Pay specialists less to save primary care

Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.

It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary care specialists earn considerably less, often 50-70% less than physicians in specialties where most of the revenue is produced by doing procedures.

For years when asked about the disparity in physician salaries I’ve said, “I think primary care physicians are fairly compensated. I just think a lot of other physicians are overpaid.”

If you look at the 2009 AMGA survey of physician income it is clear that the pay you can expect as a physician has little to do with how hard you work, how long you train, or how stressful or difficult your work is, and everything to do with whether you perform procedures that are highly compensated. It is hard to think of specialties less demanding in terms of after-hours call, emergent life-threatening care, and overall lifestyle than dermatology ($350,627), diagnostic non-interventional radiology ($438,115) and radiation therapy ($413,518) (median salary in parentheses).

Compare these to what I’d consider some of the most difficult, intellectually challenging, and demanding specialties: pediatric oncology ($205,999), infectious disease ($222,094) and adult neurology ($236,500). Family medicine is one of the very few specialties where the first number in the median salary is a 1.

For the annual earnings of one orthopedic joint replacement surgeon ($580,711) we could have one general surgeon ($340,000) who operates on the sickest of patients often emergently at inconvenient times, plus a family physician ($197,655) and a first year school teacher thrown in for good measure. There are no emergent joint replacements. When a patient with a fractured hip is admitted to the hospital a primary care physician or hospitalist admits them, works for hours to days to get them well enough for surgery, then the joint surgeon operates for maybe 2 hours, spends maybe 1 hour on rounds the next several days, and sees the patient a couple of times in the office for follow up visits. If the patient has post-operative complications, the primary care physician or hospitalist, or maybe an intensive care specialist is asked to manage these problems. It’s a crazy system.

All efforts to change this have been met with intense lobbying efforts from physician specialty groups. The theme is always that we cannot make sudden changes in compensation; things must be done gradually so that it will be fair and thoughtful. Somehow the changes then just don’t happen.

As primary care physicians we are well paid. It’s just that by dangling the carrot of really high income in front of students, who see that the workload, lifestyle and difficulty of specialty care is not greater and is often less than that of primary care where they can expect to earn millions of dollars less over their career, they have trouble justifying a primary care career choice.

I’ve read lots of articles and posts recently saying changing pay alone will not fix the shortage of primary care physicians. Maybe not, but it is the easiest first step. Increasing primary care compensation a little, and decreasing specialist pay a lot, to bring them close to equal, would go a long ways towards making primary care training more popular. In his post on KevinMD.com, John Horstkamp, MD agrees that making pay more equitable is the key to providing incentive to medical students to go into primary care. He suggests we need to pay family physicians 50-70% more. This would suit me nicely. I could live with higher pay. I also know that any proposals that increase the amount spent on health care are likely to be poorly received by legislative decision makers. I suspect a more palatable solution to American society in this era of concern over medical spending may be to pay less for procedures done by specialists.

The rates for payment are set by the federal government. Each year the Center for Medicare and Medicaid Services (CMS) sets what are called Relative Value Units, or RVUs. These determine the compensation for every procedure physicians are paid to perform. Currently the weight on RVUs is heavily weighted towards procedures, and less weighted towards the evaluation and management of health concerns. CMS could choose to change this to make payment for procedures much less. This would functionally bring pay to primary care physicians and specialists closer to parity. Commercial insurers have always quickly followed the CMS determined RVU schedule.

Could this happen? Certainly if our legislators have the will to mandate this change by CMS, and the courage to stand up to the lobbyists of the specialty associations it could happen very quickly. The AMA will undoubtedly be opposed to “rapid” change. Primary care associations will take care not to be offensive to anyone. Legislators won’t pick a battle because it is always less than two years until the next election. This makes it unlikely to see this type of change anytime soon.

Legislators will whine that there is nothing they can do to get medical students to go into primary care, because they cannot afford to pay primary care doctors more. Don’t believe them. They just don’t have the courage to make obvious big changes that will be unpopular to some of their supporters.

