Dear lawmakers: This is what it’s like to be a doctor today

Dear lawmakers: This is what its like to be a doctor today

I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared amongst many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your own family, friends, or colleagues.

I grew up in the suburbs of southeast Michigan in a middle class family.  My father is an engineer at General Motors and my mother is a Catholic school administrator in my hometown. My family worked hard and sacrificed much to enroll me in a private Catholic elementary school in a small town in Michigan.  I thought I wanted to be a doctor in 5th grade based on my love of science and the idea of wanting to help others despite no extended family members involved in medicine.  Winning a science fair project about the circulatory system in 6th grade really piqued my interest in the field. Throughout high school, I took several science courses that again reinforced my interest and enthusiasm towards the field of medicine.  I then enrolled at Saint Louis University to advance my training for a total of eight years of intense education, including undergraduate and medical school.  The goal was to prepare myself to take care of sick patients and to save the lives of others (four years of undergraduate premedical studies and four years of medical school).  After graduation from medical school at age 26, I then pursued training in Internal Medicine at the University of Michigan, which was a three year program where I learned to manage complex problems associated with internal organs, including the heart, lungs, gastrointestinal tract, kidneys and others.  I then went on to pursue an additional 3 years of specialty medical training (fellowship) in the field of gastroenterology. The completion of that program culminated 14 years of post-high school education. It was as that point, at the tender age of 32 and searching for my first job, that I could say that my career in medicine began.

Over that 14 year time period of training, I, and many others like me, made tremendous sacrifices.  Only now as I sit with my laptop in the dead of night, with the sounds of my children sleeping, can I look back and see where my journey began.

For me, it began in college, taking rigorous pre-medical courses against a large yearly burden of tuition:  $27,000 of debt yearly for 4 years.  I was one of the fortunate ones. Because I excelled in a competitive academic environment in high school and was able to maintain a position in the top tier of my class, I obtained an academic scholarship, covering 70% of this tuition.  I was fortunate to have graduated from college with “only” $25,000 in student debt. Two weeks after finishing my undergraduate education, I began medical school.  After including books, various exams that would typically cost $1000-$3000 per test, and medical school tuition, my yearly education costs amounted to $45,000 per year. Unlike most other fields of study, the demands of medical school education, with daytime classes and night time studying, make it nearly impossible to hold down an extra source of income. I spent an additional $5000 in my final year for application fees and interview travel as I sought a residency position in Internal Medicine.  After being “matched” into a residency position in Michigan, I took out yet another $10,000 loan to relocate and pay for my final expenses in medical school, as moving expenses are not paid for by training programs.

At that point, with medical school completed, I was only halfway through my journey to becoming a doctor.  I recall a moment then, sitting with a group of students in a room with a financial advisor who was saying something about how to consolidate loans. I stared meekly at numbers on  a piece of paper listing what I owed for the 2 degrees that I had earned , knowing full well that I didn’t yet have the ability to earn a dime. I didn’t know whether to cry at the number or be happy that mine was lower than most of my friends. My number was $196,000.

$196,000. That was the bill, for the tuition, the tests, the books, the late night pizza. $196,000 financed through a combination of student loans, personal loans, and high interest credit cards, now consolidated, amalgamated, homogenized into one life defining number for my personal convenience.

I then relocated to Michigan and moved into a small condo in Ann Arbor, where I started my residency. As a resident in Internal Medicine, I earned a salary of $39,000. All the while, interest continued to accrue on my mother-lode of debt at the rate of $6000 per year due to the high debt burden.  Paying down this debt was not possible while raising two children. My wife began working, but her meager salary as a teacher was barely enough to cover day care costs. During residency, my costs for taking licensing examinations, interviewing for specialty training positions, and interest on the large loan ballooned my debt further, now exceeding $230,000, all before I began my career as a “real doctor”.

Relatives and friends often ask me, “now that you are a ‘real’ doctor, aren’t you making the big bucks?” While I am fortunate to now be making a higher salary, some basics of finance make my salary significantly less than meets the eye (very in-depth article on how this is so). First, I was 32 years old as I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt. Also, as I did not start saving when I was younger, financially speaking, I have lost the past 10 years without the ability to save and invest to earn compounding interest.  In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.

We do not “clock” the number of minutes as attorneys do when we talk with patients.  We do not hang up the phone as attorneys may do if they are not going to get paid. No, we listen to patients and answer their questions, however long it may take.  Even if it is the thirty-second straight hour of work, which happens very often, we listen, respond, and formulate a logical plan.  If it involves calling a patient at home after I just worked 30 hours in a row and just walked in the door to see my family, I do it. I never come “home” from work.  As physicians, we are always available, and have to respond in an intellectual way using the $230,000 rigorous education that we received.   And if we don’t do our work well, we don’t just lose business, but we can lose our livelihood through lawsuits.

You may ask why do we do all of this?  It’s because we have pride in what we do.  We truly care for the well-being of the human race.  We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America.  We are doctors.

In reading this letter, one may think that one has to sacrifice a significant amount to become a great physician.  You may think we face physical and mental stress that is unparalleled.   You may begin to think that doctors not only have to be smart, but they have to know how to communicate with others during very emotional times.   You may think that we must face adversity well and must develop very rough skin to handle all walks of life, especially when dealing with sickness and death on a daily  basis.

Now that you see this additional aspect to our career, you may think that we have a tough job to tackle several tasks at once, demanding much versatility.  You may think someone needs a great work ethic to do what we do.  You must think that not only do we have to know science extremely well, we also have to know other areas such as writing, history, math, even law given the multiple calculations we go through in our heads on a daily basis and conversations we have with families. And finally, you must think we know finance, as we have to try balance a $230,000 loan while making $50,000 at age 30.

Now imagine, if you would,  having $230,00 dollars in debt with two young children at age 30 and listening to the news with lawmakers saying that doctors are “rich” and should have their pay cut.  Or that “studies show that doctors lack empathy”.

Unfortunately, we physicians do not have much of a voice on Capitol Hill.  There are not enough doctors in Washington D.C. who can give the insight of this letter while you in Washington, D.C. discuss health care reform.   You may hear from leaders of the American Medical Association, but these are not the doctors on the front lines.   These are the older political voices who were physicians when the times were different, when doctors did get reimbursed fairly for their work, when student loan debt was not this high, and when lawsuits were less prevalent. Many of the loudest voices in the healthcare debate are those of lawyers and lobbyists for special interests. They do not care about the well being of patients; that is what doctors do.

I want to make it clear that this letter is not just another story about the difficulties of becoming a doctor and being successful in medicine.  I do not want you to think I am complaining about how hard my life is and used to be.  In fact, I love my job and there is no other field I would ever imagine myself doing.   My true wish is to illustrate the sacrifices doctors do make because I feel we are not represented when laws are made. These sacrifices include a lack of quality family time, our large student loan debt, the age at which we can practically start saving for retirement, and the pressure we face with lawyers watching every move we make. Yet we make these sacrifices gladly for the good of our patients.

I want to challenge our leaders to address the points I have made in this letter, keeping in mind that this is an honest firsthand account of the personal life of a newly practicing physician.  It is a letter that speaks for almost all physicians in America and our struggles on our arduous yet personally rewarding life.  It is not just a letter of my own journey, but one that represents most physicians’ path on our way to caring for America’s sick.

You may ask how I had the time to write this letter?  As I’m sure many of you do, I made time.  It is now 3:00 am on my only day off this month.  I considered this a priority.  I hope you feel the same.  I just finished my 87 hour week.  Time for a short rest.

Matthew Moeller is a gastroenteroloigst.  This article originally appeared on CaduceusBlog.

Image credit: Shutterstock.com

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  • buzzkillerjsmith

    Dr. M, I feel your pain. But most other people, including lawmakers, don’t and won’t. They simply do not care. Even if they knew, they would not care.

    Business school maxim: You don’t get what you deserve, you get what you negotiate. Politicians too live by this maxim.

  • David1234

    Doc,

    That’s a lot of money and debt you’ve taken on. But it does have a reward for most. See, you can take on $230k in debt when you’ll subsequently make a huge sum of money when your training is done. So, to complete the picture, care to publish how much you’re making now? I bet it’s a lot. A damn lot. I’m not suggesting by any means you don’t earn it. I AM suggesting that saying med school training is expensive is misleading when not matched with a statement about expected future incomes.

    I don’t think anyone thinks that becoming an MD is an easy or inexpensive road. I hope everyone also realizes that doctors are among the most richly rewarded workers anywhere in the world, financially, once they complete their initial years of work. Also, if you think doctors don’t have a voice in Washington, you should really check out the amount of money the AMA, AHA and others spend on lobbying. It’s sickening.

    • azmd

      I think the intent of the poster’s complaining is to explain why further decreases in physician compensation, as CMS is proposing, are not justified. If you look at the burden of educational debt, which is very substantial, and the investment of time in training, which is even more substantial compared to law and banking, it is true that there will be a certain point at which further cuts in compensation will mean that fewer of our bright college graduates will be attracted to study medicine. There is a tendency just to look at the compensation numbers without considering the educational debt, exhaustive training and rigorous professional lifestyle that all should be a part of the equation.

      I agree that he is not making the best case for himself here by disregarding the fact that he still makes a fairly handsome yearly income.

      • Bobby

        Agreed he has a good salary but the point is that it comes at a huge loss. If he went into finance, he would have made anywhere from 70-100k each year for the same 10 year period.

        School is MORE expense now. People leave school with 300k-400k in debt @ 8%. So yeah, it’s not great to work 80 hrs a week for a decade while earning 50k only for the last few years of that… your average annual income over that 10 year period is probably 10k each year since you don’t earn anything most of the time.

        It is what it is. I expect people to think docs are overpaid and the gov’t to keep making cuts. They will continue to do this until the wipe out the talent and those people go to business, law, IT. Honestly, soon making 70-100k working only 50 hrs a week will be a much better path than medicine. You don’t live like a peasant for 10 years on that path and you still have the opportunity for advancement after putting in a decade.

  • azmd

    This is a very heartfelt plea for sympathy by a hardworking medical specialist but the fact remains that other commenters are correct, the average salary for a GI specialist is pretty generous.

    I think what might be a little more convincing would be a more analytic statement about what the net ROI after payment of educational debt for a medical specialist might be. I am not sure, but I suspect that the ROI continues to be pretty good, even after one factors in debt and lost income/savings during the lengthy training period. I could be wrong, though.

    What we can say for sure is that the ROI is much less favorable for primary care doctors, and probably our lawmakers need to be a little more tuned in to that reality.

    • http://profiles.google.com/gmlevinmd GARY LEVIN

      Good for you. The fact that you earn a good income does not affect me…However if the government decides there is one pie and they slice it up….it affects each of us in the profession. We should not allow us to be divided and reject those attempts, by refusing to buy into criticizing our medical brethren.

    • RK

      I suppose I’d just offer that the salary is high, but everything is relative.

      At least I can say with a straight face that even a 0.5M salary is earned (14 years, debt, 90hr weeks plus studying!).

      Compare that with: Celebrities, MBAs, Engineers, Nurses.

      MBAs can make 200k within a few years if they’re successful. Nurses can train in as little as 4 years and eventually earn 100k (though they usually start around 40k, at the age of 22). Engineers are much the same — four years of school, 100k a year on average until they retire.
      Of course, these professions are RISKIER than medicine (well, maybe not nursing).

      Being an MD is a SAFE life. Generally we don’t get laid off, we get paid reasonably, and our work is interesting, if arduous. But the sacrifices are real – procreating as a trainee is rough, as is finding a spouse who can put up with it. You delay “real life” until you’re 30-something.

      So don’t misunderstand MD’s “whining”. It’s not that we don’t think our salary is substantial, but we look to our peers — the lawyers, MBAs, Engineers, Accountants — and ask if the sacrifice was worth it. It won’t be for much longer, if tuition keeps rising, pay drops, and we keep being castigated in the media. (Truly though — it hurts to have strangers assume you’re a lazy overpaid professional. Maybe overpaid, but def not lazy.

  • matt19799

    Lawmakers should CURRENTLY not give me anything. The problem is how lawmakers think doctors can absorb cuts in the FUTURE when we really cannot. Another point revolves around Obama’s plan. Cuts to doctors pay is likely and we have already seen cuts over the past 10 years. We have seen a 20 percent cut to our fees already in the past 15 years. Lawmakers need to understand where doctors in general are coming from since we do not have “everyday” doctors speaking to lawmakers. First, I was speaking of all doctors, not GI doctors. The average internal medicine doctor makes 170k and average pediatrician makes 140k. Second, our income is all deferred which means we cannot save in our twenties due to our lack of any income in medical school and a stipend in residency (which translates to $10/hour for 6 years of post- med school training). So specialists finish training at age 33. We lost 11 years of compounding interest compared to the average 22 year old out of college. Third, when we do eventually make more money (11 years later than the average person who gets a Bachelor’s), the tax laws prohibit us from writing off our student loan interest and all other deductions (child tax credit, tuition and fees credit,rental income losses, being subject to AMT, etc), making us give even more to the IRS the 1st year we earn “real money”. Fourth, we have loads of debt (yes, the average is 190k) that accrues interest, which prohibits even more savings. While the business grad is saving $1000/month at age 33 and already saved in his twenties, I am paying off a loan at $1400/month with NO savings. PLUS, I need to save even more now as I was not able to in my twenties ( due to the effects of compounding interest). Saving can be hard when you have kids and 40% of your income is lost to taxes because suddenly you are in a high tax bracket. Fifth, if you lived our life, if you knew the sacrifices we had to make on this journey, you would realize that a large salary figure at the end of 14 years of post-high school training is reasonable. We don’t just leave work at 6pm. If patient’s families have questions, we stay however long it takes to finish our role to help that patient. We do not clock out of work. We did 32 hour shifts in residency (worked over 90 hours/week for 3 years) and took call every 4th night. Even after training, we wake up at 2am to drive into the city to help patients, answer calls off hours and not clock minutes like lawyers do. In addition, we are doing high risk jobs. We have people’s lives in our hands. Isn’t the risk of you job worth something? If we mess up, it is someone’s life. Plus, if we mess up despite all this work while trying to do good, we can get sued for a million dollars. If my plumber messes up, no one can sue him. If my mortgage office messes up my mortgage, no one sues him. In addition to the above, what about something obvious? Most doctors studied their hearts out since high school, worked their tails off in med school and residency and were likely in the top 10 percent of every step along the way from high school through college. They just didn’t happen to be smart and receive a high salary; they earned it. Don’t you think that with the high risk involved in our jobs (people’s lives and lawsuits), the risk we put on our own health (sleepless nights, high stress), the work ethic we needed to get through 4 years of med school and 6 years of 90 hour work weeks, and the desire to persist despite a 200,000 loan looking down on you while making $10/hour in residency, that we deserve what we get ? If you don’t understand, this, then I challenge you to complete the required training and then speak up in about 10 years (assuming you have a 4 year Bachelor degree). If you are a doctor and was just commenting of specific GI salaries, then I misspoke because my letter was intended to defend all doctors, not just GI doctors. I do agree GI doctors make a good living. However, we did 3 extra years of training compared to a primary care doctor (3 extra years of lack of saving and compounding interest) and do take on procedure related risks and complications to deal with as well as urgent on call issues (3 am scopes). We also had to be competitive academically (meaning doing more research outside of work, getting strong letters of recommendations, getting into more competitive residencies, and scoring better on USMLEs given the competitiveness of the GI field.

    • anonymous

      The cuts in pay are bad and something needs to be done about them.

      On the other hand, if you really have no savings and are hard pressed to pay $1400/mo. student loans on a $350,000 income, something is wrong with your basic money management skills. A $200,000 loan is easily paid off within a handful of years if you live a modest lifestyle. You need to aggressively start saving and investing because a bull market like the one we’re in can easily double your savings in short amount of time.

      Also, the low income averages for IM and peds are due to the large number of docs who choose to work less than full-time in those specialties. The real average is around $200,000 and significantly more if opportunities like extra call are taken.

      • John Silva

        That is a joke. I am currently a medical student who has 4,000 dollars invested. That is actually double what I had last year. Aside from that I have been living off of around 1,500 dollars with modest help from my parents. It is absolutely deluded to think that this bull market is going to somehow pay the 200,000 dollars of tuition and living expenses that is expected of me, especially since this bull market is largely describing previous growth and in no way indicates that such growth will continue. Moreover, I do not have the time to manage the money successfully enough to increase my money considering I study 12 hours during week days and 8-10 on the weekend.

        Also even 350,000 dollars is not much when you are 30 with no assets, with on average 190,000 dollars of debt, and massive liabilities due to the profession. People who want a family, kids, maybe a house, that 350,000 is even less. Add in the fact that the government is taking 40% and were talking about even less. And lets keep in mind that this is a specialist on a very high end of the doctor pay scale and not the primary care doctors that you rely on to get treated.

        I also hate the fact that everyone simplifies things to,”oh, just save money.” Well obviously its easy to say that, but it is wholly another thing to work 80 hours learning how to deal with the most basic needs of people and then have to drive home exhausted in a crappy old car in the middle of the night to another plate of cold left overs in your similarly crappy apartment, knowing that you are nowhere close to making a decent amount of money. It’s times like those that you decide to go out, or travel, or live a normal life despite the increased debt, that is if you can somehow find the time.

        • David1234

          John –

          Thank you so much for encapsulating exactly why people think negatively about the bellyaching of doctors when it comes to their compensation. This quote is comical:

          “Also even 350,000 dollars is not much when you are 30 with no assets, with on average 190,000 dollars of debt, and massive liabilities due to the profession.”

          Yes, John, yes it is still a huge sum of money. Gigantic.

          • Christopher Culbertson

            David:

            Keep in mind that your 350k average includes those physicians with lucrative private practices, or have been practicing for decades. Your average brand new attending GI won’t be seeing that sort of money for several years, and your AVERAGE primary care or family med doc won’t make that much money in TWO years.

            More importantly, you can’t look at these salary figures the same way you would any other job because it overlooks the massive financial and personal sacrifices it takes to reach that point. More than simply being a large salary for doing a highly skilled and difficult job, it’s also “deferred compensation” for several years of training and an “offset” for a time-consuming and debt intensive training process.

            These “bellyaching doctors” don’t start actually making a reasonable salary (more than 45k/year) until they’re into their 30s. By the time they get their first 45k/year salary as interns at 26, many of their college classmates have worked for 4 years earning around this salary. While this number is nothing to sneeze at, they have to work 70+ hours/week on nights and weekends rather than your typical 9-5 week, making about $11/hour. More importantly, while their peers have earned $200k in total income over the past 4 years, most new physicians have accumulated AT LEAST $200k in debt from med school ALONE, and they have to start paying it back immediately.

            Even if they live frugally and make larger payments during their 3-6 years of training, most will actually see their loan debt INCREASE because the monthly payments they can afford don’t even cover the loan interest. By the time they start making these 6 figure salaries in their 30s, many of these dollars are already claimed by student loan lenders and creditors, and they’re still expected to work 70-80 hours/week. By this point, many of their peers from college have been earning very reasonable incomes for almost a decade longer while working fewer hours, accumulated far less debt, and been able to build up assets.

            While 350k is a lot of money to be paid in a year, it’s looks a lot more fair when you consider that your average worker starts earning a reasonable wage several years before you, works half as many hours, and doesn’t end up paying ~$350K to cover their training.

            Oh, and being totally responsible for keeping patients alive is pretty tough too… so there’s that :-)

          • mark

            These are some rough numbers from a neurosurgeon I shadowed this summer. Salary = 1.5 million – income tax of 600,000 – malpractice insurance of 350,000 – rental of office space, pay of nurses, techs, equipment upgrades, and other expenses yielded him a net salary of approximately 200,000 per year, or 13.3% of his “salary.” While 200,000 is still an abundance of money to live on, I was just wanting to make the point that there is more than just salary – tax dollars involved in figuring out how much a doctor makes, as is the case with any profession. I come from a farming background and am in medical school now so I have seen a wide spectrum of incomes and know that everything is relative in the end. As long as the bills are paid and food is on the table that is all that matters, right?

          • umbrellaman

            Mark – these numbers are wrong. No one pays taxes before expenses. Either he is being paid a “salary” and another entity is paying the malpractice and the expenses, or he has 1.5 million in revenue, and then the government starts taxing him after you deduct the expense. No way he is paying 600k in taxes on 950k of income. If he is really paying 600k in taxes he is probably taking home about that much after taxes. Neurosurgeons are not the best example.

          • JG91

            I was thinking the same thing. If he’s on salary, why is he paying “rental of office space, pay of nurses, techs, equipment upgrades, and other expenses” out of that?

            It’s a lovely sad story, but it doesn’t add up.

          • DefendUSA

            Ha. You could be talking about my BIL. And I gotta tell you. The most generous person on the planet and he worked hard to get there.

          • http://twitter.com/Abolish_ Zaphod

            Who cares what they think. Its belly aching because we allowed it to be perceived as such by not having a PR and legislative presence.

            It is a large sum without any of the debt needed to be able to achieve it. For the grand majority, a very large percentage is already assigned to pay off the debts and professional costs to just be a doctor. Not to mention the high overall taxation rate and inability to get credit for loan payments due to just being on the wrong side of the salary line.

            I dont see any belly aching about your favorite sports star/rapitst, why is that? Do they deserve it more than anyone else, no, they just have made people believe they do. We as a group need to demonstrate our value.

          • Rich Haberly

            everyone quotes the numbers for salaries. does anyone actually think about the actual finances of having $300k (average) debt? how much do you think actually makes it to a docs bank account? of course docs are paid well, but the number at the top of the ledger sheet is a total phantom. can you contemplate your finances when you lose a decade and a half of your working years and are now $400k in debt before you can even earn that “huge” salary? (the loss of income alone is hundreds of thousands). does anyone realize that number includes nothing that being a doctor in america requires? no overhead, no benefits, no malpractice premiums, no licensing fees, no hospital fees, no anything, much less 401k or any. how much is left of that 398k after taxes and expenses (in my experience) is 40%. now deduct your giant loan payment from that 40% and double your current work hours. are you telling me that working 80 hours per week in a ridiculously stressful job isn’t worthy? really, you’ve got multiple degrees, a ton of stress and no free time for, essentially, working back-to-back 40 hour jobs for $60k each. THAT is your reality. THOSE are the real numbers we’re talking about. oh, and one more little thing- forget the decade and a half you sacrificed nearly everything to get where you are. even if you do everything correctly, when a patient has a bad outcome, (and, unfortunately, complications are an inevitable part of life), you will be sued, have to mount a defense, and your worldly possessions are constantly at risk. that “gigantic” salary is just a number and it’s ignortant to pretend otherwise.

          • John Silva

            First, I said that it is on the high end of the pay scale. Most doctors don’t make anything close to 350,000 dollars. In reality that salary is somewhere closer to 150,000, with no assets, and a family to raise. Considering the guy is working 80 hours a week, he is essentially working two jobs that pay 75,000 dollars a year. So yes, to answer your question, yes, he is being adequately paid and will be able to live a normal life. Now how do you reason the same financial burden on all the other doctors who make about half of his salary. Mostly the primary care physicians you rely on.

            Second, I believe people should be paid reasonably well to take care of the absolute basic needs of humanity, especially when it takes a decade of dedicated training to do that. If you think we should be paid less then you should never complain about quality of care. You should go to undertrained NPs and tough it out because that is essentially what you want. If they get it wrong, well, guess what, you got what you paid for. Just hope you don’t die.

            Also Bellyaching? Don’t throw such stupid generalizations at me. I guarantee I can do what you do.

        • Dawn Hanna

          If you go into being a Doctor to help people more than the money then that’s a pretty good salary. Plus all that knowledge you gain is worth the investment. I guess it all depends on why you went into being a Dr. I know Doctors that live in very modest homes and have adopted many kids. They drive average cars and live fairly average lives. Well, based on their modest homes and cars they live average lives, but the work they have done and the lives they have changed is by no means average in my book. When I look at these kids who would have otherwise had no families, it just gives me chills. That’s why they became Doctors. Not that one’s not entitled to a great salary after all that investment, but it really depends on why you do it. To be so greatly knowledgeable to me is worth it and the salary is then some.

      • Christopher Culbertson

        First off, I don’t think he or anyone making 350K/year (before taxes mind you) would complain about 1400/month because they’re paying actually paying whole lot more than that. 1400/month would ONLY THE INTEREST that accrues each month assuming an average 7.5% on a total of 200k in loans from med school. In fact, interest alone will almost definitely be more than that though because you’ll never be able to pay off all of the monthly interest payments during your 6 years of training since you only make about 45k/year BEFORE taxes. Assuming you paid about half of your interest each month, your new principle will be about 250k (probably more because I didn’t even compound the interest) by the time training is finished and you’re a brand new attending with a real salary (which WON’T be the average salary which is for ALL GI docs, not new ones). If by a handful of years you mean, say, 5 years, that’s going to be more than 50k year on loans alone. Considering you’re in your 30′s now and also trying to start a family or take care of a young young one, and maybe by a home, saving and aggressive investing can be easier said than done.

        As for “Less than FT in IM or peds,” FT means upwards of 60-80 hours/week and that 200k average you’re quoting is going to be highly dependent on your location and patient population, and you’re not going to be making near the average when you’re a new internist with a mountain of loan debt.

    • azmd

      Gotta say, you are not doing yourself (or the rest of us docs) any big favors here complaining about being in the 40% tax bracket. Most Americans who make less than $350K per year think that paying 40% in taxes is perfectly fair for people who make what we do.

      In the second place, offering the fact that you had to compete academically to get the residency and fellowship positions you did only proves that lots of other people were competing for those positions, which means that at the end of the day, they must be pretty desirable. It does not in any way prove that you are more deserving of a high income than the average primary care MD.

      • http://profiles.google.com/gmlevinmd GARY LEVIN

        I no longer give a rip about what others say or think. They do not walk in our shoes. Fact is most MDs are burned out by the time they start practice, and make poor financial decisions due to the prolonged delayed achievement of good income. Along with this comes little time to logically think out your financial plans. I advise all to have a financial adviser from an early age, and let them control your finances and expenses. It is not that MDs are not smart enough to do that. Early on we are trained to do evrything possible for the patient, no matter what the cost..it was not a factor/ Today it is different. Priests only get sued for immoral acts, Lawyers are perfectly capable of manipulating their situations to avoid law suits, business people decision making is based purely on financial gains. The very rich use other peoples’ money to leverage their successes, The plight of the physician mirrors that of the middle and lower middle class as the wealthy get wealthier. You see insurance executives making millions of dollars, getting big bonuses and more stock, to satisfy their stockholders. Insurance companies are the only ones who can afford large commercial buildings, skyscrapers and own infrastructure. I don’t hear insurance companies moaning about the ACA, nor Pharma, because they are the ones gaining from ACA. Smart negotiators in bed with our Congress. The patient comes last. The ACA is a lie, deceitful and will not help people who have little income or uninsured, because they will be put into the third or fourth tier of care, relegated to medi-caid…a broken system already. Has anyone here applied for medi-caid, been disabled or had a chronically ill child that used up their private insurance plan? I have ! I no longer want to rationalize nor form an objective opininonabout our system. Yet I do not believe in socialized medicine. Whatever you take from the government will cost you dearly….no doubt about it.

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

          Hello, Dr. Levin. I do understand why you feel this way, but as a profession, physicians should give a “rip” about how society feels about them. The financial status they enjoy today is a result of society valuating what they do higher than most anything else.
          Unfortunately as the very rich are continuing to extract all wealth from society at large, they are also actively trying to discredit and malign doctors and consequently manipulate people who now have no money to support their physicians into thinking that they really shouldn’t have to because physicians are rich, greedy, paternalistic, uncaring, motivated by cash incentives only, and really just guessing at medicine and killing hundreds of thousands of people every year.

          Posts like the one above are just helping reinforce this image. Physicians need to stand with their patients right now or this will all soon be over. In a very bad way for all but the 0.1%.

          • Mika

            “the very rich are continuing to extract all wealth from society at large”

            Wealth is not a zero-sum game, and in fact that attitude is not helpful to anyone.

            As Warren Buffet, Bill Gates et. al. got rich they did not make someone on, say, $40,000 earn less. They did not “EXTRACT” wealth from society at large; in fact they created it. If a doctor, lawyer or Indian Chief gets a raise, that money does not come out of my pay packet. Likewise, if if a doctor, lawyer or Indian Chief gets their pay cut, that doesn’t put any extra money into my pay packet.

            I don’t hate on ultra-successful people and wish for them to be brought down to MY level; instead I would like for me myself to work harder and move up the ladder closer to THEIR level.

          • Suzi Q 38

            Well said. I told both of my kids that their inherited wealth with be very little and what little there is will be split evenly.
            I don’t want to penalize one for being more financially successful than the other.

          • anonymous

            Bill Gates outsources American programming and manufacturing jobs. Warren Buffett invests in companies that outsource American jobs.
            So yes, they got rich by downsizing Americans.
            Don’t forgot all the Wall St. execs who made fat bonuses on bogus investments and got bailed out by your taxes.

          • C.L.J. Murphy

            So would America at large have been better off had innovators like Bill Gates not even bothered? I think not. Killing all the rich people is not going to make America’s poor any better off.

          • buzzkillerjsmith

            You are correct, sir or madam.

          • JG91

            “Bill Gates outsources American programming and manufacturing jobs”

            Without Microsoft, those jobs wouldn’t even exist in the first place.

          • azmd

            Totally disagree. Wealth is indeed a zero-sum game; the more money the CEO makes, the less there is to pay worker’s wages/salaries. We are seeing this in spades in the healthcare industry where finite healthcare dollars are increasingly being disproprotionately awarded to healthcare CEOS of all types, leaving less in the pot to pay nurses, doctors, and all of the other workers who are actually providing the healthcare services. Overworked and underpaid medical workers mean that the quality of care is diminished. If you do not see that this is directly connected to the growing trend for income inequity in our society, you are deluding yourself.

          • http://www.facebook.com/profile.php?id=14833296 Phil Hawbaker

            Completely agree. Wealth, like energy, is neither created nor destroyed…simply transferred. It can be transferred through different times (credit) or from person to person (gains / losses ).

          • SMH

            “Wealth, like energy, is neither created nor destroyed…simply transferred.”

            That simply isn’t true. You are a ridiculous person. THE ENTIRE WORLD is wealthier and better off in the 21st century than they were in the 14th or 15th, or even the 19th.

          • http://nototherwise.com/ Jessica Brookman @ N*O

            Agree. That quote only applies if money were backed by a non-imaginary standard, which it is not. Money and wealth are not real, therefore can be created, destroyed. As whoever has the proverbial printing press sees fit…

          • JG91

            So if America’s top-grossing inventors, entrepreneurs and businesspeople had never been born, we’d all have more money in the bank?

          • JG91

            And for that matter, if doctors were limited to earning just $40,000 a year, unemployed single mothers would be better off?

