Does your cardiologist deserve his salary?

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a “healthcare expert.”

“I’m not at all sympathetic with the cardiologists,” said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a fellow with the Urban Institute. “Studies show they make well over $400,000 a year” — more than twice what a family practice physician earns.

This proclamation of overpayment emanates from an Urban Institute doctor. In other words, a “think tank” doctor who toils in a cubicle with a computer and coffee mug rather than a lead apron and real lives changed if the burn gets too hot or stent placement off by a few millimeters.

On the other bipole is the patient who sees me for his defibrillator follow-up, but gets his general cardiac care in his hometown outside of the city. He is free of symptoms since the heart attack and bypass surgery 6 years ago. He is active, thin and compliant with the regimen of life prolonging medicines including statins, aspirin, beta blocker and ACE inhibitors. And he asks me, the electrophysiolgist, “Doc, is it really necessary for me to have a cardiolite (nuclear) stress test and echocardiogram every year?”

Yes, a perfectly stable non-diabetic patient without symptoms who is on all the right medicines is getting 1,200 dollars of surveillance testing every year for the past 6 years. As any master of the obvious would predict the tests consistently reveal an old scar from a previous heart attack. For the record, a cardilolite stress test has the equivalent radiation exposure of nearly 10,000 chest xrays (CXR=0.06 mrem, Cardiolite=585 mrem).

The uncynical might suggest the cardiologist ordering these yearly tests is simply doing so for benevolent and cautious motives, but surely, the historically generous reimbursement of imaging has a role in decision making. One has to ask whether ownership of the nuclear camera influences the decision to order these yearly exams.

Herein lies the conflict. The heart business is hard. Electrophysiology private practice began at age 31 after eleven years of post graduate training and a living is earned adjacent to a fluoro unit with a lead apron and a catheter burning inside the beating heart. The interventionalists or “squishers” who open blockages and reverse heart attacks do so within ninety minutes regardless of the clock face.

So, the blood heats when a “think tank” doctor opines on how much cardiologists are worth. But yet, like the bad boy in elementary school whose misbehavior cost the entire class recess, the cardiologist who games the system hurts the entire profession.

One can see both sides of the coin.

John Mandrola is a cardiologist who blogs at Dr John M.

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  • jenga

    This overpaid crap is for the “mentally disabled”. Steve Francis got paid 30 million to NOT play basketball. With the life and death decisions that cardiologists make everyday, possibly more than any other profession in medicine, I myself a noncardiolgist physician, think they might be underpaid.

  • Martin Young

    How much is a life worth? Any life! How much will rescue services spend to save a life?

    Until there is agreement to a satisfactory figure, independent of status, little value will be placed on the efforts of those who save lives. And that’s never going to happen.

    Are doctors overpaid?? Not in the slightest!!

    The general public may come to realize that you “get what you pay for”, sadly too
    late!

  • Doc99

    If there were no third party payors, we’d not be having this debate. Let the patient aka consumer negotiate with the doctor aka service provider for a level of service tailored to his needs. This class warfare has become for doctors just another example of divide and conquer. Ben Franklin said it best, “We must all hang together. For assuredly, we will all hang separately.”

  • medstudent

    Agreed. At my medical school, I have to sit through lectures every year about how we should increase the number of primary care doctors, increase the number of insured, and do so happily at a decreased income because $100k per year is more than most people make. I bit pretty hard because I definitely agree with the first two statements. But, it wasn’t until talking with my brother-in-law (to whom I had parroted those three tenets), that he replied that $100k is not much money. That’s difficult for me to judge because, as a medical student, I have never made that much money. Indeed, I would be very happy to make that much money doing a job that I love. However, he pointed out to me that he makes nearly that amount with a bachelor’s degree as a freelance consultant, and argued that with the capital investment, years of income lost during training, and educational attainment (to say nothing of the rigors and stresses of the profession) the market value should be much higher than the $150k that the average primary care doc makes.