Now, where can I find a place to hide from my specialist friends.

Edward Pullen is a family physician who blogs at DrPullen.com.

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  • another idea

    How about paying primary care physicians more and keeping specialist compensation the same?

    I hope that you considered the fact that those “rich” specialists are enduring more years of residency (in most cases) and thus earning less money for those years of residency than PCP’s.

    The bickering between primary care and specialist camps cannot help matters, only worsen them.

    • rezmed09

      You aren’t doin’ the math.

  • joe

    “Pay specialists less to save primary care”

    Your own analysis argues against your title. Certain specialties with 2-3 years of more training and a much more intense work schedule/decision making (ie. peds onc) earn little more than an FP. Maybe it is time to stop the primary care vs specialist malarky. All specialists are not paid alike. The issue as you pointed out, is that certain fields get paid much more for than others based on artificial RVU’s.

    • Easton

      Joe,

      How about a slightly different classification. Something like proceduralists vs. non-proceduralists. I realize the separation isn’t black and white, but it is apparent that those who do procedures make much more than those who don’t. I know this from first-hand experience.

      I was a rural family physician for 5 years, doing OB, C/Sections, minor surgery, endoscopy, and ER procedures. As an FP, I made very good money, because I did more procedures. One of my FP partners, who was a procedure-hound, cleared over $400K/year. I’ve now moved to a new urban practice which is outpatient based. My income has dropped to about 60% of the former level (but life is better).

      The intensity of work doesn’t necessarily correlate with income. As the article noted, Peds oncology and ID are mentally challenging and time consuming, but this doesn’t carry over to a bigger income. Why does the orthopod merit twice the pay?

      To another idea,

      I don’t think the public is willing to tolerate higher payments to doctors.

      Also, the argument that the specialists spent more time in residency, not earning much money, doesn’t hold much water. My friend and classmate is a radiologist, meaning he had two more years of residency than me. His starting salary was $420k. Mine was closer to $120k. So even if I made $100K more per year for those two years, he made it up in his very first year of private practice. Why should the person who looks at pictures of a patient get paid three times the amount paid to the person who actually cares for the patient? Something is wrong here.

      The specialties and the AMA (which are one in the same) will fight this tooth and nail.

  • JohnnyM

    What I read is that we need to move away from paying so much for procedures, and more for the evaluation and management of patients. Thus the Peds Oncologist does better, as does the FP, while the joint replacement technician gets less, and maybe even is encouraged to see his/her own patients, rather than the midlevel in the office.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    What Joe said.

    RVU’s are a black hole where “little things” like training and call-coverage matter not. When is the government going to figure out that for most of us these days it’s not just about pay . . . but about our training and our time and our knowledge being appreciated/valued . . . and our lives having some quality?

  • another idea

    To: Easton

    Not all radiologists are starting at 420,000 just as not all FP doctors are starting at 120,000. My contacts (I’m just a med student) in radiology tell me that 350-400,000 is a realistic expectation for an established radiologist, not one starting out.

    I agree that the amount that radiologists and orthopedic surgeons make over a 30 year working career is much more than that of a FP or an IM doctor, but the longer years of residency and less years of attending pay SHOULD be considered. The extra years of residency shouldn’t be glossed over; surgery looks less appealing because of their (in general) difficult residencies and great delayed gratification.

  • another idea

    Also, time value of money is another factor. If you invest your disposable income while the radiologist is still in residency, your net worth will benefit. A dollar today is worth roughly 3% more than a dollar in one year. Actually, if you invest then you should expect a 10% return pre-tax.

    Granted the specialist will have a much higher net worth after retiring but you see my point.

    • http://drpullen.com Ed Pullen

      I am good enough at the math to know that this is not a mitigating factor.

  • http://fertilityfile.com IVF-MD

    it is clear that the pay you can expect as a physician has little to do with how hard you work, how long you train, or how stressful or difficult your work is

    Should it even be about the above criteria?