          • Mandy

            Yes, if only Denzel Washington and Oprah weren’t so rich, then I’d have more money. #WTF

          • http://twitter.com/AnikaSchaedler Anika Schaedler

            How do you feel about the CEO at Blue Cross or the local Children’s hospital then? They are making tons of money at your and other patients’ expenses. How do you feel about them? Do you aspire to be them?

          • JG91

            Let’s say my partner and I run a moderately successful landscaping business. If a health executive somewhere gets a raise, that does not mean we earn less that year. If an executive somewhere gets his pay cut in half, that does not mean that we earn more that year (in fact we may even earn less, if he was one of our clients and he can sadly no longer afford our services)

          • azmd

            BUT, if that health executive happens to be the CEO of your health insurance company, his raise does in fact come out of your pocket, either in the form of higher premiums for you, or decreased benefits paid out to you and your workers. And his raise comes out of the pockets of the physicians whose services are reimbursed by the health plan. That’s just basic corporate accounting; it’s astounding to me that so many people choose to ignore it.

          • JG91

            Or, it may come out of shareholder dividends. Or capital expenses. They may decide not to sponsor a race car that year or not to re-decorate their office block. Who knows?

            I have as little to do with insurance companies as I can anyway. Only if I’m struck by a catastrophic illness or injury will my plan kick it; I prefer direct-pay.

          • azmd

            Speaking as someone who has worked for corporations, and whose spouse has been in “C-suite” positions at various companies, I can promise you that the CEO’s raise is paid for by cutting back on services or goods provided to its customers, or by cutting back on pay or benefits provided to its workers, and NEVER by cutting back on dividends or corporate perks.

            And if you have as little to do as you can with insurance companies, here’s another example for you: the low prices that Wal-mart offers its customers are a direct result of its predatory hiring practices which include not offering health insurance to its employees and instead helping them to get enrolled in Medicaid. Who do you think pays for that? That’s right, you and me.

            It’s crazy to think that Joe typical citizen is not affected by the practices which are enriching an already very wealthy elite in this country. I suppose everyone will wake up when we are finally really all serfs.

          • Mandy

            Walmart should go out of business and leave their hundreds of thousands of employees without any job whatsoever. Then we’d all be better off. #WTF

          • azmd

            Right, because suggesting that big corporations and wealthy individuals should be better citizens and not prey on the poor is EXACTLY the same as suggesting that they should go out of business. Reading comprehension much?

          • buzzkillerjsmith

            Over centuries wealth is positive sum. But anyone who thinks that it has been positive sum since 1980 is either innumerate, Republican, or, more likely, both. The stats are out there. You can’t get away with crazy at this blog.

          • http://profiles.google.com/gmlevinmd GARY LEVIN

            Thank you for your comments.

            That is the first time I have publicly spoken out about my feelings about Health Care and our Congress.
            It often seems there is no one listening in the halls of congress.

            I have never expressed those feelings verbally in a public forum. It was not spontaneous, and it flies in the face of my personal involvement with physician-patient advocacy. We have corresponded before, and you must I hold you in the highest regard. You have probably read some of my blogs. I am no longer seeing patients but have my own company, Digital Health Space. I try to keep it objective and factual, however I do inject my educated opinions on health and health reform as well as HIT.

            I think physicians are trained to be imperturbable, and are loath to express anger at the govenrment and “experts” who keep balance sheets, and insurers. After all no one likes to bite the hand that feeds them.

            Patients have caught on and most sympathize with us. The attack on how much we earn is a subterfuge and distracts from the real issues. quality and cost. All MDs very much appreciate your contributions in your articles

            .I am not contrite about my writing and I am not going to apologize for my comments, they were honest. I do not think any comments make it better. Average income figures distort our wealth. Yes, they are above average….MDs are certainly not in the 1% or even 5%. Wealth cannot be measured in income alone, but in total assets. Worth is equal to assets-lliabilities, and I opine that MD liabilities are very high. In addition it factors out the early retirements due to disabilites which shortens a lifetime of earnings.

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

            Dr. Levin, I’m not sure I was clear enough in my comment above. As you very well know, I don’t believe doctor pay is inappropriate or that it has anything to do with the health care problem other than the fact that primary care pay is too low to support a proper distribution of specialties.

            The problem here is that patients/people at large have not caught on, because those who want to disenfranchise the medical profession, and consequently the patients, are waging a very successful divide et impera type of marketing and PR war on the character and abilities of physicians and people in general (PCP vs. specialty, old vs. young, sick vs. healthy, fat vs. skinny, poor vs. less poor, etc.). It is a tactical mistake for doctors to hop right into this preplanned circus ring…. It’s a trap.

          • http://twitter.com/Abolish_ Zaphod

            What you say is true, however, the fair market value of physicians is much higher than what most are currently paid. The tax schedule unfairly punishes workers, if you were a fund manager with similar income, you’d be making much more money, with a whole lot less risk.

            I think if tuition and debt, with the resultant feeling of being imprisoned by the system were changed, people would be much happier.

            We need to get into politics unfortunately, and actively show our worth.

          • http://twitter.com/Abolish_ Zaphod

            Wow. All the people who have down voted simple statements of the obvious are part of the problem.

            Our government works by representation, and unfortunately that means time and money spent making the case.

            We all hoped that if we just worked really hard and did a good job people would see that we’re basically good and reward us with respect and a good paying career without undue litigation fear. This of course just allowed others in power to set the rules to favor corps (pharm, insurance, hosp groups) and malign drs in the mean time. We spend all our time arguing with ourselves and not for ourselves. Sadly this is just not how our system works.

            If tuition and debt wasnt set per maximum extortion levels and graduates didnt feel like they were drowning (especially after up to 7 pgy training years) things wouldnt seem so dire.
            If you work for your money the top tax rate is 40%, whereas if you work with other peoples money or just invest your own, it is 20%. It is simple math.

        • Suzi Q 38

          I think that this financial advice needs to start in elementary school. Our son was trading stock when he was bout 8 or 9. He begged us to buy stock in a little known companies. We let him do odd jobs, mowing lawns and advertising to the neighbors for jobs, gave him allowance and birthday money, then he would take it and invest it is stocks. We didn’t know much about it, so we enlisted the help of a neighbor to coach him a bit. We just knew that he was interested. Well, we invested a little money here and there, and in retrospect, too bad we didn’t invest more. He did O.K. for us.
          By high school he was creating web pages and getting fairly large checks in the mail. He showed me how he would design a page for a potential client, then ask the client for 50% up front. These people actually sent my boy checks. He was only 14. By 16, he was making money as an intern programming.
          We just let him put the money in the bank or invest it in stocks. Not a huge amount, but his just the same.

          We taught him how to be frugal. I imagine that a lot of you know how to do that. If you went through medical school, things were costly if your parents or other benefactors did not give you any money.
          Does anyone get to go to medical school by joining the armed forces? How about living at home and going to med school? Is that a possibility?

          The deal after your education is done is that you have to live almost the same way in order to get these loans off of your back. Who the heck wants to keep around a $1500.00 a month loan forever. If I made an extra $100K the first year, I would drop it on my SL. That would be about $8K a month, every month.

          The problem is that you do not know what the future will bring. What if you change jobs and accept less pay, “Obama style?” What if you started your family during med school and you are in your late 30′s and your kids are 12 and 13? Guess what?? It is almost time for their college costs. Berkeley and other colleges do not come cheap. So what, do you have to pay for your loans AND theirs??? Pay cash for your cars, unless there is a 1% interest rate deal.

          What happens if you get ill yourself? Your health is the “wild card.” You must be smart about this and get the better health insurance, large life insurance (in the millions), disability insurance, and long term nursing care (if you are over 50).

          If you run out and but a million and a half dollar house and have a mortgage of 1 million, that is a huge commitment at a young age. What if you get laid off?
          Huge mistake for anyone during these times.
          My doctor is older, but lives in a better than modest tract home. I think those houses sold for $500K when they were new. They are now worth maybe $600K.

          I am sure he lives near and next to the upper middle class family. this about what he will be able to do with his money as far as student loans, college tuition for kids, savings, retirement, vacations, investments and the like.

          It is called “freedom.”

      • Suzi Q 38

        I’m sorry, I don’t think it is fair that the government takes out 40% instead of 25% for the rest of us.
        One of the reason for the big bucks is the BIG responsibility, huge work load, long hours, 14 years of training and studying and $200K or more in student loans.

        If you have to pay $1500.00 for (how many years?) in student loans, that is a small house payment. Actually, since we bought our house in 1983, our payment is less than that.
        I think it should be a flat rate tax.

        If you are a doctor because you studied and went to school to get there, why penalize with substantially higher taxes for doing so well?

      • orthopierogi

        Why are we all falling into this trap of specialists vs GPs. It’s a very easy way for the powers that be to split us up. WE are doctors. That’s it. WE. That should be the focus. We as docs spend too much time fighting one another.

        The fact is the public only thinks about the money and the Grey’s Anatomy portrayals of medicine. Ask them honestly how much it would cost for them to be willing to leave their daughter’s first birthday party in order to sew the leg back on some thug who kicked your resident in the face with his “good leg” because your resident was placing a temporary splint on it due to an ankle fracture. What did that resident do?…wiped his bloody nose, took a minute, and then reapplied a new splint, called the OR, and got the attending to come in to save the other leg of this fine upstanding individual. The resident then proceeded to see 10 more broken limbs over the course of the night. This is not every night, but it’s enough nights.

        The fact is in medicine we deal with some of the most ungrateful, ungracious, and quite frankly despicable human beings, and we are expected just to take it. If these people behaved this way to any other profession the people would simply walk away from them. We can’t. And we won’t. Because deep down inside everyone of us is thinks everyone is deserving os some help…no matter how bitter some of us sound. And no one talks about this because we are expected to pretend it is a privilege to treat everyone. It is not. If cuts keep coming and coming and coming and we keep being portrayed as selfish by the media, then people will get fed up and leave. I for the first time have started telling people it’s not worth it to go into it at this point. I would have NEVER done that 10 years ago.

        And last thing: what blows my mind most is that people will spend $500 on an iphone, $1000 on a big tv, $1000 on a new computer (when they just use it for the web and other simple BS), and lots more on stuff they don’t need, but will be pissed about a $2000 copay on a life altering surgery.

    • DG197071

      Do you think that you are the only one with student debt?

      The Obamas paid off their student debt 8 years before he become POTUS. Your beef should be with your own profession’s education plan.

      Are you talking about cuts to Medicare? The cost of health care is constantly rising at a much higher rate than inflation. We pay double per capita than other developed nations and we do not offer universal medical care as they do, we bankrupt people with medical bills and our health care outcomes are middling.

      In other words, we are paying for a Porsche but only getting a Ford. Why is this?

      • Greg9876

        Yeah and Obama during this same time was able to buy a 1.6 million house by having his convicted felon friend buy the adjoining lot at a deflated price then bought some of that lot from Rezko back in the future. Most doctors don’t have the luxery of this and if they try to pull anything off like this they would end up in jail.

      • Tammy

        Because you are paying the middle man. He got your Porsche.

    • http://twitter.com/AnikaSchaedler Anika Schaedler

      LOL, so let’s take into account housing, property taxes, homeowner’s insurance, health insurance, malpractice insurance, car payments, car insurance, food, clothing, childcare, retirement, utilities, college funds, and disability insurance (I am certain I am forgetting something). THEN add on the $1500/month student loan payments which he will likely pay for life. THEN disparage the specialist physician for bellyaching. You’re ridiculous.

    • Guest

      “Lawmakers should CURRENTLY not give me anything.”

      So you didn’t want those government loans after all? And you don’t want any money/reimbursement from the government? Or, like a child, do you want-want-want Daddy to provide for you everything you think you deserve, but for you not to have to obey him?

      • Greg9876

        I didn’t take any “Government” loans.Mine were private and by the way the government has taken over the student loan business so there isn’t a choice these day.And it well documented that it is government supported loans that have led to the tuition explosion of recent years anyway. And accepting “Government” money for reimbursement. It’s called Medicare and it’s an insurance program.It’s not the government money.It’s the people money who payed into the system. And lastly an increasing number of doctors are opting of Medicare because of the poor pay and hassles. So many doctors don’t want any of your “government” money.

        • advocate

          “So many doctors don’t want any of your “government” money.”

          The author of this piece apparently does. It’s titled “Dear Lawmakers” because he wants the lawmakers – the gubbamint – to funnel more $$$ his way.

          • Greg9876

            If you actually understood that private insurers base their reimbursement off of Medicare rates you might understand that a cut in Medicare payments will lead to a cut in all private payers payments. It’s funny the same people whining doctors shouldn’t care about medicare cuts will be the same people whining their parents can’t kind find doctors when these same doctors drop medicare coverage. And believe me its already happening.

    • nab27

      I’m someone who has an MD but also happened to take a healthcare economics course a few years ago during my undergraduate education. It is very easy for us to sit here and blame the lobbyists, politicians, and lawyers for problems with physician compensation. After all, private insurers often peg their reimbursement rates for different treatments to Medicare reimbursement rates. When we see potential cuts in Medicare reimbursement rates coming down the line or look at the way in which reimbursement rates currently favor the specialist over the primary care physician we swear under our breaths at those short-sighted politicians. Sadly, however, a large portion of the blame for the plight of the primary care physician actually rests at our own doorstep. The board which determines the relative reimbursement rates of Medicare is composed of physicians who every five years update the Resource-Based Relative Value Scale (RBRVS) and decide how much doctors should be payed for each type of service based on ‘mental and physical skill’, ‘effort’, ‘stress’, ‘geographical adjustments’, etc. Sadly, they tend to give the short-stick to internal medicine and other such areas and instead throw money at more ‘high-tech’ treatments and specialties. Blame those physicians as much as you blame the politicians. Or blame the insurance companies for pegging their rates to medicare reimbursement rates rather than ‘letting the free-market work it out’. The doctors who can’t make ends meet after four years of medical school and three years of residency are the ones stuck in low-paying specialties that are poorly compensated because of a reimbursement board dominated by those who view newer and more high-tech as better

    • eric

      I don’t understand your animosity towards lawyers…You’ve made several completely inaccurate statements and at this point, it’s coming across as jealously. (1) Had you pursued something else, like law school, you wouldn’t have built up that level of debt?–Avg. debt for law student at private university is 125k…good try. (2) “If your plumber messes up, no one can sue him”–100% false, they can. (3) “If my mortgage office messes up my mortgage, no one sues him”–again 100% false…thousands of people do so. (4) Insinuating lawyers clock minutes and don’t do pro-bono work? I don’t know why you chose to belittle a career that requires just as much work as medicine. Lastly, your subtly saying that all Plaintiff Attorney’s are bad, which I have a big problem with. Shouldn’t a patient be able to file charges against a physician for prescribing a lethal drug concoction that caused his Mom’s heart to stop beating? Shouldn’t the physician be held responsible for leaving a 13inch retractor in a patient after surgery? Again, these are extreme examples, but you’re generalization is unfounded.

      Your argument was blurred behind your justification on why doctors shouldn’t get paid less. By the way, I’m an attorney trying to repeal ObamaCare. I’m on your side. I understand the difficulties behind ObamaCare so try and focus on why the act itself will cause patient care to fall.

      • matt19799

        I respect lawyers a lot. If fact, most of my best friends and close relatives are attorneys who do very noble things and have debt. Lawyers definitely burn the midnight oil, no doubt, and do great things that impact millions of people. And I applaud you for working diligently on Obamacare. The two lines in the whole article even mentioning lawyers was to point out the pay structure of doctors. These two lines have nothing to do with the point of the article. They just briefly illustrate that doctors do not get paid hourly, but rather as a service. When this is done, some doctors can spend 2 extra hours on a sicker patient vs another doctor who does the same management for a healthier patient. Which we happily do (I chose to work in an area in the inner city where we have a very sick patient population), but it does serve as a contrast. In addition, over 15% of my work is pro-bono as I am serving a poor population without insurance. I agree lawyers do pro-bono work as well and this should be applauded. But for the lawyers I know and chat with, they stated they usually charge an hourly rate and that they can choose to take on a case or not. This is not a bad thing at all! It is just a difference that I am trying to show for those who make the laws. I agree that patients need protection against doctor’s mistakes, no doubt, but unfortunately a lot of these cases get settled out of court and only a minority of cases are won, which can increase costs. And I do feel doctors should be held responsible for malpractice as everyone makes mistakes and not all doctors are good at what they do. This article is meant to address Congress about the future of medicine, not the current salaries. I never complained about my current salary. In fact, I love my job and would do it all over again as it is very rewarding. Rather, I was speaking for all doctors about changes in the future that could impact our ability to practice. Second, it was meant to speak for all doctors, not just GI doctors. Not all doctors such as general practitioners make the salary of specialists, and if reforming the SGR is not done, these doctors’ could see their expenses exceed their revenue, which will unravel primary care. i see this because I am on the front lines of care and I talk to 30-40 primary care docs a week with my job. I feel our leaders do not hear these things from the “horse’s mouth”, which are doctors who are taking care of patients daily. I appreciate your comments, we should work together on this. Again, keep up the good work.

  • Jonathan

    I do not think the complaint, “I studied for years to become a Dr,” is valid because, frankly, that is the job.

    What may be valid, “I’m not getting paid what I am worth.” Is also true for many who work, in what used to be well paid professions; not only our M.D.’s

    • Eric Jones

      You incur huge financial risk for at least until your loans are paid. If a student/doctor fails or is injured, Sallie May is unforgiving.

      Also, and perhaps more commonly, once you (someone who really has likely little idea of what they are really getting into, probably 22 years old) signup you can’t change your mind, or you are screwed financially, unless you had a scholarship. Phds get scholarships generally, and masters/undergrad is far cheaper. The only thing you could argue is a worse investment is law school with their low job acquisition rates. You lose your freedom. I can’t be a teacher, artist, fireman, engineer, biologist, pharmacy rep, or get get a PhD in something I realize I’m passionate about bc I have 250k in loans I have to pay off (my anticipated debt). If you ever changed your mind you would rather have been a high school dropout. At least then yor net worth would b)e higher than negative 190k and you could start saving a hundred bucks a week from Mcdonalds. This a ridiculous commitment not even including the time work effort responsibility malpractice risk of being sued.

      So yes that would because “that is the job” if my education was free, so do you have 250k you’d like to loan me? Then I’d be closer to conceding to your point. Ill pay you back 350, but if I change my mind in residency or up to 5 years in residency and quit medicine you have to forgive my loan, cool?

      • Eric Jones

        Don’t mean to be overly sarcastic or extreme btw, my first post was much more thoughtful and well written, but I’m on my phone and it was deleted sadly. Found the risk argument compelling while I see it is not the sole factor for a doctors salary. if you have any feedback or if I am wrong at anything I said, please let me know. Eg if Sally may is more forgiving than I have perceived her :)

        • Jonathan

          Just because I haven’t got much to say, does not mean I haven’t got a real understanding of the issues.

          My parents are retired professionals, and I am a professional, and I will leave it at that.

          Cheers

          • Eric Jones

            Understood, glad to hear you are thinking about things and reading the blog, even if I disagreed with you in part. No rudeness intended, please forgive my harsh tone. Passion in blogs can be a serious issue lol

            Cheers back

        • Suzi Q 38

          Sally May is never forgiving.
          She is allowed to debit your payments for life if necessary.
          If you have no money, Sally will remove it from your Social Security check before you buy your dog food for lunch.
          You can not discharge or go bankrupt on these loans for any reason.
          If you decide to go through med school, graduate, then get a job and hate medicine, get another job. The Sally May payments still need to be paid.

      • David1234

        How is your “I’m locked into a career because I’ve incurred huge debt” staetement different as applied to docs than it is for any other American who goes to grad school? You think they’re giving away MBAs and JDs? You think people don’t get $150k into educating themselves in those fields and realize “hey, I’d rather be teaching high school English…so I’ll have to go get an M.Ed.?”

        This is life. This is how it works. We make educational decisions based on blind beliefs on what a field really is like to work in with no fundamental understanding of the reality on the ground. The difference for MDs is that if they suck it up and stick it out, they make $400k as AVERAGE GI doc. No other profession can say that.

        This isn’t to say it’s not difficult for docs. IT IS. What it is to say is that it’s freakin difficult for everyone, and docs have a much better cushion than most if they do carry through and practice in the field they’ve trained in.

        • matt19799

          I agree David, we do have a very nice life if we suck it up and nothing happens to us physically or mentally while racking up this debt. However, other fields do not have residencies and fellowships.. They have schooling (ie MBAs and JDs) sure, but after that, they make their salaries. And I know plenty of MBA students who have jobs while ther get their MBAs. This is not true of medical school. In adition, Doctors have to go through an additional 3-6 years of 80 hour work weeks before they make their income (residency). JDs and MBAs dont have this. . Most of our new high income is spent paying off their student loan, paying off other debt b/c we were making $10/hour for 6 years, and the rest is given to Uncle Sam because we do in fact have a high income. Plus, for those who enter private practice, there is a buy in to the group that can be as high at 600k. Thus, we are at a huge disadvantage in terms of saving for our kids colleges, downpayments on our homes, and saving for our own retirement. But my article focused on the pending doctors cuts, not the current salaries.

          • Mika

            I understand the point you’re making perfectly.

          • DG197071

            What I hear in these comments are….I am entitled, entitled, entitled to become rich, happy, lauded, protected, privileged for life because I went through medical school.

            I am sure the small business owner who opens a bakery works many more hours and takes on much more risk than you do. He will also make a big capital investment and take on debt but with no guarantee of return.

            He faces the free market. Physicians are protected by monopoly.

            BTW, the unemployment rate among physicians is effectively nothing with some slop for people moving in and out of jobs. Half of newly minted lawyers will not get jobs in their profession.

          • williamB33

            I have read through numerous posts. I don’t understand why you or other posters are trying to demonize doctors. Entitlement has no place in this discussion. No one in their good senses would go through the long and arduous training of medical school, residency, and fellowship just for “entitlement.” There are no free ride tickets when one pursues a career in medicine. The compensation earned when one is middle age only begins to make up for the amount of debt and more crucially the time and work spent in the endeavor. Most physicians are not lauded today. The fact that you make that statement shows that you have no clear concept of what it means to be a physician in this day and age where you are subject to the scrutiny of patients, insurance companies, and legislature. The whole concept of respect for your doctor has gone out with the trash. Most patients view physicians now as a commodity, yet these physicians may be the ones who save your life one day. The fact that you make a statement that physicians are protected by a monopoly points out that you have no understanding of basic economic principles. The message is that less qualified physicians will go into medicine due to constraints. And after reading this article, it appears the author is addressing the future of healthcare and the risks if cuts are made, not his current salary. We make a good salary and the author stated he was not complaining. his point is that he is worried about future cuts, which will diminish the quality of doctors and lead to more medical errors.

          • David1234

            Matt, It’s a simple calculation. If you work 3 yrs post graduation effectively for free (and I agree it’s a sing what medical residents make), then for your NEXT 3 years make $400k a year (i.e. what an average GI makes) then you’re making $200k a year over that 6 yr period. Oh, and then for the next 40 years of your practice, even if you don’t ever get a single raise, you make $400k a year. That’d definitely be a lean first 3 years, but I think it’s a pretty solid return on investment.

            Just. Stop. Complaining. About. Money. There are 1000 things docs should feel entitled to complain about. This is not one.

          • Suzi Q 38

            You also make a good point. But didn’t you forget about all of their expenses, plus the fact that mal practice ins. and student loans are so high?

          • Medschool

            David you could be the most ingorant asshat I have ever met. You want to talk finances? You want to talk free market? You want to talk cost-benefit analysis? Let me ask you a question: Let’s say Dr. Moeller doesn’t remove those cancerous polyps? What is the “cost” to the patient. They have barometers for those things. Return to work, QoL, QALY…death? If you want to free market this in question, why don’t doctors just refuse to perform procedures unless people pay what the cost to their lives would be? Is that fair? No, but since you are all about making this a fair free market argument, let us go there. Additionally, you continue to completely distort his argument. He is not complaining about his life making $400,000k, He is complaining about the resulting damage that will happen if repressive cuts to physician’s salaries occurs. You think we are an unhealthy nation now? Wait until we have a massive shortage of primary care physicians in 10 years. When you can’t get an appointment for your hypertension, stroke out, and die? I love this stuff, its hilarious how biting the criticism is for physician’s these days. And you say there are 1000 things to complain about than money? You realize how this country works right? Cash is king. Follow the almighty dollar. Like I said, watch what happens in 10 years. This whole healthcare system is going to come crashing down. Hard. And somehow you managed to misappropriate your energy to fighting with someone who is making a valid point, which at the very least, has bottom line important implications (result will be massive shortage of doctors). So give yourself a round of applause for contributing absolutely nothing for healthcare.

        • Amanda

          “No other profession can say that”? The president of the US gets to take a 400K salary along with an additional 170K in extra expenses while in office and 200K/year after that for life. In addition to Secret Services and travel expenses. And all he has to do to get there is be popular. Yes, the 4 or 8 years he’s in office can be very demanding, but once he’s done he never has to work for it again, never has to get special training for the job and doesn’t have a huge debt to pay. US Senators get 174K/year while in office, equivalent to the gross pay for a primary care doc, and again did not have to get special training or pay off any debts. And they all are covered under government health care and retirement plans. Yet when talking about cutting salaries, doctors, who keep America healthy and often times put their lives at stake to do it, get paid too much and lawmakers get to vote in their own raises?

          • Suzi Q 38

            How can you compare yourself to the president of the United States?
            Are you going to run for office? The US senators have to run for office, gambling their savings away in the process. They also have risk.
            If they are not elected, no job and no income.
            You really need to band together to fight some of these things. Elect a leader; one that represents most of you.

          • Amanda

            I am not comparing myself to the president, I am merely pointing out the error in the previous statement.

            Also, and correct me if I’m wrong, but the last I checked, most politicians don’t finance their campaigns through a personal bank role or gamble away their savings. They are paid for through donations and anything the individual invests into the campaign is paid back in the same manner. Yes, if they don’t get elected they don’t get the income, but they don’t loose their livelihoods either. If they don’t get elected they go back to their previous jobs and lives.

            And the band that we have put together is called the AMA who is trying to fight for us, although people tend not to listen to them because they too are “money grubbing physicians”.

          • Suzi Q 38

            They still have to persuade others to believe in them and get themselves elected.
            They still also use a lot of their own money and “gamble” in the hopes of winning. Yes, through personal bank roll.

            I don’t think that the AMA is working for you. You may have to get different leaders, or a whole new organization entirely.

            When a physician gets $15.00 (is this true?) for a medicare patient, something is wrong.

  • Pharma Bob

    Unfortunately we can only quantify cost in terms of money, for which the article does a terrific job of articulating. There are other costs that cannot be undone by a high salary, and that is another part of this reality of the medical training. When I married my wife twelve years ago, we hoped to have at least three kids, we have one who is three and with sixteen months left in her residency, we will have to wait to try another year and a half before getting into a situation which will allow pregnancy to be manageable, because pregnant and 80 hour work weeks don’t cut it. If we are lucky we will have one more, but due to age, it will be considered high risk from the moment the stick turns blue. We, unfortunately, are well-read on the list of complications that we may have to deal with as a high risk pregnancy. Our son will hopefully have a sibling, but the age gap is much larger than either of us wanted. This is a huge challenge for women in medicine because the medical education years are also typically the best birthing years and so many women have had to amend their family hopes to accommodate the rigors of residency. It is not to say that had she not gone into medicine there are any guarantees of familial bliss with lots of kids, but residency steals the opportunities to try. Many cite the money that is earned after training as the reason physicians should be quiet on these issues, but money cannot make up for some of these sacrifices.

    To get indignant over this article or to cast it off as a perceived rich person complaining about not having enough money to count misses the point. There are many, many thirty-something young physicians who are looking at their new career and what they gave up and wondering if it is worth it. We all have friends who have the kids and the house and the dogs and a growing retirement account who are working in medical devices or some other health care arena and wondering if it is worth it. We are looking at allied health professionals and overseeing their interactions with patients and we are wondering if we could settle for those interactions to be done with our education earlier. It is becoming harder for current physicians to encourage the next generation that the sacrifices are worth it as the education costs increase, the bureaucracy increases and compensation is continually threatened to dwindle.

    The problem is that government continues to look to health care overseas as the model we should aspire to and they do not see the connection to medical education in the U.S. and there. In many countries, high school graduation occurs at 16 and students enter a combined undergrad/medical school curriculum where they are done by 22, and even after a 4 year residency, they come out at 26 or 27 ready to see patients, oh, and the government pays their way through the education process. Now, those doctors are not compensated anywhere close to what doctors are compensated here, but they have no debt and the life sacrifices are much less.

    • C.L.J. Murphy

      “It is becoming harder for current physicians to encourage the next generation that the sacrifices are worth it as the education costs increase, the bureaucracy increases and compensation is continually threatened to dwindle.”

      +1

      This is what I see as the gravest danger.

      • Mika

        Since the time she was a little girl, my niece thought she wanted to be a doctor. Fast forward to now, almost done with junior year in high school, she’s a brilliant hard-working student and still loves science but has just announced that she’s decided to be a veterinarian rather than an MD. From her reckoning, she sees becoming and practicing as a physician as too much pain; not enough gain.

        • http://www.facebook.com/profile.php?id=547632468 Lauren Smith

          Being a veterinarian isn’t much better. with the exception of slightly better hours and less pay, pretty much everything he said is the same. But just like this author, there isn’t any other field I would imagine myself in.

          • http://twitter.com/ruffianxc ruffianxc

            I always wanted to be a veterinarian and am now a doctor. I shadowed a vet. their hours are a bit better, the pay is worse, loans are just as much. Sure I guess you get to skip residency usually. I would say if these things are important to you that you should be neither a vet nor a doctor.

          • buzzkillerjsmith

            Vetmed, tough gig. We feel you, Lauren.

        • C.L.J. Murphy

          Your niece has chosen wisely if it’s government interference and bureaucracy she wants to avoid. At least so far, there is no government-deemed “right” to veterinary care, and any pro-bono or reduced-fee care she chooses to do will be up to her. For medically-minded young people who don’t want the State dictating how they practice, and willing to forgo a State-imposed monopoly and concomitant reduction in pay, I can see why Vet practice might seem attractive.

          • buzzkillerjsmith

            I have to disagree. Vets work very hard and get less money and respect. There is currently a glut. Most of them a primary care grunts like us. Tough gig.

        • http://twitter.com/aztezcan Ayse Tezcan

          ask one of my vet friends, she/he will contradict. they go through the same intellectually and physically rigorous application process and training with much less prospects of job security and paying back their loans. just saying!

        • doc

          As a veterinarian, your niece will have the same training, the same debt, and make an average of $65,000 annually. It is heart-breaking and economically unsustainable. I am a veterinarian, married to a resident physician. I cannot in good conscience recommend either career choice.

        • donald aievoli

          It seems to me the best way to practice Veterinarian medicine successfully would be to operate a clinic alongside a full-service retail operation and/or training clinic: mixing medicne with Milk Bones.