    Likewise, added years of fellowship, with similar years of income lost (approximately $300,000 for a 3 year fellowship) constitutes a financial and educational investment that should result in an increased pay. How much, I don’t know. But I do know that we should start asking that if a Cardiologist shouldn’t make $400k a year, then who should?

    • jsmith

      100k per year is peanuts for what a primary care docs does. 200k is more reasonable. My in-laws have master’s degrees in engineering and earn 100k per year. Doctoring for that amount of money is idiotic.
      I don’t think 400k per year is too much for people, like cardiologists, who routinely save lives in the middle of the night.

  • scubaredneck

    As an older medical student who has spent quite a few years in both the academic world and the 8-5 working world, my perspective is similar to that of “Primary Care Internist.” The problem is not that cardiologists and other specialists are over paid but that primary care docs are undervalued and under paid. They have become the “blue collar working stiffs” of the medical profession. They are the ones to whom you run and demand to be seen when you have a sniffle (that you could have self-treated) but don’t want to wait for an appointment. In most of the professional world, this sort of demand would either be laughed at hilariously or would cost you several arms and multiple legs. Primary care docs allow it because it comes with the oath.

    But because what they do is not glitzy or glamorous or sexy, and because we see them all the time at church and the supermarket and such, it’s easy to undervalue them and the work they do. So when payers want to make cuts, it’s the primary care docs who take it in the shorts while the public clucks their tongues and criticizes “those rich doctors” for complaining about taking a cut in pay.

    We had a hand surgeon come speak to our class and at the end of his talk he put up a slide showing the cost breakdown of a typical wrist surgery based on the negotiated rates of various payers, as compared with the actual cost of the procedure. What was kinda scary was that, if he was doing it for a medicare or medicaid patient, he barely made enough to cover his overhead and pay his staff. He ended up donating his time to the procedure. Try pulling a stunt like that at your local auto repair garage!! Or with any other profession, for that matter. The emergent specialists have been pretty good so far at keeping their reimbursement rates high because their services are often of the “life and limb” variety. However, their day of reckoning will come too if we don’t find a way to fix the system. Then you won’t be able to get anyone smart to go into medicine because they don’t want to spend the rest of their lives paying off their school debt when they could do the high-paying jobs “Primary Care Internist” with their eyes closed.

  • Primary Care Internist

    I don’t at all think cardiologists make too much money. On the contrary, I think primary care docs are grossly underpaid, and all docs are subject to intense regulations and scrutiny.

    Where I live, in the northern suburbs of NYC, it’s quite expensive to live and raise a family. Most docs (including myself) find it difficult to make ends meet here. Rather, the area is crammed with mediocre minds who work in law or the financial industry, making 5x or more what a typical physician does. This is what this country is incentivizing now.

    When I was in high school my mother (a pediatrician) was making more than double what she is now, in real dollars. At that time her home cost one-tenth what mine did. So the numbers really have changed, and while it used to be said to me by uncles & aunts who are physicians “you won’t get rich but you’ll be comfortable” with a career in medicine, now the reality is “you might have a hard time making a living as a doctor”.

    I agree that some cardiologists are overtesting to recoup the costs of that nuclear camera, and I think that the incentive to test (or treat with chemotherapy, for oncologists) shouldn’t be part of the equation. No i don’t have a good answer for how to accomplish that. But cardiologists should be paid, and paid well, to do what they’re trained to do – save lives.

    I really never understood people who think cardiologists, or any doctor, are overpaid. These are the most intensely trained professionals in ANY field. Is it really crazy if they even made $1,000,000/yr? After all MANY MANY insurance execs, CEOs, lawyers, and bankers make that much and more. And i think anyone who got through med school, residency, and fellowship could easily be one of the above.