    When we hire people to do things for us or when we pay people for a product, do we care how hard they worked to make it, how long they trained or how stressful their job is? I really don’t. All I care about is how much I want that product or service and how much that benefits my life.

    How about being paid plain and simply according to the value of the benefit that the patient receives as judged by the patient, not as judged by some committee?

    No matter what anyone says, I really can’t imagine a pediatric hematologist getting paid substantially less than a cosmetic dermatologist under these circumstances. I can’t imagine that a parent wouldn’t pay more to help a cancer-plagued child that to lighten up her crows’ feet.

    Isn’t it remotely possible that the reason that many procedures command more than non-procedural care is because patients are willing to pay more for them?

    If I had diabetes, hypertension, and a hip joint in need of replacement, the relative desire that I would allocate to solving the three problems would naturally dictate how much I’m willing to pay. It makes sense to me.

    • http://drpullen.com Ed Pullen

      In the current payment model, with the patient having little say over the payment for procedures, this really plays little role. Maybe it should. We’d need to change to a system where patients had a primary responsibility for paying for their care.

      • http://fertilityfile.com IVF-MD

        Thank you. I was beginning to think that I was the only one this board who saw that. It would certainly solve or at least improve a lot of things.

  • primaryMD

    specialists train more, we all know that.

    so what’s that worth? A few hundred grand ultimately? So let’s assume the average career is 25-30 years. That would mean maybe 10-20 grand a year more they should make, right?

    So average primary care should be 180-200 a year. Avg specialist should be 210-230. Govt can make this happen with a few RVU changes, no problem.

  • jsmith

    The pay discrepancy is the single most important cause of the primary care shortage. If it does not decrease, the primary care shortage will intensify, period. Paying more for cognitive care and less for procedural care would help a lot, but it is still possible that there is something about primary care that would make it less attractive than, say, neurology, even if the pay were the same. I’m not saying this is the case, only that it could be the case. Experimenting a bit with that salaries would tell.
    Derm, rads onc and rads salaries are a ridiculous joke. I guess the joke is on us family docs.

  • http://drpullen.com Edward Pullen MD

    I agree with some of the above comments that a better post title, replacing specialist with procedural specialist would be more descriptive.

  • jenga

    If you don’t think specialists are worth it. Don’t use them. With higher salary is going to come increased responsibility. The responsibility of bailing yourself out, not calling a specialist to do it for you. The orthopod might deserve twice the pay. They still get up in the middle of the night, unlike most FPs who now farm everything to the hospitalist service. They have a greater risk of disease transmission and lawsuit. Then throw in the two extra years of a SURGICAL residency and why exactly do you deserve to be paid the same? There wasn’t a clamor for the 80 hour work week because of the oppressive primary care residencies.

    • rezmed09

      And If you don’t like primary care docs for this attitude, don’t use them… Oh, maybe we are all necessary to the system. We all have responsibilities and all get sued and all lose sleep at night. Realistically most docs don’t believe that all docs should get paid the same, many do work harder, have more expertise and have more value in a particular field. But the dollar value is what is debatable and the disparities are creating problems with our health care system.

    • http://drpullen.com Ed Pullen

      I don’t know when you trained, but no one worked harder than the internal med and pediatrics residents in the places I trained.

      • Primary Care Internist

        FYI, i DO NOT think primary care should be paid more at the expense of specialists/proceduralists. I, for one, think all doctors are relatively underpaid.

        After all, we’re the most educated, hardest working, and arguably most intelligent and skilled professionals. Yet secretaries on wall street are making as much as a typical primary care doctor. We’re in an industry that provides a service that people WANT, and employs huge numbers of support staff. But the gov’t sees fit to bail out everyone from Citibank (has their name attached to a baseball field) and GM (whose corrupt union brass have fueled a situation where lineworkers earn almost as much as a typical pediatrician, with unheard of pensions). I really don’t see why we all don’t toe the same line, along with the AMA, that doctors SHOULD make a damn good living. I’m so sick of everyone thinking docs make too much money. When I hear people spewing such BS my response is “yeah it’s great, so go ahead and do it – see youin 12-15 yrs, if you make it through”.