      • Bobby

        I know this is negative but I say let it all go down. Let medicine be decimated and give them what they want.

        When the field is full of incompetent people in 30 years because all the talent went into other fields, then maybe things will change.

        • EE Smith

          Once upon a time, it was patients who paid doctors, and upon whom doctors depended for a livelihood — not the government. Maybe that’s where we’ll end up again in the end.

          • Caitlin Peebles

            I am genuinely curious as to whether doctors think the answer lies in “more government involvement” or “less government involvement”. “Involvement” consisting of both giving them money, and of consequently setting the rules.

          • http://twitter.com/Abolish_ Zaphod

            Currently “government” is just a pseudonym for the highest bidding corporate faction.
            Bobby, this is happening as we speak in all likelihood. The real issue is the time it takes to train up doctors and the response time to fix anything will make for an unavoidable period of less than the best, who knows how much that will put medicine in general behind.

          • http://twitter.com/aztezcan Ayse Tezcan

            i agree. the decisions made by ama (through physician consensus) in the past to secure the physician income resulted in less worry about whether getting paid by chicken or eggs and increased potential to make money if abused. unfortunately, they did not see that it would also lead to the loss of autonomy. now losing this perceived autonomy is the source of unrest. as they did in the past, the physicians are again panicing and forming these haphazard agreements with hospitals, which will further constrain their autonomy.

          • ALHL

            The AMA betrayed doctors across America and has few member these days, they’re really a joke.

          • buzzkillerjsmith

            Therein lies the question. More gov involvement would likely mean better care for the poor and worse for the wealthy. America will resist.

            More gov involvement would likely mean fewer of the best and brightest going into medicine as other options would be more attractive.

            More gov involvement might or might not mean a decrease in the rate of HC inflation. It could hold down our salaries but increase the pts being seen.

            It is unknown whether more gov involvement would change morbidity and mortality rates. My best guess is that there would be little change since MM rates are more related to environmental factors than HC.

          • dt

            More government involvement will definitely NOT mean better care for the poor. Those making 30-40k when Obamacare goes into effect will get screwed as they won’t qualify for medicaid but will be penalized and forced to get insurance with high premiums they can’t afford. The more government backs off the better because free markets can compete to bring down prices (just look at lasik eye surgeries and how those prices have plummeted compared to the past)… Do you or anyone else really want government to tell you how to get your healthcare and what to do? I don’t think so…

          • Leah

            Before I begin, I’ll offer the following to qualify my position. I am currently a medical student, so not a doctor yet. I decided to go into medicine entirely because I love people and science. I am going to be a rural family medicine doctor because I’m a country kid and I love the environment, and continuity of patient care/ interaction.

            The answer to your question really depends on who you talk to in our field. In my opinion, I think less government involvement is best. Medicare and Medicaid, the current government-run healthcare programs, are very illogical in their reimbursement schedules and much of the time do not even reimburse the doctor’s cost to care for the patient. As an example of the illogical reimbursement – medicare will pay for a patient to go to the hospital every day for 2-3 hours to receive antibiotic infusions, but the patient would have to pay $80 per infusion to have a qualified family member do the infusion at home. To me, that’s ludicrous Think of how much more it costs for that one patient to be in the hospital during that time.

            Further, I guarantee you that I will never know everything about medicine, but I sure hope that after all these years of schooling, I know more than your average lawmaker about how to care for patients. It’s hard to imagine that someone thousands of miles away could have the audacity to tell us that he can care for our patients better than we can when we are in the room with them in the hospital.

            As far as the money end of things goes, I would rather take care of patients in exchange for chickens than rely on broken government reimbursement systems. I frankly don’t care about money. Do I worry about the amount of debt I am accruing? Sure, I don’t enjoy being in debt, but I do what I can (work on the side, buy food on sale, etc.) to keep it to a minimum and I figure that it will work out in the long run. Since money isn’t what makes me happy (or upset), I look forward to a rewarding career taking care of people who need it because after all, that’s what medicine is about.

          • ALHL

            My son is a MD and has one more year left of residency. His opinion is — the government should completely stay out of HC…. He graduated from Medical School the day after Obamacare was passed.

          • http://twitter.com/aztezcan Ayse Tezcan

            then physicians united and decided to secure their income w/o foreseeing the loss of autonomy. a recurring theme seems to be on the physicians part for they are relinquishing their autonomy further by partnering with hospitals now, which is fine, but then there should be no complain when they don’t get the lion share of the income from medical practices. you give some to get some: more financial security and time, less income.
            when the doctors got paid by chickens and eggs, we had many snake oil sales people – today we would add more competition for those eggs. if that’s what today’s physicians want, they can still do it. i have some friends who did exactly that (one even providing care for some livestock; but making a good income was not his priority and he had all the autonomy in the world.).

          • ALHL

            Matter fact, I intend on paying the doctor cash as that is what many doctors are going to end up doing.

        • http://www.facebook.com/janet.hawkins.758 Janet Hawkins

          Hopefully your wife bringing forth your child would not be helped by an incompetent provider just to prove a point to the government!

      • http://twitter.com/Abolish_ Zaphod

        Its not a danger its a reality. The difficulty getting in, the crappy work environment during residency, the crazy cost, pay subject to whim of lawmakers (for many), the high annoyance/cost of licensing, and everyone painting doctors as overpaid and fat cats quite effectively leading to lack of all around respect…its not worth much. Its hard for people to continue caring when they are underpaid and under respected over and over again.

        Combine that with drs somehow letting themselves be brainwashed and ashamed they make any money until they are so far in debt and learn what others who havent given up as much personally or temporally, all without the tangible good to the world. Recipe for disaster.

        We live in a world where youre to be celebrated if you make a sex tape and act like an idiot, and despised if youve given up most of the best years of your life and other opportunities helping others recover from mostly self inflicted and preventable issues. I cant honestly recommend the career to my kids, they should do whatever they want Maybe the security guarantee will be there still, but its certainly no longer worth the risk.

        • JG91

          “drs somehow letting themselves be brainwashed and ashamed they make any money”

          Being demonized for being successful is not unique to doctors. Remember the cheers when Obama declaimed, “Sometimes, you gotta say, ‘You’ve made enough money already!’”

          That practice you spent over a decade of your life in school for and went into hundreds of thousands of dollars of debt for? “You didn’t build that!” {{wild cheers}} “Sometime, sometimes, you’ve got to spread the wealth around!” {{more wild cheers}}

          • http://twitter.com/Abolish_ Zaphod

            Thats more the poison the public part, and I agree. I was saying doctors think about themselves and their colleagues the same way (see gp vs. specialist stuff here), their own worst enemy.

            Drs can still do just fine in life, dont do anything dumb when you get a job, and due to the nature of our income and debt, the safest investments are not risky in nature and take time to accumulate, but it is what it is.

          • Dr. Jordan S. Gonzalez

            Why put OBAMA into the discussion? Especially when he was refering to the 1%? If there are any Doctors in the multi BILLIONAIRE, yes, BILLIONAIRE level providing patient care it wouldn’t be any more than 1. Is that who you’re refering to? Please remember there are people here with brains and by the way…I’m no OBAMA apologist.

          • Mandy

            “The 1%” include any family whose adjusted gross income, or AGI, is $343,927 or more. Plenty of doctors fall into that category.

            It’s both sad and scary that someone claiming to be a doctor is functionally illiterate when it comes to maths and economics.

        • JohnSkookum

          I’m a physician. I’ve told my kids to forget all about medicine, and become worthless, lazy, goldbricking, unionized government worker toads sitting on a leather chair in an air conditioned office no one has ever heard of writing memos no one will ever read.

          They can retire at 55 with a pension that you or I wouldn’t receive unless we had put aside $2 million in our 401k. Their shop steward will ensure they never have to do a lick of real work or be accountable for even the grossest dereliction or incompetence. No greasy-haired shiny-suited ambulance chasing scumbag trial lawyer will ever drag them into court and steal their life’s savings because they were the nearest deep pocket to an act of God. Their days will begin at 9:30 and end at 4:30, weekdays only, with plenty of time to read the paper or post to Facebook at their desks. They will be celebrated for their “public service” by media jackals and grandstanding politicians alike– sneering elitists who have never signed the front of a paycheck in their lives. They will never carry a beeper.

          The tail now wags the dog. The whole country now exists for the sole purpose of providing something for nothing to (1) those who do no work at all, and (2) those who do trivial and grossly overpaid work handing out the dole to the people in group 1.

          Why fight it? Quit. Join the looters. Go Galt. Set your sights low, and become just another useless government slug. Let the system burn to the ground. Let people call their nearest plaintiff’s lawyer, politician, or chiropractor when they are having a heart attack. The people voted for Obamacare; now let them have the full joy of it, and to hell with all of them. This nation of thieves and grifters and loafers does not deserve the benefit of my childrens’ talent and dedication. Fuck you, Barack Obama, and everyone like you and everyone who voted for you. You’re my enemies, not my countrymen.

          Let it burn.

          Let it burn.

          Let it burn.

          • Mandy

            When my son and daughter started expressing opinions similar to yours, @JohnSkookum:disqus , I was appalled, and we had some quite heated debates, to the point where we wouldn’t even be speaking to each other by the end of the day. But I must say I’m starting to be able to see things from their point of view now. I think we’ve wrecked the system to the point where the generation coming up is going to be the first in American history not to be able to do as well or better than their parents did. What do we say to that? How can we dare order them not to be angry about that? How can we demand that they “settle”, when at their age we never would have been willing to do so?

            I still consider myself a Progressive Democrat at heart, but as someone who admits to having marched with signs shrieking “QUESTION AUTHORITY!” and “F**K THE GOVERNMENT” in my youth, I feel like I’m a different breed to the vast bulk of those who call themselves “Democrats” today.

            I feel for anyone under 40, and can completely understand how they feel ripped off and cheated. They’ve inherited a broken system, and they must do what they must to bring about a fairer, more just way of being on this earth and in this country. If the answer is “let it burn”, then I just pray that it happens sooner rather than later, so that the rebuilding can commence.

          • http://www.facebook.com/PathologyMax Brett Snodgrass

            Your a physician? Really?

          • Guest

            Your [sic] a high school graduate? Really?

          • Suzi Q 38

            Obama has just proclaimed that making over $400K is too rich. You must give 40% of it away to others, in spite of the fact that you owe $300K in student loans, have to pay for malpractice insurance, office costs, family and housing.

          • Mandy

            Any family with an adjusted gross income of $343,927 or more is in the hated “1%” and must be punished for that. Thus spake Obamacles.

          • Red October

            Too bad that letting it burn won’t help, either, because even then the media will manage to convince most people that the disaster is attributable to the reluctance of greedy doctors to join hands in supporting the one true solution, which is to throw unlimited amounts of food to the insatiable government rats in the basement.

      • Bob12221

        Tell that to the 20k applicants who didn’t even get in to medical school last year. Other countries have much lower physician compensation and still attract the best and brightest because it is a rewarding, mentally stimulating field. Once the bitter greedy docs are out of it it will be all the better for patients.

    • anomalouserudite

      You nailed it.

    • http://www.facebook.com/dayananda.mruthyunjayappa Dayananda Mruthyunjayappa

      This is true in Indian scenario as well.. The enrollment of women in Medical Schools has drastically come down because of the same reason.. The long duration of the course..

    • Noni

      I remember glaring at my OBGyn who told me when I was 16 “are you sure you want to be a doctor? Why don’t you go to PA school?” I thought she was insulting me; I think she was actually trying to warn me.

      Of course I didn’t listen and I went to medical school. Childbearing was delayed, of course. I was high risk with pregnancy one and even higher risk with pregnancy 2. Now I enjoy the stigma of being an entitled female physician who’s chosen the “mommy track;” working limited hours, not taking call and not carrying my weight. Thank GOD my student loans were paid off (yay to being old and having gone to an inexpensive state school!). Otherwise our mortgage and childcare would be completely unaffordable. And people think I’m a “rich” doctor.

  • http://profiles.google.com/gmlevinmd GARY LEVIN

    I see there were 799 comments on this post. It was excellent and very accurate for most physicians. It varies a bit from specialty to specialty. In residency some are able to “moonlight”. It is frowned upon by professors and department heads, whle younger attendings just smile as long as you are getting your work done.

    You also did not factor in the loss you experience by delaying funding a retirement plan. Your early years of deposits are the most powerfull in terms of the compound curve. That loss of interest income is not a small amount over 30 years. Most MDs do not start saving until almost 40. MDs lose out two ways. 1.The compounding interest of loans, and 2.The inability to start funding an IRA.

    If you factor in those figures it is even worse…you pay for your own vacation benefits, and even after training your work week will be from 55-65 hours a week or worse if a surgeon, ob/gyn, cardiologist, etc..Many physicians will become disabled, just like the rest of the population. MDs now have few perks or priveleges. Society used to treat MDs better…Government will not allow tax credits to MDs for giving free care (it is too politically hot, because everyone thinks they know how well of MDs are. They should be more appropriately treated, and honored.

    Medicine is a long and harrowing career decision requiring an abnormal ability to accept emotional turmoil from patients, physically exhausting hours, threats of legal issues, and the burden of unrealistic demands from patients, payors and medicare.

    After 40 years of practice…I am glad it’s over ! Cannot say I enjoyed most of it.

    • Bobby

      I’m just starting out but I understand what you’re saying.

      The public and the law makers don’t appreciate physicians any longer. They will continue to attack them, think they are rich, etc. No one looks at decades of sacrifice, hard work, debt, etc. They just see that the average GI doc earns 300k or whatever, WOW, that’s a lot – more than what I make at my job for 70k or whatever. Greedy docs.

      Well, if you factor that many of the doctors have basically been working 2 jobs worth of effort for a decade with no pay and 300k in debt @ 8%, well then you’ve now put a capable human being down about a million dollars between debt, interest and lost income (opportunity cost). So yeah, when doctors finally get through that they are happy earning their salary.

      Medicine in the future is going to suck and the talented people will avoid medicine. Just like our talented athletes avoid soccer because it’s not popular here. Well, our talented students are going to go into business and IT instead. What will this do? Maybe not much. Maybe just a little bit worse doctors, a little less innovation, more malpractice and more lawsuits. Basically a more bloated and inefficient system than there is today.

      It’s pretty sad. But I’m over it. I fully expect them to keep taking doctors for granted and I expect the public to be upset by looking at the end result. Everyone looks at the end result. They see an amazing body and think, “wow, great genetics”. They don’t see that the people have exquisite diet and exercise habits that would blow everyone else out of the water. They just say, wow that person has a great body, how lucky. Same with doctors… wow, great salary. Rich guy.

  • Suzi Q 38

    You have to live on basically nothing until the student loans are fully paid and “off your back.”
    I would continue to live modestly until all loans were paid off.
    You can do it with your newfound higher income.
    It is so hard to do this, as you have been denied financial gratification for so long. Fight the urge to buy that big house, in the best neighborhood, drive the upscale car, or go on lavish vacations.
    Do not rest until the loans are paid off, then enjoy what you have worked so hard to achieve.

  • PhilaLawyer

    If you want to bitch about a career path you willing chose, that’s fine, but don’t diss on lawyers….I don’t know of any lawyer who “hang[s] up the phone…if they are not going to get paid.” In fact, to “bill” 8 hours a day, it takes a lawyer almost 10-11 hours of work. You are unfairly characterizing a profession you clearly know nothing about.

    Also, I think it is interesting that you didn’t disclose your salary now that you are done with your training. Chances are it is significantly more than $50K….

    • Greg9876

      As a doctor if I spend one hour speaking to a patient on the phone, I can’t charge one cent. I’m sure as a lawyer you never bill for phone conversations. If I spend 3 hours on a colonoscopy removing 20 polyps from a patient, I can’t charge anymore than if I removed one polyp on a colonoscopy which would average about 30 minutes. It’s funny if you call a plumber to fix a broken pipe overnight, he can charge you double. Not only do I not get paid to take call at all but if I have to come in at 2 am to save someone’s life I can’t charge a cent more than if it was a normal daily procedure. If it costs me more to take care of Medicare patient than the government is willing to pay me I can’t charge the patient a cent out of their own pocket. Why do you think internists are increasingly refusing to take Medicare patients? It’s because what they get payed to see them won’t cover their overhead.

      • DG197071

        Are you actually claiming that you do not get paid to perform a colonoscopy if it takes more than 30 minutes? Are you actually claiming that you are taking out polyps for free?

        • Greg9876

          No i’m claiming, unlike you, I can’t bill by the hour. If a procedure that normally takes 30 minutes because of patient circumstances takes 3 hours, I can’t bill anymore for it. I get payed the same to take out 20 polyps as I do to take out 1 even if it takes 6 times as long.

          • Suzi Q 38

            But those are the risks. You do not know what you will find. One price. One DRG.

          • Greg9876

            Suzi Q you are making my exact point Those are risks you take when you are subjected to the government mandated payment

          • Greg9876

            What if Lawyers got payed the same amount for every client they represented or defended no matter how much time it took to represent them. And as an additional point I’m not payed by DRG I’m getting payed by CPT which is not the same thing as a DRG.

          • Suzi Q 38

            Yes, that does not sound fair. But take this for instance:
            I went in for an anterior discectomy with fusion in January.
            The DRG for the hospital stay is 4-5 days.

            I was fairly fit when I went in, was up and walking within hours of my surgery, ditto for catheter removal, and eating.
            The next morning, after a long night of interruptions for vitals, I had had enough. The floor was visibly filthy, same with my bathroom, the nurses were visiting nurses (pleasant but not helpful), so I asked the fellow surgeon if I could go home.
            Ironically, the surgeon I chose is not big on bedside manner. That would be nice, but I just need the best hands to do this type of neurosurgery. I never saw him before or after my surgery, LOL. Usually the surgeon at least stops by and does the obligatory hand shake with myself and family members. Not this guy. I didn’t care.
            Two weeks later when I went in for my check up with the surgeon he said: “Hey, what happened to you? I went to visit you the day after your surgery, and you had already left.”
            I just got tired of doing everything myself, and not getting any sleep. Yes, I was jealous that my roommate’s surgeon came over to visit her, and was all English with that delightful accent and all. My doctor was no where to be found, and I was alive, so I didn’t mind.

            Anyway, I was out from start to finish in 30 hours.
            Doesn’t the hospital still get paid for the 4-5 days?

            My point is that maybe you are truly paid for removing 10 polyps on average. Sometimes, you have it easier and have to remove only one, but other times, life is a beech and you have to remove 20 or more.

            I still am surprised lately at the surgeons and doctors bills. I feel that I am getting good value for the money, based ont the fact that you all keep us alive.

          • Suzi Q 38

            Maybe I am not getting the point. So you would treat me differently because the payment was only a flat fee?
            I understand your frustration, but it would be sad to take it out on the patient.
            I would rather unite with other doctors and walk on Capitol Hill like women, gays, minorities, and teachers have done. Whoever is feeling “the pain” of it all. The injustice.
            i hear you, but I don’t know what the answer is.
            You are too good at what you do to strike. Patients would die. Yet, even nurses strike.
            Maybe you can semi strike by only doing necessary surgeries and refusing the ones that are elective and can wait.

          • David1234

            And unlike you, Greg, the lawyer you’re responding to doesn’t work in a profession where an average practitioner makes $400k. You do. You can afford it, man, so take out the polyps “for free.”

          • http://www.facebook.com/daniellewismd Daniel Lewis

            What price do you put on the 14 years of his life? Clearly, zero.
            When you need open heart surgery, you should go to the physician who didn’t spend 17 years of his life training for the job and doesn’t make good money. Let’s see how that works out for you.
            You’re a troll

          • Andrew Carter

            That swings both ways; you also get paid in full even if a procedure takes far less time than either you or whoever sets your rates expected.

      • Suzi Q 38

        I have a question: If I have to go on medicare, can I pay my doctors more money for every visit?
        Why not?

        • JG91

          You don’t “have” to use Medicare. I direct-pay for most things my self, and have a high deductible catastrophic policy for, well, /catastrophes/.

    • mt

      haha omg 10 whole hours of work sitting on a phone to bill 8.. how do you feed your family?

      Its a comparison, genius. Lawyers who know nothing about medicine are making the laws/regulations

  • azmd

    Right, what I was saying was let’s see that same analysis for someone like you who’s a specialist.

  • http://www.facebook.com/lilnoelle Lisa Noelle Ruckman

    Interest rates are higher now, my interest accrues an additional $30K a year and we are no longer able to defer during residency.

    • David1234

      Your interest accrues at $30k a year? How much of a loan do you have and at what rate?

      • Mika

        Borrowing $300,000 at 10% with a payback term of 10 years (120 months) would see you paying close to $30,000 a year in interest alone, at least for the first few years until you start making headway on the principal. I can’t see paying 10% interest though.

        • Suzi Q 38

          This is why it is so important to “attack ” these loans with a vengeance. Go OCD on them with all of the money that you can find.

        • David1234

          …or not consolidating it over 30 yrs at a way, way lower rate. It makes a better argument, though, if you just throw out “I pay $30k a year in interest.”

          • advocate

            Maybe they don’t teach math in med school.

    • Suzi Q 38

      Don’t defer, pay as much as you can.
      Live simply for the next dozen years or so.

      IF you make $400K at a teaching hospital, then 40% goes to the government for taxes.Now you have a net of $240K. That is about 20K month.

      What is left? Continue to live frugally, until the huge SL’s are completely paid off.

      Make 4X the payments each month, at least.

      Drive a used car that just gets you to work and back.

      Once they are paid off, splurge a little on a nicer house.
      Or, better yet, save it!

      I have seen doctors totally “Blow it.” and spend all then retire in a trailer park or apartment on nothing. There is age discrimination sometimes, too. If you don’t have a solid job by the time you are in your late 50′s, you may struggle.

      My BIL’s father was a physician. He fell in love and married a golddigger, lost half in a divorce from the first wife, then just got older and older and struggled to find work after a few decades.
      He was an FP, so he kept working for struggling, small HMO’s.
      As they closed down or downsized, he would get laid off.

      By 60, it was hard for him to find work.
      His wife had to work for a doctor as a receptionist to make ends meet. He came to work with her everyday, becauase he had alzheimer’s at the age of 70. She was still working!

      She had left her husband of 15 years who was a car dealer.
      She thought she was marrying up by marrying a doctor.They were not careful with their money at all. BTW, the car dealership ex husband is doing quite well, with 3 dealerships and worth millions.

      Don’t be a cliche.

      Choose your specialty wisely, continue to pay off the loans, and live comfortably and frugally, until all is paid off.

  • David1234

    Ya, I looked at that. It lost me right where there was a chart that bemoaned that the $200k gross income during fellowship really is more like a $120k income after…income taxes.

    Can you hear the violin music playing? Welcome to America – you make a bunch of money, you pay a lot of taxes. The training time is cerainly extended for docs, though not all that extended over other graduate school grads. And when the training is over, you better believe doctors make up for lost time quicker than anyone this side of Goldman Sachs.

    • matt19799

      You are missing the point. I am not arguing that doctors are not paid well. I wrote this as a reaction to Congress considering cutting doctor’s pay. We have sustained cuts over the past 15 years already. In order to be able to continue taking care of patients without our practice expenses exceeding our revenue, we need reform where the sustainable growth rate is fixed so doctors do not continually have to be worried about cuts of up to 26% ( the current proposed measure to the SGR). If that happens, doctors will be forced to not see Medicare/Medicaid patients because they simply cannot stay in business. If you look at what doctor’s put into their education, including time, education, training, loss of income in their twenties and early thirties, $190,000 worth of average medical school debt, and even board exams that cost 2-3000 dollars a piece, you will realize that cuts to doctor’s pay is not sustainable. I realize that we make a healthy salary (ie high income) after completing 14 years of training, but unfortunately, this is money that is taxed heavily unlike a person who saved in their twenties. This money cannot be compounded as well as someone who saved in their twenties(basic economics). Our student loan interests on 190k we cannot even deduct, this is pathetic. But to say doctors are “rich” or wealthy” right off the bat is not accurate. Most doctors postponed their lives, first homes, retirement plans, just to make ends meet. And honestly, shouldn’t a physician deserve to be compensated well given that people’s lives are at stake and the amount of training and debt that was involved? We have lives, homes, and children just like everyone else to keep up! Keep in mind medical school was not a part time job. You went to classes in the AM and studied all night with 40k/year in debt and NO income. Try digging yourself out of that debt only to know you’ll be making $10/hour in residency for the next 3-6 years depending on what field you choose. No doctor that I knew could take on a wage earning job during medical school because of the workload and the pressure to do research to advance the field.

      • David1234

        Matt,

        I’m not a doctor hater and have a doctorate of my own (not in medicine). Respectfully, I think the only two messages you clearly convey are that (a) you worked and work hard (b) incurred debt. I don’t doubt either, by the way.

        The subtext that, perhaps, you’re missing is that (at least to me), your tone comes off as very entitled.

        Do you think doctors are the only people in American who bust their butts and have huge debt and feel overtaxed? Imagine someone who feels that just as sincerely as you do, but makes $40k instead of $400k reads this. How would you feel if you were them?

        • Caitlin Peebles

          Quite so.

    • Jack

      It’s not a difficult article to understand, and you clearly didn’t read all of it. A physician has rather more expenses than most people in other professions. This is also ignoring that a lot of people complaining about physician salaries don’t work anything close to 80 ~ 120 hours per week, and so don’t realize that a lot of physicians are making large sums of money because they work 2 to 3 times as long as the others in a more consistently both physically and mentally demanding job.

      It’s not an ivory tower, either – anyone who can demonstrate the ability to do the job can become a physician. Nepotism is present, but not nearly so much so as in the upper echelons of the business world. People who aren’t willing to do the job themselves, but feel entitled to whine about the people who do perform the work… that’s the America I’m looking at. PhDs know what they’re getting into when they sign up for academia, so the comparison to their training is baseless.

      It’s an amusing notion America has that doctors should be paid less, while everyone seems perfectly comfortable with the business-types making multiples of even a physician’s salary. “How dare those greedy doctors earn so much money while dedicating umpteen hours to saving our lives.”

      The day the populous decides doctors should be paid less is the day the health care system crumbles. Most entering medicine today are only doing so under a cautious naïveté that everything will work out in their favor in the end, and many of our physicians only work as hard and as long as they do because they’re paid what they are. Cut them down, and you’ll find the primary care crisis turn into a physician crisis in a generation, and nothing increases patient costs more than far fewer physicians.

  • Heather Fitzgerald

    I am sure that no one wants to hear this but I am a nurse. My pay has remained the same (or decreased) for over 10 years while the cost of living goes up and up. I was educated before the “nursing shortage” ruined our educational requirements (or lack there of). While I can definitely appreciate the dedication and financial burden it takes to become a doctor I have a hard time mustering up any sympathy. I have worked for 20+ years caring for others under the direction of some wonderful (and not so wonderful physicians). I have no retirement plan, no savings and barely survived raising my children. Our healthcare system is a compete disaster. If we could prevent the lawyers, politicians, lobbyists’, pharmaceutical companies and insurance companies from controlling our industry we might be able to recover. Until then, it’s just going to get worse. My eldest daughter considered going to medical school. I advised her to stay out of healthcare altogether.

    • Suzi Q 38

      Why didn’t you put into your hospital’s retirement plan?

  • Another MD Out There!

    Thank you Dr. Moeller for taking the time to write this letter. Although much of the content or even most of the content of this letter is accurate in regards to many aspects of an average physician, and it reflects many of the things that doctors go through initially, it pays off at the end and it is definitely worth it. I love my job and there is no other field I would ever imagine myself doing. Let me just say, if time goes back, say 16 – 20 years back, I would not even hesitate to do this again… This is unparalleled view in my mind at least, as well as many other physicians… I think.

  • Kaycee

    This article lost me at beating up attorneys and misconceived notions of the legal practice. Perhaps I would have found the author’s case compelling if he did chose to cut down another profession that serves and equal yet very different noble pursuit. Now, I just have no interest in reading a poorly drafted and hard to follow opinion blog.

    • Aurora

      I felt the same way. I guess maybe I’m biased, because I’m a law student. I do get where he’s getting the misconceptions from, and there are some lawyers that it would apply to, but I agree with you, I was a little put off by the comparison.

      Either way, this article kind of scared me.

      I’m 26 right now, and reading the article it was almost like reading about myself, always wanting to be a doctor- except I didn’t get into medical school on my first try, so I’ve been planning to try again. I’m studying health law (and patent law) right now, because I’ve always wanted to practice medicine, but when I found out some people do MD/JD, I really wanted to do bioethics too.
      Figured I’d apply to med school again and try to go once I’m done with law school… But now I’m not sure I should, after reading this article and the comments….

  • Guest

    I’m really surprised to read this (and surprised that someone would go on record saying all of this).

    Background about me: I am the child of a doctor, and I began medical school before realizing that I didn’t want to follow in my father’s foot steps. So, I have literally lived the entire gamut of the life of a doctor (my Dad is now entering retirement after practicing my entire life).

    Let’s make one thing clear: you know what it takes to become a doctor when you choose that profession. You know the level of effort, the cost, the debt amounts, the chance that congress could do something to alter how you’re paid, etc.

    I don’t understand why this letter was necessary. If you became a doctor without understanding how difficult and expensive it would be, I question your judgment and your research abilities.

    But, what you’re leaving out, is what you make AFTER residency and once you’re a “real” doctor. When my Dad was finishing medical school and in his residency, we were a Kraft Mac and Cheese with hot dogs family.

    Fast forward a few years and most of his debt was paid down and we were doing much better.

    Fast forward a few more years, and we were doing very well, with my parent putting plenty back for retirement.

    Fast forward to my high school years and my father wasn’t wealthy necessarily, but he was very well off.

    Now that I am an adult, my father has only continued working because he loves it. He could have retired 15 years ago, with a healthy retirement account to fall back, and without scraping by for decades.

    Becoming a doctor is brutal and it’s expensive. But you know that going in, and it’s temporary. If you are worth your salt as a doctor, you will find a position post-residency where your pay accounts for your education and that debt burden, as well as your cost of living. And, if you are smart with the hundred of thousands you’re now making a year, you can handle the debt quickly.

    • guest

      I think you are missing the point. He’s calling out lawmakers who are proposing cuts in physician’s salary. He’s not complaining about his current salary.

      • Mandy

        “I think you are missing the point. He’s calling out lawmakers who are proposing cuts in physician’s salary.”

        How did we even get to the point where it’s lawmakers who decide a physician’s salary?

    • http://www.facebook.com/amanda.goertz Amanda Goertz

      Worth your salt? I’m sorry, but as a family doc, who was awarded for my high grades in med school, I take issue with the idea that good doctors are paid well and bad ones aren’t. I’m a 0.7 FTE (because a full time employee where I work works 60 hours per week and I actually want to see my family). In primary care, working at an organization that cares for the indigent, I barely make enough to pay my loans and mortgage. Not because I can’t be frugal, but because my job doesn’t pay well. It isn’t because I’m a crappy doctor. It’s because there is a need and I’m filling it. Not all”good doctors” make 6 figures, you know.

