Patients think most doctors are out to make money

in Policy | 59 responses

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.

That’s the sentiment from patients polled in Boston in this video clip.

I’ve often wondered if doctors were offered a reduced, fixed salary, but were given medical malpractice protection, more vacation time, and a weekly limit on the number of hours they worked, how many would take that deal?

If it’s less than, say, 50%, then maybe these patients have a point — most doctors are in medicine for the money.

Comments

http://dign.eu Pieter Kubben
Good question… I think it depends on how much less. But if the remaining is enough to make a decent living, I would be very interested.
Thanks for bringing up this issue!
Pieter
David Allen
Hmm. Can anyone say ‘false dichotomy’? Would any of them do their jobs for nothing? If they would, is that the right thing to do? Perhaps the sentiment is that they are doing the job only for money. But how could you really know this? One of the interviewees said they were doing it for money, rather than ‘because they cared’ – introducing another false dichotomy. We must take off the socialist ethics goggles (that you must live for the sake of others) and put on the capitalist ones (that true harmony and progress results from freely trading values serving our own interests). One of these approaches leads to misery and complaints of selfishness. The other leads to prosperity, self-responsibility, and lots of good doctors.

http://paynehertz.blogspot.com Payne Hertz
Did your spouse marry you for money, or was the motivation love and a genuine desire to be with you? Was she wearing capitalist or socialist goggles when she said “I do?” Will you be happy when she acts in her enlightened capitalist self-interest and takes you for every penny you’re worth while shacking up with her mambo instructor?

John
Shocking. In other breaking news, nurses, secretaries, waiters, and people who invest for their retirement are also “out to make money”.
What’s the point here? Unless you’re independently wealthy, no one would be able to work his or her current job for free.
http://warmsocks.wordpress.com/ WarmSocks
As a patient, I’d say that everyone is out to make money. When I work, I expect to be paid what I’m worth. When my clients paid me $25 per hour and someone new called offering me $5, I was insulted and declined the job. When I went back to school, it wasn’t just because I love learning; it was to acquire the skills needed to get a better job. People train for a career anticipating a specific salary; most of us expect to be rewarded with raises for a job well done. It shouldn’t be any surprise when people feel cheated and undervalued when they get salary cuts instead of raises.
The plumber charges $150 per hour. The furnace repairman makes the plumber look like a bargain. Have you priced electricians lately? To say that doctors are in it for the money completely misses the point the doctors are people who should be justly compensated for their labor.
Johnathan Blaze
Yes, and they are absolutely correct. Like it or not, medicine is one of the most corrupt institutions in the US.
In fact, doctors successfully lobbied to prevent medical schools from opening in the 80s and 90s under the guise of preventing a “doctor shortage”
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
“Do no harm”? I think doctors were referring to their bank accounts, not people.

madoc
Johnathan—your comment makes me think.
Certainly health care is very dysfunctional but as in most things there is bad and good. What speciically are you most angry about. I’m a doctor.
Are you mad at me?

ninguem
In fact, doctors successfully lobbied to prevent medical schools from opening in the 80s and 90s under the guise of preventing a “doctor shortage”
Do you maybe mean surplus?
Since the med schools kept expanding, guess it wasn’t very successful lobbying. As opposed to the dental schools, which really did close in the 1980′s. Talk about a successful lobby.
One of the reasons we have shortages now, is frankly the docs are retiring at the usual retirement age, instead of working ’till they dropped. With people like Blaze out there, I can see why.

http://www.ohiosurgery.blogspot.com buckeye surgeon
Absurd. Why is this an either/or paradigm? Doctors either want to “help people” or they are pursuing purely financial incentives? Really? Is that truly how doctors view the situation? It’s all black and white like that? Why is an interest in adequate, fair compensation mutually exclusive from being an excellent and compassionate clinician/surgeon? Saliently, are all good doctors most ably recognized by their Francis of Assisi-esque tattered white coats and the loud retorts from their backfiring 88 Honda Accords in the ER parking lots?
This is an unserious investigation into human motivations.
Marc Gorayeb, MD
Now there’s a trade-unionist mentality if I ever saw one.
Never figured you for a socialist, Kevin.
guest
So Johnathan Blaze, you don’t care if your salary/compensation drops? How would you feel if you had the same net worth of somebody that put in my less work and was less intelligent or gifted.
Or, in the case of doctors, how would you feel if you get paid 4 times what another person gets paid but you put in 8 times the work? Something to think about.