        • justascrub

          Sure, the country is going broke, people can’t find work for months on end and you want more money. I don’t think most people begrudge a doctor’s high salary but how much is enough and where is the money going to come from?

        • maribel

          Open your concierge practice and charge whatever you want.

      • jenga

        Say’s you, but It’s not a surgical residency. Eighty hour work week mandates resulted directly from the difficulty of surgical residencies in the US. Not from IM, Not from peds. That’s not debatable

        • jmh

          Correct me if I’m wrong, but I believe the 80 hour work week stemmed from the Libby Zion case in New York. She was being taken care of by medicine residents.

  • Hawkeye

    If the government would allow balance billing (for most care except emergent treatments) patients would easily determine the true value of different specialties, years of training, experience, skill, etc. Let the free market sort this out.

    • http://fertilityfile.com IVF-MD

      For a while, I thought I was the only free market advocate on this site. From a perspective of fairness/morality and from a perspective of efficiency, the free market beats central planning, even moderate central planning.

      • http://www.twitter.com/alicearobertson Alice

        For a while, I thought I was the only free market advocate on this site. From a perspective of fairness/morality and from a perspective of efficiency, the free market beats central planning, even moderate central planning. [end quote]

        I am an apprehensive free marketer (meaning I like the idea, but the reality is people are pesky! :) ). I have libertarian leanings and don’t like government regulation……yet sometimes the government has to regulate because of bad behavior (thinking of the movement…”Give Us Our Damned Data.” If hospitals, or doctors would have just given patients respect and the data the government would not have had to jump in and regulate so heavily). Just seems a few bad apples spoil the whole bunch.

        • http://fertilityfile.com IVF-MD

          In a free market, patients choose which doctors and hospitals to patronize and the doctors and hospitals will compete to make patients happy or suffer the consequences.

          The doctors and the hospital either make the patient happy or they lose business, so in this scenario, you can bet that the good providers will exercise top-notch customer service and give the requested data/records ASAP or else risk the ire and monetary withdrawal of the consumer.

          Regulation did not solve this problem any better than the free market could have. In a free market, if the infraction was a violation of a contract, meaning the doctors had an obligation to provide the records within 48 hours or some other agreed-upon time span, they would go to an arbiter who would make things right or gain just compensation for the injured party.

          Just because something has never been allowed to succeed doesn’t mean that it can’t succeed.

          • http://www.twitter.com/alicearobertson Alice

            Just because something has never been allowed to succeed doesn’t mean that it can’t succeed. [end quote]

            While I overall agree with you, that even with it’s quirks the free market is usually the best choice. I can only share from personal experience. There is a huge, very good, top-rated hospital near me. All the doctors are salaried (with bonuses), and again, overall, it works well for patient and doctor (there is a lot of grumbling from patients, but the place keeps growing so they are doing something right). But…there are always problems. Some of the better doctors refuse to be bound by the severe contract. We just lost one of the best neurologists I have ever met. He felt the head of the department was crushing him on time spent with patients. He made a choice to move to a hospital that would actually allow him to do what he was trained to do. His staff was crying when he announced he would be leaving. A local private doctor (another excellent doctor) who refused to sell his business said he will have to move about 100 miles away and set up business again to get out from under what he feels is a strong-arm that he won’t surrender too (and he feels is making it hard for him to practice medicine with any freedom).

            And, of course, these doctors could join up and be good soldiers, or continue to feel they are victims of the free market. The free market is a very good system……..and if my area suffers the loss of some good doctors the patients where they move will, hopefully, gain. Guess that proves your point on a certain level?

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    I’m one of the overpaid specialists. What will happen is that we will be paid a lot less and primary care will be paid just a little more. Is this the desired objective?