      • Dave

        Amanda, thank you for your devotion to helping the indigent. I’m sure you’re an excellent physician, but don’t pretend your ability/inability to pay your loans and mortgage are not by your own choice.

    • Eric Goldberg

      No offense, but you’re way off base in your assessment. Your dad’s prime working years as a physician were in an entirely different era. There are plenty of physicians in numerous specialties today who do not and will never earn “hundreds of thousands” of dollars a year under current and future reimbursement rates- as medical malpractice premiums and medical school tuition continue to skyrocket. The glory days are over, the ship has sailed. Glad things turned out so well for your dad and he enjoyed such financial success. The next generation of physicians won’t be as fortunate. See my post below. The “big payoff” for today’s med students is a big illusion.

  • Chris

    It is really sad that people just look at an anual salary and think that is what some one makes.. What we should all want know is the take home pay based on hours work. I assure you it will make a big difference. First lets take the assumption that a GI doc makes an average of 400k a year. Sounds like a lot.. Now lets brake it down first 40% goes to the Gov. so he is now taking home roughly 200k.. still not bad. But wait he has to pay malpractice insurance. That is 1/2 of that.. so take home 100k if he is lucky… If he has his own practice what do you think his overhead is? I am going say 20% and salaries to his employees even more. so you can see where I am going. The botom line is 20k take home is not that much and when you got 1400$ in debt to pay.. That is nothing. My point being most Doctors are not wealthy. They really are lucky to take home a livable wedge for all the great work they do. And the gov want to take that away from them.. Why even become a Doc when you can make more life time serving fast food.. Chew on that…

    • Suzi Q 38

      I don’t think that the numbers add up. 40% of $400K is $240K….
      malpractice for a gastro is 100k a year?? What if he or she works at a teaching hospital? If you work for a big hospital, are your costs covered? Do you get the $400K minus taxes?
      Doesn’t the hospital cover the malpractice, nursing, and other staff costs?
      Then why is it that most doctors in our area have multi million dollar homes? I know that they are not being careful, but I am thinking that they wouldn’t buy that high beyond their means.

      I really don’t believe that a $400K salaried doc is taking home only $20K when all is said and done as far as student loans and the like.

    • Suzi Q 38

      Chris,
      What if the doctor works for a teaching hospital?
      How do the numbers stack up then?
      Doesn’t the teaching hospital cover the malpractice and overhead for an office and staff?

  • http://profiles.google.com/gmlevinmd GARY LEVIN

    Thanks for the link

  • DG197071

    Why is there so much whining from the medical profession?

    We would do much better as a country to have nationalized health care, offer up subsidized or even free medical school to many more qualified students and pay rational salaries to a much larger population of physicians. We would have more physicians with little or no debt making much lower salaries servicing more people.

    Takers from the ranks of current physicians? I didn’t think so. As far as I can tell, current physicians want gobs more money, little or no debt, fewer hours, no criticism, little or no liability and….did I miss anything?

    The medical lobby is huge. The patient lobby is practically nonexistent. Note that we have been saddled with the despicable Medicare Part D fiasco but not Medicare Part E for Everyone or even the public option.

    • jbw2013

      Easy for you to make these statements, but you obviously have no idea the dynamics about which you speak.

      A. who do you propose pay for medical education??? The government is in so much debt it’s laughable.
      B. Rational salary: What does that generalized statement even mean. Also, did you even pay attention to what is posted above? Even if you can manage to make medical school free to future doctors, how do you expect them to pay for food, shelter, etc while going to medical school? A job is out of a question, so 8.5% and higher interest rate loans will still exist. After taxes, malpractice insurance, and the monthly loan payment doctors still will not take home anything close to their actual salary. A salary that doesn’t start until age 30 for most. Let’s not even talk about trying to save for retirement.
      C. More physicians: Much easier said than done. Where will they train and who will train them? Medical schools and residency programs have to be accredited and part of that is making sure students and residents are seeing enough patients/cases to become proficient. I guess we could lengthen training programs so more folks could go through and everyone could still see enough patients/cases, but that would require more loans and fewer years of actual earning power. Also, since medicine typically attracts many of the best/brightest minds (more on this in a moment), where do you draw the intellectual line on who to admit??
      D. “want gobs more money”. You generalize based on the comments of a few. What most of us actually want is for the government to quit taking so much. Even as inflation goes up, we are expected to be payed less, work more, and be held liable for random things that happen to patients that could only be seen after the fact.
      E. Medical lobby: If you’re referring to the insurance companies, you’re correct. The AMA sure as hell doesn’t stand up for the average doctor (the reason I am no longer a member). Also, doctors didn’t saddle you with anything to do with medicare. Call your local politician and thank them for that.

      In 15 years, the best/brightest will no longer want to practice medicine because it will no longer be worth it. Instead we’ll take jobs in other fields where we’ll make money earlier, not have huge loans to repay, be able to spend more time with family, and not be constantly worried that someone will sue us for an honest mistake.

      For those of you to have something altruistic to say….Yes, I truly love taking care of others, but why shouldn’t I want to be compensated for very little family time, long hours, high stress, a late start to earning potential, and everything else mentioned above. Trust me, you take away all the people who do love taking care of others, but want to be paid for all the other reasons, your medical care will become second rate at best.

    • http://twitter.com/CSquared913 CC

      I love this response. Not because of the ignorant lack of information, but because people that know absolutely nothing about what it’s like to work in medicine or understand its politics go on a rant and assume things. Uneducated opinion. Sorry, but true.

      For starters, free education would never work. It sounds lovely, but universities run on money. The government doesn’t have the funding for every school in the country. Secondly, you can’t put any schmoe in a medical school “factory” as you are suggesting. This is not meant as insulting, but not everyone can be a doctor. At least 3/4 of the people in my undergraduate pre-med major were weaned out, either because they changed their mind, didn’t have the grades/scores, or couldn’t hang in there for the long run of how much time it actually takes to complete training.

      To answer your question: Yes. There would be many takers. I would continue to do my job, if I made less money and didn’t have the debt. It’s my calling in life, and I couldn’t imagine doing anything else. My colleagues feel the same.

      Are you missing anything here? Completely everything. I don’t know where you are forming your opinion from, but I can only hope the world does not think like this. $380k is a lot of money. Its a lot of money when one compares it to their $50k salary and compares it to their life, but dont realize all the stipulations that change and come with that $380k. Is it a lot of money when 40% gets taken away from taxes, you have to support a family, and you owe $3k/month in loans while trying to make up investing that you lost out on for the past 10+ years? Different if you think of it that way, huh?

      I don’t make $380/year (clearly, I should have went into GI). I live in a 2 bedroom apartment and drive a Saturn, because I pay $3,000/month in loans and try to invest anything since I’ve paid a quarter of a million dollars to work for FREE for a DECADE. Did you do that? No takers? Ok.

      I’m not complaining. Just giving an example. I knew what I was getting into and accepted it because of my love of taking care of the sick and my love of medicine. It really takes a particular person to do and see what we do.

      The problem is that doctors, as a whole, are unorganized. As others have said, the problem is that there aren’t enough clinical docs in government to say, “hey, X isn’t how it is nowadays”. The other problem is that most hospitals have taken a “please the customer” approach, which makes patients feel entitled to “order from the menu” requesting tests they don’t need, and when their physician protests they are dissatisfied. Oh, and they want to pay medical employees (not just docs) based on this satisfaction. That makes as much sense as basing child satisfaction on parenting. We need to educate patients, but changing a standard mentality is very hard. We advocate for patients consistently, and people also need to be responsible for their own health.

  • twr1985

    A large part of the problem is that medical school tuition is much higher than it needs to be. Student loans are for the most part paid upfront to the school by the federal government, and then the student pays back the government. Since the loans are guaranteed, private medical schools especially have no incentive not to let their tuition creep up over the years. I’ve seen this at my medical school, where my tuition dollars go to pay dozens of staff members who don’t actually do anything to further my education.
    I often wonder, since the content of step one is standardized across the country, why don’t we just sit in a library and study 14 hours a day for two years? As for the 3rd and 4th years, the staff at my school have made it clear that they don’t do anything to help you find rotations, besides cashing your check. Other than my anatomy course, which certainly shouldn’t cost $50,000, why do I need the school at all? Of course, medical schools have a government-enforced monopoly, so even if you could score in the 99th percentile of step one you still need to go through them. Something here has to change.

  • http://www.facebook.com/ChadAEdwards Chad A Edwards

    It’s even worse now… With grad plus loans at 8% and loans (at my school) at 80,000 a year; we are taking on 320,000 in debt… If I pay 2700 a month (starting in residency, which isn’t even reasonable), it will take 20 years to pay off my loans and I will have paid over $320,000 JUST IN INTEREST! That brings the total of my medical education to $642,385. Now… that’s not taking into consideration that I may not be able to afford a 2700 monthly payment during residency, so add a few more years of interest…. It’s all downhill from there.

    • Suzi Q 38

      It doesn’t have to be.

      Right now this sounds daunting, but pay it all off ASAP.
      Even during residency, pay a little consistently. Get into the habit.
      When you make the big money, pour it on “the fire.” Tell your spouse to wait for that big dream house just a little while longer. Buy a mdest one instead. If your spouse is also a physician, don’t look at those paychecks! You owe double the loans! Live frugally and modestly until all is cleared off of your debt.
      If anyone asks why you are a doctor and you live so frugally tell them you are smart.
      Drive a modest paid-off car.
      If your neighborhood and school district is good, send your kids to public schools.

    • advocate

      Did you not realize, as you were borrowing all that money, that you were going to be expected to pay it back at some point?

  • karen3

    This is what I hear. You made life choices, hoping to be instantly wealthy by being a doctor, you did not assess well the costs and benefits and you are now bitter about it and wanting to blame others. By the way, this often happens around thirty. The grownups decide not to be blame others, but to make the best of what they have. The perpetual teenagers expect someone else to pick up the mess for them.

    As for doctors answering phone calls and not checking the clock, that is fantasy.

  • American_Medical_Association

    We are acutely aware of the impact that medical student debt has on physicians and aspiring physicians, as well as the many sacrifices made by our members and leaders practicing on the front lines. Averaging $166,750 for indebted graduates, medical student debt plays a major role in career decisions and impacts the supply of our nation’s physicians. To help address this growing issue, the AMA has advocated for additional tuition assistance and loan forgiveness programs and recommends lower interest rates on medical student loans. Just last month, more than 300 medical students from the AMA’s Medical Student Section spoke with Congressional representatives on this issue during the AMA’s Medical Student Advocacy Day. We have engaged important Washington stakeholders, such as the Consumer Financial Protection Bureau, in an attempt to find innovative solutions to this issue. The AMA will continue to help medical students, resident physicians and young physicians manage and reduce their debt burden.

    • yogii89

      been very successful thus far on that front…………..

  • http://www.facebook.com/daniellewismd Daniel Lewis

    For those of you who feel like bashing Dr. Moeller, you should focus on the real issue at hand. The issue is not how much physicians are being paid but rather how much it costs to become a physician. If our country would adopt policies like the rest of the Western world regarding training physicians, Dr. Moeller would have never needed to post this letter. As a medical student, I look at what specialties interst me and realize that there are some, such as primary care, that I CANNOT go into because I will literally go bankrupt. Dr. Moeller went to medical school at a time when costs were not nearly what they are not.

    My state school:
    In-state tuition 67k/yr
    Out-of state 99k/yr
    Of course these loans are taken out at a 6.8% rate for the first 42k per year and 8.5% after that. Also, the interest compounds while you are in school and in residency.
    If people would wake up and realize that these costs incured by the future physicians are unsustainable, we could do something about it. I’d be happy to make 200k as a GI, but not when my education will cost 748,000 dollars after loan and interest. Oops, I forgot the loans from undergrad…damn
    STOP DEMONIZING THE PEOPLE YOU CAN’T BE

    • JG91

      “STOP DEMONIZING THE PEOPLE YOU CAN’T BE”

      “The people you can’t be”? Oh good lord. Get over yourself.

  • http://www.facebook.com/kanani.titchen Kanani Titchen

    Great piece. Here’s what it brought up for me:

    Nobody promised me a free medical education, half-million dollar salary, and 35-hour work week and then turned the tables. I knew what I was getting into.

    When I started, I saw the $250,000 investment as just that: an investment. An investment in myself, in my intellectual curiosity, in my work ethic; an investment in my country – trite but true; an investment in the health of people – American, immigrant, foreign, black, white, young, old, rich, poor, gay, straight, bi, undecided, Muslim, Christian, atheist, Hindu…; and, ultimately, an investment in our parents and kiddos. And I’m fortunate to be partnered to someone who shares my values and agreed to invest with me and for me.

    Do I wish there were more loan forgiveness? Absolutely.

    When I go to my own doctor now, I know that the 50-minute delay is not because my doc is kickin’ back enjoying a cuppa joe in the back room. She’s attempting to do the impossible: She’s trying to see each patient before me (each of whom brings a laundry list of things to “fix”) – in 10-20 minutes. And all of them want quality time with their doc – to feel heard and cared for. I know that before she sees me, she’s looking through my chart to review my health history, issues and needs. And I know that long after I’ve left her office and continued my day (and night), she’s still documenting everything she did for me, analyzing test results, consulting colleagues, and following up on any questions left unanswered; so that when I see her again in 6 months or a year or 5 years, she’ll remember me and be better able to help me.

    THIS is what we do. We don’t cut corners – not because cutting corners gets us sued but because cutting corners could cost a patient her life.

    Restructure the medical education system to produce more physicians, and restructure the American healthcare system so that medical students and residents encounter appropriate incentives for pursuing and remaining in primary care.

    • http://twitter.com/aztezcan Ayse Tezcan

      well-said. unfortunately, you are a minority…

    • anonymous

      finally. thanks for posting this. you are undoubtedly a good physician.

  • Amanda

    This is mostly true in that it’s not the doctor’s salary that is the problem, it’s the rising cost of doing medicine driven by consumers. Expensive tests are preformed, drugs are prescribed and many doctor visits are undertaken because consumers want them. Doctors know full well that the tests will not aid in either the diagnosis or treatment of the patient, but if the test isn’t done, consumers are all too happy to get a lawyer. Same goes for end of life care. Only in this case, it’s the patients’ families that are all to happy to sue.

    In response to healthcare professionals and administrations marking up prices, it’s only because if they don’t, the “discounted” rate would put them out of business. Once the insurance company discount is applied, or out of pocket cash payment discount for that matter, the overall profit is barely enough to pay the bills. If you don’t want the price marked up, stop trying to negotiate it down.

    As a future physician, I would love to have the government pay for my education free and clear and take a lesser salary in the end. But the reality is, they don’t. And if they did, they would not make it retroactive and pay for all those currently out practicing and under the huge debt load accrued during school. So of course no current physician is going to be on board with a grossly reduced salary and no help on their debt load.

    Even if they did decide to pay for education, what makes you think you’d have more qualified physicians out practicing? Part of what makes a good physician is the type of person who is willing to make personal sacrifices, including the debt of going to school. Also, what makes you think that even if the government paid for our education the schools would have more positions available to train more physicians? Which, by the way, student tuition at my school only covers about 1/4 of the total operating budget, including pharmacy, nursing, physical therapy, physician assistant, dental, and graduate schools in addition to the medical school. The majority of my school’s operating costs come from research grants, and that’s including being associated with an excellent hospital. In addition to all that, currently, the national medical school class size is limited by the number of residency positions available. And residency positions are paid for by Medicaid. If they government can’t afford to pay for more residency positions, what makes you think they can afford to pay for the rest of our schooling? And to further that point, not only can they not afford it, they’ve already cut some of the little help they did give us. All graduate school, not just doctors, loan subsidies have been cut as of this year. You’re living in a dream world if you think the government can pay for things they’ve already decided aren’t worth keeping in the budget.

    As a final word, yes, many physicians do in fact “want gobs more money, little or no debt, fewer hours, no criticism, little or no liability” but doesn’t everybody? Show me a person who didn’t want any of that no matter what job they were working, and I’d show you a complete baldfaced liar. Before you go offering up suggestions about how to fix healthcare in America and slandering the profession you know nothing about, maybe you should be a part of it. Then at least you may understand where the real problems are, rather than trying to fix the perceived ones.

    • http://twitter.com/Abolish_ Zaphod

      Not a human alive would turn down more money with less debt and time involved, that is a simple straw man I agree.

      Hospitals dont mark things up because it would otherwise put them out of business they do it because its the most they can charge and still operate without undue scrutiny. They take as much as they possibly can, most notable are the “non-profits”, who of course are allowed to work for profit, some having sizable investments.

  • YG

    It is a shame how the general public and non-medical personnel have such limited insight into the life of a physician despite it being so clearly described above. How about the years of life lost to those sleepless nights and self-sacrifices which are rewarded with ambitious lawyers and hostile patients. How would people understand when the TV shows only last 1-2 hrs when a physicians day never ends. Very nice description Dr. Moeller.

  • Daniel Diaz

    The first comment my professor made in clinical medicine was, “if you came into medicine thinking you were going to make a bundle and become rich….. boy, were you all wrong. The glory days of medicine are over.” He’s right. Docs are not compensated properly. While the media portrays physicians as frivolous spending, audi driving, money hungry mongrels, I look outside my 1 bedroom apartment at my ford focus and scoff out loud. I don’t want to make a million dollars a year… just enough to live, pay loans off (number given by the author is considered low for med school loan debt. I’ve seen 400,000 and 500,000 loan debt) and live comfortably. Jeeze, I can’t even imagine having children and paying for them as well. Ironically, most women in medicine have to wait to an age to have a baby where they are taught that down syndrome increases exponentially. Residency salary for the amount of hours on call is literally a joke. I love what I do, and have no regrets about the sacrifices made thus far, but let’s not pretend that doctors are selfless, rich tycoons. Because from first hand experience, that is certainly not the case. I applaud this article and hope it receives the attention it deserves.

  • http://www.facebook.com/ariel.m.morales Ariel Menelio Morales

    Thank you, that was deep but utterly sobering. As a second year medical student in the mists of the volcano, it’s difficult to comment without going on a rage tantrum on all the nincompoops who can’t sympathize with our struggle..

  • NS Desi

    Um, average salary for a gastroenterologist is approximately 300k. I don’t see what hes crying about.

  • kma10125@aol.com

    You bitch about 230,000 in loans and what you probably make now?! I have over 100,000 in loans and make a meager 30,000a year and probably won’t make 50, 000 for another 8-10 years. So quit your bitching! You made this decision, noone forced you to do it!

  • rose1954

    Hi David1234
    I see your point. However the one thing that you may have missed is not juts the money but the time and energy vested. It is sad that people.barely see their spouse and kids.because they are dedicated to the cause in return they ask for respect and compensation in accorance to their efforts and dedication. Please dont boil it down to numbers, the article is about much more.

    • kmjab81@yahoo.com

      Thank you!! It is heartbreaking when I hear my 6 yr old son ask my husband why he can’t get a different job–why he has to be a doctor–why his friend’s dad is able to come to his school functions, etc. M-F my kids see their dad about 3 hours for the week. 3 Saturdays & 1 Sunday a month he is either moonlighting at the VA or on call, holding clinic, or doing in-patient for his group.

    • Aimee Mclendon

      Thank you for this. My husband is a first year Resident. He loves what he does and is good at it so I do not mind taking over all other responsibilities and our son is used to sometimes going a week without seeing him. It is so much more than the money. It is him never ever taking ONE day off from studying. Even on vacation days, honeymoon, birthdays he always has to get some studying done. It is him being gone before dawn and home after dark. It is that patient he saw that day that he can’t stop thinking about. It is not knowing how much debt we have because we aren’t even going to be able to touch it until 2018 (he started med school in 2008, yes- med school, not college!)

      It takes a toll on the whole family. He never comes home when he is supposed to because every day is backed up due to patients being late. He never once has complained about that, but patients complain all the time because they had to wait.

      He missed our son’s first word, roll, crawl, walk, and so much more. I did not personally know any doctors growing up so I really had no idea what this life was like.

      I don’t want to complain because I have found a wonderful group of women in our town that are going through the same walk of life. My husband and I are actually just grateful he has a job that he enjoys.

      If you do want to make it about the money, though: think of breaking down the actual amount of hours worked + study time and it doesn’t really seem like that much of a salary anymore!

  • gifpaste

    Life is about choices. I’m sure kids are nice but that was choice you made, and those are your own consequences, sorry you did not like how it turned out. You both made a choice to have your wife not work to stay at home with the kids, other people don’t have that luxury.

    People are raising children in far worse places than your “meager” 50k in salary and they do it with only 1 parent.

    I’m not sure what fly by night lawyers you are speaking to, but highly qualified lawyers with the same level of training you put into medical studies meet or exceed 300k in debt

    I feel sorry for neither of those professions as they make plenty and while they start out far behind, they finish far far ahead.

    I’m also rather amazed with how bad your math skills are. Sitting there typing up some diatribe about your debt while making hundreds of thousands of dollars really falls on deaf ears.

    You honestly complain about missing out on 10 years of compound interest? How much would you like to wager you come out well ahead of the majority of people who started 10 years earlier than you?

    Working 80 hours is not limited to doctors. Step out into the real world and talk with people who WANT to work 80 hours just to feed their kids

    I’m really flabbergasted.

    I look forward to a post by you in 2050 when you are retired and can compare all that you have with those who got that 10 year head start

    • matt19799

      If you read the article with care, you will realize that I love my profession and my patients. I directly stated that in the article that I love medicine. I would do it all over again as well. In fact, I am not burnt out in any way and see extra patients on a daily basis and treat their sickness diligently. The point being made is that our government is interested in sacrificing doctors pay in the name of “Medicare cuts”. We have already had several years on cuts and a 26% cut in on the horizon. If another business in America saw its goods and services drop 26% in price and their expenses remained constant, they would go bankrupt. I do think that we current;y make a competitive salary, but I am concerned about the future of health care. I have this concern because most of my colleagues in practices have seen their reimbursement cut and their expenses increase. When these two things happen, one either works more hours in the week, their expenses increase until they go out of business, or they start charging PATIENTS a premium just to stay in their practice (called concierge medicine). Also, I never complain, in fact I never blog. This article is intended to get lawmakers to realize what doctors go through in terms of unfavorable factors so that we do not continue to get bullied into seeing more patients for less pay until it is too late and doctors can no longer provide quality care.

  • Guest

    What a well written and to the point letter. It’s amazing that I, a medical student, have already heard myself make many of these same points across various conversations. It’s nice to know that we don’t have to talk to eachother to understand what it’s like, once you’ve been through it you just know.

    Now to figure out a way to turn what you learn from experience into something capable of being learned from ignorance.

    Cheers.

  • http://twitter.com/AnikaSchaedler Anika Schaedler

    Thank you for sharing your story. My colleagues who have recently graduated have the same debt burden and same issues. Meanwhile, cost of living increases and reimbursement decreases. It’s so frustrating and it’s hard not having anyone on your side.

  • tomatoketchup

    Bull. Doctors are doing fine, and if not, oftentimes it’s their own fault. Have you been reading anything about the job market law students are facing once they get out of law school? Not good. How many graduating medical residents end up unemployed after training? Medical students are ridiculously better off than all but the very best law students.

    Doctors end up deep in debt because they end up spending more than they make. I see it every day with my colleagues. Big houses, expensive cars, and boats (really?) while they are still six figures in debt while simultaneously siring 4 children in a span of a few years.

    I paid off my six figure medical school debt within two and a half years of becoming an attending and am on track to be financially independent and able to retire by the time I’m 40, well before my partners who are 20 years older than me. It can be done, but not when you live like a jackhole and owe money to the bank at the same time. Articles like this will do absolutely nothing to sway the opinion of the average American who makes 50 grand a year.

  • Ben Hart

    Give me a break. I’m not going to type up an essay like you and most others on here are doing, but doctors make far more money than almost anyone else.

    Yes, your job is demanding. Yes, the schedule is hectic. But you didn’t know this? Are you telling me you didn’t hear this from other students a few years ahead of you? Shoot, I heard it so many times as a pre-med student that I ended up switching to dentistry.

    And what about the money? What about the prestige? As a dentist and I’ve lost count of the amount of times when someone I’ve recently met is excited to hear that I am a doctor and then becomes upended and purses their lips when they find out I’m a “mere dentist”.

    Doctors do put up with a lot of crap but they make enough and receive enough accolades to compensate. Anyone who’s made it as far and long in the field as you have and has the nerve to complain sounds greedy, childish and cocky to me. You aren’t God. The letters before your name are “Dr.” not “St.”

  • disqus_xD6UgC8HqT

    the spelling is GASTROENTEROLOGIST.

  • Blues Clues

    You made the choice to go into medicine. If the financial budens or government regulations are such an issue, you didn’t do enough research up front. Welcome to life and the power choice. Maybe you should have taken an economics course during your time at school.

  • Guest

    Education costs are higher for everybody, stfu

  • betterDoc

    Woe is you. Your parents were measly engineers and teachers. My parents didn’t go to College at all and I’m in medical school, and you know what…we make plenty of money! Quit bellyaching and if you really cared about helping people as you claim, you would have never written this because we have the most amazing job in the world. If I ever get out of my debt, which will be closer to 350,000 as my parents are not rich like yours, I will be happy. We make more than enough. Just be responsible. As a medical student who is from a much poorer background than you, this is one of the most aggrevating things I have ever read. Get over yourself.

  • Guest

    is this guy kidding?

    the only income figures posted by the author are when he was a resident. How is it that he conveniently neglects to mention that the average salary of a gastroenterologist is $330k? Even if he only takes home 52% of his salary after taxes/401k, his monthly take home is $14,000/month. In response I’m sure he’ll say “waaaaah…but I have $230k in student loans.” Well, a 25 year plan of 6.8% on $230k is a $1596/month payment. Heck, a 10 year plan is only $2,646/month. This guy will have anywhere between $11,000-$12,704 per month TAKEHOME. If he thinks the government should decrease his taxes, because he doesn’t have enough income money in his pocket, he’s taking some of the drugs he’s prescribing.

    • user_kl7924

      “Even if he only takes home 52% of his salary after taxes…”

      He has plenty of deductions – he wouldn’t even be paying full tax. Kids, childcare, mortgage interest…

  • http://www.facebook.com/kristi.baker2 Kristi Baker Herron

    I’m shocked at all the negative comments criticizing both this article and doctor’s salaries. As a nurse who sees firsthand what sacrifice and hard work doctors go through both before and after becoming doctors, doctors both need and DESERVE a high salary that they will hopefully attain by their 40′s. They save lives. How many other high paying careers can claim that? And what other high paying career costs as much to attain? I can’t think of any.

    • amused bystander

      “doctors both need and DESERVE a high salary”

      Deserve’s got nothin’ to do with it.

  • Christopher Culbertson

    That average is misleading since it doesn’t differentiate by years in practice, or the range in salaries, Also, it doesn’t mention the fact that your average starting GI doc doesn’t earn nearly that much, and can’t even start WORKING as a GI doc until they’re at least 30. This of course is also after many years of 70+ hours/week of incredibly stressful and poorly-paid training, which was preceded by 4 years of medical school that cost $200K.

    Ideally (AKA never going to happen), lawmakers should improve subsidies or regulate the cost of medical education since they’re so crucial to public health and we already have a critical shortage of physicians. If you look at the cost of a medical education in other developed nations, it’s either far less expensive or the cost is almost entirely subsidized by their governments for the sake of maintaining public health and having a diversified pool of physicians. Here in the US, while the government does subsidize some of student’s medical education, tuition rates are AT LEAST twice as much as what any other nation’s students would pay. Much of that money goes towards “administrative costs,” which have ballooned in the last few decades. Perhaps they could mandate that all schools receiving federal training grants (ie: most every med school) can spend only X% of tuition fees on administrative or non-medical purposes.

    Something lawmakers need to consider is containing the rapid rise in tuition rates, which borders on extortion. It’s almost common knowledge amongst US med students that the tuition rates are largely determined by the maximum amount banks will loan out to med students. Banks know that physicians are generally well-compensated and have stable incomes, so offering larger loans can provide years of guaranteed profit. As for the medical schools, with so many people trying to go to medical school (only 40% of applicants get in every given year), there’s no incentive to lower tuition and a strong financial incentive to raise it since there will always be someone will to pay. Since there’s so much money on the table and both the school administration and its “preferred lenders” stand to benefit from tuition hikes, there’s a clear conflict of interest that could only be resolved legislatively.

    In a perfect world, lawmakers would push for better subsidies for medical education or government regulated tuition rates to remove financial pressures However, since that’s never going to happen, I think a more realistic short-term solution would be to allow physicians to deduct a much larger percentage of their student loans and interest payments on their federal taxes. In this way, physicians would be able to write off their medical education much like a small business is able to write off capital expenditures or essential business expenses. In turn, this would remove the financial barriers to going into lower paying specialties which is a driving the current physician shortage, and might also exert some downward pressure on healthcare costs.

    • Michael Corcoran

      Unfortunately, most physicians can’t deduct their student loan interest AT ALL.

      • Christopher Culbertson

        Oh right, there’s a maximum income for even the $3500 deduction. doh.

  • SMS

    I would encourage you to click on the link included in the article about the actual cost of becoming a doctor. At $300K that is roughly $60-70/hour for an 87 hour work week as mentioned in the article. Deduct from that malpractice, health insurance ( many doctors are considered self employed and pay 100%…we pay about $1500 month to insure our family with just health insurance), overhead costs, commuting, student loan payments. It is about the future of health care which is something we all should be concerned about.

  • anonymous

    Mr Moeller, MD has a wealth of confidence in himself; a trait usually found in most physicians. You guys have no one to blame but yourselves for how the government/ public perceives you and your “lifestyle”. Bragging about vacations, spending 6 figures on a 3 month kitchen remodel, fancy import cars that retail for more than other college educated people’s annual salary, and my personal favorite, how much your wife/ girlfriend/ mistress costs have all created the public’s opinion that physicians are compensated too well. Also, I am not buying the “caring about the public’s health” either. That is a rarity among physicians. Sure, you may have started out that way but somewhere in residency you adopted the “Gomer” attitude from “House of God” that you undoubtedly read the month before med school.
    What the public is really going to suffer from in the next 10-20 years in the lack of experienced and “outstanding” physicians because of the federal cap on residency hours. The new doctors aren’t prepared for 87 hour weeks of private practice and instead of mistakes because of fatigue, we will have mistakes because of lack of experience. So yes, in the future, 350K a year is more than enough money for physicians as it should be more than enough money for anyone in America. Greed is still a sin. Arrogance should be as well.

    • http://www.facebook.com/clint.mohr.77 Clint Mohr

      stereotype much…

      • JG91

        Given the way so many doctors online ridicule and stereotype patients, a bit of turn-about is probably fair play.