Mike
Unfortunately, we do not live in a meritocracy. As gifted and intelligent as you appear to think you are, I do not think there are reimbursement codes for “gifted” and “intelligent.”
By the way, if you are as intelligent as you imply, you signed up for medical school knowing how many hours you’d be working and how much money you’d be making as a physician. So why all the complaining? If you didn’t want it, there were many other career options available to you. The argument is old and I am tired of hearing it. And importantly, it does absolutely nothing to curry favor from the public. That’s what you need to make things go your way, right? Public support? The public is tired of the whining.

family practitioner
If I am out to make money, I am pretty bad at it.

jsmith
Good one.
http://hematopoiesis.info/ Alexey Bersenev
well if you’re able to make more than 40-50k/year (average household income in US) – you’re very good at it!

Dana
As a lawyer – and NOT a personal injury/medmal lawyer – it would go long way to dispel this perception if doctors would quit whining about their insurance premiums. Your average compensation is four to five times lawyers’ average compensation, and your insurance premiums are about 10% of your annual gross income. Do you have any idea what health insurance costs the average consumer, as a proportion of annual income? Hint: if I were paid $0.16 per hour over federal minimum wage, then I could pay my health insurance premium with ONE HUNDRED PER CENT of my income. If you’re truly concerned about something other than money, then prove it by talking about something other than money.

Mike
“If you’re truly concerned about something other than money, then prove it by talking about something other than money.”
I literally could not have said it better myself.

paindoc
Yes doctors are out to make money..what the hell is wrong with that? Of course money is a motivation, but just like any other field, it’s probably not the only motivation. I think the disconnect occurs when the public thinks docs just do stuff to bill and make money, even if its not medically indicated. I actually don’t think that happens all that much, most people who go into medicine are reasonably moral, and in the end do want their patients to get better.
Also, why would you want the guy about to plunge a knife into your chest be pissed off about money and feel he/she is being treated unfairly by the system? I would in fact, want this person to be very happy, and not tired and overworked because medicare keeps cutting reimbursements, so in order for him to make the same money he did before he needs to do 4 open hearts a day instead of 2. You entrust your most valuable asset, your health, to these guys, so don’t you all think they should make an appropriate salary? Honestly I think primary cares should make around $250K a year for the volume they see, and the risk they incur, specialists should range from 200-500K a year. I think it’s perfectly fair, ibankers, dentists and lawyers routinely make this kind of money, so why not physicians? If salaries keep going down, you know what americans are going to end up with? A bunch if shi**y doctors since all the smart ones will leave and end up in iBanking, dentistry, or law.

http://hematopoiesis.info/ Alexey Bersenev
It depends what you mean under “appropriate salary”. If average salary in US is 35k/year, average US citizen think that doctor’s salary is inappropriate. Because it’s way much higher than 35k/year, I guess it could be around 200k/year. Of course this difference make most people jealous and think that doctors are chasing money.
I think 200k/year and above is too much for doctor’s salary. I’m family (+ wife + 1 child) budget is 45k/year and we are living ok on the east cost. I was always curious why doctors need more than 100k/year? Where this salary (150-300k) even came from? 100k is good enough money to live fine in NYC or Boston or SF.
Maybe I’m being too naive, but my impression that most of doctors came into medicine followed by passion and highly professional. Being in medicine for the last 15 years of my life I still don’t believe that most of doctors (>50%) come to medicine only because of money, even in US.

http://nostrums.blogspot.com Doc D
Actaully the number of training slots in medicine limits the number of medical students you can matriculate (unless you all want to be taken care of solely by trainees). There just aren’t that many training institutions, and each intern and resident has to have faculty oversight. It’s manpower intensive to train doctors and take care of patients at the same time. This limits the number of doctors you can put out. I think most medical medical schools would love to double their student body. But then where would they all go for internship and residency?
The lawyer analogy is misplaced. We corner the world’s market on lawyers because there are no limits on output.
And, in 30 years I’ve never made what they say I do. Maybe the reason is, I never paid much attention to it…and was happy that way.
Of course, I was wearing a military uniform.
Vox Rusticus
Dana, I am going to call you out on your claim. Average compensation means noting in comparisons. Are you comparing private practice attending physicians with all law school graduates or just people working in the practice of law as lawyers (i.e., not people with law degrees doing something else.) or private practice lawyers that are partners in the firms where they work? Have you lumped in first year associates and public defenders and law graduates that aren’t working full time? If you have, then did you also include the salaries of resident physicians in your hyperbolic averages.These “statistics” you claim need to be explained or they are worthless, and so, the rest of your point. Lots of lawyers in my family; i know what they do make.You don’t fool me.
I do not accept responsibility for the cost of health insurance, and strange as it might seem to you, pay what everyone else has to pay for those policies. It isn’t any obligation of mine to spend my time and energy on those costs issues any more than it is yours. I am not an underwriter. As for professional liability coverage, I pay almost twice for that than I do for health insurance. So please don’t presume to post that those amounts are insignificant or that doctors are wrong to complain of the costs those coverages impose on their practices. Every dime I spend on medmal coverage is money I don’t have for anything else in my practice business.

