Pay me like a French doctor. You know you want to.

Pay me like a French doctor.  You know you want to.

Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France.

And on cue, Vox’s Sarah Kliff — normally an excellent health care writer, by the way — is uncharacteristically lazy in framing physician salaries through a biased lens.

After presenting the data, she writes, “Primary care doctors in the United States, do tend to earn a lot more than their counterparts abroad. One 2011 study, which looked at doctor salaries from 2008, found that the average primary care doctor in France earns about $95,000, compared to the $186,000 that physicians net in the United States.”

For a site that prides itself on providing context to the news, these numbers require a bit more, well, explaining.

The clear implication is that American physicians are paid too much, and disproportionately contribute to our rising health costs. In fact, Kliff says it outright: “Doctor salaries are a pretty significant part of the reason why the United States spends more per person on health care than any other developed country.”

Really? According to pediatrician and the New York Times’ The Upshot contributor Aaron Carroll,

In 2006, physician salaries accounted for $138 billion in costs, which is nowhere near 56% of health care spending. Plus, some of that is to be expected. Calculations by McKinsey pegged “excess spending” on physician salary, or that which was above what you’d expect given the wealth of the US, at $64 billion.

That’s not an insignificant amount of money. But it’s not the major cause of our over-spending on health care.

And listen to celebrated Princeton economist Uwe Reinhardt, also writing in the New York Times:

Cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

What most fail to include when comparing physician salaries across countries is the cost of medical education and medical malpractice.  Let’s consider France, the go-to country when pointing out how expensive health care is in the United States.

Medical education in France is government subsidized versus a median 4-year cost of a private American medical school of $286,806.

Medical malpractice in France is based on a national no-fault compensation scheme versus an American medical malpractice system where OB/GYNs in some New York counties pay annual malpractice premiums of $227,899:

Pay me like a French doctor.  You know you want to.

Comparing physician salaries with those in other countries is fine.  Even saying American physicians get paid too much is okay.  But if you want to cut physician pay in the United States, also reform the cost of medical education and medical malpractice to match systems of those abroad.  Don’t pick and choose numbers to fit an agenda.

If you want to pay me like a French doctor, also give me the French cost of medical school and the French medical malpractice system. Any takers?

Pay me like a French doctor.  You know you want to.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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