    And if have particular disdain for “doctors” who make & influence policy rather than treat patients. To me this means they couldn’t do the latter, and now are trying to make up for their insecurity by screwing those that can treat patients. While we are on call & working at all hours, day & night, and weekends & holidays, these guys are at home relaxing and still collecting a paycheck & fat benefits. Same for insurance company medical directors – what a bunch of crooks.

  • TrenchDoc

    The problem is the way payment to physicians is calculated. It is currently procedurally based instead of time based as most other professions i.e. lawyers and accountants. Society sets the level of education and training that is required for us to do this job and then sets the value of compensation at a level below a reasonable payback. We then make up the difference by increasing the volume of patients we see (primary care model) or by increasing the volume of procedures (cardiologists). In fact 400,000 for any doctor is not overpayment when you think of what value that doctor brings to society in terms of healing and controlling disease processes.Just look at what we pay our professional atheletes.

  • joe

    Well said PCI:
    Please see “Dr” Berensen’s info. The man clearly has no been actually a real practicing doctor in well over a decade.

    http://www.urban.org/about/RobertBerenson.cfm

    This guy is not a doctor he is a healthcare policy wonk with an MD. He couldn’t hack the real world and now tells those of us actually living in it how it should be. Sheesh…get a clue.

  • http://www.rahulgladwin.com Rahul

    Does Tiger Woods deserve his $1 billion income?

  • scubaredneck

    Also, Randall, the question of how much a person makes is far more than a function of the subjective worth of their job. It will not be long before new docs will routinely begin their careers with $500,000 in school debt (that’s 1/2 million dollars!!!). To expect them to work for peanuts and spend literally the rest of their lives paying down that debt is patently absurd. No talented, intelligent person is going to willingly submit to that when their talents will allow them to do something different. So what will happen is you will see folks less qualified, with fewer options before them (which was the case with medical training in the early to mid-19th Century, before John’s Hopkins ushered in modern medical training) and the overall quality of health care (particularly primary care) will absolutely plummet.

  • scubaredneck

    Randall,

    Since when does the AMA or specialty societies set salaries? Those are decided by the payers, often over the objections of the professional societies. However, you are correct in that primary care docs could do with being a bit better at standing up for themselves. Indeed, when doctors cut our medicare and other lower-reimbursing insurance plans from their practices, they make more money. The downside (at least for most who go into primary care) is that they end up not seeing many of the folks for whom they got into medicine to serve in the first place.

    As far as the dwindling pot of money, that was part of the whole point of the beginnings of the thread (as I understood it), that so long as the system is controlled and regulated by the government, there will be this idea of a finite pot of money from which to draw. Free market economics doesn’t have a finite pot but continues to make the pot bigger (until, as illustrated by the current recession, the government monkeys with the system). Whether or not health care (particularly urgent or emergent) is a fungible commodity that can be properly subjected to market forces is indeed one of the questions at hand.

  • BD

    >>Does Tiger Woods deserve his $1 billion income?

    Or John Mayer? Good point. They’re both worthless, disgusting pigs unworthy of minimum wage to me. But people willingly buy what they’re selling, thus, huge salaries.

    Salaries aren’t calculated based on what’s “fair”. They’re calculated based on the price the system will bear, though in the case of physicians there are price controls which sometimes cause artificially low (or high) salaries.

  • Randall

    What about firefighters who risk their lives, teachers who shape the next generation.. where does this end? For the most part whether doctors like it or not are paid by third party (insurances including Medicare), Pot of money is distributed and AMA and Cardiology societies decided what that share would be. Same goes for Dermatology and this is power of lobbying, whoever is powerful wins. Primary care doctors have to stand up for themselves especially because they been thrown under the bus long time ago. Whoever says and primary care needs to go up in reimbursements without any change for other specialists, have their head in Sand. WE ARE OUT OF MONEY.. we need to make tough choices. Ironic that people claim to be worried about deficits but when they have to have the tough choices and cuts, they balk. Easier said than done!