Johnathan Blaze
Oh please. Residency is just a training program. Most residents get paid around 40-50k, which is more than the average US salary. That’s right, the salary for a doctor TRAINEE is more than the US national average. That just shows how ridiculous doctor compensation is.
Also, residents have the comfort of knowing that they are guaranteed to make bucketloads of cash once they are done. Do lawyers have any sort of paid training program? NO. Are lawyers guaranteed to make bucketloads of money? NO. They have to hustle for it, or get one of the few jobs at the elite firms. The only hustle a doctor has is getting into medical school, maybe taking boards. From then on they’re riding the gravy train to EASY MONEY.
If you have well-paid lawyers in your family, that’s great, but rest assured that they are the exception, not the norm. Take a look at the scads of law school graduates who can’t find jobs. When’s the last time a MD couldn’t find a job?

Vox Rusticus
How conveniently you ignore the substantial barrier to entry and what that barrier costs to overcome. Setting aside the value of the sweat involved, the cost of eight years of post-secondary education and the opportunity cost of at least eleven years of the same education along with the minimum three years of residency (which you so conveniently devalue by ignoring that 1. the resident pay comes with nearly no benefits and 2. is paid as salary for 80 hours per week of work (or more if you were lucky enough to do residency back in the day,) twice the full-time work week of that “average” worker, except that by the same worker’s standards, half the time is off the clock, unpaid which is patently illegal in any other line of work.) Oh, and that trainee you speak of, has an M.D. degree. The trainee lawyer working as as associate with one less year of graduate professional school education earns three times what the trainee doctor makes in the same city. It is more than the rare and exceptional lawyer that earns well, if you want to be honest about that profession. I really don’t begrudge them their honest incomes, and most do come by their incomes honestly.
“Easy money”? You have no idea. We have special access to ATMs that pay us whatever we want, and the money comes from the Government. Forget about working. You don’t have to. Gravy train it is.

Johnathan Blaze
First of all, stop the whole “8 years” thing. Everyone goes to undergrad, OK? So please stop trying to inflate your numbers. It’s 4 years post-grad.
Residency: while it is more hours, it still offers the ability to make 50k. Most jobs out there don’t even give you that option. Secondly, residents get MANY perks and benefits (http://mdsalaries.blogspot.com/2007/08/benefits-and-perks-for-medical.html). Thirdly, as stated before, the knowledge that huge salaries lie ahead is a huge motivating factor that people in other jobs don’t have, and yes, it matters. Please stop the facade of making residency look so tough. Oh, and lets not forget moonlighting, where you get paid $60/hr to SLEEP.
There is no such thing as a “trainee” lawyer, that is my whole point. Lawyers don’t get a training program. They go straight to jobs after school (if then can find jobs in this economy, something that MDs are also shielded from) The big firm jobs that pay $160k/yr are available to the TOP 5-10% of all law graduates, maybe 1% will be partners and earn millions. Meanwhile 100% of doctors are guaranteed to make a LOT MORE money when they start. You are comparing 10% of lawyers to 100% of doctors. The remaining 90% of lawyers will be lucky to ever break $100k in their lives. Trust me on this one, you CANNOT compare doctors to lawyers, the disparity between the two is ridiculous.
Honestly, the jig is up. Everyone just rolls their eyes when they head a doctor complain about anything money-related. The crooked, anti-competitive workplace provided by the medical industry ensures huge sums of money for very little effort. I just got a $200 bill from some doctor who looked down my throat for 2 minutes. 10 minute procedures rake in thousands. It is absolutely ludicrous what doctors are getting away with. There’s a reason over 60% of all bankrupcies are due to medical costs (http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/).

