Doctor, do you have enough money?

Are you paid fairly for what you do?

How much are your services actually worth?

Of course you are worth more than you are paid. Enough money is never enough.

“The market decides.”

But, in medicine, there is no way that it is a “free market”; the American medical marketplace is historically rigged by innumerable visible and, to the average person, invisible factors.

We live in one world. Ask Detroit about wages for making American cars as good as the Japanese; ask North Carolina about wooden furniture; Motorola about manufacturing TVs and cell phones; Pittsburgh about steel; the garment district of Manhattan about clothing; Long Beach about passenger airplanes.

Why do you think medicine is immune to the economic realities of the global market?

Whether you participate in, or show open contempt for, American “organized medicine,” over the decades it has taken very good care of us American physicians.

In this month’s Health Affairs, a study supported by the Commonwealth Fund of New York reports that the 2008 per capita spending for U.S. physician services was $1,599 while per-person spending for physician services for the 34 member countries of the Organization for Economic Co-Operation and Development was $310.

In cross-country comparisons of primary care physicians and orthopedic surgeons, they reported that U.S. primary care physicians were paid 27% more for public insurance and 70% more for private insurance patients than their counterparts in Australia, Canada, France, Germany, and the U.K.

For orthopedists it was 70% more for public and 120% more for private insurance patients.

U.S. physician incomes, after expenses, including malpractice expenses, were also greatly higher.

The study did not assess true medical need, use of evidence-based medicine, or patient outcomes.

Maybe all those doctors in other developed countries are seriously underpaid.

Or maybe … we American doctors … are … hmmm?

Of course, enough money is never enough.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • http://twitter.com/DarrellWhite Darrell White

    Let’s see…those doctors in other developed countries paid how much for their educations? They forfeited how much in wages compared with their peers while they trained? They labor under what types of tort liability? In terms of education, expertise, and physician-determined outcomes (surgical success, correct diagnosis, etc.), they stack up how? In their daily lives they do what % of the work done by a U.S. physician?

    You’ve created a strawman, a strawdoc. 

    I have enough for my life as it is now. I may not be able to make enough to retire to a life that in any way approximates my life now. Ever. But I have enough, now.

    I am also underpaid. Dramatically, by any metric you wish to propose. I am more efficient, achieve better outcomes, and outwork a ridiculous % of any segment of the workforce you wish to choose, medical or otherwise. I support 14 families that do not share my name. In a meritocracy I would make 10X what I make now. In any meaningful economy, in any system that rewards relative value, it would be revolting to learn what I make relative to Eva or Evan Longoria (although both are, admittedly, prettier than I). 

    At some point you get what you paid for. Always. At some point I, and my peers, will stop. I am underpaid for the efforts I have made to reach this level. I am underpaid for the risks I bear. I am underpaid for my experience and my production. 

    It will not always be so. At some point I will stop. You will have paid legions of my successors what you have paid me recently. You will look to the healthcare systems  of other developed countries and you will realize:

    You have gotten what you paid for. 

    • Anonymous

      Two years ago, on this very blog, someone posted that the reported salary for the JAMA editor-in-chief was around $500,000 annually.

      My goodness, I can’t imagine how fast Dr. Lundberg’s pen must have been to “justify” that salary level.  Wonder what the editor in chief for British Medical Journal gets paid?

      • Anonymous

        Just looked up the salary for the director of the British National Health service–it’s 220,000 pounds.  Doubt the editor would make more than that.

  • Anonymous

    Well, you’ve really outdone yourself in your own fantasy world, Lundberg. 
    One of the reasons there is no such thing as a “free market” in our capitalist democracy is because “organized medicine” likes it that way. 
    And since you are so into the neo-liberal globalist bit, perhaps you can explain why American medical education costs so much more compared to the rest of the world. Or why we get plundered and intimidated by our own legal system designed to “protect” us. I guess “organized medicine” has been looking out for us there as well. 
    It is not about money. Although that would be difficult to understand for someone making half a mil a year for “editing” things. Rural physicians cant keep their damn doors open because regulation is out of control and reimbursement cant keep up with overhead. This isn’t about salaries. 
    You are a fantastic example of why people have contempt for those in “organized medicine”. 
    Enjoy your time in the clouds. 

  • Anonymous

    Sigh.  Once again we have to contend with someone whose economic knowledge is pre-1776.  This time it is Dr. Lundberg.  Lundberg’s argument is based on the just price (or just wage) theory, late of the Middle Ages, an era not known for its economic or medical dynamism. This theory would have us all earning what we deserve–supply and demand be damned. 
    There is a better way, described by Adam Smith in 1776, John Stuart Mill, Alfred Marshall and others –not including Karl Marx.  The idea is that wages paid should be sufficient to induce workers to meet the demand. Medical salaries in France or England or Timbuktu might be interesting, but they are irrelevant.  What is relevant are the salaries paid to occupations in the United States that young, intelligent, ambitious medical students could have chosen instead of medicine.  Medicine is in the labor market for such persons, and it must compete for them, here in America.
    Could America pay doctors less and still get the kind of medical students it desires? I suspect it could in some fields, but it is of course an empirical question, not a question of just price.