  • teach

    John –

    As an individual who is an educator and a business owner, I work with refugees from extreme 3rd world counties. My experience have lead to believe that there are two type of dentists and lawyers: one set for the rich and one set for the poor. My students and their siblings often see the dentists for the at the local health care clinic or Kids’ Smiles. (Don’t get me started about that group; one of my student’s sister has three metal caps and she is 2.5 years old!). The parents receive legal care through a free Christian Legal Aide service. However, in my town, there are no separate hospitals for the poor and wealthy.

    On a different note, I have had conversations with a few students who want to study medicine. I always tell them to teach first; I tell to do so for a few years, live in Mom & Dad’s basement, tutor 10+ hours a week, and pool the teaching money into a medical school fund. Average beginning teaching salary in my area is $35,000, so in 3 years they have $105,000 for medical school.

  • joe

    Randall:

    “Whoever says and primary care needs to go up in reimbursements without any change for other specialists, have their head in Sand. WE ARE OUT OF MONEY.. we need to make tough choices”

    I’ve got news for you randall, all doctor salaries could be cut to zero and you would only decrease expenses by 20%. The only answer to our longterm medical costs is some form of rationing period. Did you see that happen when medicare D went through? Have you seen any discussion of this subject by any politicians (Dem or Rep) in the latest healthcare debate? No because that would take character and honesty, something sorely lacking by both parties. Sure make the specialists the boogeymen. Cutting their salaries to increase PCP’s salaries (which should be increased) and expecting some type of overall cost savings is akin to fighting a 4 alarm fire with a squirt gun. Until is some rational rationing in this country, costs will just spiral.

  • http://www.drjohnm.blogspot.com DrJohnM

    I am grateful for the comments which were surprisingly favorable -so much insight.

    Make no mistake, the gratification of success in medicine is the greatest reward. Really, it is. All have their respective examples. For me, it is often in the EP lab when an arrhythmia disappears with an ablation lesion, or the patient who reports a shock from the ICD and sudden death was averted, or even a successful encounter in the office in which a patient stands satisfied through education and time spent.

    The reality though is reimbursement remains a major source of dissatisfaction. And, as pointed out it is affecting the future of medicine, primarily by deterring talented youth from pursing medicine. As the population ages and requires more modern day care, this fact seems under-represented in the conversation on health care reform.

    How the present payment system evolved is mysterious to me. It is just so convoluted. E and M criteria that simply increase the size of the note -absolutely no one looks at a specialist’s review of systems, the recent confusion on was this a consult or new patient and differing patient deductibles and out of pocket costs are just a fraction of the silliness.

    I wonder how other professionals, like the dentists and the lawyers have escaped this silliness. A few months ago, I wrote on the root canal experience. In brief, before getting in the chair to have that painful tooth fixed there is a swipe of a ccredit card and voila, one is 950 dollars less rich. No coding or pre-certification, no denial of payment, and hence no need for a business office. Do not want to pay, no problem, we will not fix the tooth.

    The lawyer sends an itemized bill listing times for phone calls and email. Try coding for 15 minute phone call or email.

    After a spending a night with politicians recently, all of which liked they have no trouble obtaining health care, it seems a tenable solution is far in the distance.

    JMM

  • Randall

    AMA decides the RVUs and all Insur pay accordingly, that is the mantra for payment for all doctors. It has a 23 or so board members and 70% of them are specialists. They are the ones who decide how each speciality has to be reimbursed. The process has been skewed and it is unbelievable that many doctors don’t have a clue that this happens behind the doors, nothing about this is transparent! Basically this has been a power game for a long time.

  • Anonymous

    >>it is affecting the future of medicine, primarily by deterring talented youth from pursing medicine>>

    This hasn’t seemed to affect the number of bright students willing to enter veterinary medicine, where applications remain more competitive than for medical, dental or law school – despite loans comparable to those from medical school, and very low salaries. It will affect the number of “talented youth” who, unlike Dr. JohnM, do not truly consider the gratification of success to be the greatest reward in medicine.