Dr. G
You have no idea what you are talking about. I calculated my hourly wage while in residency and it was about 1 dollar an hour. Yeah, residents are well paid. That is laughable. I also graduated from medical school with over $200K in debt. If medicine is such a great job that pays so well, why would so many doctors choose another profession if they could do it all over again? I certainly will encourage my children not to go into medicine.
Vox Rusticus
Jonathan Blaze, you play around with the “average worker” notion as a foil for contrasting to doctors incomes, but you won’t acknowledge what investment that average worker has made in education or how many hours are worked for that average income. You need to be honest when you make those arguments. The average worker does not have an undergraduate degree. The average worker does not work 80 hours (or more) per week; he works half that.
Residency does not “offer” the opportunity to make $50K, unless you are referring to a PGY5 or PGY6 senior resident in a major US city. But then I doubt you were comparing that income to the average non-physician income in, say New York City, were you? You need to be honest in your comparisons.
Moonlighting for $60 per hour and sleep? I’d like some of that, and I am an experienced attending. Please, that kind of story is at best apocryphal. Can I also say that a firefighter gets paid $60 per hour to sleep? I’d like to apply your standards, now.
There are trainee jobs for lawyers. They are called clerkships. (You knew that, just didn’t want to say it.) The only difference is that you don’t have to do a clerkship unless you someday want to sit on the Court of Appeals. Then you probably will need one to be competitive.
And please don’t pretend to say that all doctors are “entitled” to large incomes but only 1% or 10% of lawyers (you confuse me, there) are seeing white-shoe associate pay. Associates get paid very well in many U.S. cities and while that may not be as much as Manhattan associates make, neither are their living costs what Manhattan lawyers are (or what Manhattan residents are, for that $50K you envy so much.) To make an honest comparison, there, only 1% of medical school graduates become neurosurgeons, and probably an equally small percentage become interventional radiologists or cardiothoracic surgeons.
Crooked and anti-competitve? You need to go over to the insurance industry blogs. Medicine is where it is illegal to even compare fees, the government has seen to that. They think it encourages price fixing. Or do you mean anti-competitive as in having to meet standards to practice? Then I hope you extend that to your lawyer brethern; I am sure some bright person would like to join your ranks having read for the bar, just like Abraham Lincoln.
And that $200 bill you got will probably be settled for 35% of that price by your carrier, which is a far better example of the kind of industry you seem to take issue with than medical practitioners.
Johnathan Blaze
Vox, you seem misinformed.
A clerkship is when a lawyer gets a job working under a judge. It is not a “trainee job”. Very very few people get clerkships, as they are highly sought after. Some lawyers are career clerks. Others move on to law firms. There is no trainee program for lawyers. They are thrown out into the market and have to fend for themselves.
Even if residences are underpaid, it doesn’t matter, they are training programs, stepping stones. That’s it. You can’t compare them to real jobs. What real job offers to quadruple your salary in 3-4 years, as occurs with residency? Complaining about the hours is shortsighted when you see how much money it leads to in the future.
I knew doctors who would make $75/hr moonlighting and jokingly refer to the job as “sleep for dollars” . A firefighter gets nothing CLOSE to this.
Very few law school graduates become associates. Like I said, most are lucky to break $100k in their lifetimes Compared to doctors, 100% break 200k. There is no comparison. Let’s just stop the whole lawyer talk, as you have shown that you are badly misinformed.
I don’t think it’s bad that doctors do better than lawyers. I think it’s a good thing. Doctors deserve to make good money, but the problem is that greed is pervasive in the profession, and the rates keep going up and up. Med school debt is a paltry sum compared to the income you are guaranteed to make, and complaining about it just makes you look silly and out of touch.
I notice how you don’t even comment on the fact that over 60% of personal bankrupcies are related to medical bills. That just shows how unsustainable doctor salaries are. This is why our health care system is in shambles — pure greed from doctors.
Johnathan Blaze
Dr G, a question for you. What career would you guide your children towards? What’s out there that guarantees at least 200k/yr (or more) and infinite job security?
Dr. Gonzalez
Blaze wrote: “Dr G, a question for you. What career would you guide your children towards? What’s out there that guarantees at least 200k/yr (or more) and infinite job security?”
A lawyer.

bw
Residents make 40-50k per year, which, for the hours worked (about 70 hours/week for an internist) is about $12/hour. I would say that the pay rate is comparable to an assistant manager at a retail store. That the resident works hours similar to two full time jobs in order to make that 40-50k is not a reflection of overpay. I am not necessarily disagreeing with your larger point. However, it is misleading to imply, as you did, that the resident earns a higher wage than the average American.

Dr. G
Blaze wrote: “100% break 200k.”
I have been out of residency for 7 years, and currently make over the 75th percentile for my specialty (pediatrician), and have yet to make $200K in a year. I think you may have a distorted view of doctor’s salaries. I know a lawyer that makes over $500K a year, therefore, all lawyers make a killing.

Kathy
I’ve been a nurse for 20 years and I’ve seen FAR more unethical doctors than ethical ones. What I’ve witnessed is just mind boggling. In the city where I reside, about 50 docs got together and bought a MRI clinic and sleep center. Suddenly, all of their patients are getting sleep studies and MRIs. These idiots actually get a print out every month on how many patients they’ve referred and if their numbers are down, they have to explain it to the manager! They’re also giving $200 “kickbacks” to doctors who are non-owners for every patient they refer to their facilities.
Doctors are referring patients for MRI’s of their FINGERS, after x-rays were negative. In fact, about 90% of the time, the MRIs are negative no matter what the patient was sent for – WHAT A FRICKING SCAM! So, you don’t think doctors are in this to help people?
I’ve got an even better one for you. A pain management doctor had his staff call little elderly patients and tell them they needed to be seen by the doctor ASAP. Some of those people hadn’t seen that doc in years! Imagine the patient’s surprise when they came to their appointment and found out they were actually there for a PRE-OP EXAM for a procedure they knew nothing about!
These doctors have absolutely NO BUSINESS practicing medicine, because it’s obvious they care more about money than they do about the health of their patients. God, how I wish the public was privy to what really goes on in the medical profession!
If doctors want people to respect them, then they need to report scum like this to the medical board!

