Change is coming. I just hope the single payer folks don’t beat the real reformers to the punch. Don’t be surprised if I come back to all of you asking for your input in a reform effort I’ve just joined.

The study was run back, 1994 or 1995 in JAMA or NEJM, it’s been a while. Make the assumption that someone able to get into medical school could get into the top half of law of MBA programs.

If one accepts that premise, calculate average pay, length of training, the best return is a MBA degree. Secod is a tie between law and specialty medicine. Primary care is dead last.

A doc told me that years ago when I was a high school kid thinking about medicine. He said if you just want money, take your effort and sacrifice as you would in medical training. Put it into just about any endeavor you like. Build houses. Become a plumber. Instead of spending the money, put it into a business as the doctor would be paying tuition and working long hours for low wages in postgraduate training. You will be better off financially in the end.

I say that’s true……if you really do the sort of sacrifice in youth that a doctor has to do.

There are good reasons some of us post anonymously. That said, I think the most important flaw with international comparisons vis-a-vis the U.S. primary care practice is that they are largely irrelevant to the menu of choices actually faced by U.S. medical graduates.

Think about it. When a U.S. student graduates from medical school, his or her choices are not “should I practice in the U.S. or in some other country?” The choices are “should I make $150K a year working like a dog after a 3-year residency, or should I do, say, radiology and make $500K a year while enjoying a nice, predictable lifestyle with relatively low hours?”

Of course, now I suppose there’s the option to leave the U.S. and practice primary care in the UK for big $$. I wonder if IMGs have shifted from taking rural PCP jobs in the US to taking similar jobs in the UK.

I sympathize with the general sentiment the U.S. doctors are well-paid. But some specialties are so ridiculously well-paid (GI, cardiology, dermatology, anesthesia, radiology, pathology, etc) that the _discrepancy_ in pay chokes off the pipeline of new PCPs. So there are 2 possible solutions: increase PCP pay, or decrease procedurist/imager pay while holding PCP pay constant.

If you think international models of physician compensation are better, then you would do the second option and maybe have free medical school. This might be politically tough…the U.S. electorate has repeatedly shown a real dislike for learning from other countries.

Dowsn’t apply to primary care phyaicians.

NHS GP’s can make the equivalent of US$250,000 How do I know? I ask them.

They’re private strictly speaking, not “government employees”. Of course, when you’re talking about government payment schemes, this might be a fine distinction.

Procedural specialties, yes, they are definitely paid a lot more here.

And actually, it makes sense. A government-run healthcare scheme is politically sensitive. Give the people free primary care, most will never need specialty care, and things look rosy. If one patient suffers from a long waiting time for heart surgery or cancer care, compare it to a thousand who remember their free PAP smear or free minor medical event. Turn that into votes.

So yes, primary care usually does well in that system.

Don’t get me wrong, I have tremendous appreciation for what physicians do. I work with them on a daily basis and my number one job responsbility is making sure that my physicians make as much money as possible. I am 100% on board with the fact that there needs to be a compensation realignment between PCPs and specialists. With that being said, I don’t see the average physician deserving a big raise because you are not significantly underpaid in comparison with other professions in this country.

http://www.kevinmd.com/blog/2008/09/if-you-dont-care-to-have-pity-for.html

Medical school is subsidized abroad, and malpractice costs are a fraction of what American doctors pay.

Only if you make US medical school free, and substantially decrease costs of malpractice, can you compare salaries with other countries.

Thanks,
Kevin

http://www.worldsalaries.org/generalphysician.shtml

I would love for you to back up the 2X figure because it’s garbage or possibly an anomaly at best. I also think it’s cowardly to post something anonymously.