  • anonymous

    Pediatrics and vet medicine will always attract people because they both have a special hook that somehow grabs the hearts of people (women especially).

  • Vox Rusticus

    Veterinary medicine seems to have very diverse markes. On one hand, there is the ag-industrial side (sorry, not like All Creatures Great and Small) and then there is small animal, which is what most people experience (leaving aside the relatively small numbers going into teaching, research, government/military and non-agricultural industries.)

    I have heard that the retail pet supply chains pay vets very poorly and skim the profitable services as loss leaders to draw retail customers and so probably do some private practices, but other private practice venues, especially small-animal hospitals in affluent areas, and those with advanced diagnostic lab, specialty surgical and imaging equipment do very well on a cash-pay model.

  • Anonymous

    >>I have heard that the retail pet supply chains pay vets very poorly…>>

    That’s not exactly true, though they do pay their support staff poorly. Whether the amount of money they pay veterinarians offsets the numerous negatives of working for a corporate practice (one of which is that these corporate practices are run by non-doc MBAs… welcome to human medicine, IOW).

    >>>…and skim the profitable services as loss leaders to draw retail customers>>

    That’s true enough.

    >>..and so probably do some private practices, but other private practice venues, especially small-animal hospitals in affluent areas, and those with advanced diagnostic lab, specialty surgical and imaging equipment do very well on a cash-pay model.>>

    Sure, as do physicians working in cash-pay models (plastic surgeons, IVF, concierge practice, etc.). The argument is not that veterinarians earn minimum wage (we don’t).

    Rather, veterinary medicine does not and will never pay as well as human medicine. Not gonna happen. $150K is a huge salary for a veterinarian (even a board certified veterinarian) – not right or wrong, just a fact of life. $150K is a low salary for a physician – also a fact of life.

    My point is very smart people who could have gone to human medical school chose, for whatever reason, veterinary school. Every single one of my classmates could have gained admission to medical school (those of you who squeaked into medical school off the waiting list should thank them.) Not all took vows of poverty, but they settled for a fraction of the salaries they could have earned as physicians. It would be interesting to consider what factors other than money motivate people to choose human medicine vs. veterinary medicine. If money is the primary motivator, well, that’s just sad. I think (hope) the issue is more complex.

    • Anonymous

      I’m sorry, but not all veterinary schools require the MCAT which, it could be strongly argued, is more difficult than the GRE. Most schools accept the GRE and a few accept the MCAT and VCAT.

      Also, 46.8% of applicants were accepted to medical school in 2009 while 46% of pre-vet students were accepted to veterinary school. It seems that they are probably equally difficult to get into, though the MCAT requirement may make medical school more competitive.

      “This statistic results in nationwide acceptance rate of 46 percent, less than half [26].”

      http://en.wikipedia.org/wiki/Veterinary_medicine#The_Road_to_Becoming_a_Veterinarian

      “In addition to satisfying pre-veterinary course requirements, applicants must submit test scores from standardized tests such as the Graduate Record Examination (GRE), the Veterinary College Admission Test (VCAT), or the Medical College Admission Test (MCAT). The decision as to which test should be taken depends solely on the requirement of the college to which the applicant is applying. As of 2007, 22 schools require the GRE, 4 require the VCAT, and 2 accept the MCAT.

      Admission to veterinary school is highly competitive with the number of qualified applicants admitted varying from year to year [23]. This is due in large part to the fact that the number of accredited veterinary colleges has remained largely the same since 1983, but the number of applicants has risen significantly. As a result, only about 1 in 3 applicants were accepted into veterinary school in 2005.”

    • chinocochino

      I’m sorry, but not all veterinary schools require the MCAT which, it could be strongly argued, is more difficult than the GRE. Most schools accept the GRE and a few accept the MCAT and VCAT.