    • rezmed09

      Yes, this is the question. What is the optimum formula? and who will decide? Here is a starting point.

      How much more than a nurse practicioner should docs get paid?
      -10% more for every extra year of training?
      -10% more for every call night taken per week (not phone call).
      -10% more for number of patients seen or double the pay for double the hours worked per week.
      -Add 20% proportional the malpractice rate (this is proportional to the stress and procedural risks)

      -Subtract 10% for every weekday off per week.
      -Subtract 10% for ever week gone over 5 weeks per year.
      -Subtract 10% for routinely using a hospitalist service to admit and manage your patients.

      Who decides? Right now it RVU committee – mostly specialists.
      How about the patients? They will value the guy that opened their artery last week, not the person telling them to eat right, exercise, and take their meds for the last 20 years.
      How about the government?
      How about the corporation you will be working for?

      • HJ

        “How much more than a nurse practicioner should docs get paid?”

        I we want to stay with the pay for service model, the price for a given service should be based on the value of that service. Does the value change is different types of providers perform that service? If I have a ear infection why should I pay different amounts for someone to look in my ear?

        A free market could sort this out. My guess that is that primary care providers will still make less than specialists.

        • rezmed09

          If the expectation is that when looking in your ear, I will be more liable for missing a schwanoma or other problem, then the pay for the more educated, more trained provider should be higher. Let’s face it ENT’s, PCP’s and mid-levels all treat sinus infections, but if an ENT misses a sinus tumor, the ENT is much more likely to be sued successfully. The expectation for higher trained providers is different.

          Maybe the solution is to have all “simple” problems go to a Walgreens clinic first. That would be cheaper initially.

          • HJ

            “Maybe the solution is to have all “simple” problems go to a Walgreens clinic first…”

            Isn’t that what many primary care doctors do now…let the NPs and PA take care of the simple…the only issue is the patient is paying for a someone more educated. At least at Walgreens, you get a better value.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Michael, I’m one of the primary care docs – although not exactly underpaid (anymore) because I’m covering desperately-needed hospital (nights/weekend/holiday) call for all of the (rural) office docs who’ve backed away (and they had very good reasons to throw up their hands) from that duty. Ergo, I’ve worked both side of the (nothing-to-$omething) primary-care pay fence. But even I thought the title of this post was awful – and a gross oversimplification of the problems at hand.

    But that’s all we really got when “healthcare reform” was rammed down our throats wasn’t it? Thirty-second sound bites designed to appeal to one interest group or another . . .

    . . . and pit physicians against one another.

    OBTW, yes, I think that you’ve stated the “desired objective” of those who would pit us against ourselves very accurately.

    For the record, as a Ped often stationed in “podunk”, I am very grateful for the sub-specialists who answer the phone at all hours of the day or night – and you deserve what you’re paid – whether the public thinks so or not.

  • r watkins

    “But that’s all we really got when “healthcare reform” was rammed down our throats wasn’t it?”

    No, it wan’t rammed down out throats, it was voted on by the elected members of the two houses of Congress under long-established procedural rules. No, I don’t like everything about “healthcare reform,” but don’t let’s play the victim here

    “Thrty-second sound bites designed to
    . . . pit physicians against one another.”

    But we’ve been pitted against each other for decades, thanks to the AMA. Why change now?

    • http://fertilityfile.com IVF-MD

      Please don’t equate “being voted on by representatives” to being “what people actually want”. It’s pretty easy to game a system so that there are only 2 parties to choose from, neither of which is accountable. If you don’t believe it, open your eyes and observe the reality.

      If you think it’s bad that different factions of physicians are pitted against each other, how laughable is it that we have a country with two political parties being pitted against each other when the real culprit is behind the scenes steadily growing in bureaucratic power.

      • r watkins

        ‘Please don’t equate “being voted on by representatives” to being “what people actually want’

        No, I’m equating it with what’s in the Constitution.