      • anonymous

        i only relate what has been my experience.

      • anonymous

        the physicians are the ones creating the stereotype- i only related what i have experienced. blame them, not me.

  • Marie

    Just want to point out this problem is not unique to physicians. Other health care professions such as psychologists go through similar training routes, many moves, and below poverty level pay before being able to work independently. The debt load can sometimes be similar as well and yet pay is not where close.

  • http://www.facebook.com/dan.byun Danny Byun

    As it will ALWAYS be…no one will understand the blight of a physician until they themselves have gone through medical school and residency

  • Guest

    Those of you who are arguing for “free” med school or “forgiveness” of med school debt don’t seem willing to understand or acknowledge where all that “free money” is going to come from.

    The government has no money of its own. All it can do is confiscate part of the wages of workers who have earned it, and hand it over to those who have not.

    Your “free” med school would be paid for by the very people you seem to delight in sneering at and looking down upon. You want to demand that the government confiscate other peoples’ wages in order to give you a shot at living your dream and earning the big bucks.

    Your “loan forgiveness” would mean that you were allowed to take out a $300,000 loan which would benefit you, and then blow it off, leaving the rest of your fellow citizens to pick up your tab. If my son takes out a $300,000 loan to expand his auto electrical business and it doesn’t work out, will you be happy to pay off his debt so that he can be ‘forgiven”?

    TANSTAAFL. “There Ain’t No Such Thing As A Free Lunch”. All the things you are demanding to be given to you “free” are things which everyone else will be forced to pay for.

    • JG91

      I think it’s cute how in one breath, they’re saying they want “free” (ie taxpayer-funded) med school for all, and in the next they’re complaining about taxes being too high. LOLZ.

  • Mother of a younger doctor

    It was so true. It is like the same story happened to my daughter. Thank you Matthew.

  • John

    Unfortunately, the article does not address about how the physicians have been reimbursed for their services for many years: fee for service. What does fee for service mean? Every single time a x-ray, ekg, mri, unnecessary tests or procedures are conducted a physician, they are reimbursed for their professional services. They are not reimbursed on the quality of care received by their patients. They do not treat the patient holistically. Stated differently, the expensive duplicate tests costs are passed on to the patient. Most of the patients that are struggling to pay their bills for a meal are the ones that are receiving these unbearable bills. Given how much money our GDP and patients spend into the ecosystem of their healthcare and the quality of care received is not the top-rated globally is the cause for the need of change. The healthcare ecosystem: providers, AHPs, pharmaceuticals, devices, insurance, Health IT etc. all are being impacted and forced to drive change and innovation in the industry to help trim costs, increase efficiency, and ultimately help our patients. Medicine is the only profession today, where professionals are not assessed on their ability to deliver or the performance that they provide; CEO’s, finance, consulting, dentistry, pharmacists, professional industry, & IT are assessed on the performance they provide in their respective jobs. Going to med school / residency, making personal sacrifices, is arguably no different than what a CEO or a senior manager does in any profession to get to the top. One last closing thought, as part of the change, there is a huge need for altering the legal structure around the liabilities and risks for physicians to allow them to practice more freely vs. the malpractice fears that may be a cause to some of the cost issues on the eco-system. There is definitely a need for change and we are all role players in the system for treating and taking care of patients.

  • Thomas Burke

    Wow! Want some cheese with that whine? You are the curriculum winner, you got to go to med school. You know what else sucks? Being a lawyer at a competitive firm that has to bill (not counting lunch, bathroom breaks, or getting coffee) 2200+ hours a year, with a blackberry that you can never turn off. How about being in academic science when you get paid a fraction of your “meager” salary to put in 70-80 hour weeks, not to mention they are totally dependent on consistently securing funding from outside sources. Talk about ungrateful. “We have it all and we want more because being a doctor is hard!” Sorry, every other upper echelon career is this way, get over it and grow up.

    • MagickChicken

      “Don’t take away what we have” is different from “we want more.”
      -From an 80 hour work week scientist

    • Greg9876

      2200 hours a year. That’s 40 hours a week? In residency and fellowship I easily worked 100 plus hours a week making about 6 dollars an hours. And that was for 7 years. And that was after 4 years of medical school. I finished training at age 34 with 180,000 in debt. Law school is 3 years and your done. I’ve taken a break for lunch about 20 times in the last 8 years. Show me a single person in the acedemic science field who payed for the PHD out of their own money.

      • http://twitter.com/aztezcan Ayse Tezcan

        epidemiologists!

  • e_mayhan

    The numbers don’t lie- fewer and fewer college students are interested in the medical profession as a whole, and becoming a doctor is low on the list even among those who are interested in it. Lawmakers have attacked this profession so much that there really is no good reason to do it aside from seriously wanting to make one’s contribution to society in this way.

  • verkMD

    I find it amazing, I must be the only MD in American not under a mountain of debt. Undergraduate education at a fine state school and academic scholarships cost me nearly nothing as I was also able to work part-time. A few years of work before med school added to my contribution to tuition, again at the state school, and I came out with a very modest debt load. I did not need $10,000 to relocate, I just packed it up in my pickup and drove to the next station in life. My residency years felt wonderful as I started to earn a paycheck for doing pretty much the same thing I’d practised in the last couple of years of med school. Unlike the author, I consider that my practice started in med school. My family physician income is meager, but has been more than enough to pay off my loans and my home mortgage. Stress and potential burnout do worry me. I do feel medical education needs reform, but my income is not an issue.

    • http://twitter.com/aztezcan Ayse Tezcan

      what a refreshing insight!

  • John

    Thanks for deleting my post on the quality evaluation and a critique of your article, along with others who posted on how other professions are not a walk in the park either.

  • AutumnBanter

    My mom had a cerebral aneurysm and after her clipping surgery fell into a coma for several days. The doctor who was in charge of the ICU who stopped by to look in on her while she was in a coma charged more than $10,000 for that one visit. A surgeon who assisted on her surgery charged more than $17,000 for that surgery and a routine angiogram cost more than $6,000. That was on top of a hospital bill that cost more than $300,000. How is any of THAT fair?

    • Greg9876

      There is no way $10,000 dollars was charged for a single visit. You should get you facts straight before posting misinformation like that. In fact if you a doctor in the office I bet 9/10 you end up paying less than if you took your car in for a routine repair.

      • advocate

        If auto mechanics got into bed with Uncle Sam and willfully handed over their autonomy to him, the auto repair industry would be just as stuffed up as the healthcare industry.

        • Greg9876

          How did doctors willfully hand their autonomy over to the government? When the government takes over the insurance of everyone over 65 how is that doctors handing their autonomy to the government.

          • advocate

            Did you fight it, or did you just see the benefits of getting all that lovely government money and go along eagerly with it, not considering that once you’ve sold out to The Man, he owns you?

          • Greg9876

            Considering I wasn’t born in 1965 when Medicare was created I would have had little chance of fighting against it. Advocate are you going to say one thing on this site that is based on facts or just going keep spouting of lame phrases like “the man” into “bed with uncle sam” that were tired lame phrases 40 years and are still lame phrases today. You sound like a “hippie” on a really bad sitcom from the 1960′s.

    • matt19799

      Charges are not what physicians or hospitals get reimbursed (get paid). They are inflated numbers that are done because of insurance carriers lowering reimbursement rates over the years and has to do with contract negotiations. What gets reimbursed to the hospital or doctor is the “allowed charge’ and even after that charge, there is an adjustment and overhead expenses, etc. After all is said and done, the doctor and the hospital get separate payments, so when you finally break all those numbers down, that doctor really got paid a small fraction of that number as in 1-2% of that charge. And that is supposed to cover his overhead which can be up to 50%. When all is said and done, that doctor who trained for 14 years and has lives in his hands got paid less than a automotive repair (100-200 dollars). The hospital will get 2-3% and the rest is an “overcharge” and I don’t know what happens to it. Now why do they publish these high numbers as “charges” is beyond me. I agree with you that these inflated numbers mislead patients and is completely inaccurate and unfair, but just know the doctor nor the hospital get even a fraction (1-2%) of that charge. That is an insurance company issue that doesnt exist in other professions. If a transmission flush costs 79.99, that autoshop gets 100 percent of that money and use it as revenue. Doctors and hospitals are paid completely different based on all the hassles of insurance companies and paperwork and gets small fractions of the charges.

  • Matt Dickson

    Your average Joe Blow can comprehend how much money $400k is, however they will never understand what a 100+ hour work week as a resident feels like unless they’ve done it themselves.

    • Rn73

      As the wife of an educated businessman, I watch him work 16 hour days 7 days a week. Income will never equal your potential. Including my own educated average Joe blow RN self. And yes I have two under grad degrees. My income will never compare either. We all make choices and sacrifice. Do I understand, more than you think. What you don’t understand the big picture. As that Rn who put her spouse through school while raising two small children working extra 12 hour rotating shifts for years you’d be better to think about who see’s and reads posts. Not to mention my blue collar brother in law who owns a labor intensive business. hasn’t paid himself in over 5 years, because the economy has forced him to work at the cost of material and workers. No he had no idea. He thinks your life is easy. Don’t be quick to make flip comments. He would never be your patient after reading your attitude. You must be young, oops I am stero typing like you.

      • Caitlin Peebles

        Well said. Sometimes the “closed shop” here needs a reality check.

  • Dave

    I am a physician in training but have a pretty good idea of what lies ahead after I finish training. Unfortunately, I’m in a specialty that’s super saturated in any urban market and expect to make less than a primary care physician over the first decade of my career.

    That being said, it’s a bit inaccurate to say most physicians would easily have been able to make more money in banking, business, law, etc. The skills are not directly transferrable. It’s absurd to even talk about law. Graduates from top 10 law schools have been having a hard time finding a “lawyer” job anywhere let alone graduates of 2nd and 3rd tier schools. Medicine is not a bad gig any way you spin it. We’re pretty much guaranteed an upper middle class lifestyle, something that’s not the case is any other profession.

  • Bobby

    I think in the end, the unfortunate thing is that the public will always look at the end result and not what is put into it.

    They see the income. They don’t see the debt, the pain, the decade of working 80 hrs a week.

    It’s the same with people in great shape. “What’s your secret?” or “You must have amazing genetics.” Yet, in reality the people in shape have amazing diets and exercise routines. Look at the show the biggest loser, that’s a perfect example that the genetics really aren’t the determining factor.

    In a nation that is getting more and more obese, watching more and more television, and is obsessed with instant gratification – It’s fair to assume they will always just assume that being a doctor took a lot of time, but it’s just like any other job. LOOK at that salary! wow!

    All great successful people put years of work in and the general public just is amazed at how talented they are… they don’t see the process EVER. Why should or would it change for medicine? What will happen is doctors will continue to be seen as overpaid because they just compare their salary to a doctors salary. With the internet, now everyone can complain about how doctors are paid to much and site ______ study.

    I see bad things happen to medicine. In 30 years the talent pool will have shifted to business, IT, finance, etc. It will make our nation even less healthy, add malpractice, and what not. I’m just trying to be objective here – I don’t really care what happens. If the government and people want it bad enough, then give it to them.

  • seaofsidewalk

    There are so many comments that i doubt anyone will get to see mine, but I have a couple issues with this article.

    1. The 45k/year that they make as residents is the equivalent of a phd’s stipend, if not more. If you want to fight for loan deferral (which is legit) then do that, but lots of people pay of undergrad loans on 45k salaries.

    2. Wrt lost opportunity of investing in your 20s – most people don’t really start making money until their mid to late 20s anyway. If you start working at 30, you’re not missing out on 10 years of investing, you’re missing out on maybe 8 – and you’re forgetting that people who don’t get advanced degrees aren’t ever going to make as much as you, so they damn well better start investing. Oh and a lot of folks spend their 20s paying off their undergrad loans.

    3. Related to number 2, stop comparing yourselves to business people and start looking at the rest of the spectrum of professions and incomes. If you want to be a trader and make 170K after your bachelor’s, go do that. Business is one of the ONLY professions where you can do that, so please stop using it as a benchmark. You’re in a helping profession and you just can’t be in it for the money.

    4. If you have a problem with debt, then work to change the education system. Undergrad is useless except for your premed classes – fight to encourage more 6 year fast track programs.

    Finally, med students need to understand that they will get a payoff eventually. If you live frugally for a few years, you can pay down your debts. By the time you’re 45 you’ll have no debt and will be making bank – which you can invest and very quickly gain ground on the people who have been investing their meager salaries.

  • xc

    “Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt.”

    You probably also would be less likely to have a job … at least if you make it through med school/residency there isn’t a disproportionate number of graduates to the number of available jobs, as is the case in law these days.

  • Neuro MD

    Give me a break, The story is a tired and boring harangue that so many
    of my colleagues have spewed out so often. The ideals underlying such
    stories reveal a self-inflated ego, but what would you expect from a
    profession where everyone has (viz: demands, expects) the same first
    name as ‘Doctor’? Being a physician is not the most demanding, most
    under-payed profession. The bottom line: doctors made the choice to
    become doctors. Diatribes such as this have little credibility with me
    as a physician, and much less with someone who may be out of a job or
    less fortunate.

  • Higher Ed

    It’s interesting that you purport to write in order to clear up the misperceptions an involved in working as a doctor, and yet to prove your point you spew stereotypes about what it is like to be an attorney. Having gone down the law road myself and seeing how far off base you are in that area doesn’t lend you any credibility

  • Lily

    Great letter! I have felt the exact same way as a struggling hospitalist trying to pay off my 300+ thousand dollar loans and feel completely overwhelmed after a day of taking care of very sick patients,answering their several questions, providing emotional support for them, their family and loved ones. I also answer to my hospital authorities about how to appropriately bill, to our quality improvement team to make Sure I’m documenting appropriately, and coming home to finish more paperwork so that I don’t get sued during this rigorous process only to ignore my loving and supportive family.friends and families asking “isn’t it nice to get all that money”. How so? After spending about 2500 dollars in monthly loan debt
    And income taxes at 33% if be lucky if I were to save 2 thousand a month which I know most of my friends and family do without half the mental, physical, and emotional burden. I have missed most of my best friends graduations, engagements, weddings because of my career. I miss most of my daughters dinners, baths, and putting her to bed. I’m with you, I love what I do and for whatever its worth-I know I help a lot of people out and make differences in their lives but its very disheartening to hear law makers who don’t recognize the sacrifice we make to make those differences in people’s lives.

  • http://twitter.com/SayChris3x Chris

    So this guys wrote this entire groaning, poor-me, sob-story just because one day he turned on CNN and someone offended him by saying something about his career and field?

    Well, this morning some guy cut me off on the interstate, so tune in to my blog later this afternoon as I will write 3500 words on how I was raised not to do that to other people, and how sad I am to be wealthy for my age with a happy-yet-somehow-unfulfilling-life.

  • http://www.facebook.com/poorad Poorad Razavi

    This article makes many fine points, most of which with I agree. However, it is misguided at best, and highly insulting at worst, to demonize the legal profession as one filled with people who simply “hang up the phone” when we do not get paid. I spend a significant amount of time speaking with and advising clients regardless of “getting paid.” In fact, it is often the clients that I cannot recover money on behalf of that I spend the most time counseling in order to empower them to seek self-help in situations where the law cannot reach.

    Again, while I certainly empathize with the plight of doctors, especially since many of my family and friends are among them, I think it is very poor judgment to depict lawyers as the “counter profession” driven solely by money and an apparent easy disregard for the clients who are the foundation for our entire industry.

  • kparikh

    Dear Dr. Moeller

    I’m a 4th year medical student, graduating in April, and I must say that your article really touched home. But I have to tell you that you have had it easy. You’ve had it incredibly easy. You see, I’m a 4th year medical student from the Caribbean. After spending four years of my undergraduate career, striving to become a doctor by taking my MCAT three times (that’s three summers of my college life gone), staying in on Friday and Saturday nights because my organic chem test was on Monday at 8am, and bending myself backwards doing the most mundane research each summer to beef up my resume, I found myself without
    a medical school to go to after I graduated. I did not give up. I decided to go to a very expensive private school to obtain my Masters degree, only to find myself, again, without a medical school to go to after I was done. So I chose my Caribbean medical school, as a second option. It’s about $60,000 each year, and we spend our first half of medical school on a god forsaken island – you’re lucky if you have air conditioning, let alone clean, running water. While most American medical students spent their nights studying at Starbucks or the comfy couches of their prestigious medical school library, I spent my nights studying in my dim lit apartment, hoping the power would not go out. I had to study the exact same material that American medical school students had to study, but I had to do
    it much worse conditions. People to the right and left of me were failing out
    due to the lack of mentorship at our school, because it’s more of a business than an academic institution (but that’s a whole other story).

    After the first two years of medical school, we had to take a test in order to sit for the first part of our board exam. If people got weeded out of our school before, we hadn’t seen anything yet. I saw my class size shrink from 600 to maybe 200 people. Think about all of those people who had invested $100,000 already into their medical education, only to find out
    that they did not meet the school’s standards to become a doctor. But they didn’t give up either. They went to another Caribbean medical school to ensure their dream came true.

    For those people that made it past their Step 1 board exam, we still had two years of medical school left. On top of our $50,000/year tuition, we were forced to move around every 4-6 weeks, packing up our one
    suitcase and moving state to state for yet another rotation. We were taught minimally, but had to find the time and resources on our own to study for our Step 2 board exam. Some people quit, but most of us made it through.

    Fast forward four years, after we have spent $200,000 in tuition, plus moving costs, living costs, and interviewing costs. Our school churns out primary care physicians, but for those of us that wanted to separate
    from that mold, we tried to pursue something different, whether it was
    Emergency medicine, Ob/Gyn, or even surgery. Dermatology and Plastic surgery are out of the question for us – after all, we go to a Caribbean school. How dare we even try to shoot for something that grand?! After thousands of dollars spent on applications and interviewing, some of us were left without a residency. Some of us, despite our great board scores and good grades, were left with a $350,000 debt and no job. Why? Because we are Caribbean med students and not American med students. But because we have been hustling our entire medical career, we will not give up. We’ll try again next year, and you’ll see us in your residency programs and you’ll be our colleague one day. This is what we, as Caribbean students, do. We hustle and make our life as doable as possible with a huge financial cloud hanging over us, and for some reason, we love what we do. We have it hard, but you would never know this caring for our patients makes all of this worth it.

    I completely agree with your article, and I wanted to put it out there that there are some doctors who have truly known what hardship
    means who still continue to work every day and make sure that their patients are as healthy and happy as they can be, all the while they have a huge financial burden weighing them down. So with that said, you’ve had it easy, Dr.Moeller. But you’ve still had it a lot harder than 90% of America. What does that say about this system? It’s messed up, that’s what it says.

    Yours truly,
    A Caribbean medical student

  • kp0926

    Dear Dr. Moeller

    I’m a 4th year medical student, graduating in April, and I must say that your article really touched home. But I have to tell you that you have had it easy. You’ve had it incredibly easy. You see, I’m a 4th year medical student from the Caribbean. After spending four years of my undergraduate career, striving to become a doctor by taking my MCAT three times (that’s three summers of my college life gone), staying in on Friday and Saturday nights because my organic chem test was on Monday at 8am, and bending myself backwards doing the most mundane research each summer to beef up my resume, I found myself without
    a medical school to go to after I graduated. I did not give up. I decided to go to a very expensive private school to obtain my Masters degree, only to find myself, again, without a medical school to go to after I was done. So I chose my Caribbean medical school, as a second option. It’s about $60,000 each year, and we spend our first half of medical school on a god forsaken island – you’re lucky if you have air conditioning, let alone clean, running water. While most American medical students spend their nights studying at Starbucks or the comfy couches of their prestigious medical school library, I spent my nights studying in my dim lit apartment, hoping the power would not go out. I had to study the exact same material that American medical school students had to study, but I had to do it in much worse conditions. People to the right and left of me were failing out
    due to the lack of mentorship at our school, because it’s more of a business than an academic institution (but that’s a whole other story).

    After the first two years of medical school, we had to take a test in order to sit for the first part of our board exam. If people got weeded out of our school before, we hadn’t seen anything yet. I saw my class size shrink from 600 to maybe 200 people. Think about all of those people who
    had invested $100,000 already into their medical education, only to find out that they did not meet the school’s standards to become a doctor. But they didn’t give up either. They went to another Caribbean medical school to ensure their dream came true.

    For those people that made it past their Step 1 board exam, we still had two years of medical school left. On top of our $50,000/year tuition, we were forced to move around every 4-6 weeks, packing up our one suitcase and moving state to state for yet another rotation. We were taught minimally, but had to find the time and resources on our own to study for our Step 2 board exam. Some people quit, but most of us made it through.

    Fast forward four years, after we have spent $200,000 of our loan money on tuition, plus moving costs, living costs, and interviewing costs. Our school churns out primary care physicians, but for those of us that wanted to separate from that mold, we tried to pursue something different, whether it was Emergency medicine, Ob/Gyn, or even surgery. Dermatology and Plastic surgery are out of the question for us – after all, we go to a Caribbean school. How dare we even try to shoot for something that grand?! After thousands of dollars spent on applications and interviewing, some of us were left without a residency. Some of us, despite our great board scores and good grades, were left with a $350,000 debt and no job. Why? Because we are Caribbean students. But because we have been hustling our entire medical career, we will not give up. We’ll try again next year, and you’ll see us in your residency programs and you’ll be our colleagues one day. This is what we, as Caribbean students, do to become a practicing physician. We hustle and make our life as doable as possible with a huge financial cloud hanging over us. We have it hard, but you would never know this because our feelings toward our patients make all of this worth it.

    I completely agree with your article, and I wanted to put it out there that there are some doctors who have truly known what hardship means who still continue to work every day and make sure that their patients
    are as healthy and happy as they can be, all the while they have a huge
    financial burden weighing them down. So with that said, you’ve had it easy, Dr. Moeller. But you’ve still had it a lot harder than 90% of America. What does that say about this system? It’s messed up, that’s what it says.

  • bghy

    wealth inequality is a whiners game…the wealthy weren’t prevented from getting that way because someone else was hording all the money..it is an ever growing pie

    • http://about.me/fixer Fixer

      Assuming you can get approved for the massive student loans and have some way to support yourself thru those years of training and have rich parents who can fund your private school education before college and raise you in a stable safe environment with basic needs met, all of which contribute highly to learning.

      Wealth inequality is real, we just haven’t haven’t found a good way to fix it yet (higher taxes and welfare payments doesn’t seem to be a good answer, btw)

    • http://twitter.com/Abolish_ Zaphod

      Its a concerned for the economy long term kind of game. Our is economy is consumerism based, yet the economy is demonstrably removing money from the consumers. Its not a good path for overall health of the economy, country, or world.

  • Ammad Syed

    I am an older medical student (late 20s) in my 2nd semester and Im already close to 100,000k in debt. Thats with 2 bachelors degrees + 1 Masters and working on current MD. Before starting medical school I worked for 3 years and was able to pay down SOME of the original loan. Regardless, your letter is spot on. Great job!

  • John

    As an attorney, I can say that billable hours + attachment to blackberry is my life. 2200 hr / year is the minimum billable criteria that is true work, not consults or bathroom break or anything else. Other professionals that I work with are also working extensive hours, including in IT where they conduct deployments over the weekend. At a bare minimum your job is regulated by AMA & Medicare who is limiting no of individuals going through med school. I would also say, every profession to date is evaluated in quality of performance & care delivered and not on the basis of receiving the golden egg once they have finished their program.

  • http://about.me/fixer Fixer

    How much did you bill for those 87 hours, and how much of that is being discussed to be cut?

  • http://twitter.com/JoeTanason Joe Tanason

    Modest roots? Engineer dad and School administrator doesnt exactly qualify as modest. Not the point of the article but yea….

  • Jay2128

    Wow, I honestly hope people who posted these past comments read this. You are all pathetic. Try being a doctor. I’m currently a pre-med major and as a volunteer EMT, I’ve noticed it gets so stressful when families are around yelling above your shoulder, screaming save my child, or husband, or relative. You lawyers don’t have to go through that bullshit. Majority of the lawyers lie. Who cares if you’re attached to your blackberry’s, that’s besides the point. You aren’t dealing with lives, fools. You can’t kill someone, only make them poor so seriously, shut up. Doctors have too much on their hands and this article sums it all. About the debt, someone here said “you’re bitching about $230,000,” well, that’s with his undergrad scholarship. If he didn’t have that this would have been doubled. Do your math right, not everyone gets scholarships. If there aren’t any doctors in this World, all you lawyers would be trying to save your own lives with some over the counter medicines. Have fun when doctors don’t exist, then use your law to save your own asses from diseases.

  • Jay2128

    Wow, I honestly hope people who posted these past comments read this. You are all pathetic. Try being a doctor. I’m currently a pre-med major and as a volunteer EMT, I’ve noticed it gets so stressful when families are around yelling above your shoulder, screaming save my child, or husband, or relative. You lawyers don’t have to go through that bullshit. Majority of the lawyers lie. Law firms don’t even have jobs, that’s how pathetic your field is doing. Doctors have too much on their hands and this article sums it all. About the debt, someone here said “you’re bitching about $230,000,” well, that’s with his undergrad scholarship. If he didn’t have that this would have been doubled. Do your math right, not everyone gets scholarships. If there aren’t any doctors in this World, all you lawyers would be trying to save your own lives with some over the counter medicines. Have fun when doctors don’t exist, then use your law to save your own asses from diseases.

    • Caitlin Peebles

      All of this talk about “without the government giving us MOAR MUNNY! there will be no doctors in the world, ever ever again!” is ridiculous. There were plenty of doctors in the world before the government started getting so involved. The government did not provide doctors huge loans to go to school; the government neither paid you nor set your rates & conditions (“he who pays the piper calls the tune”); and yet still somehow people managed to go to college, go to med school, and practice as doctors.

      The government’s involvement has distorted everything, from med school tuition to doctors’ pay and conditions.

      Meanwhile, you medicos who never tire of telling us common shmoes how much Smarter Than Everyone Else Under The Sun(tm) you are knew what you were getting into when you started down that path, or should have done anyway. All this whining is really a bad look.

      • Greg9876

        Do you even understand the fact that even private insurers set their payments based on Medicare rates. Or that the easy availability of government student loans has lead to a tuition explosion.

  • Eric Goldberg

    I’d just like to comment on the numerous ill-informed and misleading comments here regarding physician incomes and the perceived large incomes physicians are paid once they finish residency. Understand that there is a huge discrepancy in income potential between those physicians working in specialties at the top of the pay scale (i.e., oncologists, cardiologists, radiologists) versus those at the bottom (psychiatrists, pediatricians, F.P.’s). Reality is that the majority of practicing physicians do not make the magical, arbitrary “350K” number I see thrown around a lot on here, or anything close to it. Personally, as a specialty-boarded physician with over 5 years of working experience post-residency, my income is not even half this amount. For whatever it’s worth, the CRNA’s at the hospital where I work make more money than I do (!). I drive a 12-year-old Honda Accord with over 200K miles on it, which I don’t park in the physician parking lot mainly for fear it would get towed. And I do work full-time and then some.

    Not to complain about money, I do love my job and couldn’t imagine myself doing anything else. But I don’t think anyone should have to apologize for working hard, succeeding academically and suffering through the incomprehensibly rigorous marathon of training that must be endured to become an American-trained physician (not to mention having to continually acquire and pay for CME indefinitely, being subject to potential lawsuits under the American tort system and being held personally accountable for carrying private medical malpractice insurance in order to be able to maintain a valid state-issued physician license) and expect to be paid well. But the perceptions people have about all doctors being “rich” are just plain false, and I take issue with it. The majorrity of us working in the non-glamour, lower-reimbursing specialties, particularly those of us who graduated more recently from medical school with large debt loads, don’t enjoy an upper-class lifestyle or anything close to it once medical malpractice and student loan payments are subtracted from our salaries.

  • Megha

    Our lives are far from the “woe is me” picture painted in this blog post.

    I get it. We work really hard. We make sacrifices in our personal lives. We are in major debt. I share many of your experiences, Dr. Moeller – except I don’t feel like I’m getting the short end of the stick.

    I am currently a resident in Internal Medicine and planning to pursue a career in academic primary care medicine. My expected salary will be way less than any gastroenterologist. It will take me years to pay off my debt, which, I agree, is accruing at a nauseatingly fast rate.

    What I don’t understand is this: Since when did an annual salary over $100K (the lowest that most physicians will ever make after residency/fellowship) become a sacrifice in any context?

    I grew up in a middle class household in which the combined salary of my parents was well under $100K. My brother and I were comfortable. We didn’t go on lavish vacations. We didn’t live in a mansion. We went to
    public school (where I think we received phenomenal educations). We had everything we needed.

    A career in medicine is a choice. In the United States, unfortunately it’s an expensive choice, but we have the opportunity to pay for an education with loans. That in itself is a privilege we take for granted. Yes, we have to pay loans back, but we are allowed to pursue the career that we desire! My mom grew up in India; she wanted to go to medical school but couldn’t because her family did not have the money to pay for it up front.

    If nothing else our poor, sick, and disenfranchised patients should teach us what real sacrifice is. I can live with loans that I will pay back over time. No bill collector is knocking on my door or threatening to take anything away from me. The rest of the rich people in this country may sympathize with our “plight” as young doctors, but I feel lucky to be in this profession, even in a state of political turmoil.

    We do need to unite as a medical profession and dispel the stereotype that money grows on trees for physicians. It certainly doesn’t. You are right, Dr. Moeller, we need more doctors in Washington, D.C. advocating for physicians and protecting reimbursement rates. Why can’t it be us?

    • tomatoketchup

      Excellent comment!

      In response to your question, “why can’t it be us?”, it can’t be us because most doctors have no idea how to relate to a normal person and end up writing articles like the one above which do nothing to appeal to anyone outside of medicine.

      You know what we need? We need a lobbyist like the character Nick Naylor from the movie Thank You For Smoking. Someone like that would serve our profession far better than an M.D. with an IQ of 160 and the personality of a slate rock.

      • advocate

        I’m flabbergasted that the author of this piece apparently had NO IDEA how his whining would be perceived by those who live and work out in the real world.

        What is the medicare code for treating the tone-deaf?

    • http://twitter.com/aztezcan Ayse Tezcan

      i wish i could have given this comment many ups! you have an awesome outlook of this profession

  • Mike

    This article lacks the foundation to substantiate the asserted claims.

    Having children before one is financially ready is a result of poor life planning. Everyone one else is the real world realizes how expensive it is to raise a child, and the substantial amount of time required in caring for that child.

    It only makes sense to have a child when you are both financially ready to do so, and are able provide that child with necessary amount of time he or she will need. Having a child when you are $240,000 in debt is a poor financial decision.

    When entering Medical School, I am certain your were fully aware of the financial implications, time required, and the low pay during residency. In spite of the aforementioned, you chose to have children.

    • http://twitter.com/CSquared913 CC

      “Honey, we are going to have to wait 20 years until we can catch up financially to have children” said no one ever.