PAULMD
I work hard for the services I provide.
I am good at it.
People seek my services.
I run an honest ethical practice and stress doing the least to gain the most in all of medical and surgical testing and treatments. Cost benefit and risk benefit guide my open discussion with “reasonable” patients.
I seek to get paid well for my work.
When it is no longer in my interest to continue to do this work (mostly financial and stress) I will quit as soon as I can afford to.
I make no apologies for my professional life.

Kathy
Good for you! I’m all for honest and ethical physicians making a good living. Unfortunately, the UNETHICAL ones are making a MUCH better living and giving the medical profession a bad name!

Max
Well said, Paul. And you probably echo the sentiments of most physicians.
madoc
Why is everyone needing to justify that they earn a living.
For god sake. Most primary care docs should be making more for what they do, but they don’t.
madoc
If all those persons that see doctors making all that money; well go into medicine and go through all that stuff.
Then you will be rich and happy.
http://paynehertz.blogspot.com Payne Hertz
Machiavelli once questioned whether mercenary soldiers were better or worse than citizen soldiers. In his views, mercenaries were unreliable, because they were in it for the money, and were likely to switch sides if offered a better deal or turn tail and run if the going got tough. They were solely motivated by their own self-interest. Citizen soldiers, on the other hand, were more reliable, as they were often motivated by a sense of patriotism, a desire to protect their homes and families, and loyalty to their fellow soldiers, and not just a paycheck. Of course, both groups expected to be paid, and would often quit fighting if they weren’t paid.
Is our army of doctors a citizen army or a mercenary army? Reading blog posts and articles from physician groups strongly suggests the latter.
Let’s be honest. What are most doctor blog posts about?
1. We don’t make enough money. (number one topic)
2. I hate my patients. They are all losers who refuse to take personal responsibility. How dare they expect me to fix their medical problems?
3. My patients won’t do what I tell them to do! Have they forgotten who’s boss?
4. We need to do away with malpractice insurance. If you’re injured by a doctor, blame God.
5. My patients complain of being in pain and ask for pain medications! I hate drug-seeking scumbags like this.
What you don’t see very often are anguished posts from doctors who are heartbroken at all the suffering their patients endure, not even stories of little kids with chronic illnesses which might melt a heart of stone or two. Nope, the trials and tribulations of their patients is not what most doctors vent about on their blogs, as you would if that was their primary focus.
Nothing wrong with wanting to earn a living and doctors should earn a good living. But if you wanted to give the impression you were actually concerned with patient well-being and not just making a buck, your profession has done a poor job indeed.

bw
I think you are right. I wonder if the medical profession is going through a phase similar to the teenage girl who spills all her innermost thoughts and secrets onto a twitter feed, forgetting that people around the world are reading. I think physicians are struggling, just like everybody else, with the ramifications of their online personas. Hopefully a time will come soon when everybody wakes up and can be just as professional to a computer screen as they are face to face with a patient. I hope it comes soon because you are right. It’s not appropriate.
Dr. G
There is likely a selection bias taking place when you look at doctors who blog. They are probably more opinionated or disgruntled than most doctors. So i would not assume that the views of doctors who blog represent all doctors.
Nemo
Pain is an emotion that translates poorly on blogs – most often it is the spouse that sees the pain each night their wife/husband returns home. We, the spouse, see the pain when they come home, saddened to the point of tears because of the premature birth at 22 weeks or the finding of cancer in a young 20-year old woman’s uterus or having to tell a young couple their child has a horrible birth defect. None of the doctors I know share that pain freely to the public, it is kept close to the vest, shared quiietly, the grief and mourning for a patient done privately.

Jay
@Alexey,
First you quote 40-50k/yr then 35k/yr avg.US salary–get your numbers straight. Don’t be such a hater. Doctors certainly do not make too much money for our worth. If you don’t like, it don’t go to the doctor. Why don’t you focus on bankers or actors etc– all groups that add very little to humanity.