      Also, 46.8% of applicants were accepted to medical school in 2009 while 46% of pre-vet students were accepted to veterinary school. It seems that they are probably equally difficult to get into, though the MCAT requirement may make medical school more competitive.

      “This statistic results in nationwide acceptance rate of 46 percent, less than half [26].”

      http://en.wikipedia.org/wiki/Veterinary_medicine#The_Road_to_Becoming_a_Veterinarian

      “In addition to satisfying pre-veterinary course requirements, applicants must submit test scores from standardized tests such as the Graduate Record Examination (GRE), the Veterinary College Admission Test (VCAT), or the Medical College Admission Test (MCAT). The decision as to which test should be taken depends solely on the requirement of the college to which the applicant is applying. As of 2007, 22 schools require the GRE, 4 require the VCAT, and 2 accept the MCAT.

      Admission to veterinary school is highly competitive with the number of qualified applicants admitted varying from year to year [23]. This is due in large part to the fact that the number of accredited veterinary colleges has remained largely the same since 1983, but the number of applicants has risen significantly. As a result, only about 1 in 3 applicants were accepted into veterinary school in 2005.”

      • Anonymous

        >>not all veterinary schools require the MCAT which, it could be strongly argued, is more difficult than the GRE.>>

        Most veterinarians would have done very well on the MCAT had they been required to take the test. I’d agree the MCAT is more difficult than the GRE, just as the GRE is more difficult than the GMAT. So what? I’ve never taken the LSAT, but that does not mean I wouldn’t do as well, or better, than most law school applicants.

        >>only about 1 in 3 applicants were accepted into veterinary school in 2005>>

        So, the rate of acceptance for veterinary school has increased since I applied (before 2005) and increased further to about 46% in 2009. When I applied I think the acceptance rate was around 15-20%, depending upon the school. That was significantly lower than the acceptance rate for medical school at the time.

  • stargirl65

    How is vets malpractice? Can they get sued and lose everything? Do they have to do preauths to insurance all day long as well?

    • Anonymous

      >>How is vets malpractice?

      Our premiums are much lower. Obviously, since our premiums are lower, our actual gross income is much lower than that of a physician with the same net income. A physician’s more expensive malpractice premium results in higher expense of running a human medical practice. Therefore, a physician’s gross must be higher than a veterinarian’s gross to arrive at the same net income.

      >>Can they get sued and lose everything?

      Yes. Usually for human injury, almost always when the owner is restraining his own animal (or even standing nearby) during a procedure, no matter how routine. There are several million-dollar lawsuits pending. This is a huge problem for large animal veterinarians, especially when covering emergencies, because owners frequently restrain their own animals.

      Equine veterinarians tend to have the most expensive medical lawsuits. Horses can be worth six figures and up, and even though they’re legally regarded as property, that’s expensive property.

      >>Do they have to do preauths to insurance all day long as well?>>

      No. This could well be one reason why we don’t dislike our jobs as much as many physicians seem to.

      I’m not saying veterinarians should command higher salaries. But the fact is, the veterinarians I know would almost all have made fine physicians. I know several who started out in medical school then switched. I even know one who completed veterinary school, decided to attend medical school, then left after the first year because he preferred veterinary practice.

      Veterinarians who easily could have attended medical school made a different choice, and I don’t think the hassle of insurance paperwork is the entire explanation.

  • Vox Rusticus

    Thank you for the clarification. I am well aware how competitive vet school application is (didn’t apply, but I worked for a veterinary spine surgeon at one time). I am sure you are correct, that veterinary practice won’t on average pay as well as human medicine. I will leave the questioning whether this is reasonable to others, except I will note that residency generally doubles the time for training that human medical practitioners complete after undergraduate university degrees and that is not nearly the case, on average for vets. Now I am sure that those who do equine practice and others also have advanced degrees in addition to a DVM, but similar examples exist on the human side. Smarts aside, I don’t think the disparity is all that unreasonable. If you are smart enough to get into vet school, then you ought to be smart enough to know ahead of time what you are getting into.