    • Greg9876

      So now doctors should not only delay compensation for 10-15 years they should wait until they are in their late 30′s to early 40 before having kids?

  • ExHedge

    I stopped reading after you said you would be better of financially by going to law school. I guess during residency and the crazy hours you’re putting in you have no idea what the legal landscape looks like these days.

  • http://www.facebook.com/steven.schreiberstahl Steven Schreiber-Stahl

    Poor timing with this article: lawyers (who also go into their profession to do good in the world) graduate with 200k dollars in debt and can’t even find jobs. Meanwhile you, a specialist who makes almost as much money as the President, are bitching about how hard it was for you. Are you still going to be in such dire straights when you’re able to retire at age 55? I’m sure you’re well aware that people’s main criticisms of doctors are that they are out of touch with their patients. It sounds like you’re out of touch with the whole world.

  • Rn73

    As an RN having worked in teaching hospitals and now homecare, I am not nearly compensated my worth. As there has been a shortage of nurses for years I still chose this profession to help people. I have resident friends and take care of attendings and their families. Yes the earning potential is there eventually, but I see the present day and future results from the sacrafices today’s doctors make. Those of us in health care give up quality time with our own families to help everyone else. The misconceptions are that doctor’s have the best of everything. Funny, why does the doctors’ wife have less insurance benefits than the Medicaid patient? I know but the American public does not have a clue. While eventually your salary increases, so do your cost of living. Malpractice insurance, health insurance, family, cost of private practice. None of this info is widely known. So educate the non clinical population. Over 20 years I have watched and experienced the decline of health care on all avenues. If you want change educate.

  • http://www.facebook.com/alysonmarieengle Alyson Engle

    Active practicing physicians should be granted a pay, equal to congressmen’s pay, to help write the health care laws and advise them on realistic approaches. This country should not be paying congressmen with ZERO experience practicing medicine (and far from going through the same schooling & training) to write, let alone, pass laws of medicine. They first should AT LEAST go through medical school and residency to have that privilege and make lots of money doing it.

    On a separate note, congress should lead by example, and cut their salaries to $39,000 and increase their work load to a physicians of at least 80 hours per week. I doubt they would ever let this happen to them… unfortunate our “leaders” do not lead with integrity or respect for other professions.

  • Suzanne Phillips

    don’t you know? the goal of the current administration is to remove the middle class. doctors are the last hurdle, you earn enough and have enough clout to have influence in the world. they would rather you didn’t…

    • Caitlin Peebles

      Doctors have got themselves in the position where they depend on the government to fund their education and training, through government loans; and depend on the government for their income, through government reimbursement systems and tight government regulation of the private insurance market. As a result, the government now pretty much owns their arses and can do whatever they like to them. It’s a frightening state of affairs.

  • Julie Contes

    Recent medical graduates have an even greater financial burden due to higher interest rates that were available at the time. The amount that my interest grew during residency is horrible. I just started to pay $2300 a month for an original $200k loan. For the next 20 yrs I have this financial burden, but lucky for me I didn’t go to a private medical school. I have colleague with over 300k in loans. Imagine then making anything less than the average physician salary while paying back those loans! Especially after sacrificing soooo much.

  • http://www.facebook.com/clint.mohr.77 Clint Mohr

    Well spoken my friend. I had the pleasure of spending those medical school years with Dr. Moeller. fortunately my wife worked and as a result I was only about 170,000 in debt. It seem unfortunate that most of the comments completely miss the point. At its core this has nothing to do with how much any of us are making. But we have become a class warfare society. This is further propagated by the current administration that tried to define rich as 250k per year. We get to see news footage about people railing against the top 1 percent. I would like to point out that most people are on the top because they earned their way there…period. I lament the fact that fewer of the truly intelligent kids in college want to study medicine. They see high malpractice costs, huge student loan debt and long hours and many choose a different path. In this country we cant even train enough physicians to meet our needs and nearly 1/3 of our doctors are imported from other countries. Personally I could have utilized my undergrad degree in mathematics…also had one in chemistry…went to a top 10 b-school, grad degree in finance and I would likely be cashing bonus checks larger than my current salary. there are easier ways to make money than by choosing the career paths we have. Many comments talk about other high paying jobs. None of those jobs involve caring for your mother while she is septic and on a ventilator will requiring temporary dialysis. I’m proud to say to I do deserve to live better than most because I’ve earned it. I earn it every day by making sure the patients under my care get to go back home and be with their families. I spend extra time away from my own family and help staff small critical access hospitals. These places would close if not for doctors who are willing to spend the extra time to make sure quality care is provided. I did have today off but I put in 132 hours in the prior 10 days

    The regulations kill us and make our lives far more difficult than they need to be. I said something the other day that made my colleagues laugh. I proposed writing a note for the chart that said….patient seen and examined. see orders for changes to management. They laughed and said that would be great but you medicare wouldn’t let you keep being a provider if they saw it. then I said ‘but wouldn’t it be great if I could just see my patients and think about what they need done…I could take better care of 40 than I do 25 if it wasn’t for all the paperwork.
    I applaud Dr. Moeller for his writing both as his friend and colleague.

  • kailey

    As a nurse I understand the cost student loans as I was not one of the lucky ones because there were three of us in a 4 year university. And I coild have gone to a two-year then transfered however many hospital have stopped hiring 2 years degrees unfortunately. And the total loans verse income is 190 with an income of roughly 50k before taxes. I agree with most that Dr. M has written however as a nurse and patient I have seen a real decline in truly caring drs and it may due with locations, different hospitals, and even different fields of practice. I habe worked with many surgeons (general, ortho, obgyn, gi, peds, hospitalist, ent, etc) and of course there are always a few bad apples qnd sadly to say I see the same with nurses a lot of new graduates come out feeling entitled lack empathy and sympathy. I feel laws need to be made but what’s going on now is not the way and I firmly stand behind the opinion insurance companies should not run your health care if a dr orders a certain test then it should be that test as they have been seing you and not just reading a file patient are not book studies.

  • http://www.facebook.com/profile.php?id=74500987 Chris Jones

    How much are your 20′s worth to you guys? I bet you all (that are older than 29) LOVED life during those years, started a family, bought a house, etc. Forgetting about the financial debt that I’m in that is MUCH greater than your mortgage, I’ve gone out with my friends exactly once in the six months…Mainly because I’m too exhausted and too broke to do so. I’m currently 26 years old, not married, and don’t have a career. I pay 20k in tuition per year to hold retractors and be reminded on a daily basis of how stupid I am. There’s no other “job” like it, and unless you experience it, you have no idea.

    How much are you willing to compensate physicians? I’m thinking that we should start charging an HOURLY rate. Then the public would realize exactly how hard the profession works. After salaries INCREASE, you’ll tell us that “350k isn’t that much…Can we please go back to that? Thanks.” You pay your plumber and lawn mower more per hour than you pay your physician.

    • advocate

      Do you really have no idea how pathetic and childish you sound?

    • Suzi Q 38

      Chris,
      This is not true once you graduate and make $400K a year as a specialist.

  • RK

    A lot of comments focus on the dollars and cents. Here’s my bit:

    I know I’ll make a safe, comfortable living as a doctor. So, I get to do interesting work, serious work, important work, and never worry about layoffs or being outsourced.

    But I look to my peers — the lawyers, MBAs, Engineers, even nurses, and wonder if I made the right choice. My engineer frat brother makes 80k a year at Intel after college. I could have done that….

    My classmate from senior statistics works at Deloitte doing analyses makes 120k, and they want to pay him to do an MBA. I could have done that….

    I hear about CEOs and lawyers making millions even as their companies burn, and I wonder……

    The nurses make 50k a year after 4 years of school, and that can eventually rise to ~100k. Over a 40 year career, they do pretty well eh? And I could have done that, and saved a lot of tuition and years.

    As a society, we need to decide where the priorities are. If we want capable physicians, we need to make the job attractive. Right now that means high salaries. But I would take half the pay if I tuition were only 15k a year, and residency was only 60hrs a week. That would be sweet. Maybe I could find the time to meet a girl and have a kid if that were the case.

    (also, there’s a weird parallel between physicians and teachers I think)

    Anyways: don’t feel sorry for me. I meet interesting people, and do wonderful work. Maybe I’m overpaid for healing the sick, but that’s better than being overpaid to sue Samsung on behalf of Apple, right? But we should all think about what we ask of doctors (training, tuition, years, personal life, insurance costs….), what we give in return, and if that bargain is going to keep the system running.

    P.S. If I ever have a kid, I’d tell them to stay away from the MD. But then again, I want to have grandchildren, so maybe I’m biased.

    • RK

      Oh, and to the docs who knew what they were getting into: god bless you. I only realized what the sacrifices would be after 1st year of medical school, but with 50k of debt already….well, you can only go forward.

    • RK

      Oh, and I forgot the trades. I like working with hands and am considering surgery, but what if I’d become a carpenter!

      • advocate

        If you blithely embarked upon medical school without even knowing what it would cost you, I don’t think you’re smart enough to be a carpenter.

        • Suzi Q 38

          You know as well as I do, that you don’t want to be a carpenter.
          Anyone that chooses and is qualified to pursue surgery wants the excitement of surgery.

    • advocate

      “My classmate from senior statistics works at Deloitte doing analyses makes 120k, and they want to pay him to do an MBA. I could have done that….”

      But you didn’t. Be a grown-up and keep your regrets to yourself.

      I’m reminded of Marlon Brando in “On The Waterfront”: “I COULDA BEEN A CONTENDER!”

      • Suzi Q 38

        My daughters room mate works for Ernst and Ernst.
        She gets far less, maybe $100K, but she works about 80 hours a week.

        Another daughter of a friend is a Stanford Grad, then USC Master’s …she is a lawyer for a firm in Newport Beach, Ca.

        Yes, she makes the “big bucks,” but she works 80 or 90 hours a week. She sometimes sleeps at the office!
        It sounds easy, but it is not.

    • Suzi Q 38

      You will find the love of your life. Just take your time.

      If you stay hospital based, I think the doctors there have it easier.
      Doesn’t the hospital pay the malpractice insurance, and all office costs? Isn’t the pay for just aout any specialist about $400K???
      The new tax laws are horrendous. 40%. That is not cool.

      Just live frugally after you make the big money once you graduate.
      Pay off all of those SL’s. Get them off of your back by making quadruple payments each month.

      Once they are paid off, you will feel so much better.

      Good luck with everything you want in life.

  • http://www.facebook.com/ryan.merriam.52 Ryan Merriam

    Other than helping limit and reduce the nuisance lawsuits most doctors face that have lead to outrageous malpractice insurance rates, which I am 100% in favor of, the rest of your arguments stem from your own lifestyle choice to breed. No one is forcing you to have kids. If you wanted to start paying off your debts earlier and/or start saving for retirement at 27 the answer is simple. Don’t procreate. All of your financial complaining boils down to your 100% elective decision to have children. Don’t get me wrong, you have every right to start a family as soon as you want. You just can’t complain about not having enough money to pay down your debt AND save for retirement because those things are, as you said, “not possible while raising 2 children.” Our leaders and lawmakers should not be spending one minute of their time working on ways to reimburse you for having kids.

    • 2Keith

      Way to misconstrue everything that he was trying to communicate and add in your personal 2-cents.

  • anonymous

    I think the non-physicians will have a better understanding of this financial predicament if an example of monthly income was given with monthly loan payments, malpractice insurance etc. I personally have a hard time seeing how, in this example, one could complain about making around 300K a year. Unless the goal was to buy ferraris, own multiple vacation homes etc., even with debt it seems one would be living a fairly comfortably.

  • Tammy

    I don’t care what the crap you all are arguing about. However, being 30 with $322,000 in debt (because no one helped me with my tuition since undergrad) and no time to make my own family or enjoy a month of vacation, it would be nice to make over $200,000/yr just so I can retired early and have some ME time before I die. But, if someone can pay off my debt for me, I don’t mind making $85,000/yr as a doctor.

    • Suzi Q 38

      Great attitude.

  • Caitlin Peebles

    Amen.

  • http://www.facebook.com/profile.php?id=819809 Varun Sharma

    Okay. There are good points to me made in this article, but am I missing something? The pompousness of this author is horribly off putting and it seems he is just more interested in tooting his own horn. And you aren’t a slave, you don’t have to work 87 hours straight as a specialist. Calling yourself “outstanding” and being able to make great medical decisions after 32 hours on call is what you say when you get into a fight with a law student who complains their hours are rough… not when trying to start a nuanced discussion. The lay public already hates doctors and is going to do so even more after this drivel. There is an important message buried in this article, but this is not the right way to spread it. And I say this as a physician

    • Mandy

      “The pompousness of this author is horribly off putting and it seems he is just more interested in tooting his own horn.”

      Yes. I was a bit embarrassed for him, but on the other hand it’s good for us citizens & consumers to know how doctors actually think. If he was trying to confirm all our worst stereotypes, he succeeded magnificently.

  • DC Lawyer

    Dr. Moeller, let me tell you as a lawyer that our lot isn’t any better, and in a lot of ways substantially worse. My brother (14 months younger) is in his second year of a radiology residency at a top hospital for that specialty. Both of us are struggling in very different ways but our commonality is our $200k+ debt.

    As for Congress, you are right. We don’t have a voice. Which is why 40% of our paycheck goes to state, local and federal taxes. While the very wealthy, most of whom didn’t earn it (but rather inherited or were staked early and had no debt) and/or work in a field that produces nothing but zero sum financial speculation pay half to a third of that in taxes, do have a voice.

  • advocate

    If you don’t want to become a doctor, don’t. Embark on a career in one of those other professions you’re eyeing-off so longingly instead.

  • http://www.facebook.com/people/Barbara-Hyman/1125251577 Barbara Hyman

    So why doesn’t anyone see the obvious? Make college education free, subsidize medical education, end medical malpractice suits and bring about a sensible treatment that takes into account the side effects of treatment and pharmaceuticals, and brings in nutritional and emotional aspects of disease. Doctors bristle at the thought of socialized medicine, but it works very well in Europe for doctors, they have wonderful lifestyles with plenty of vacation time, no insurance worries, and they’re very happy to be doctors.

    • DanielB04

      There’s no such thing as a free college education. Everyone would pay for it in the form of higher taxes.

    • JG91

      Everything should be “free”. Food, clothing, housing, college, medical care… everything FREE!

      I honestly don’t see what could go wrong.

      /

  • WhiteCoatRants

    The general animus toward physicians in these comments is scary.

    That’s OK, though. When the best and brightest students repeatedly read about the contempt that so many people have for physicians, they’ll go into some other career path that doesn’t involve so much derision, debt, and sacrifice.

    Then, when patients with complex illness have limited or no access to necessary medical care because most of the physicians have either retired or restricted their practices and the current shortfall of physicians worsens, society won’t have to worry about all the rich doctors with their six digit salaries and six digit debts – there will be fewer and fewer of them around to complain about.

    With the governmental regulatory morass, the payment cuts, the high cost of education, the cost of maintaining one’s licensing, and the growing entitlement mentality in this country, a perfect storm is brewing. Some people may consider medical care as a “right,” but when there is no one available who is properly trained and willing to provide you with that “right,” you’re SOL.

    The health of our society will incrementally worsen and by the time that the “oh no” realization is reached, it will be too late. It takes 10-12 years to educate a physician — years longer for specialists.

    I suppose that in 10 years, everyone who is still alive will be able to complain about how much money nurses, medical assistants and lab techs make, while drinking beer at a bar, eating deep fried chicken wings, and thinking nothing about watching ARod swing a bat for millions of dollar a year.

    Sad.

    • JG91

      “The general animus toward physicians in these comments is scary.”

      To be fair, physicians’ (and nurses’) general animus towards patients – as on display on any given day on any given medblog – is scary as well. If you’re a patient.

      • JG91

        “…while drinking beer at a bar, eating deep fried chicken wings…”

        Q.E.D.

      • amused bystander

        Now that doctors, nurses, EMTs and the like have started blogging, the average patient gets to see the utter contempt in which these medical practitioners hold them.

        Since the average patient is free to see how much the average medico despises them, it’s changing the game a bit.

        Once a patient reads that his doctors and nurses have spent a freaky amount of time ridiculing the size of their penis or their cottage-cheese thighs, once they’re safely under general anaesthesia and totally helpless and can therefore no longer object, and then it’s written up on a blog so that thousands more medicos can join in the point-and-laugh session, it’s pretty much game over as far as the “respect thy doctor” thing goes.

        You hate us; why shouldn’t we hate you?

    • http://twitter.com/aztezcan Ayse Tezcan

      you probably have not noticed the one’s including the author of this write towards lawyers and law makers.

  • buzzkillerjsmith

    Please see the link that Dr. M posted.

  • http://twitter.com/aztezcan Ayse Tezcan

    being a medical family, i understand where you are coming from and feel your pain, but i would also add that there are many professions that require similar amount of demands and personal sacrifices with much much less financial gain (even after aca) and appreciation (most do their work behind the scenes with no recognition). additionally, there are many physicians, who really don’t understand all of the additional disciplines you cited. hence, they seem to keep talking amongst themselves and missing the big picture. one of the commentators below, Kanani Titchen, made great points and has a positive outlook. you cannot properly appreciate some of the values such as respect and trust (definitely >>>>> a lawyer) and admiration by your children you gain by becoming a physician when just adding the $$$s. when you are doing a cost/benefit analysis, you should also factor these externalities into your equation. you should also incorporate the overall effect of confidence gained by accomplishing something so grueling and intellectual stimulation resulting from life-long learning into your calculations as healthy years gained.
    one of the missing elements of medical training is economics. when economies begin to change, the physicians panic and make rushed decisions – not necessarily bad ones. but there is no area of work that everything remains as status quo. when we make investments, we make them to collect benefits in the long distance. just as any investment, if you make the financial aspects of the medicine main profit, there will be disappointments. and yes, some part of that investment may go bad as any, but i believe the medice has more rewarding profits to collect than many other profession.

  • Skippermd

    To all of the attorneys and other professionals who are quick to criticize the author for “whining” and compare medicine to your profession, you have missed the point of the article. Unlike medicine, the government does not control what you can charge for services or who you render those services to. Let’s see how you feel when the government mandates that you practice as a public defender for x% of your time, and caps what you can charge per hour. Then we can have a meaningful discussion, as you will have a full grasp on the issues at hand.

    • JG91

      If the government were footing the bill for lawyers, then yes, they’d have to accept the government setting the rules.

      • Skippermd

        I accept that logic. So, lets follow your hypothetical reasoning path… In your scenario, what do you think about all the attorneys who had been practicing in private practice who would now be forced to accept x% of clients (or whomever walks through the door regardless of his/her ability to pay, as physicians are in accordance with EMTALA)? Do these attorneys not have a basis to be upset about how their practice and income will change? Do the huge corporate firms not have grounds to try to fight the regulation and address their “lawmakers?” This is at the heart of the frustration for most physicians with the ACA and part of what the author is trying to articulate (albeit I dont think he explicitly states these issues). Many physicians will be forced to accept more patients who cannot pay or who have been transitioned from private insurance to medicaid which pays a fraction of their previous reimbursement with absolutely no control over their practice anymore.

        • http://twitter.com/aztezcan Ayse Tezcan

          my husband is an oncologist and i am an epidemiologist; there is no such force on physicians to accept more patients than they can see and they are free to open practices outside the system and charge their patients whatever they want. the problem is competition with hmo-like organizations fierce to survive unless you have something unique to offer – which is by the way the case currently in california even without the aca. uncertain physicians are now forming unions with hospitals to prepare for perceived damages from aca – biggest winners from this uninformed panic will be hospitals! I don’t have any objections towards hospital or hmo practices: better hours and life style but less pay. however, please don’t make blanket assertions that are not accurate; this is a choice not requirement – no risk, no benefit.

          • Skippermd

            Well, I suggest you do your research in the state you are licensed, as there has been legislation introduced in some states to make accepting medicare/medicaid/tricare a condition of licensure. In addition, any reimbursement from insured patients is based upon the medicare reimbursement schedule, which is set by the government. Furthermore, maybe as an epidemiologist you don’t get may “emergency cases” but there IS a requirement to see anyone who walks in the door in the emergency room thanks to emtala regardless of the patient’s ability to pay. So, thanks for your thoughts but I disagree with your assessment.

          • JG91

            “there has been legislation introduced in some states to make accepting medicare/medicaid/tricare a condition of licensure.”

            That sucks. My doctor is a member of a direct-pay practice, and he’d probably quit if that were the case. He has nothing against the poor or against the military (I know for a fact he sees some military families and retired vets at *very* discounted rates); he just hates paperwork and government bureaucracy.

            You’re right, if the government can do that to doctors they could conceivably do it to a lot of professions.

          • http://twitter.com/aztezcan Ayse Tezcan

            you are arguing a completely different point than what seems from your initial statement. as i said, choice is yours: you can open a practice to completely free of insurance payments; no one is preventing you from doing that. this may not represent your particular situation if you are are owning and emergency room practice (? as far as i know most er physicians work in a hospital-based setting), but it is an option. you were making it sound like everyone is obligated to see anyone comes to their door. i am not familiar with any state that made accepting medicare/medicaid/tricare a condition of licensure. license to practice medicine? for every specialty and any setting? what are those states? i highly doubt a blanket law such as this would pass.

          • Skippermd

            Clearly from your reply and the information I can gather from your comments you are not a clinical physician (likely an academia-world PhD) and have no real grasp on the situation. So, your opinions are yours but once again, try telling an emergency room physician that they do not have to see everyone who walks through the door and you will have an enlightening conversation on your hands. The legislation I mentioned has been proposed in some states– I correctly stated that it has been proposed, not that it has been passed. So, carry on with your academic career and leave the opining on issues relevant to clinical practice to those on the front lines please. thanks.

    • matt19799

      Right on. This article was not meant to criticize lawyers. It was meant to point out that in order for doctors to continue to have their practices open to all patients, we need government, specifically, the sustainable growth rate formula, to be fixed, so that doctors can set budgets to provide the best care. Lawyers do not have this problem of “set or fixed rates”, but doctors do. We will get reimbursed the same for an office visit from Medicare ( assuming the location is the same) no matter what. We cannot charge more unless we start doing concierge medicine. We have to rely on government rates (ie Medicare) because private insurers follow Medicare rates. If Medicare cuts rates 26% (which has been proposed), doctors will see a 26% reduction in their reimbursement for a procedure or office visit or hospital visit. Asking if we think government should run health care is a whole other discussion not meant for this article.

    • http://www.facebook.com/kara.e.kerr Kara Elaine Kerr

      As an attorney, I do fully grasp this author’s position. there is a lot of bitterness from so many. Attaining a dream only to discover that it is a nightmare of debt and poverty. Attorneys are capped at what they can charge too, but also most newly hired are being offered salaries around $35K with around the same debt as doctors. There may be a few practitioners/ doctors or lawyers out there whose parents financed their education…but I have not seen too many. Most of us now appear to be from middle class…I myself came from a family in the upper end of the lower class. My family was so proud of my “achievment.” I feel more like I was played the fool. I had no idea what I was really getting myself into. There was no discussion on actual salaries that would be offered nor the montly payments that I would need to make. Indentured servants indeed! We shouldn’t be fighting amongst each other. We should be standing together and demanding relief!

  • Sergey

    The main problem is two fold:

    1. The education is exorbitantly expensive. If someone can explain why learning Newtonian mechanics costs $800 per class plus $120 for the book?! The government needs to step in and fix the education.

    2. The doctors are not allowed to focus on being just doctors. It’s also all about covering up from the lawsuit. If the education would focus only on what is required to learn to be a doctor, the path can be shorter.

    • JG91

      “The government needs to step in…”

      Whatever the problem is, “more government intervention” is never the answer.

      • Sergey

        Well, the government is already knee deep in the system.
        The government is injected into educational system, the government is injected in the licensing system.
        If the government would not establish this “beautiful” educational loans system, the educators and publishers would be forced to find more affordable solution to fit the market.
        So the government needs to step back, stop protecting industry red tape and motivate the industry to innovate and streamline.

        • JG91

          Yes, I agree. I just finished reading a book called “The Higher Education Bubble” and one of the lines the author uses sticks in my head: “Something that can’t go on forever, won’t.” At some point we’ll get back to sanity, but I don’t doubt we’ll have an ugly time of it for a while.

          • Sergey

            Question is, how many good doctors need to burn out trying to cover bubbled student loans and how many people need to die because of burned out doctors and messed up medical system….

          • JG91

            No idea. It’s hard to see any elegant way out of this mess. Mass forgiveness of student debt (which tipped $1 trillion a year ago this month; no idea what it is now) would make the subprime mortgage fiasco look like a church picnic – it would crash the economy worse than it did in ’07. But for a basically broke country with near 10% real unemployment to use taxpayer dollars to keep propping up high doctors’ salaries (yes, they are high by historical and world standards) so that they can afford to pay off their inflated student loans doesn’t sound very “sustainable” either.

            And then there’s the big question of how Obamacare is going to change the landscape – is that something that’s going to make practicing medicine more, or less, attractive to young people? I don’t have any answers.

          • Sergey

            $1 trillion is what laundered to military contractors every year by the government. If half of this amount would go to resolving student debt gridlock, we would probably be in better place.

  • http://www.facebook.com/sean.shepard1 Sean Shepard

    As an undergraduate student who is constantly hearing that there will be a shortage of doctors pretty soon (if not already) and many medical students are going into specialty fields rather than primary care, I begin to wonder why haven’t they restructured the medical education system. I do not mean lower the standards by which to get into medical school, instead why not take experienced Physician Assistants and/or Nurse Practitioners who have a certain amount of experience in primary care (say 5 years or more), and have them take a test similar to the MCAT to try to gain acceptance into medical school. That way if they gain acceptance they go through the four years and receive there MD or DO. Then rather than them go through the grueling residency, they can start practicing Primary Care right away since they have had so many years being a PA or NP in primary care. Just a thought, of course I feel I will be getting backlash from this saying being a PA or NP is not the same as residency, but I see this as the best alternative to the ever dwindling amount of primary care physicians.

  • http://nototherwise.com/ Jessica Brookman @ N*O

    And this is why i dropped out of med school.

    • Guest

      Why, because all your classmates were over-entitled whining pricks with huge egos ? Ya, that’d get to me after a while too.

      • http://nototherwise.com/ Jessica Brookman @ N*O

        Partly. Doesn’t make sense to take out debt for that…

  • Love_My_Country

    AMEN!!! I am $335,000 in the hole. Indentured servant for life.

    • JG91

      If you took out a loan that’s going to take you your entire life to repay, that’s not anyone’s fault but yours.

      • http://twitter.com/ScutariusMedico Scutarius_Medico

        No one forced me to take out my loans, true and no one forced you to respond to my statement either. I am a MD/MBA student whose parents both lost their jobs,homes and cars. I could of dropped out not paid my loans, and been a burden to my country or I could be a burden onto myself, which is more noble? why does our congress bail on paying for EHR when they request it. why does the private model of medicine have opinions from non-medical staff. The increase in administrator fees in colleges and hospitals has led to overspending and poor outcomes for students and patients respectively. A more proper tone from you would be warranted as well.

        • Suzi Q 38

          Sorry for h/her rudeness. Not all of us think that way.
          Keep up the good work.
          Just don’t be a cliche and make the big money and spend it all because you are sick of being “poor.”
          After school is over, get that big paying job, ignore the huge number that you see on the paycheck, and continue to live frugally. Pay off your loans by focusing on quadrupling the payment every month.
          If you do this, maybe you can pay it off a lot sooner, with a lot less interest. Once you are free of this enormous debt,
          enjoy your life! It will take you 5 years or less if you focus.

          Just live modestly after you graduate in a small house or condo, and you can do it!
          Drive a modest car, preferably used.

    • Suzi Q 38

      You will be able to pay that off, if you are careful after landing your first big job.
      The problem with a lot of doctors is that they look at that huge paycheck and go out and buy a big house and an expensive status car.
      Such a cliche.
      Now they have difficulty paying off the student loans.

      You need to continue to live frugally after you graduate until those loans are paid off completely. Maybe “throw down” $10K a month on them and live in a small house with a modest mortgage.

      You could be done in 3-4 years.

      After they are paid off, you will be “living” well.

  • http://www.facebook.com/benjamin.wyatt.184 Benjamin Wyatt

    The problem with this article is that unless you tell people your salary there is zero context in which to evaluate is financial sacrifice in which you largely base your article on. If you make 500K per year then don’t expect a lot of sympathy for your 200K of debt (with or without a family).

    The age 30 issue and being 230K in debt is misleading because you know full well that you are actively working toward a much much higher salary and that said debt is only a temporary situation.

    As far as hours go, I am sorry that you need to stay awake (and somehow function at your high level) for 32 hours straight. However, that’s an internal problem. The medical system itself should find a way to not keep their staff working for 32 hours straight.

    I’m not at all arguing that doctors need to have their proverbial wings clipped in terms of salary. However, I am not sure this article is providing a very accurate picture either.

  • Solitaire28

    I appreciate this piece for the attention it gives to the high amount of debt that professional students are accumulating as they pursue their dreams. However, I am disappointed with the inarticulate attack on ‘lawyers’ and ‘lawmakers’ as a class. I am a joint degree law and masters in public health student at a large and well respected university, away from my home state of Michigan. The price tag on my four year post graduate education is $230,000, not including undergraduate costs. Thank goodness I have received a significant scholarship and am pursuing ways to get in state tuition, otherwise my education would be unaffordable. However, I will still leave school with over $100,000 in debt and the prospect of a weakened job market. Yes, this was my choice and I fully accept the consequences, just as my close friends in medical school have. What makes me different from the type of ‘lawyers’ loosely mentioned in this article is that I love the healthcare field. I am not trying to rob physicians of their money, time or energy in the form of relentless malpractice suits, or impractical legislation. Rather, I am the law student who is hoping to some day defend physicians against the attacks that are coming from some of my ‘colleagues’ in the legal profession. I truly believe that physicians and lawyers/lawmakers can engage in a conversation that is centered on what is best for patients without disrespecting either the profession of law or medicine. There are many lawyers who work in fields where they live by billable hours. However, there are many other students, myself included, who are hoping to enter healthcare public interest fields where the average salary is $45,000 a year – less than what I am paying to attend school. It is quite discouraging to hear the term ‘lawyer’ bandied about as if all lawyers are enemies of physicians. There are many of us who recognize the problems that physicians face and are pursuing ways to make those changes on behalf of the healthcare field as well as the realm of professional education in general. There are many of us who are facing the same debt load as physicians, but will be facing the equivalent of a medical resident’s salary for the rest of our lives if we pursue our dreams in the health care policy field. Please do not paint with too broad of a brush when doling out criticism.

  • http://twitter.com/aztezcan Ayse Tezcan

    seriously! some of the reasons why people discourage their children going into medicine do not make sense. instead of discouraging, why would you not educate them to make informed decisions? maybe then they will complain less about the consequences of their convictions. some of the commentator physicians here have the right on spot attitude for their chosen profession and don’t feel like victimized.