http://hematopoiesis.info/ Alexey
@Jay,
I listed 2 different numbers because 40-50k was in 2007 -
http://en.wikipedia.org/wiki/Household_income_in_the_United_States
I don’t have exact data for 2010, but I have heard or saw in the new that it dropped to close to 35k. Unfortunately I can’t link to the source now.
I’m not a hater, but as I told above I love medicine and I love doctors. That’s why i’m in medicine for the last 15 years and i’m a doctor.
I was trying to explain (find a reason mostly for myself) why general public can think about doctors as money makers as was shown in that video. As I told difference in salary and human nature make them jealous – one possible explanation. I think many people consider it’s simply amoral to make 10x and more than average.
And If I even think (it’s my personal opinion) that doctor is US making too much money, that’s not a reason do not go to doctor. Why shouldn’t I go if I love doctors, love medicine and maybe will need professional help from them? I’m not jealous about how much they making. I’m pretty much comfortable with my way of living.
I don’t criticize any professions and businesses (bankers, actors, ect.) making more money than average American, I’m just expressing my opinion. We’re talking about doctors and medicine here but not bankers or lawyers or actors…
I’m sorry if you took it so personally Jay, take it easy, it’s just an opinion, it’s just a discussion

AnnR
Actually, I’m not convinced most are out to make money.
You’ve got to be a good student to be a doctor and slog through some tough subjects so you aren’t stupid, yet you spend years and year poorly paid in training.
If all you really cared about was money you’d be working on Wall Street or starting up a business with just a Bachelor’s or Master’s degree.

Johnathan Blaze
Ann, if you haven’t noticed, Wall Street has crumbled. Not everyone can just work on Wall Street, it is shortsighted to think this. The people who make big money on Wall Street are the top of the ivy league, which is a very small number. If all doctors working today said “I want to go work on Wall Street” they wouldn’t be able to, because there are not enough jobs.
Also, do you think it is easy to just “start up a business” ? Do you realize that 90% of all businesses fail?
Actually, there is very little difference between the medical industry and Wall Street. Both are focused on short-term profits, getting as much money as possible without worrying WHERE it comes from. Thank god the Obama administration has instituted 21% cuts on Medicare ( http://www.californiahealthline.org/articles/2010/6/28/obama-signs-doc-fix-into-law-states-lobby-for-medicaid-aid.aspx ) that should hopefully get doctor salaries more in line with reality.

guest
Dude, not cool. You are comparing physicians to the average US salary? The average person is considerably less intelligent and lazier than the average physician. You mean to compare the average salary of somebody with a HS or college degree with somebody that attended college, 4 years of difficult (understatement) medical school, then 3-7 years of residency? (80 hours a week)
You’re OK with lawyers having their salary set by the market while doctors have their income artificially limited? Look at the difference between law school applicants and medical school applicants. Law school applicants don’t need to take set courses (arguable MUCH more difficult than the english, political science and sociology courses that they take), submit secondaries, nor attend interviews for medical school. Its MUCH easier getting into law school than medical school. You’re pretty much saying that its OK for less talented or lazier people to make as much as doctors or that you wish for them to make the same amount.
I hope you aren’t paying all that money for your smart phone, cable tv, and athletic events and then complaining for your medical expenses.
What about those healthcare CEO’s that rake it in. Are they saving lives? One CEO got 98.6 million in stock OPTIONS last year. Not just his total compensation!
Johnathan Blaze June 30, 2010 at 4:31 pm
Oh please. Residency is just a training program. Most residents get paid around 40-50k, which is more than the average US salary. That’s right, the salary for a doctor TRAINEE is more than the US national average. That just shows how ridiculous doctor compensation is.
Also, residents have the comfort of knowing that they are guaranteed to make bucketloads of cash once they are done. Do lawyers have any sort of paid training program? NO. Are lawyers guaranteed to make bucketloads of money? NO. They have to hustle for it, or get one of the few jobs at the elite firms. The only hustle a doctor has is getting into medical school, maybe taking boards. From then on they’re riding the gravy train to EASY MONEY.
If you have well-paid lawyers in your family, that’s great, but rest assured that they are the exception, not the norm. Take a look at the scads of law school graduates who can’t find jobs. When’s the last time a MD couldn’t find a job?

BizOwner
During graduate school, I worked 4 jobs and carried 12 hours plus of school. I worked constantly! And didn’t have anything to show for it, and rarely had a moment to sleep.
The individuals that went to med school had free time, tons of it, and complained about it every way. They had time to date, time to get married, and time to party.
To be a good doctor, you just have to have a good study-ethic, for if they had a good work ethic, they would dropped out of college, worked hard and developed their own businesses.
Kathy
It’s been my personal observation that it doesn’t take much intelligence to get into law school – just about anyone can do it.
I’m all for doctors making money, as long as they’re ethical. If I ever need brain surgery, I want my neurosurgeon pulling down around $1,000,000.00 a year!