        • http://fertilityfile.com IVF-MD

          With all due respect, where in the original Constitution is there a provision for the federal government to get involved with people’s individual health care?

          • rwatkins

            As I think I made clear, I was referring to the procedure by which the bill was passed, not its contents.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    MJ,
    With each passing year, the public will realize increasingly that the passed health care ‘reform’ legislation delivers little and costs too much. In other words, the public will soon feel what many of us in the profession already realize.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    r watkins, beg to differ, but after TWELVE YEARS of writing letters to the Congressional “representatives” you cite – letters that begged for SIMPLE oversight and help (with ONLY ONE tepid/half-way response in all that time – if I sound like a “victim”, it’s because I AM) . . . and being ignored by my so-called “adovcates” at the AMA . . . and FIVE YEARS of blogging . . . and, most recently, being promised boatloads of “hope and change” by Obama & company (yet somehow NOTHING has changed in terms of correspondence actually being read or acted upon) . . . I’m gonna stick with what I said.

    The “reform” we got did not begin to address what we NEED.

    • r watkins

      “The “reform” we got did not begin to address what we NEED.”

      I won’t argue with that!

  • http://thehappyhospitalist.blogspot.com Happy Hospitalist

    Subspecialty medical training

    1) Sit in conferences
    2) Get enough procedures under your belt so everyone is happy. Love doing procedures. Patient is sedated and no family to get touchy feely with. Less talk = more happiness.
    3) Round up your residents and medical students every day and make sure they’re writing notes appropriately. You’re management. You’re special. Act like it.
    4) Get your research block completed to make sure your salary is paid for and your attending get’s their promotion.
    5) Moon light the heck out of VA officer of the day and your local small town ER or hospitalist slots
    6) Allow the attendings to yell at you make themselves feel superior. You know it’s only for a year or two.
    7) Put up with inpatient clinicals and all the bull that comes with it. It’s only for a year or two.
    8) Sign up for some more moon lighting shifts. The wife and kids gotta eat.
    9) Punt work to your intern or second year residents
    10) Act smart. You’re now a specialist
    11) When you don’t know the answer to rare things you get consulted for, look it up just like the intern did. Then act smart.
    12) Pass your boards
    13) Complain about not being treated like a specialist
    14) Complain about coming in in the middle of the night. I’m a specialist now. I shouldn’t have to come in anymore.
    14) Complain about getting all the easy consults or complain about not getting any easy consults.
    15) Complain about getting all the hard consults. Never complain about not getting hard consults.
    16) Complain that nobody consults me except at 5PM on a Friday
    17) Complain that insurance keeps screwing me over
    18) Complain that the hospital call is unfair
    19) Wonder were all the referrals went
    20) Stop complaining
    21) It’s too late. The hospitalist is has taken care of it, on their own.
    22) Subspecialist gets to go home at 4:30 PM and never gets called after hours.
    23) Subspecialist wonders why they aren’t making any money, which is still2-5 times more than what their referring docs make.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    I only have questions:
    1) Yes, doctors should make a damn good living, but how do you define a damn good living compared to the rest of the country, considering the economic circumstances?
    2) IF health care costs are indeed driven up by supply, shouldn’t we attempt to reduce supply of those performing procedures by making those careers less desirable?
    3) IF primary care is on short supply and IF increased use of primary care actually reduces overall costs of care, shouldn’t we increase supply of this particular service by increasing reimbursement?
    4) Is it possible for any segment of society to give unbiased consideration to the pros and cons of reducing its own earnings?

    • Primary Care Internist

      I’d say that doctors’ pay should easily eclipse 90% of wall streeters, and 100% of secretaries, nurses, drug reps, PAs, and hospital administrators.

      And health care costs are, in total, only slightly influenced by physician salaries. Many of my patients (geriatrics) are taking like $500/month worth of meds – who pays that bill? we all do.

  • jenga

    Happy,
    Yawn, alot of complaints there for someone who seems to be complaining about not being a specialist.