  • http://www.facebook.com/people/Tim-Anderson/800759414 Tim Anderson

    The AMA is a HUGE voice on Capitol Hill…I worked outside as part of my job for 12 hours on a 95 degree day last summer. I’m self employed. The idea that you work in an air conditioned office, for maybe 8 hours a day, means your smarts are being rewarded. You’re working an 87 hour week? NO ONE I KNOW and I know several doctors an OB/GYN, a cardiologist and my own physician works those hours. The only time you have to work those hours are when you’re on residency right?

    • anomalouserudite

      The AMA may be a “huge voice” on Capitol Hill, but it is not a huge voice for physicians, with only somewhere around 17% of all doctors being members–and even that small number diminishing in recent years/months. The AMA has not been a voice for physicians for years.

  • anomalouserudite

    This is the most balanced article I have read on KevinMD. Thank you for sharing. I long for the day Physicians have true representation on Capitol Hill.

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      I agree. His levels of confidence and self-awareness endeared me from the start: “My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician.” No nauseation there.

      • anomalouserudite

        You’re trolling this thread hard for a fight, guy. The statement you quoted was so innocuous, that you even latched onto it to try to discredit the author by it reveals how desperately you’re creeping this thread looking to bait someone. A quick look at all your comments on this thread, as with those on another article by the same author, leads me to believe you have it out for Dr. Moeller.

        • http://www.facebook.com/jared.jameson.10 Jared Jameson

          Not at all. I don’t know him from Adam. His attempt at framing an argument in the way he has, however, is all to easy topple. His letter’s intent is to frame his politics by using his personal finances – with exaggeration, I might add – to make a plea. It’s nauseating and disingenuous, and he’s being roasted among the doctor circles I frequent.

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      You think they don’t have true representation? Go research Atul Gawande. His reporting and writing for The New Yorker supplied a lot of basis for the healthcare reform act.

  • al eyen

    As a 4th year medical student about to start residency July 2013, I will say there is a large flaw in the medical system for several reasons. Currently Obamacare is setting up private insurance to take the fall much sooner than later and this is going to make a big difference in medicine. It will go something like this in the next few years:
    #1- Insurance costs are rising at exponential rates
    #2- Next year insurance companies can not refuse coverage for existing conditions and can NOT discriminate on rates between a healthy person and a person with say heart failure.

    #2 in practice with numbers is interesting. Say a 35 year old healthy man wants insurance his cost before obamacare was cheap maybe 50-100$ a month but after obamacare every man or woman with with a long line of medical problems joins our 35 y/o healthy male’s insurance company. Now he will have their cost spread to him. Now he will pay 300-400$ a month with higher co-payments and less coverage. SOMEONE must pay for those with pre-existing conditions and the healthy will put much more in than they take out. Which leads to the following

    This will lead to a shift in healthy people that have private insurance for a few reasons:
    (A) As people with pre-existing conditions pile onto insurance, the cost of insurance will rise quickly.
    (B) This will make healthy people AND Businesses have no choice but to drop insurance and pay the “tax” or “fine” for not having insurance. (This “tax or “fine” is much cheaper than insurance premiums even now much less in the near future.) This exodus from private insurance by the healthy will be driven by many “sick” people that enroll into private insurance. They of course will use the insurance quite often will drive up the rates exponentially higher still.
    (C) Eventually private insurance will be a “club” or “group” for the sick or medically needed when in 2-3 years from now the rates are in the 1000$ a month range for coverage. This is due to having many many sick people that would have been excluded now generating large hospital bills and fewer and fewer ‘healthy” people to spread this large new cost over. (Insurance companies have to also make a profit as well)
    *****(D)***** Most healthy people will now not have insurance due to its cost. But if they have problems arise or become sick they can always just jump onto the bandwagon of insurance because they can not be refused. Why pay for others now when you can just wait until you need the coverage?

    ***&***Main Point***%***

    The above goes into detail as why the private insurance model will fail. They will become clubs for the sick and healthy people will not be able to afford them and would be ill adivsed to carry private insurance much after no one can be excluded for pre-existing conditions without price discrimination. This will bring about the government to do what it wanted to in the inception of Obamacare. THE SINGLE PAYER SYSTEM!

    Our medicine will become totally “socialized.” A new tax will probably me made and everyone will have free health care if you are a citizen (and heck even if you are not a citizen.)

    ********** Doctors will become civil servants just like police, fight-fighters, teachers, librarians, etc. Doctors will be government employees with a set, fixed salary like the above. I hate to say this but if you read the Obamacare law and look at how private insurance companies are doomed to fail then what happens after they do? The government loves to take ever opportunity to take control of a system and this will be their way into medicine for good.

    • JG91

      “I hate to say this but if you read the Obamacare law and look at how private insurance companies are doomed to fail then what happens after they do?”

      The motto “never let a crisis go to waste” comes to mind.

      Your assessment is depressing but probably accurate.

      • http://www.facebook.com/jared.jameson.10 Jared Jameson

        Private insurance is not going fail. Neither are hospitals. Are they going to struggle for a few years as they tighten their belts with lost payouts? Yes, but guess what? Eventually, the goal is to get hospitals/providers and insurance companies to quit gaming each other on their fees and costs. THAT, in the end, will drive patient cost down.

  • phd student from MIT

    Well, I think you are too stuck in your own world, and you think you are going to become a victim, the reality is that you get paid really really well, and you have job security. Doctors are paid too much in America, that is a fact. On top of that, most of them get perks from pharma companies, really really amazing perks. I know this because I attend the BIO conference each year and I can see how the AMA and doctors get huge loads of money from pharma to keep the system rolling.

    Try this: I studies physics for 4 years, top of my class, then got a masters of chemical engineering for 2 years, also top of my class, then moved to MIT for a year of research, followed by 6 years of PhD, now I am 31, have to do another 3 years of post doctoral work before I can land a faculty job, thats 34 years old, hoping to get a job at that pays 90k (if you get into top 10 schools). There are a total of 15 openings for these jobs in all of the US, all of the country!! And do you know how many PhD’s there are? Many times more than doctors.
    Then assuming I land that golden faculty job, I have to work for 5 years before I get a tenure, thats 39 years old before I know for sure I have a secure job. During this time, I have to work around the clock to raise money from the NIH at 8% success rate on grants. Thats 8 grants for every 100 grants I write, averaging 20 pages each. And I am supposed to teach 3 classes and supervise research of students, and keep an high profile research agenda, and attend conferences and faculty meetings, its a 24 hour job.
    I also have debt from my studies in undergrad, and I got paid $26k during my PhD, and $36k during my post doc. And on top of that, I actually design drugs that help millions of people at once, doctor’s don’t even know how most drugs function, they just memorize their use, you can’t design a new drug even if you life depended on it. So I do something that actually cures people, and I get paid shit for it.

    And don’t tell me I can start a company and make millions, its totally false. The cost of pharma development is so high, that with dilution of your company by investors, by the time you make it into the market, you are lucky if you end up with 2% share of the company you started, if you sell the company for $100million at beginning of phase II (typical number), you end up with 2 million dollars. It takes 7 years to get to this point, 2million/7 years = shit pay. And this is all assuming your company’s drug does not fail!

    And I was also the top of my class, I went to MIT. One other thing to keep in mind, I had admission to Harvard medical school. But I didn’t go, do you know why? Because I don’t want to profit from other people’s misery. When someone has cancer, I think it is a sin to charge them $90k for anti-cancer drugs. So I went to MIT to learn how to develop new drugs, and guess what, because of the blood-sucking AMA and doctors, the FDA which you support, it is so costly to make new drugs that I find it impossible to pass new drugs through FDA these days.

    I have to work like a monkey until I am 39 before I know I have a job for life as an academic, I see this as the only way I can support myself and find new drugs that other people can commercialize to one day save millions of people from illnesses.

    Now think about this and come back here and complain about you life, which by the way was “planned” for you from the beginning. All you medical education you slept tight at night knowing you are working towards a secure well paying job, while other people who studied just as hard and are even better at sciences have to worry each and every night about job security. I say suck it up and take your salary and keep your mouth shut, you are too overpaid to complain.

    • anonymous

      amazing. I’m a phd student in medical physiology and have no idea why people making 6 figures (even after deducting insurance/loan payments) are complaining.

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      Big Pharma is a big part of the problem. That industry is yesterday’s cigarette/tobacco industry. Seriously.

  • http://www.facebook.com/suzanne.cavilia Suzanne Cavilia

    my my you poor dear…

  • phd student from MIT

    Well, I think
    you are too stuck in your own world, and you think you are going to
    become a victim, the reality is that you get paid really really well,
    and you have job security. Doctors are paid too much in America, that is
    a fact. On top of that, most of them get perks from pharma companies,
    really really amazing perks. I know this because I attend the BIO
    conference each year and I can see how the AMA and doctors get huge
    loads of money from pharma to keep the system rolling.

    Try this: I studies physics for 4 years, top of my class, then got a
    masters of chemical engineering for 2 years, also top of my class, then
    moved to MIT for a year of research, followed by 6 years of PhD, now I
    am 31, have to do another 3 years of post doctoral work before I can
    land a faculty job, thats 34 years old, hoping to get a job at that pays
    90k (if you get into top 10 schools). There are a total of 15 openings
    for these jobs in all of the US, all of the country!! And do you know
    how many PhD’s there are? Many times more than doctors.
    Then assuming
    I land that golden faculty job, I have to work for 5 years before I get
    a tenure, thats 39 years old before I know for sure I have a secure
    job. During this time, I have to work around the clock to raise money
    from the NIH at 8% success rate on grants. Thats 8 grants for every 100
    grants I write, averaging 20 pages each. And I am supposed to teach 3
    classes and supervise research of students, and keep an high profile
    research agenda, and attend conferences and faculty meetings, its a 24
    hour job.
    I also have debt from my studies in undergrad, and I got
    paid $26k during my PhD, and $36k during my post doc. And on top of
    that, I actually design drugs that help millions of people at once,
    doctor’s don’t even know how most drugs function, they just memorize
    their use, you can’t design a new drug even if you life depended on it.
    So I do something that actually cures people, and I get paid shit for
    it.

    And don’t tell me I can start a company and make millions, its
    totally false. The cost of pharma development is so high, that with
    dilution of your company by investors, by the time you make it into the
    market, you are lucky if you end up with 2% share of the company you
    started, if you sell the company for $100million at beginning of phase
    II (typical number), you end up with 2 million dollars. It takes 7 years
    to get to this point, 2million/7 years = shit pay. And this is all
    assuming your company’s drug does not fail!

    And I was also the top of my class, I went to MIT. One other thing to
    keep in mind, I had admission to Harvard medical school. But I didn’t
    go, do you know why? Because I don’t want to profit from other people’s
    misery. When someone has cancer, I think it is a sin to charge them $90k
    for anti-cancer drugs. So I went to MIT to learn how to develop new
    drugs, and guess what, because of the blood-sucking AMA and doctors, the
    FDA which you support, it is so costly to make new drugs that I find it
    impossible to pass new drugs through FDA these days.

    I have to work like a monkey until I am 39 before I know I have a job
    for life as an academic, I see this as the only way I can support
    myself and find new drugs that other people can commercialize to one day
    save millions of people from illnesses.

    Now think about this and come back here and complain about you life,
    which by the way was “planned” for you from the beginning. All you
    medical education you slept tight at night knowing you are working
    towards a secure well paying job, while other people who studied just as
    hard and are even better at sciences have to worry each and every night
    about job security. I say suck it up and take your salary and keep your
    mouth shut, you are too overpaid to complain.

  • phd student from MIT

    Well, I think
    you are too stuck in your own world, and you think you are going to
    become a victim, the reality is that you get paid really really well,
    and you have job security. Doctors are paid too much in America, that is
    a fact. On top of that, most of them get perks from pharma companies,
    really really amazing perks. I know this because I attend the BIO
    conference each year and I can see how the AMA and doctors get huge
    loads of money from pharma to keep the system rolling.

    Try this: I studies physics for 4 years, top of my class, then got a
    masters of chemical engineering for 2 years, also top of my class, then
    moved to MIT for a year of research, followed by 6 years of PhD, now I
    am 31, have to do another 3 years of post doctoral work before I can
    land a faculty job, thats 34 years old, hoping to get a job at that pays
    90k (if you get into top 10 schools). There are a total of 15 openings
    for these jobs in all of the US, all of the country!! And do you know
    how many PhD’s there are? Many times more than doctors.
    Then assuming
    I land that golden faculty job, I have to work for 5 years before I get
    a tenure, thats 39 years old before I know for sure I have a secure
    job. During this time, I have to work around the clock to raise money
    from the NIH at 8% success rate on grants. Thats 8 grants for every 100
    grants I write, averaging 20 pages each. And I am supposed to teach 3
    classes and supervise research of students, and keep an high profile
    research agenda, and attend conferences and faculty meetings, its a 24
    hour job.
    I also have debt from my studies in undergrad, and I got
    paid $26k during my PhD, and $36k during my post doc. And on top of
    that, I actually design drugs that help millions of people at once,
    doctor’s don’t even know how most drugs function, they just memorize
    their use, you can’t design a new drug even if you life depended on it.
    So I do something that actually cures people, and I get paid shit for
    it.

    And don’t tell me I can start a company and make millions, its
    totally false. The cost of pharma development is so high, that with
    dilution of your company by investors, by the time you make it into the
    market, you are lucky if you end up with 2% share of the company you
    started, if you sell the company for $100million at beginning of phase
    II (typical number), you end up with 2 million dollars. It takes 7 years
    to get to this point, 2million/7 years = shit pay. And this is all
    assuming your company’s drug does not fail!

    And I was also the top of my class, I went to MIT. One other thing to
    keep in mind, I had admission to Harvard medical school. But I didn’t
    go, do you know why? Because I don’t want to profit from other people’s
    misery. When someone has cancer, I think it is a sin to charge them $90k
    for anti-cancer drugs. So I went to MIT to learn how to develop new
    drugs, and guess what, because of the blood-sucking AMA and doctors, the
    FDA which you support, it is so costly to make new drugs that I find it
    impossible to pass new drugs through FDA these days.

    I have to work like a monkey until I am 39 before I know I have a job
    for life as an academic, I see this as the only way I can support
    myself and find new drugs that other people can commercialize to one day
    save millions of people from illnesses.

    Now think about this and come back here and complain about you life,
    which by the way was “planned” for you from the beginning. All you
    medical education you slept tight at night knowing you are working
    towards a secure well paying job, while other people who studied just as
    hard and are even better at sciences have to worry each and every night
    about job security. I say suck it up and take your salary and keep your
    mouth shut, you are too overpaid to complain.

  • phd student from MIT

    Well, I think you are too stuck in your own world, and you think you are
    going to become a victim, the reality is that you get paid really really well,
    and you have job security. Doctors are paid too much in America, that is a
    fact. On top of that, most of them get perks from pharma companies, really
    really amazing perks. I know this because I attend the BIO conference each year
    and I can see how the AMA and doctors get huge loads of money from pharma to
    keep the system rolling.

    Try this: I studies physics for 4 years, top of my class, then got a masters
    of chemical engineering for 2 years, also top of my class, then moved to MIT
    for a year of research, followed by 6 years of PhD, now I am 31, have to do
    another 3 years of post doctoral work before I can land a faculty job, thats 34
    years old, hoping to get a job at that pays 90k (if you get into top 10
    schools). There are a total of 15 openings for these jobs in all of the US, all
    of the country!! And do you know how many PhD’s there are? Many times more than
    doctors.

    Then assuming I land that golden faculty job, I have to work for 5 years before
    I get a tenure, thats 39 years old before I know for sure I have a secure job.
    During this time, I have to work around the clock to raise money from the NIH
    at 8% success rate on grants. Thats 8 grants for every 100 grants I write,
    averaging 20 pages each. And I am supposed to teach 3 classes and supervise
    research of students, and keep an high profile research agenda, and attend
    conferences and faculty meetings, its a 24 hour job.

    I also have debt from my studies in undergrad, and I got paid $26k during my
    PhD, and $36k during my post doc. And on top of that, I actually design drugs
    that help millions of people at once, doctor’s don’t even know how most drugs
    function, they just memorize their use, you can’t design a new drug even if you
    life depended on it. So I do something that actually cures people, and I get
    paid shit for it.

    And don’t tell me I can start a company and make millions, its totally
    false. The cost of pharma development is so high, that with dilution of your
    company by investors, by the time you make it into the market, you are lucky if
    you end up with 2% share of the company you started, if you sell the company
    for $100million at beginning of phase II (typical number), you end up with 2
    million dollars. It takes 7 years to get to this point, 2million/7 years = shit
    pay. And this is all assuming your company’s drug does not fail!

    And I was also the top of my class, I went to MIT. One other thing to keep
    in mind, I had admission to Harvard medical school. But I didn’t go, do you
    know why? Because I don’t want to profit from other people’s misery. When
    someone has cancer, I think it is a sin to charge them $90k for anti-cancer drugs.
    So I went to MIT to learn how to develop new drugs, and guess what, because of
    the AMA and doctors, the FDA which you support, it is so costly to make new
    drugs that I find it impossible to pass new drugs through FDA these days.

    I have to work like a monkey until I am 39 before I know I have a job for
    life as an academic, I see this as the only way I can support myself and find
    new drugs that other people can commercialize to one day save millions of
    people from illnesses.

    Now think about this and come back here and complain about you life, which
    by the way was “planned” for you from the beginning. All you medical
    education you slept tight at night knowing you are working towards a secure
    well paying job, while other people who studied just as hard and are even
    better at sciences have to worry each and every night about job security.

  • http://www.facebook.com/kara.e.kerr Kara Elaine Kerr

    HR 4170 Student Loan Forgiveness Act: I am hoping this bill is still viable. Started by MI Rep Hanson Clark…all of us…doctors, lawyers, nurses, teachers, all of us who have educated ourselves only to find out that the actual salaries we will make will barely allow us to scrape by after paying the monthly student loan cost (which principal never seems to go down) All of us should call our legislators and make this an issue…we should be calling our attorney generals office of consumer protection and telling them we demand protection; we are the educated poor…they should listen to us as we are possible the scariest creation of untapped power and potential. Doctors, Lawyers, educators, law enforcement…we ARE society. I am an attorney…I hear this story and while it is a different profession…the story is mine too and so many of us…why should we allow ourselves…our children to be treated like indentured servants? There were bailouts for banks, big business, homeowners…but no relief for the people who hold this nation together by their skills and fortitude? We should simplify it for our “leaders” drop the debt or no re-election. Debt forgiveness = election. Sometimes…just sometime being a one issue voter is in your best interest and in the best interest of your community

    • Mandy

      Y’all took out loans for your own benefit, which you now don’t feel like repaying, so you’re demanding that your more fiscally responsible friends and neighbors and even complete strangers who DIDN’T take out such huge loans repay them FOR you?

      Oh FFS.

  • WZ

    Simply WOW!

  • Glenna McKinley

    I just wrote a message, I think Doctors are Saints and could never overcharge. I remember when office calls were $3.00 and that is before insurance butted in…………

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      Insurance butts in, and then hospitals and doctors butt back, and now it’s a vicious billing cycle. THAT is the problem with our healthcare cost crisis. Why does an MRI cost significantly more – or less – at a hospital located 10 miles away from another, for example? And, when the hospital sets rates for its fiscal year based partly on losses/gaps not provided from full insurance or gov’t refunds, guess what? The hospital not only increases the rate for that procedure, within x amount of time, it starts to profit off that rate and never lowers it again. The insurance companies, knowing this, resist hard. It’s a vicious cycle.

  • Jonboy

    This is ridiculous. All we need is more people in the top 1% to squabble about financial issues and not being appreciated enough. And the hubris? Really? Yo Matt -”outstanding” physicians shouldn’t have to label themselves as such. By the way, you cannot take care of every medical issue. By and large we’re all specialists. But I digress….You know Matthew I get it. Medical debt blows. The healthcare system is broken. Politicians are idiots. But instead of having a constructive debate on the real issues (ie, broken healthcare system, insurance, incentives, etc), how they affect the most vulnerable (ie, our patients), and what lawmakers can do to support us (so that we can better help the public), the hubris and “it’s about me” attitude you display are saddening. I’m currently at one of the very top medical schools and hospitals in the northeast, and I cringe when my colleagues talk about money. Have a little perspective – perhaps you’re not aware that the unemployment rate is still high, the gap between rich and poor is growing, and our healthcare system is flat out broken. Entering the medical field was and is still an honor for me. I feel like the luckiest man alive. I have debt. Training is long as hell. But everyday I see those much more vulnerable than me and the position I’m in to alleviate that is worth more than any interest rate. I thank you for informing the greater public of some of the real issues we face as we go through the process. But don’t describe a pit party for us. Busting your ass studying was a choice you voluntarily made. And by the way, law students have it way worse than us.

    • Mandy

      “And the hubris? Really? Yo Matt -”outstanding” physicians shouldn’t have to label themselves as such.”

      Yes, that was more than a little embarrassing.

      The rest of your comment shows a remarkable perspicacity and awareness, and I’m glad you took the time to have your say.

      I have luckily been very healthy so far and not needed much medical care, but should that ever change I hope I end up with a Jonboy doctor rather than a Matt doctor. No matter how “OUTSTANDING!!!!” he may judge himself to be.

  • Miss M

    Wow, you are quite modest, aren’t you?

    “My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician…”

    Who says that about themselves? Anyone who talks so highly of themselves in the first paragraph give us a warning that there’s some self entitlement issue in the following, immediately.

    -It was your choice to have two kids at age 30, there’s something called contraception, you know doc? Most professionals I know wait until they are financially stabled before having kids. Please don’t use your kids as an excuse, it was simply your choice.

    -I’m pretty sure via salary survey sites, you make at least 300k to 350k a year. Do I need to remind you that most Americans who happen to be your patients (probably) make an average salary, if they are lucky, no more than 60k a year.

    -If you want to see poverty, do yourself a favor, drive down to the closest town that you would consider as “dumpy”, and I’m sure you will stop complaining.

    Please stop whining and be more appreciative. You ain’t poor, period!

  • Miss M

    A couple more things, you know who are the people that are underpaid?

    Cooks, construction workers, maids, bus drivers, and other manual/hard laborers. Those professions are underpaid, doc. You are not! You should feel lucky that you are getting paid 300k to 350k, and not 35k.

    And if you want to compare only to people who have to spend many years studying – consider the plight of many recent PhD graduates. They rack up big debts too as they seek to expand the realm of human knowledge – arguably a much more impactful activity for humanity than helping a few sick people – but they don’t finish their studies and walk into one of the highest paid professions there is.

  • Professional Defense

    Go to law school, come out with little debt, work short hours, and make the big bucks…chill out, buddy

  • http://www.facebook.com/PathologyMax Brett Snodgrass

    Healthcare spending could be reduced if medical schools were provided supplmental funding by the government. Cut 50 billion from graduate medical education and use it to run medical schools. This will decrease the number and amount of student loans. When a medical student pays 200,000 to go to school, then spends three to ten years in residencies and fellowships, a siginifcant amount of interest accrues. Solution is simple, transfer some of the funding of graduate medical education to medical schools. Do not pay physicians more because of the high price of medical education. Reduce the cost of medical education and need for subsequent spending will be drastically reduced.

    • http://www.facebook.com/PathologyMax Brett Snodgrass

      When I was an intern in North Carolina I worked with physicians who recognized that they were privileged to be in their position and they gave back to the community. In fact, every person in the department contributed to one if not several local charities. They gave back significantly to the community and they did not try to make people feel sorry for them.

  • http://www.facebook.com/profile.php?id=165401649 Justin Palu

    As a new attorney, I appreciate and understand the stress of training, both mental and financial, that is caused by trying to achieve. That being said, this article is way off-base when it comes to the discussion of attorneys. We share many, if not all, of the same burdens. I help people with terrible situations-divorce, death in the family, job loss-on a daily basis. I don’t get paid a dime unless I am successful, and even then I do everything possible to ensure my clients receive as much as possible, to my own loss. While I appreciate the idea of the article, the backhanded comments about the legal profession are completely untrue and unprofessional.

  • amoebatt

    Most of us who went into this field did so because we inherently care about people. After years of sacrificing ourselves (family life, social life, health) we are being made to feel that we are the enemy in patients’ ability to obtain access to healthcare? It’s just plain ridiculous. We did not create this mess, this broken system. To an extent, I understand why the onus is now falling on us (ie. physicians in the past charging exorbitant prices because they knew insurers would pay anything), however that is not my/our fault. The climate has changed and we are getting punished for the greed exhibited by a different generation. That being said, there are always going to be a few bad apples (greedy docs) in every bunch… but what we are asking for is to be able to survive. Survival through undergrad, med school, some went to grad school first, and then residency. We have been in “survival mode” for so long that it is no wonder that being a physician is associated with poor health. How many of us are obese, have heart disease and/or diabetes, poor nutrition, lack of exercise, poor mental health, marital problems? ALL of us are driven individuals. Had we chosen a different path, most of us would have been successful. We love what we do. Some of us have become resentful because it seems that society doesn’t respect the “abuse” we put ourselves through to do what we do. Top this with financial struggles and many of us are angry.

    Why isn’t anyone going after health insurance companies? Let’s talk about that. I would like to see their net profits!

    Those of us here have dedicated years of blood, sweat and tears to provide
    quality care to our patients. When our financial sacrifice doesn’t get any
    aknowledgement.. in fact, we get villainized, I get mad. I am 36 years old and became ill inmed school leaving me with an additional $100, 000 in debt to pay for my own healthcare costs. I could not afford independent insurance at the time, I was too old to get insurance from my parents, my medical school’s health insurance covered mainly catastrophic events… I was fortunate to receive a full ride for undergrad and worked for spending money. Even still, although I came from a middle-class family and lived at home with my parents until I was 30, I racked up $240, 000 in loans… and then I started residency (late due to being a patient for a few years).

    Look, I have been on both sides, patient and physician. There are a lot of problems with the system as it stands, however I never would have made it out the other side without the team of docs who cared for me. I owe them my life and think they deserve every penny they make. Their care inspired me to continue on and care for others in the same fashion… but the question still remains, when will we physicians stop being the victims? When will we stand up together and tell OUR stories of hardship? I commend the author for starting this conversation. It is time to pull together and be heard on The Hill. Please join your local and state medical boards. We are the future of this field. It’s time to be heard. Let’sturn our stories into action.

    • user_kl7924

      “When will we stand up together and tell OUR stories of hardship?”

      Young Matthew here has just done exactly that. I’m thinking it didn’t go over quite the way he’d hoped, though.

  • A. Bruce Janati, M.D.

    The corrupt, predatory, and intrusive regime of the United States and its dilapidated health care system uses its system of “judicial tyranny”as a conduit to oppress its people, in particular,its physicians who are inherently meek , subservient , and seemingly altruistic. When a leader of a country makes an “off- the cuff” remark that ” it is the duty of American physicians to serve indigent patients”, he does not comprehend that in a “taxing regime” philanthropy has no meaning. If the pettifoggers and shysters are ” plundering” the country, who would become the “easy target”? Of course doctors!
    I do not think you should be too concerned about “the American sick”–as long as the US imports foreign physicians who are volunteers for slavery ( thanks to their mercenary leaders)!

  • Dad of two doctors

    Amen! So true, when DC talks of taxing the wealthy (IE- Doctors) because if their salary; they do not realize or give consideration to all the financial sacrifice it took to arrive at their destination. They just want to take from those individuals that create jobs, help and assist others and implement a system of socialization!!

    Wonderful article. I am not a Doctor, but rather a father to two boys who have entered medical school and just now embarking on their journey. I can certainly relate to Dr. Moeller’s synopsis of his journey!

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      You and I both know that whatever his tax rate, he likely doesn’t come close to paying it. If he has a house w/mortgage and interest, and kids (he has 3, as his FB profile shows) with daycare, and other deductibles, I’ll bet any amount his ETR after all deductions and credits is more like 15 percent or less. I guarantee it.

  • http://twitter.com/Abolish_ Zaphod

    Nearly everyone had a hard time during the worst of the recession, but not a lot of plastic surgeons have given up private practice for hospitalist life.
    However, it is definitely going to be much more difficult if youre in an extremely over saturated market where overhead costs and marketing are through the roof. Thats a choice and risk those guys took knowing full well the market (or maybe not), and you have to have savings in those environments. Poor business practices abound in medicine.
    Now that the market is turning again, even those guys are doing well, and if you didnt bail you get a boost from loss of competition of those that did.
    Other markets really didnt have much problems, even expanding and raising prices. Bad markets will expose poor business models. Its not like we get much training in the business arena.
    I agree with the gist of your post in how we got here however, and it does drive me nuts that the loudest complaints have traditionally been the ones who made it what it is today.

    • amused bystander

      “Bad markets will expose poor business models.”

      You never know who’s swimming naked until the tide goes out.

  • http://www.facebook.com/anh.noose Anh Noose

    What article failed to mention is what he’s making now and how long it took him to paid of that $230k debt. Isn’t the yearly average salary for a gasto-internist about $350-400K??

  • http://www.facebook.com/jared.jameson.10 Jared Jameson

    everything is relative, and he’s being a bit disingenuous. he says he only made $39,000 as a resident, but an easy public search for his salary for that tax year shows he actually earned the rate of $41,500 his first residency year, with a 9 percent increase for his second year, then another 8.8 percent increase in pay for his 3rd year. Also, he never states his current salary, which would help put his debt in perspective. Or, was he afraid that framing it that way would render his argument weak? Again, it’s all relative. If he’s making $250,00 or more today – and I suspect he is based on my 3 UM doctor friends and their starting salaries out of residency/fellowship – he’s ahead of the game in terms of what most undergrads make out of school vs THEIR debt loads.

    Again, it’s all relative. If, say, any number of undergrad majors graduated from a top school in their chosen major with lots of loans, his debt load likely would be close to double or almost triple his starting salary. Not so with a doctor, typically speaking. So, is he living below his means today? Is he struggling to make it and living in a modest house? Or is he in a ‘doctor house’? Just curious. Cuz the two doctor friends I know who somehow managed to buy houses in my subdivision ($200,000 houses) BEFORE starting their residencies did the following immediately out of residency/fellowship: 1 built a sweet-ass house on the West Coast with a starting salary in the upper $200,000s, and the other bought a house in a ‘doctor subdivision’ in Ann Arbor, making a starting salary of about $200,000. Both have considerable debt. Another UM doctor I know who is 6 years or so removed from schooling bought a house in the most exclusive subdivision in A2.

    • user_kl7924

      I wonder whether he’s regretting having written and published this epic sob story now?

      • http://www.facebook.com/jared.jameson.10 Jared Jameson

        Furthermore, he works at Henry Ford Hospital, in a region that rates on average higher than nearly any other for gastro. Average yearly salary at his region, where Henry Ford rates high for gastro pay, is $397,000 a year. These types of letters fall on deaf ears, not only among ‘commoner’ people, but among other doctors.