David Alllen
Payne Hertz – Overall I’ve liked your blog over the years. Your first comment on this topic is logical although I think you must realize how hard most doctors work on behalf of their patients in real life (not what they blog about). It would be nice to see a serious response to my comments rather than a predictive analysis of my personal relationships!

http://paynehertz.blogspot.com Payne Hertz
Looking over that comment I can see you are right, David. It looks as though I am attacking your marital relationship and that was not my intent. The remark was stupid and offensive and I apologize.
The point I was trying to make (badly) is that we don’t value mercenary selfishness in our mates, so why should we value it in our doctors? I don’t agree that selfishness is a good thing, that “greed is good.” I tend to side with most of the religious and ethical systems in human history who unanimously agree that selfishness is the root cause of evil.
I believe that greed, selfishness and egotism are the root causes of most of the problems in our medical system, and capitalism is a system designed to facilitate greed and theft by the elite, to the detriment of the people. The only ethic in capitalism is the pure pursuit of profit. There are no other ethical considerations. Therefore, capitalist ideology is incompatible with a medical system whose success depends on adherence to ethical and moral standards by doctors which are often at odds with the pursuit of profit.
Sadly, whenever there is a conflict between ethics, morality and the best interests of patients on the one hand and profit on the other, profit usually winds hand down. This is what it means to be in it for the money, and that is not good. The only way to eliminate this behavior is to either hire better people to work as doctors, or eliminate the highly lucrative incentives in our system to do the wrong thing, which is a huge driver of costs as well as a disaster for patients victimized by scams, unnecessary procedures, tests and scripts, or those who are denied proper treatment because the money is elsewhere.

Mike
Let’s see… I answer emails, return phone calls and do paperwork as part of my job for no extra money. Doctor groups are beginning to demand extra money for these tasks (and even for writing rx refills)… which are all part of their jobs and part of maintaining good patient care/continuity of care. If I demanded extra money for these tasks, I’d be laughed out of the building. In fact, I don’t know anyone who gets paid extra for these duties.
There seems to be a push for second-by-second reimbursement. There is, in fact, a fixation on reimbursement. It is not difficult to see why patients might see doctors as being “out for money” when all they hear about is the “flawed” reimbursement system and about how doctors ‘don’t make enough’. AMA does not help in this regard. AMA’s fixation with reimbursement makes it seem to the public that all doctors think about is reimbursement. After all, when the AMA speaks, the public erroneously assumes that it speaks for all doctors.
paindoc
The reason doctors complain so much about money is that we literally have no control over what we make. What I make today, could be cut by 21% in 6 months with no warning, just a fax from cms sent to my office announcing this in one or 2 lines. This would not only affect me, but also my patients as I would most likely not be able to see medicare anymore (if collections don’t meet overhead, it’s just not possible to keep seeing them)…not to mention I would probably have to fire an RN or a few MAs, all of whom rely on my company for a substantial part of their income, as well as health insurance.
Can you think of any profession where you render a service completely for free up front, and then hope you recieve payment for it sometime within the next 6 months? And sometimes you may not even get paid at all? Well that’s medicine.
Payne Hertz, you sound like a chronic pain patient….It’s true, I do expect a certain amount of ownership and responsibilty from my patients in regards to their healthcare. Theres no magic pill that can make it “go away” (can’t tell you how many times I’ve heard that one). Medicine is an imperfect science, just like everything else in this world, and doctors have to use every tool available to them, including the patient’s willingness to work with them.

http://paynehertz.blogspot.com Payne Hertz
What planet do you live on where everyone else has control of what they make? Most people work for salary set by their employers and are subject to firing without notice even without poor work performance. Doctors can routinely kill and injure people and still expect to keep their jobs. Hell, ordinary folks get harsher sentences for shoplifting than this doctor got for fabricating bogus studies that lead to the deaths of thousands.
http://e-patients.net/archives/2009/03/dr-reuben-deeply-regrets-that-this-happened.html
How would you like to have your livelihood dependent on convincing a doctor that you need pain medication to work, and have to live with the possibility that your career and life could be destroyed on a whim by a doctor who decides you must be a drug seeker because you know what OxyContin is and had the temerity to ask for it?
How much money do you think pain patients make when they have to forgo working for a living while they spend months and years dealing with rejection, exploitation and abuse while jumping through endless hoops to get the pain medication they need to be functional and employed?
Payne Hertz, you sound like a chronic pain patient
This statement says it all. Tell me, what does a chronic pain patient sound like? I’m dying to hear this.
I would bet my left arm you are more than happy to dictate to pain patients what their responsibilities are, how they are supposed to live their lives while under your “care” and what hoops they have to jump through and they’d better do it, or else. But if you’re like most “pain docs” then your enthusiasm for holding your end of the responsibility stick is next to nill. Most “pain docs” make you sign “pain contracts” which certainly detail the patient’s responsibilities, but typically have no mention at all of the doctor’s responsibilities. Convenient, that.
Just curious, are you one of those shot jockeys who canoodles caboodles of money out of desperate pain patients giving injections, blocks and other invasive and expensive procedures with little to no evidence of safety or efficacy and then when the milk runs dry, kicks them out on the street? Do you charge cash retainers of as much as $500 a month in exchange for writing scripts for pain meds? (Do the math on that one, folks. $6,000 cash per patient per year times 1000 patients, and all you have to do is write scripts).
When you have to deal with crap like this just to avail yourself of something everyone took for granted in the 19th Century, come and complain to me how terrible your 250k + a year job is. You have no clue how good you’ve got it.

