Do American medical specialists really make too much money?

Whether specialists make too much money depends on whom you ask.

Policy experts

If you ask policy experts, most of whom are progressives, they will say  “yes, of course, specialists make too much money.” Too many specialists making too much money spoil the national health care broth.

Just look at any other country, especially countries with government-run systems.

Specialists there make one-half of what our specialists bring home. Look at their total health costs, one-half of what other countries pay, even with universal coverage. The answer, therefore, lies in more progressive government policies that encourage more lower-paid primary care doctors and discourage more highly-paid specialists.

Specialists

If you ask specialists, who comprise 2/3 of American physicians,they are likely to say, “get real.” Other countries generally offer virtually free or low-cost medical educations and do not have punitive malpractice systems. Nor do they offer widely available effective high tech life saving and life style restoring high tech care for which the public demands and clamors.

As Kevin Pho, MD, pointed out in, “The tension between physicians and health policy experts,“ the cost of a 4 year medical education in the U.S. is $250,000 vs. $75,000 in Canada and less than $10,000 in France.

Who to trust

Whose judgment to trust? Policy experts, specialists, or the public at large?

Kevin cites a June 13-14, 2010 Gallup poll asking the public who they trusted to do the right thing about the health system.

The results were:

  • Doctors, 73%
  • Health experts and academics, 62%
  • Hospitals, 61%
  • President Obama, 58%
  • Democratic leaders in Congress, 42%
  • Drug companies, 40%
  • Health Plans, 35%
  • Republican leaders in Congress, 34%

Lack of clarity

These results offer little clarity on what direction the health system is likely to take. The November 2010 elections, an overwhelming Republican victory, and the recent Democratic upset of a Republican in district 46 in New York State, said to be a revolt against Ryan’s Medicare proposal, add to the confusion.

Now that we’ve had a year of Obamacare under our belts, public resistance to the health reform law and calls for its repeal show no signs of abating.

Reform changes everything

Only one thing is for sure: the reform law and other economic pressures have forever changed the future for doctors and contributed to pervasive physician angst. This angst, based on extensive national physician surveys, is beautifully outlined and articulated in a white paper A Roadmap for Physicians to Health Reform sponsored by The Physicians Foundation, a physician advocacy group.

A “free” medical school education

Meanwhile, progressive policy experts continue in their efforts to transform the health system from the top-down. In a New York Times op-ed, “Why Medical School Should Be Free,” Peter Bach, senior adviser at CMS from 2005 to 2006, and Robert Kocher, a special assistant to President Obama on health care and economic policy from 2009 to 2010, say the answer is straightforward:

… free medical school tuition, subsidizing primary care training, and withdrawing training stipends for specialists. In short, to meet the shortage of primary care doctors, charge to specialize.

Cost and results

The cost? A mere $2.5 billion.

The results?

Presto!

  • Eliminating the impact of the average medical school tuition of $38,000 on specialty and primary care career selection.
  • Ending the average medical school debt burden of $155,000.
  • Shift of workforce from specialists to primary care practitioners, with narrowing of the gap between the average income of $325,000 for specialists and $190,000 for primary care doctors.

As cliché-mongers like to say, beware of what you wish for, there’s no free lunch, if it’s free it may be too good to be true, and when it’s free, the Piper will call the Tune. For, although Bach and Kocher do not explicitly say so, a “free” medical school education with more primary care goodies and specialty baddies could be a giant step forward towards complete centralized control.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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  • westeasterly

    That pole really makes me wonder about the methodology: I’m surrounded by democrats, and still, I don’t know anyone who would trust drug companies/insurers to “do the right thing” more than an elected official, even if we’re talking about republicans.

  • http://hematopoiesis.info/ Alexey

    Medical education should be for free and health care should be for free. Because health of citizens should be national priority and supported by government. Billing the patients after surgery in ER is amoral and crime against humanity.
    In US right now Wall Street is giving orders to government. When Americans will get rid of financial elite, health care will become a national priority and interest. It will be very powerful and healthy nation again. Medicine is not a business.

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

    As always, a thoughtful post from Dr. Reece.

  • solo fp

    Specialists have learned to exist in a dysfunctional system. When Medicare and the private insurance companies started bundling services and cutting fees, specialists simply added more procedures per day by running multiple procedure rooms. More procedures = more money.

    If docs want to make more money, why not have them think about ending the traditional Wednesday or Friday off and work a full work week. For primary care, the way to make money is to get up an hour or two earlier and start the office earlier each day and see 4-8 patients more per day. Forgo the 6 weeks of traditional vacation. They talk about a doctor shortage, but I watch hoards of docs taking weeks of vacations, such as 4 day or longer weekends when Memorial day comes around or 4th of July shows up. Docs can make a lot more if they work more hours. When I first started and was slower, I noticed bundles of docs sitting in the lounge for 1-2 hours reading the paper and gossiping. I quit the lounge, start 2 hours earlier each day, and added over $100,000 to my income each year. Also quit wasting 1-2 hours a day at drug rep lunches and interrupting patient visits to talk to drug reps. The patients are paying for your time, drug reps do not.

  • Joe

    “Free” medical education will inevitably lead to more medical schools and more doctors. More doctors = more diagnoses and more cost because demand follows supply in healthcare (vs supply following demand as in normal markets).

    After all what did “Free” healthcare get us — more expensive healthcare costs for the nation.

    • http://medschoolodyssey.wordpress.com/ Med School Odyssey

      Uh…as long as the AMA is around, the problem of not enough doctors will never be solved.

  • http://? W Harris

    Eliminate the need for insurance, esp. primary and the doctors can make more money. Insurance is the culprit here. We can then afford to see a doctor!
    bill

  • BobBapaso

    Right on, W H-, give everyone a Healthcare Savings Account, and everything else will take care of its self. The insurance companies caused the problem by paying for everything, from the beginning, and now they can’t stop, even though they’ve tried with managed care and by adding co-pays.

    All education should be free to everyone, to the degree that they want it and are able to benefit from it. Think how far we’d leave the Chinese behind if we did that.

  • Dorothy Green

    “There is no free lunch”

    Well consider this. Unhealthy food is very cheap (and addictive) and is close to a “free lunch” pushed by Big Ag TV ads and flashing unhealthy fast food signs everywhere. such as much as you can eat for $10, supersized soda, burger and fries (2000 cals for $3,99. Then corn, corn everywhere in a diet of 90% processed stuff to put into our mouthssubsidized by our gov’t (even if those of us they represent say no, no, no)

    The US leads in diet-related body and mind damage referred to as chronic preventive diseases – diabetes II, CV, and an ever increasing every day. .

    To treat them? A soverign profession inclusive of most of the 53% specialists mentioned and a vast medical industrial complex*.

    If the American eating culture were more like other countries, we wouldn’t need all those specialists and expensive drugs of these self inflicted conditions.

    On the other hand, someone in the US who develops a disease whose cause is not yet known, like ALS or a non- diet related cancer has fewer new technologies and research available and less assurance of getting care than those in other countries because non-diet related diseases are not as prevalent and therefore not as profitable.

    Go Figure!!

    *adapted from The Social Transformation of American Medicine and the rise of a sovereign profession and the making of a vast industry.

    • doctor1991

      “corn, corn everywhere”…
      This is correct, and remember, as I think you hinted, that it is our government (the same that will now “rescue” medicine) that is responsible for this. Remember that Iowa has an early caucus. I wonder if ethanol will be found to be the cure for the common cold? I will look forward to similarly effective future decision making from our public leaders.

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