  • Missy

    While I understand that becoming a physician takes a great amount of study and can involve sacrifice, I think this post is elitist and discounts the sacrifices people in other professions similarly make to learn their profession. Other professionals incur large amounts of debt to learn the foundations for their profession and still do not bill on an hourly basis. Just because an attorney bills on an hourly basis, that does not mean their pay tracks accordingly. An attorney may make the hourly wage of someone working at McDonalds. I have great respect for my friends and classmates that became doctors, but a profession is a choice. I have put off having children to become secure in my profession and earn a decent living. I will be paying off college and grad school loans for quite some time as well. My profession requires intellectual rigor–but I do not put down my friends who are doctors because their profession is different than mine.

    • http://www.facebook.com/kermit.morningstar Kermit Morningstar

      A profession is a choice, yet you sound a bit bitter. You’re not the only one who’s put off children for your career; I have plenty of doctor friends who’ve done the same thing. You may not put down your doctor friends, but here you are. What’s the difference?

      He’s not putting down other professions, he’s writing about his own. Maybe you should stop taking it personally.

      PS. I made the same mistake in going to law school, too, but I’m not attacking doctors because of it.

  • http://www.facebook.com/brian.adamsthies Brian Adams-Thies

    I completely understand the horrid debt situation. I am not a “real” doctor but a PhD in anthropology. My debt is equivalent to yours. However, I will never ever ever be able to pay off that debt…..there is just so possible scenario (other than winning powerball) that would allow for that debt to be paid off. Lawmakers should create change……and soon.

    • user_kl7924

      “Lawmakers should create change……and soon.”

      What change do you want to see lawmakers create? Tighten up lending standards, reserving loans for only those who might have a hope in hell of paying them back?

  • MC

    You might want to google what law school costs before you go complain to a bunch of lawyers how much it costs to be a doctor. You might also want to google what Capitol Hill staff get paid before you complain to them the pains of living on $50k a year. With this article you won’t even need to show them the study to prove that doctors lack empathy.

    • http://www.facebook.com/kermit.morningstar Kermit Morningstar

      I went to law school. I know what the costs are. I also finished at 25 into a crappy job market. Going to med school means spending an extra year (of debt) plus several years of residency ($50k @ 80 hr/week). I’ll also tell you that, having spent plenty of time with doctors, they studied a LOT more than I or anyone at my school did. And I also went to Michigan.

      Attorneys, face it: law is NOT medicine. First of all, our society acts like their services belong to the greater good. Ours don’t. We get paid for our services, but it’s not like we’re in as much demand as doctors are. Yet we can set our own rates and expect to be paid for it. Doctors can do that too… but the compensation paradigm is locked into what insurance/Medicare is willing to pay.

      Furthermore, $50k is not $50k is not $50k. $50k with 4 years of undergraduate debt is one thing, $50k with 4 years of undergraduate, 4 years of medical, and deferred interest on all of that is a lot different.

  • http://www.facebook.com/PathologyMax Brett Snodgrass

    When I was an intern in North Carolina I worked with physicians who recognized that they were privileged to be in their position and they gave back to the community. In fact, every person in the department contributed to one if not several local charities. They gave back significantly to the community and they did not try to make people feel sorry for them.

  • amoebatt

    I did not mean it that way… I commend him for telling his story. I was trying to motivate others who read this to do so too. Mainly, I would like for us to “organize”. I am excited to see that Dr. Moeller is making his mark. If we can tske it to the next level, to goverment, to actually work together to change policy, then we should. Perhaps someone on here is already. If so, please contact me. I hope Dr. Moeller did not take my words as an insult when I meant for them to be a compliment. I added my two bits as my story; and to say that we all have gathered here, inspired by Dr. Moeller. Now let’s DO something about it, together. Dr. Moeller, I too am in Michigan. I would like to work on these issues, somehow.

  • http://www.facebook.com/jared.jameson.10 Jared Jameson

    Look, everyone, if he was a family practice/private practice doctor, I’d have a ton more empathy for him and his cause. But guess what? He’s getting paid no matter what – maybe a bonus thrown on top each year for the revenue generated – and it’s a sweet salary. Sob stories like this one fall on deaf ears.

  • jay

    ya law school was a great move….moeller should stick to commenting on his own field

  • anonymous

    “I would like to personally relate my own story. My story discusses what
    it took to mold, educate, and train a young Midwestern boy from modest
    roots to become an outstanding physician, who is capable of taking care
    of any medical issues that may plague your own family, friends, or
    colleagues.”

    Outstanding eh? Awesome. So when I have a heart attack, I can hope to be treated by you and your wealth of GI expertise; you know, since you can take care of ANY medical issue that plagues me.

    “The completion of that program culminated 14 years of post-high school
    education. It was as that point, at the tender age of 32 and searching
    for my first job, that I could say that my career in medicine began.”

    Many people in America have a Bachelor’s degree and make 36K a year to pay off an undergraduate loan. Why do physicians always include four years of college into their number of years in preparation for their career as if no one else has the same education at that time?

    This whole “letter” reeks of entitlement whining. Be quiet, financially plan better and go see a patient. If you really want to blame someone for your financial plight, talk to the 70 year old retired docs that committed medicare fraud. Might enlighten you.

  • charlottedann@ymail.com

    HAVE YOU CONSIDERED SENDING THIS TO THE OP-ED SECTION OF THE NEW YORK TIMES?!?!
    Your essay gives voice to many physicians like me who “feel your pain”, but at the same time, I believe the public would also respond similarly if they knew….. you really should try to get this out to the mainstream! bravo!

  • Talbott Paynter

    I have no sympathy for physicians and decreasing salaries. Look at the rest of Americans. Medical inflation is causing many families to file for bankruptcy. While doctors are purchasing large family homes and then summer beach homes and winter mountain chalets the rest of America is losing their homes due to layoffs and foreclosure. After residency their incomes jump dramatically from $50,000 a year to $230,000 plus per year. By living a bit more modest a physician could have his loan debt paid off in 3 to 5 years. On the other hand a law student going into practice has approximately $100,000 to $150,000 in debt with low a much lower wage that will take twice as long to pay off. Most lawyers don’t make start making six figures until they are in their mid to late 40′s. And the poor business school grads…they have it worst of all. The average MBA comes out with $75,000 to $100,000 in debt and most are lucky to sart out at $35,000 or $40k per year. It is much harder to live on those salaries than a $230,000 salary. If a doctor takes $100,000 a year and puts taht towards his school loans they can still live more comfortably than a business school grad living on $40K a year and paying off their $25K loan. I know many lawyers and business men who work 60, 70, and 80 hour weeks making much less than a doctor. Sounds to me as if the doctors are the ones who think they are entitled because God gave them the intelligence to become a doctor. Cry a litte bit more form me doc, I feel your pain with my 65K salary and $75K school loans from business school plus my certifications.

    • DefendUSA

      Obviously, you have not read the comments here. My FIL practiced for 40 years. His top was 100k. You are falling prey to the fact that all doctors by nature of profession are getting rich at the expense of the patient. That is nothing short of complete ignorance. My FIL wrote off nearly 50 k a year in costs that were not re-imbursed to him as a result of accepting medicare 20 years ago!! You have a mindset that just because you have a degree means you should earn a boatload of money…Well, newsflash! Not so much. Who picks the degrees and the choice to take on the debt? The point you miss is that docs are not in it to get rich, but the price they pay to stay in the business is HUGE. And the government spread is going to shrink this profession in droves because their intellectual capital WILL go elsewhere.

  • http://www.facebook.com/profile.php?id=564133278 Lauren Bowling

    Welcome to veterinary medicine. Same tuition costs, time invested, and only 1/4 the salary. And we are also accused of being money grubbing jerks simply for trying to make a living. Law students are now in the same boat due to the economy.

  • http://www.facebook.com/nola.blavatsky Nola Blavatsky

    I am studying in a different field, however my 10 years of edu, post high-school will cost me dearly. We too must put off children, home ownership, and down-time. I am not on call as MDs are, but in my area of science I must travel frequently. Travel is not fun or exotic. It is exhausting and does not “count” in determining my income. It’s more or less considered something I must do in my free time. As if time is actually free. To manage my edu, I lived in a ghetto; my grubby apartment was robbed more than once, someone with a gun tried to steal my car — while I was in it — and yes, I escaped after being fired at by the guy in the hoodie. I too like what I am doing, and what I hope to do in the future and I also see the cost of edu as a problem that far exceeds what it cost just one generation ago. It far exceeds the cost-growth of every other aspect of my life. In a time when it’s easy to be sued, I too will take my chances. Perhaps not as intensely as MDs but many professionals in the USA face this issue. The same liberals who decry injustice and greed, are often speaking directly from their position in educational institutions, where not a word is said to address the cost, and more importantly, the debt today’s students are buried-alive in. Just read or watch Robert Reich from UCB — the quintessential liberal warrior who never says a word about student debt and educational costs.
    It’s costing all of us way too much and there is no accountability and no transparency. WHY? It’s not helping us, our future, or the future of anyone who wants to contribute meaningfully to our world.

  • Mike Miller

    One time my basement flooded, there was poop floating around everywhere. Two men came by and worked for hours going up and down stairs carring buckets of filth and stool out of the basement dumping it into the grass. You know what they charged? 250 dollars. My friend who is a pediatrician makes the same amount in 15 minutes and his work is much, much easier. Physicians try to increase their standard of living above the rest of society. They act like they are the only ones who have a rough time or have to work hard. Then when they harm a patient, they don’t want to give up their money.

  • http://www.facebook.com/janet.hawkins.758 Janet Hawkins

    I work for a nationwide Hosptialist group as a Certified coder in Compliance. I applaud this article. I have seen my doctors be so patient, kind, smart, sad, tired, smiling, encouraging as they see 30 hospital patients, do the admits, discharges, stand with the families as their family member dies, be interrupted 100 times and still get up and go see the next patient, sit down, smile and hold their hand. I am in awe of physicians that they can work like a computer, know exactly what needs to be done in a Code Blue at the right moment to save that life. Thank you to all of you, even the cranky ones :) you are awesome!!

    • Mike Miller

      Yeah, and they are grossly overpaid for every step of their kindness. There is a shortage of primary care physicians because they put stringent restrictions on the number of residency programs so they will remain in demand and get paid more for each visit. Sure they should be paid and they are kind, but any bum on the street will be kind to you if you pay him several hundred dollars an hour.

    • Mike Miller

      If Lawmakers are serious about improving patient care and decreasing costs they will mandate that the ACGME drastically increase the number of residency positions in all fields. Most physicians are some of the most greedy people you will ever meet. They limit graduate training so they stay in demand and can charge high prices. Yet there is a shortage of physicians. Hmm.. Are they really interested in training excellent physicians to provide healthcare at reasonable costs? Hardly, you will see them lobbying from the AMA at the White House every year demanding their already high salary not be cut by even thirty percent.

      • Mike Miller

        The reason congress goes along with this is because if they cut physician pay then more physicians will refuse to provide care to medicare patients. Thus they leverage their demand for higher prices. Is that really helping the majority of patients? Are most truly altruistic by demanding high salaries. They like to complain about being over worked but the physicians lobby to limit the number of post-graduate positions, pay them fifty thousand a year while they are still in training, and then more when they graduate. What if, lawmakers increased the number of physicians? There would be more physicians to provide patient care, they would be paid less, be less overworked. Who benefits from the AMA lobbying in Washington? Is it the patients? Hardly, why isn’t the AMA lobbying to increase the number of physicians in order to take care of the patients. Instead the AMA spends their time lobbying to maintain their physician salaries. Then people like Dr. Moeller like to whine about not having enough money and the risk of lawsuits. Physicians like Dr. Moeller are self-interested, greedy persons, who want to be treated as the elite of society.

  • http://twitter.com/LivvyJeffs Olivia Jeffers

    Thank you for writing this. I grew up reading medical encyclopedias, and studied neuroscience in high school (I went to a special high school for science and technology in Northern Virginia). I really wanted to be a doctor, but as I started learning about the exact process that you entailed, I decided I wanted my life to start sooner, rather than later, and I didn’t want hundreds of thousands of dollars in debt. I ended up studying Civil and Environmental Engineering, hoping that an understanding of the built environment and my passion for human health, can help at least as many people as I could have helped as a doctor.

  • Nick

    Unfortunately the high cost of education is not only limited that of physcians, it touches anyone that pursues a 4-year degree, albiet physicians have many more years to attend for an advanced degree. University costs are out of control in the United States and something does need to be done to resolve this issue. There are so many factors that go into the cost of tuition and the materials that support the educational process, however because of how bureaucratic everything is, it would take a miracle to see a change anytime soon, if at all. One thing that can help young adults entering the workforce is a requirement to take personal finance courses, believe it or not you can stretch a dollar pretty far, you have to be willing and understand the true value of a dollar (conservative budgets, living bare minimum, rent, even though you may not be able to afford a house for 20-30 years).

  • Mike Miller

    In addition, physician loan repayments are usually income based. That means that they can still maintain a significantly above average of living and be paid less. It baffles me that they are so grossly overpaid and still lobby for more money. Having student loans does not affect their status of living. Furthermore, paying physicians in training “residents” up to 50,000 is outlandish. If it is part of their training, why do they need so much money. Why does the AAMC lobby for more funding for graduate medical education. Many residents buy BMW’s, some buy porsches. Physicians might argue, well even I am an attending and I can’t afford that. Those physicians are the minority. Physicians shouldn’t be so overpaid that on average, they drive around in expensive cars. Their work is not that hard. There are 20,000 qualified candidates who are rejected from residency programs every year. Perhaps if physicians were less greedy and bemoaned their situation less, patients might find a physician at a reasonable price.

    • Mike Miller

      Their work isn’t that hard compared to other jobs in society. Physicians feel entitled to be unreasonably compensated for their work because they are in such great demand. Yet the AMA, the AAMC, and the ACGME primarily lobby not for more positions to make more doctors, but to maintain the current funding. In a random survery of 6 residents. Three of them drove porsches, two drove a normal cars, and one drove a BMW. Hmm

      • anonymous

        I am beginning to see the light. This guy wants the government to reimburse him more money after the government paid him 50K a year to learn/experiment on the “uninsured” American population AKA “service cases”. Talk about handouts and entitlement.

        • dost

          this is ignorant babble meant to spur doctor-hate. what specifically makes you so angry at doctors?

          • anonymous

            That they act like they walk on water and deserve more respect and money than other people in this world.

          • anonymous

            and my reply isn’t “ignorant babble” it is the truth.

        • MG

          I agree that physicians in general should stop whining about how hard their lives are…but a few points in your post should be fleshed out a bit…he didn’t get paid 50k, he got 39k…you can’t be a doctor if you don’t learn by taking care of patients…no one is experimenting on anyone, more like experiencing…residents don’t just take care of the “uninsured”, they take care of all types of patients…paying residents 50k a year is a really great deal for the American public – they work about 80 hours a week, or about $12/hr, or even less if you were to factor in that they should be making time and a half for the second 40 hours…that’s not much money for the complexity of the work they’re doing…people can gripe all they want about physician salaries, but leave the residents out of it…if anything, they deserve more.

      • dost

        LOL a survey of SIX people! Thats some seriously high-powered study!

    • dost

      200K in debt turns into 500K very quickly at current interest rates… doesnt matter if its a doctor or teacher or anyone. the point is that soon only rich children will have the chance to become a doctor.

    • dost

      BTW its usually the international medical grads (the ones without debt who may no speak english) who buy the new cars!

  • Guest

    Medicine : it’s not about the money: neither how much you earn or how much you spend to get there. 8 years of private school (undergrad and medical school) of which the author speaks adds up to high debt. No wonder the author is ranting and overworked to keep his head above water. Medical school is expensive but not unattainable. And a sane life in medicine is not an oxymoron. I attended the least expensive in- state undergrad university and came out debt free, with about $200 in a bank account when entering (in state) medical school. Although I graduated with debt, no doubt my debt was markedly less than that of private med school. And while residency hours were brutal and I estimated that I earned about $1.50 an hour during my three years,I was able to scrimp and pay off my med school debt within 5 years of finishing residency. My spouse (whom I married three years after residency) and I have pledged to living a debt free life, by choosing a modest home well within our means. We put our kids in public school and in state universities. The payoff? We have the ability to work for enjoyment rather than the constant burden of living to afford a lifestyle. 65 years of medicine between the two of us, and we are NOT burned out, NOT angry, NOT frustrated. And to those who feel they lack a say in the political process? Become the political process. Support the AMA, or your state or local medical society , or your specialty’s political action group.
    Being a physician is a privilege and an honor. Embrace and enjoy it.

    • dost

      Sounds like liberal guilt. Sorry I love helping others but I require the shirt on my back to stay warm. I’m sure your the most ethical honorable human being of all time. Annoying when folks like you act as though everyone else needs to be the same. BTW the AMA is a puppet organization who would figuratively ‘jump off a cliff’ if Obama told them to!

      • Guest

        what brand of shirt are you wearing? lol!

      • anonymous

        hyperbole post of the day. you can buy shirts for less than 20 bucks.

  • http://www.facebook.com/andy.straight.9 Andy Straight

    Thanks Matt. You rule.

  • dost

    What a great article! I hope President Obama takes a break from rubbing elbows with the hospital/pharma/insurance lobby and reads this! Over the years I have used the term ‘doctor-hate’ when the media (eg CNN) paints doctors as these insanely rich jerks who steal sick peoples money. I am a resident doc from a poor family (my dad a janitor), and I can say that this article felt like an autobiography. The main difference is that our loans are at 6.8% interest (making ~$12,000 in interest annually for $200K of debt).

    • anonymous

      i wish your weren’t so myopic and could see that other careers accrue the same debt load. at least you will one day be rewarded with a large salary.

  • http://www.facebook.com/christisforreal Ruth Hirt

    If there are any humanitarian professions deserving humane considerations, it is the medical-health-rescue-care branches. This is obviously self-explanatory. Human life hinges as well on their services. Come to think about it, let us accept, to err is human. It takes an innate conviction from a merciful Creator, that there are so-such self-sacrificing talents whose devotion to rescue the ill undermine the costs to be regarded by a demanding world as ”qualified”.
    My prayers of support goes to humanitarian workers : physicians, nurses, caregivers, all of them in the medical-health category likewise to rescue, paramedic category …

  • Bob12221

    Reading this article, I can almost guarantee that this physician had ZERO real life working experience before entering medicine, and this has lead to the entitlement mentality that he and many other college-straight-to-medicine physicians exhibit. I love that he invokes law school as a possibility that would’ve been so much better for him. Guess what buddy, most law school grads can’t even find a job as a paralegal right now to pay off their debts. Sure, being a physician may not be all rosy, but it is way better than being a software engineer having to worry about being downsized all the time, or being an investment banker working 120 hours a week looking at spreadsheets, or being out of work after all your training as a NASA engineer. You have job security and a guaranteed income, plus the work has variety and is meaningful. Stop whining and quit if this is your attitude, there are tons of unspoiled people wanting to fill your shoes.

  • http://www.facebook.com/jared.jameson.10 Jared Jameson

    The problem is the welfare state of our education system, such that colleges market loan money to kids and know they are gonna get federal and state moneys, so what the heck if the college raises tuition 8 percent this year, 4 percent the next, 7 percent the third year? It knows that whatever the rate is, kids and families are gonna take the loans necessary. It seems like we’re starting to get to the max amount where families are saying ‘whoa!’ this cost is getting out of control. But is that government’s fault? Or is it colleges taking advantage of the system? Much the same way, the healthcare/insurance industry operates. It’s why you’re better off getting your hernia fixed the right way for a fraction of the cost in Canada, or going overseas for certain procedures that cost x-amount less than in the U.S., with greater outcomes/prognosis.

  • im2thepoint

    I thought this was a physician’s blog. Why are there so many lawyers and non physicians here commenting????

  • revrobertmcmillan@gmail.com

    After reading many of the responses, I find it curious that there is one glaring piece that is missing from the discussion. Everyone is taking the myoptic view that the American healthcare system is the best model. (how we do medical school, “free markets”, etc). The first step in addressing not only the problems we face in healthcare itself but the issues raised by the article is to admit we are not always the smartest people in the world and be willing to look at how other people do it. The first thing I notice is the cost factor of the medical education. Where in the hell is it written that medical schools should be profit centers that require such high tution? (of course the same could be said for undergraduate programs as well.) We support most of the universities through taxes and grants, why should students have to add to that? I agree there are problems for all of the people who work in health care, there are problems in the system itself, and I’m sorry, you can call me a socialists, but I think there is also a problem when so many are without adaquate or no access to health care in what is supposedly the richest country in the world.

  • Gisele

    Hmm, unfortunately empathy is hard to come by for someone whose income is likely to be over $300,000 per year in a supposedly service/care-giving position. Many, probably most actually, college graduates and even those with advanced degrees end up with tremendous amounts of debt for far smaller salaries. And while you may deem your work vital, that of others in many professions is no less important and they work just as hard with less rewards.

    • Suzi Q 38

      They can pay off those debts.
      They have the large paycheck to do so.
      Totally doable, if they are careful for a few years.

  • jvhinson

    Well said. My brother is now a resident and none of us had any idea the toll becoming a physician would take on an individual. Both in the cost of loans, and the physical, mental, and emotional demands put on them.

    • Suzi Q 38

      IF you make $400K at a teaching hospital, then 40% goes to the government for taxes.Now you have a net of $240K. That is about 20K month.

      What is left? Continue to live frugally, until the huge SL’s are completely paid off.

      Make 4X the payments each month, at least.

      Drive a used car that just gets you to work and back.

      Once they are paid off, splurge a little on a nicer house.
      Or, better yet, save it!

  • http://www.facebook.com/laurie.barrett.357 Laurie Barrett

    The economics behind the medical industry are way out of control, from schools, to pharmaceuticals, to hospitals, to md and medical administrative salaries–everyone with a bit of power in the equation is rapacious. Medicine needs a values shift, a cultural shift. Currently, medicine and economics are in bed together. Perhaps some cross cultural studies are in order.

  • http://www.caduceusblog.com/ Deep Ramachandran

    Followup to this article now posted at caduceusblog.com. Due to
    tremendous popularity of this article as well as the controversy and
    questions it generated, Dr. Moeller has written a followup addressing
    many of these issues.

  • http://twitter.com/Cascadia Sherry Reynolds

    It sounds like you made some poor financial choices along the way based on the expectation of a future income? Did you take any classes in finance? I am not sure why you are only being paid 50k either since the average starting salary for a lowly family practice doc is over 175,000 a year.

    BTW – Nearly everyone who goes to college has debt so that is a given.. I have friends who majored in social work (7 years of college) and after 2 r 3 years of graduate school worked for free on internships and then finally are paid $15/hour and are able to pay off their debt

    Very very few people start out a job with relocation costs covered (I recently moved across the country and paid out of pocket to do so) and we didn’t buy condo’s or have kids until we could afford to nor did we expect to have a spouse who didn’t work.

    There is no question that becoming a doctor is a long difficult and in some cases (private school) expensive but it is not a surprise and you had the ability to make different choices along the way. There are far more people who are capable and willing to become a doctor than open slots so perhaps we should screen people out up front who don’t understand the costs?

  • mhz0282

    This is one of the dumbest things I’ve read in a long time.

    1. When writing a letter to lawmakers, you might not want to try to demonstrate the superiority of doctors by contrasting them with lawyers, seeing as how most lawmakers are, you know, lawyers.

    2. You think law students don’t rack up $200k+ in debt? Also, do you realize that employment prospects for law students (and almost every other kind of student) are just a bit lower than that of med students?

    3. Shouldn’t people decide whether to go to law/med/whatever school based on things like what you’re interested in and what you’re good at? The implied suggestion that what profession you choose should be driven by how to invest fungible talents is cynical and bizarre. (Frankly, if this letter is any indication, the writer does not have the talents to be as successful in other professions as he is in medicine.)

    4. The implications mentioned in point #3 contrast sharply with all the parts of this piece that focus on the nobility and intellectual superiority of doctors. The writer attempts to use the sacrifices that doctors make to appeal to people’s sense of sympathy, and uses them to argue that doctors are special (aside: “We are doctors.” – this is basically the most obnoxious thing a doctor can say)… but does this in the context of asking for those sacrifices to be alleviated. It’s not necessarily contradictory to do this, but the extent to which he extols the nobility of being a healer would seem to suggest that this should be enough for someone who truly believes it.

    Doctors work extremely hard and are obviously indispensable to humanity. In return, they are well compensated. They have incredible job stability. They are about as privileged a class as there is in the country. They are held to high standards of accountability because when they screw up, the consequences can be severe. These are all facts.

    Doctors have every right to advocate for their profession to lawmakers, surely. But you all might want to find a better spokesman than this tone deaf writer.

  • Peace

    Thanks, Kevin, for sharing your thoughts. I’m probably bit biased and wanted to offer a different point of view. 1st, this article doesn’t mention the money physicians make after completing residency.

    Is one of the basic theme of this article that physicians could have made more money doing something else, not be in debt, have more free time, etc. if they didn’t pursue medicine?

    What the article neglects to discuss are a few things:
    1. No one is forcing medical students to pursue to this route
    2. It is a privilege to work as a physician
    3. No doubt, medical students/residents sacrifice a lot of their time vs. the rest of the population, what about people from other professions, who work hard, and not compensated as much? Median household income in the United States is ~$46,00.

  • Ramon

    Not sure what other doctors he’s spoken to, but he’s living in a fantasy tale of what doctors are like. Call me and I’ll tell you our ordeal in Chicago with Loyola and other hospitals. We are now also going through another bullshit situation where my pregnant’s wife asshole doctor won’t call another hospital to get her transferred, even though the hospital she’s at won’t even do ultrasounds cause for some reason in the world, a hospital doesn’t have an ultrasound machine. Most doctors I’ve met are egotistical assholes who think they’re God.

    Oh yeah, and I’ve seen numerous occasions where they’ve billed the insurance for numerous services that were never performed, with the majority of these being “full service,” full consultation or whatever other term they have for office visits when the doctor was actually in there for about 30 seconds.

  • http://twitter.com/LindaSpencer55 Linda Spencer

    I thank you for taking your time to write this letter. I am a Practice Administrator in a three physician Family Practice. I have been with this same practice for 34 years. It saddens me what is happening to our medical system. I see what the Family Practice Physicians bring home. I see what they put into their practice and patient care. Shame on our society. Shame on you………PHYSICIANS NEED TO STAND AND STAND NOW. I believe there is a need for mid level care; but you cannot replace the physician. I believe that is where we are heading. Who would want to go into family practice? I thought I would never live to see where we are in our society. Yes, we do have an EHR. (another letter for that one- the costs of doing all the right things) I would like to work another eight years- but with all the demands and decreases it scares me.
    As this doctor, I have put my life into this practice. The Manager stands behind and forward sometimes. What has kept me going are the committments all of our three physicians have given to their practice. I would not want to let them down or our patients.

  • PoliticallyIncorrectMD

    Brilliant summary. I wish more physicians would speak up like you have. I admire you for standing up and not being afraid to speak the truth. Do not be discouraged by ignorant comments made by some people raised in the culture of class envy and entitlement.

  • Freshdoc

    I’m a resident physician who loves my job. When I talk to premedical students I always tell them that the physician career comes with extreme gains and extreme sacrifices that are unparalleled in most other careers. The sacrifices are those described in the article – the debt, the hours. The gains are in the everyday, getting involved in patients’ lives and getting to know their families, developing a deep connection with patients, successfully using science to literally change another person’s life whether via a medication or procedure etc.

    My bottom line for those considering a career in medicine is that you have to understand both sides of the career. You will face difficulties that most others don’t and have rewards that others will never get.

  • http://twitter.com/mvrak Amit Kumar

    Appealing to the lawmakers? They are not health practitioners of any kind, and have no need to understand. Government regulation is not the answer for this precise reason.

  • Kelly Maguire

    As a sister who is a doctor, you are spot on with the life of a physician. However, as a lawyer who is graduating with $225,000 in student debt, I think you are really misinformed about the legal profession. Especially since many lawyers start off with jobs that pay $35K a year. We are a lot more similar than you think.

  • Guest

    Good thing I went the engineering root. $60 000 starting salary right out of school (undergrad), good hours, free nights and weekends with a minimal loan payback. Going to university in Canada also helped – way cheaper than US schools.

  • talala

    Almost did medicine, good thing I went the engineering root instead. $70 000 starting salary right out of school (undergrad), good hours, free nights and weekends with a minimal loan payback. Going to university in Canada also helped – way cheaper than US schools.

  • thelight@yahoo.com

    14 years of college… really?

  • Francis Ruthven

    This is what is is like to be a patient. You lay your care on a person whom may have began a career of quality care and concern. Over the years that physician has become a drug user, a grown incompetent or with an insidious personality disorder having significantly changed his ability. He continues to provide service. He does harm. He does so much harm even his peers are aware and encourages injured patients to report him to the TMB. The Board receives a complain as they find it contains substantial concern. They slowly, grind through meeting every once and a while. Meanwhile the incompetent dangerous physician continues to do harm for months and years. The board seeks evidence from peers..and do not get it. Peers direct patients to the TMB. This is the saving cycle for a bad doctor. Then, THE SAME PHYSICIANS who take an oath not to harm..will stand by and allow harm…because they are not about to give witness against brother. How bold does the perpetrator become. He/she now getting away with harming patients regularly. In a known case, as soon as the troubled physician is given advice by the the attorney of the complainant, he or she sends a copy of their tiny Mal Practice insurance. The message is this. “You cannot touch me, I am too expensive to touch and I have the protection of Texas Torte Reform . It is the second most disgusting act of the most despised President in U.S. history. It is not so strange that the Texas Medical Board is elected by the Governor. It is not even strange that lawyers operate the government., What is odd is that they pass laws that protect the same bad physicians that will harm THEIR family. Tort reform will be back at the table one day and the stories of bad medicine will have years of sad documentation. SHAME, that some of the most educated of our culture are the most harmful, the most protected and the most wealthy.

    George Bush did more to harm medicine than any future laws on costs.

    He unleashed the incompetent, the deranged, The chemical and alcohol dependent, the geriatric, the extreme narcissist and yes even some criminals on our families in Texas. They are coming to your family soon.

  • donald aievoli

    Washington does not care. All that matters is redistribution of wealth away from the greedy conservatives. Of course, the assumption of greed presupposes that the wealth was obtained by oppressing the poor. I feel sorry for you MD’s. I am an RN and would never want to become a physician in the US. There just is no upside. The best pay-off today in healthcare exists with Nurse Anesthetists (CRNA). CRNA school is cheap compared to medical school and tha base salary is around $160,000/year.

  • http://www.facebook.com/mark.baird Mark Baird

    While I agree with the work doctors put in why does the AMA lobby for congress to restrict residency seats limiting the number of doctors?

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