Ron Pittenger
In a capitalist economy, asking how much someone else makes is like asking about their personal bathroom or bedroom habits–none of anyone else’s business, in other words.
As a patient, I have no philosophic issue with my doctors charging a competitive fee for the services and advice they give me. If I feel overcharged, I have the right to replace my current physician with another whose prices I like better. But, in fact, since all I pay is a co-pay, neither I nor many other patients are actually aware of the “list price” my medical providers are negotiating from with my insurer (this is one of the few things I actually believe needs “reforming”).
I really hope we haven’t reached the point where the general populace of the USA is ready to open an overt class war on those who “make more than enough” in some politician’s opinion (having lived through Nixon’s Price and Wage freeze, I can assure you politicians do NOT set values as well as free markets). However, if anyone here really wishes to work for less, I guaranty if you look around, you can find plenty of volunteer organizations that will be delighted to utilize your services. In fact, if you live in the Boston or Worcester areas, email me, and I’ll find you a place to volunteer if your “guilt” is too heavy to bear.
ronpittenger@townisp.com
http://Www.texmed.org Steve Levine
This “data” contradicts much polling results from our own surveys and national polls. Most patients think docs:
1. are “in it” for the patients; and
2. Deserve a good income based on their skills, services, and debt
Vox Rusticus
Johnathan Blaze wrote:
“I notice how you don’t even comment on the fact that over 60% of personal bankrupcies are related to medical bills. That just shows how unsustainable doctor salaries are. This is why our health care system is in shambles — pure greed from doctors.”
That is a pointless and incorrect factoid. And no, given the well-documented fact that doctor’s pay accounts for only about 10% of aggregate medical expenses, bankruptcies will not be forestalled by cuts in doctor’s pay. What is unsustainable is patients’ consumption, which is not the same thing as doctor’s pay, nor do bills unpaid at bankruptcy judgment count as anything except as losses to the doctors who are going unpaid. The ones who get stuck in ban kruptcy, as you conveniently choose to ignore, are those who have done the work and are owed their pay.Yes, some people list medical debt as a cause for personal bankruptcy. Some are just plain unlucky and have catastrophic events or massive sudden expenses for which they are underinsured, uninsured or unprepared-for with any personal resources. But those “causes” are not really all the causes of people’s unpreparedness. Overextension with debt from other expenses in life, overextension on debt for housing, excess debt on cars and consumer spending all add to the total insolvency picture, even if they aren’t directly listed in the bankruptcy proceeding. Medical expenses may be what finally breaks some families financially, but many are set up for disaster with no capacity to absorb sudden expense, and medical expense is the most common form of sudden expense. Medical care is very labor intensive and the cost of preparing that labor is also very expensive. Trauma surgeons, ICUs, interventional cardiologists and many other people and services in modern medicine make use of the most intensively trained people and vetted products in our economy. There is no way any of that is going to come cheap. And if you think the European systems that seem so wonderful are the exception, just remember that personal income taxes reach over 50% for that “average” worker you like so much and VAT is 19% or more in many places. All that social spending does cost something, even if it isn’t at point of sale.

http://hematopoiesis.info/ Alexey Bersenev
@Vox Rusticus -
If you think that it’s incorrect factoid, can you give us a link to the correct number?
I have in mind 62% of personal bankruptcies caused by medical problems (AACR 2010 data) – http://www.youtube.com/watch?v=3pobQRfz0No
stop at 1 min 20 sec.
In countries with high taxes, citizens usually can get free education and free medical care (any type, exclude cosmetic surgery) in any part of country independent of insurance. And people happy with that because high taxes work for them, unlike US where all of our taxes go to pockets of greedy federal reserve bankers.

sad
Let’s ignore people like that Blaze guy; apparently medicine is super easy to get into and all doctors are money-hungry jerks that go for the quick buck.
Let’s instead focus on underpaid professions like actors, professional athletes, and celebrities in general.
I wonder why he doesn’t go into medicine to make the quick buck….
elizabeth
Most people respect doctors and know that they worked hard to get where they’re at but with the job market and economy the way it is it seems out of touch to ask to be paid more money. So many of us are are struggling – where would your extra money come from? There will have to be a redistribution – take from specialists and give to PCP’s.

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