    “You can’t be envious and happy at the same time.”
    -Frank Tyger

    • http://thehappyhospitalist.blogspot.com/ Happy Hospitalist

      Hospitalist medicine is a specialty. You can Google hospitalist for more details. The Society of Hospital Medicine has a wealth of information for you to review about the specialty.

  • I wish

    I wish the market would decide doctor compensation but these artificial limits on doctor pay really bite…no cost transparency and very little incentive for people to take care of themselves in the US.

  • http://www.twitter.com/alicearobertson Alice

    Primary Care says: After all, we’re the most educated, hardest working, and arguably most intelligent and skilled professionals [end quote]

    That’s a bit presumptious. Doctors are well-educated……but hardest working and a type of hands-down “most intelligent”. Hmm……..I don’t think so………maybe speaking in a generality most ambitious……….but intelligent? How about nurses? How about lawyers? Phd’s?

    For fun I copied a list of the careers of Mensa members. Imagine being the world’s most brilliant barber, or postal worker? They were smart enough to follow their heart……Hmmm……..I don’t see physician listed on the short list of their front page, but if doctors are the “most intelligent” I would image Mensa is full of them? I am so grateful people with brains don’t all go into certain-limited fields. Diversity of the gene pool is really a great gift.

    Mensa members by occupation
    The diversity of Mensa’s membership is best described by the various ways they earn their livings. These are just a few of Mensa’s occupations.
    Barber Lawyer
    Realtor CEO
    Musician Rocket scientist
    Clergy Nurse
    Taxi driver Engineer
    Police officer Teacher
    Homemaker Postal worker
    Interpreter Database administrator
    Veterinarian Logger

  • well

    Who cares what your IQ is if you never do well socially and financially in life? One may have a genius intellect and have a poor-paying, not very ambitious job as a janitor. Perhaps the people that realize that they have to study more and work harder are the truly intelligent. In other words, as long as you have the results, who cares how you got there?

    • HJ

      “Who cares what your IQ is if you never do well socially and financially in life?”

      So money and social status are the only things that are important?

  • Primary Care Internist

    Mensa membership requires passing a test, akin to an SAT or IQ test. By virtue of the selective nature of med school admissions, I would say that 95+% of MDs would have no problem becoming a member, if they wanted to sit around with a bunch of pretentious people and brag to each other about how smart they all are.

  • http://www.twitter.com/alicearobertson Alice

    Who cares what your IQ is if you never do well socially and financially in life? One may have a genius intellect and have a poor-paying, not very ambitious job as a janitor [end quote]

    Hmmm………altruism is missing from your list, and what good is an education if you lack charity of heart? I am not inclined to admire clever devils….they often do more harm than good in their arrogance.

    • http://fertilityfile.com IVF-MD

      Great point about the altruism, Alice.

      This would be my argument about the interconnection between IQ and altruism.

      Wisdom and intelligence would be expected to naturally lead one toward discovering the best life strategies for achieving happiness, right? While the aforementioned money and prestige might provide a quick fix of short-term happiness, a genuinely wise person would come to the eventual realization that lasting happiness is achieved only with a life purpose that includes a healthy component of altruism. This is my just my opinion, anyway. :)

  • http://www.twitter.com/alicearobertson Alice

    Wisdom and intelligence would be expected to naturally lead one toward discovering the best life strategies for achieving happiness, right? While the aforementioned money and prestige might provide a quick fix of short-term happiness, a genuinely wise person would come to the eventual realization that lasting happiness is achieved only with a life purpose that includes a healthy component of altruism. This is my just my opinion, anyway. [end quote]

    Wonderful post! I tell my kids it’s all wallpaper on life!

    Now is this a good day or what? HJ and I agree on something.

  • well

    There is a difference between being altruistic and being so idealistic that your life consists of rainbows and fluffy bunnies. There are people that wish to take advantage of you and those that wish to do you harm. Personally, I see no problem in securing one’s financial independence and being compensated what the market will bear. I don’t agree with price fixing and would love to provide charity work as an attending–but only under my free will.