    • Anonymous

      >>I am sure you are correct, that veterinary practice won’t on average pay as well as human medicine. I will leave the questioning whether this is reasonable to others, except I will note that residency generally doubles the time for training that human medical practitioners complete after undergraduate university degrees and that is not nearly the case, on average for vets.>>

      In 2009, about half of new graduate veterinarians went on to internships and residencies. It isn’t required; veterinarians can enter general practice without board certification. But veterinarians who are board-certified in internal medicine (3-4 years+ additional training) do not command the same salary as physicians who are board-certified in internal medicine. Even my colleagues who are double-boarded with PhDs don’t commmand the salaries of MDs with equivalent training. Those are facts, and I’m not saying it’s wrong that veterinarians’ salaries are lower.

      >>I am sure that those who do equine practice

      Equine veterinarians can enter practice without additional training, though they tend to focus their electives and rotations on their preferred species (just as small animal, exotic, cattle, swine, or poultry veterinarians do).

      >>Smarts aside, I don’t think the disparity is all that unreasonable.>>

      As I stated initially, the fact that veterinarians make less money than physicians is simply a fact.

      >>If you are smart enough to get into vet school, then you ought to be smart enough to know ahead of time what you are getting into.>>

      Ah. Is this what you tell your colleagues who choose family practice rather than a more lucrative career in nearly any other specialty? If so, it’s no wonder morale is so low for family practice docs.

      So, to finally return to the topic that actually interests me …

      Fact: most veterinarians would have made fine physicians (just as many physicians would have made fine veterinarians).

      Fact: veterinarians make less money than physicians. This is a well-known fact. I don’t see this changing anytime soon, and I’m not arguing that the salary disparity is wrong.

      I really hope you’re not arguing that if veterinarians were smart they’d choose a higher-paying career. That would be an ugly, but illuminating, statement. So instead, consider…

      Questions of interest: why do people choose veterinary school? Could some of the factors that make veterinary medicine attractive be applied to human medicine?

      Because honestly, I don’t see physician salaries rising, given the problems the current system is now experiencing. The system sucks, for patients and for physicians. I wouldn’t want to deal with it. Why did you decide to, if you were smart enough to get into medical school?

  • rezmed

    This seems ridiculous. No one wants to say no. Sure, you are worth a million dollars for what you do – especially when that no good ……. (choose one) is making millions every year for doing so much less. But where does it stop? How much more should a cardiologist make compared to a nurse, or a state senator or a teacher or or a Airbus pilot or a primary care doctor? Is it all negotiable? Or should we just say “you are absolutely worth what ever you want to make”?

    This is a problem for all of America – we can’t say no to any group out there and our budget deficit is exploding. No one says no to brand name drugs for Medicare patients. No one says no to any cuts in Medicare or entitlements. We only seem to be cutting schools and police and social programs. Where are we going to be in 20 years? As a doc, I only know I will be very, very well off.

  • scubaredneck

    No disrespect for vets but, in terms of pay, most (if not all) vet practices are straight cash-for-service setups. This is not true for most MDs or DOs. Anon mentioned that $150K was a huge salary for a vet but a low salary for a human doc but $150K is about average (or a bit above, actually) for a primary care or family practice doc these days.

    As far as competitiveness, part of that is due to the fact that there are only around 30 veterinary medicine schools as opposed to well over 150 medical schools in the U.S. Fewer slots means a lot more competition to get one.

    I would also challenge the notion that vets graduate with similar loan amounts. According to the AVMA, “Today’s veterinarians graduate with an average of $120,000 in student loan debt.” (as of Jan 2009). At my school (which is towards the lower end of average for tuition and fees), this represents just 3 years of tuition and doesn’t include additional fees and living expenses, scheduled tuition increases or the entire fourth year. I have seen predictions from AMCAS suggesting that average indebtedness could reach $500,000 by 2020. This is a major contributing factor to the looming shortages of primary care docs. Study after study continues to show that medical students are choosing the higher-paying specialties at least in part due to this level of indebtedness.

