FP salary will only make NPs more attractive and the job market worse for FPs. I think there is some interesting potential in the idea of hybrid practices with NPs handling less complicated/followup type things. There’s boutique medicine but I don’t think that will ever really grow beyond a small segment. I’m not saying this is necessarily the ideal state of affairs, but the situation does not seem to be set to improve.
The more NP you use, the more exposed they will be to malpractice and eventually their rates will go up. At that point they will become more expensive. honestly, the NP that worked with me used to make 60000 for 40 hrs worked and I was making 100000 for 60 hours worked, including calls and hospital rounds which she was not doing.
I agree that with present reimbursement rates FPs really have nothing to fear from NPs because the FPs are honestly way better bang for the buck. But if you add 30 or 40% on to the FP’s income, I think it would change things as far as salaried physicians go (with the employers moving to more NPs) which would have an effect on the whole FP market.
The 2L summer student will get $24,000 for a 10 week summer internship.
The law grad will get $160K out of law school. The med student has been taking care of patients for two years upon graduation, after four years. The law student, has never spoken to a client, nor even written a legal demand letter in anger, after three years of empty verbiage.
The mid-career law partner makes $1.2 mil a year, as an average.
Let’s put things in perspective.
The average lawyer destroys more than $1mil of our economy each year the land pirate lives.
The average doctor restores over $10mil to our economy year after year, by keeping people working, or keeping people from getting worse.
The lawyer makes 99% of the policy decisions of the government. They have been dealing themselves the wealth and power, entirely unopposed by organized medicine. These disloyal clinician traitors have played dead in the face of the onslaught of the lawyer against clinical care from all sides.
ANON 7:04 from 1:03.
I said with exceptions. Neurosurgeons, among others, deserve their bucks.
In terms of NPs, until there is evidence to say that increasing their prevalence to manage anything beyond basic health care needs, I cannot agree. Enough data exists to support buttressing primary care in lieu of subspecialists (better outcomes, lower cost). We need a national workforce policy and more well thought out ratios of physicians. Continuing down current path will lead, if we are not there already, to collapse of our primary care infrastructre (of which midlevels should be a part by the way).
I’m in one of the lowest paying specialties–but I picked it knowing that. Sure the discrepancy has worsened, and I used to whine about that, but when I realized that I am (barely) still young enough to retrain if I went about it right, and seriously considered doing so for more money, realized that I don’t want to—so I must not think they are so terribly overpaid. I mean some of those guys doing the same procedure over and over and over again. If they have a reasonably bright IQ, it must be tortuously boring.
If we all put our troubles out by the street where we could see our own in comparison to our neighbors, most of us would drag our own pile back into the house rather than someone elses. We picked our own particular poison for a reason, and if we now see the reason to have no basis in our essential character, then we have the freedom to change.
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