    I was only trying to point out that if one is born with the “tools” to succeed, it doesn’t necessarily mean that they will amount to anything. Who cares how smart or talented you are if you never apply yourself?

    Alice August 4, 2010 at 9:58 am

    Who cares what your IQ is if you never do well socially and financially in life? One may have a genius intellect and have a poor-paying, not very ambitious job as a janitor [end quote]

    Hmmm………altruism is missing from your list, and what good is an education if you lack charity of heart? I am not inclined to admire clever devils….they often do more harm than good in their arrogance.

    • http://fertilityfile.com IVF-MD

      Well said, well.

      There is a difference between taking money out of your own earnings in order to help others vs taking money out of other people’s earnings in order to help others.

      Obviously, there is a moral difference. Don’t underestimate the practical difference. When you are donating from your own pocket, you will have greater diligence as to where the money is going and how it’s being spent. When you are spending other people’s money, the risk of waste, inefficiency and corruption skyrockets.

  • kl

    When I was a resident and stated my interest in infectious disease, people scoffed. “Why would you want to do 2-3 extra years of training for less pay?”

    Well, I did the 2 extra years of training and now make on par (+/-) what the PCPs make (hospital employee model). But I’m a specialist right? I have no problem with compensating PCPs more but yeah I cringe with the thought that that could come at my expense.

  • http://www.twitter.com/alicearobertson Alice

    Well said: I don’t agree with price fixing and would love to provide charity work as an attending–but only under my free will.

    I was only trying to point out that if one is born with the “tools” to succeed, it doesn’t necessarily mean that they will amount to anything. Who cares how smart or talented you are if you never apply yourself?
    [end quote]

    I agree about charity work. There is a book titled, The End to Poverty that encourages us to do charity work beyond government involvement (which, usually, means it’s not as efficient and it creates an entitlement mindset).
    Maybe I am thinking too personally, but I hesitate to share much publicly………but I will say because of IQ tests, etc. and my skipping the fourth grade based on that, and doing well in college there are people who think I wasted my life staying home to homeschool my six children. It’s an odd thought really to me. Surely, the hand that rocks the cradle rules the world, and I have did a greater service being at home? My children volunteer with me, we don’t have much money because we are a single-income family in a small home. But, recently, when our daughter’s cancer spread and we have went through quite a trial, the gift of my family is priceless. I reflected upon the lost career and felt absolutely no remorse, just gratitude that I followed my heart.

    The stereotype of moms at home being of less value, or of less intelligence is bothersome, although I don’t really dwell on it much. I work with a conservative think tank (with my kids), we go into the ghetto and have become comfortable enough there (we stand out like a sore thumb, so we are of great interest. People don’t understand why people who don’t have to be there, and want to help for nothing, seem mystified by our presence…….not that we haven’t been terrified in high-crime areas. Taking my three girls there where gangs seem ultra interested in them has caused some heart-stopping moments). My youngest is now 13 years old, and I hope to start a classical literature class away from the upper class kids I now teach for free. I want to teach them analytical skills, and ways to cope with bad circumstances through literature. To love words with a passion, and learn how to understand feelings that can envelope us, and see the world through a different lens. Something beyond literacy, but a way to see the world as CS Lewis said through a myriad of eyes, and to travel to a thousand places, yet remain the same person. A contribution from my heart to their own.

    So………when someone says they are a mere stay-at-home mom who gave up everything to raise children my hope is there would be admiration………..not a condemnation that would place a mom on the defensive.

    There are so many ways to change the world, and in truth, sometimes I think intelligence (or particularly high intelligence) is a deficit because knowledge can puffeth up when it’s not used to help others.

    I shared with my brilliant doctor today about the statement about doctors being the most intelligent and he scoffed. I shared that I contested and he encouraged me. And it’s why conversations like this are great, because iron-sharpens-iron.

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