    • Anonymous

      >>in terms of pay, most (if not all) vet practices are straight cash-for-service setups. This is not true for most MDs or DOs>>

      Correct, but $150K = $150K, no matter how one’s salary is derived.

      >>$150K was a huge salary for a vet but a low salary for a human doc but $150K is about average (or a bit above, actually) for a primary care or family practice doc these days.>>

      The consensus amongst physicians seems to be that family practice docs as a group are poorly paid physicians, therefore, $150K is a low salary for a physician if one considers the salaries of ALL physicians. $150K is a large salary for a veterinarian.

      >>I would also challenge the notion that vets graduate with similar loan amounts. According to the AVMA, “Today’s veterinarians graduate with an average of $120,000 in student loan debt.” (as of Jan 2009).>>

      The average student loan debt for medical students graduating in 2009 was also around $120K. I’m sure that students graduating in 2010 and beyond – from both medical and veterinary school – will have even more debt.

      >>At my school (which is towards the lower end of average for tuition and fees), this represents just 3 years of tuition>>

      Most students pay at least some portion of tuition with savings, help from family/spouse or money earned from summer jobs. Thus, total cost of tuition does not necessarily equal total loans accrued.

      >>I have seen predictions from AMCAS suggesting that average indebtedness could reach $500,000 by 2020.>>

      That wouldn’t surprise me, as indebtedness has tended to rise over time for both medical and veterinary school.

  • anonymous

    i was at a fundraiser this past week. the guys donating 50k and up weren’t physicians. they were successful business owners-restuarant, car, furniture, insurance, financial, banker, etc.
    yet we spend all this time focusing on doctor’s salaries as being too much. really, we should be discussing how to get primary care up to reasonable salaries and how to minimize insurance paperwork to make the career choice enjoyable.

  • Mike

    As a primary care internist, my issue is with cardiologists(and many other specialists) being paid ridiculous sums of money on a time invested basis for procedures/tests that lets be honest, , they probably learned to perform quite competently in a fairly short period of time during their fellowship. Come on, is the effort and expertise of doing and reading a nuclear stress test really worth the huge amount of money that was being reimbursed for it. I have no issue paying huge sums of money for people being up in the middle of the night performing complex/stressful procedures. Let’s pay the guy extremely well for putting in a stent at 4AM. Let’s get real about cranking through a bunch of echos(with color doppler of course) in an hour and what will be paid for that. And what are they paying lately for an epidural injection or nerve conduction study. Oh my god!!!
    It’s a specious argument to claim that the payment is worth it just because we’re talking about people’s lives. Of course it’s people’s lives. That what we chose to do. It’s our job. Does the firefighter get a 50,000 dollar bonus for carrying a kid out of a fire? It’s his job. Taking care of people is our job and it can be hard to do. We all deserve to be well paid for it. But, let’s get real. The delusions of what some things are worth has got to stop. And, guess what, the pie isn’t going to get bigger. It’s time to be honest and start cutting the slices a little more fairly.

  • Anonymous

    >>Does the firefighter get a 50,000 dollar bonus for carrying a kid out of a fire?>>

    I just watched the first documentary about 9/11, which was originally a documentary about a “probie” (new) firefighter during his first year. In one scene, the kid gets his first paycheck: $650 for two weeks’ work. Wow. Just a couple of months later, he and his colleagues ran into the World Trade Center, which was on fire and collapsing, trying to save as many people as possible.

  • fitzy

    The whole world is rittled with uneven salaries. Athletes are the worst…..they get paid millions to play a kids game! Granted they have limited careers because of age and injuries but I still don’t think they should get THAT MUCH!!!! I’ve been on both sides, Ive been paid more than I should have and I’ve been paid less than I should have. Proves the point…..Work Smarter not harder!!!!

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