Are American doctors paid too much or too little?

Are American doctors paid too much or too little?

A version of column was published in USA Today on July 2, 2014.

There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs.  I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, while those of specialists like radiologists or anesthesiologists approach $300,000.  It seems like a lot of money.

Vox’s senior editor Sarah Kliff pointed out that U.S. physician salaries were twice as much as those in countries like France and concluded, “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.”

Author and economics writer Matthew Yglesias also wrote last year in Slate, “America has the highest-paid general practitioners in the world.  This doctor compensation gap is hardly the only issue in overpriced American health care, but it’s a huge deal.”

Not surprisingly, many doctors feel otherwise.  A 2014 Medscape poll found that only half of physicians felt that they were fairly compensated.

So, which is it: Are American doctors paid too much or too little? And would cutting their salaries appreciably reduce health spending?

While I’m certainly not complaining about how much I make, important context should be considered when analyzing doctors’ wages.

Rather than compare salary figures between the United States and countries with wholly dissimilar societies and economies, it’s more useful to compare physicians relative to others in the top 5% of the income bracket. The talent pool that supplies doctors also likely produces other high earners: business executives, lawyers and corporate bankers, for instance.  Harvard economist David Cutler did this comparison, and surprisingly found that U.S. physicians were actually paid less than non-U.S. doctors relative to other high earning professions by country.

Also, consider the significant human and financial capital it takes to become a doctor in the U.S.: The median 4-year tuition of a private American medical school is $286,806, and physicians must complete a three to seven-year residency after medical school and undergraduate studies before they can practice independently. Christopher Conover, a research scholar at Duke University, calculated whether physicians’ eventual pay was worth the exorbitant investment.  While this professional rate of return was certainly respectable for doctors, it paled in comparison to those who pursued degrees with shorter and less expensive training, such as business or law.

And let’s not forget the salaries of health insurance and hospital executives, which comprise 20 to 30% of all health care costs, more than twice as much as any other developed country.  The average health insurer CEO pay was $583,700; for a hospital administrator, $236,800.

Finally, slashing physician salaries won’t even move the needle much on health costs.  According to Princeton economist Uwe Reinhardt, doctor salaries comprise about 10% of total health costs.  If physician pay was cut in half, only a paltry 5% savings would be achieved, “in return for a wholly demoralized medical profession to which we so often look to save our lives.”

Proponents who want to bring the salaries of U.S. doctors in line with those from Europe must also offer government-subsidized medical education and nationally regulated medical malpractice systems that many European nations enjoy.  Doctors abroad don’t graduate with over $175,000 of medical education debt or pay tens of thousands of dollars in annual medical malpractice premiums as they do Stateside.  Such a proposal has yet to materialize in our health reform conversation.

Better yet, stop targeting physician salaries altogether. Let’s focus on other factors that have a much bigger impact on health costs: wasteful spending and administrative overhead, for instance.  Those comprise a much larger slice of the health cost pie, and dwarf the sliver that physician pay represents.

Are American doctors paid too much or too little?

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.

Image credit: Shutterstock.com

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  • goonerdoc

    Sorry Kevin, even though the points you make are quite germaine to the conversation, when it comes to the American public, NO ONE CARES. Do we have a lot of debt coming out of school? Of course. Does it matter to anyone except us? NOT ONE BIT. People see six figure salaries, and immediately the calculus is six figures=rich doctor=paid WAY TOO MUCH. This will never change. I am convinced of it.

    • NewMexicoRam

      I agree. When it gets to the point of primary care docs closing their doors and/or retiring, then “the public” will have 3 choices:
      1. Put up with 3 month waits to see a PCP.
      2. Demand a system where PCP’s are paid more to entice more to be trained, or
      3. Demand a system overall where ALL docs, specialists included, only get paid “X” amount by the government, no exceptions.

      • Suzi Q 38

        1. I have never had to wait very long to see my PCP. I can see him the same day, even if he has a waiting room full of patients. If need be, I will see someone else if I can’t see my own doctor. If it has to be an NP or PA, I will take my chances rather than wait 3 months. In the meantime, I would keep the 3 month appointment.

        I am more fearful of my doctor retiring altogether, which is something I can not control. He is looking fairly tired and grey lately. He doesn’t yell at me to lose weight anymore.

        2. I like solution #2. Take some money from the specialists and give it to the PCP’s. That would be fair, but don’t look to the specialists to fair and generous. They are looking out for #1 themselves.

        3. That won’t happen. Nice thought, but the specialists go through more training.

        I just think though, that some of them lack clinical skills outside of their “tunnel vision” specialty. There is a huge body outside of the body part they specialize in. A lot can go wrong when a patient like myself trusts too much and puts too much faith in them.
        They really mostly know just that specialty.
        The PCP’s treat the whole body, so I am most comfortable with them most of the time and don’t mind them getting a raise…even at the expense of the specialist’s fees.

        • Thomas D Guastavino

          Fascinating. Do you know a PCP that can do heart transplants, bariatric surgery, fix broken hips, Etc….Etc.? I would be more then happy to pay such a person handsomely.

          • Kristy Sokoloski

            I don’t know of any PCP that can do the things you mentioned but I don’t think that’s what Suzy Q had in mind. I think she was taking it from the point that they can treat the whole body in that when they spot something not right like in the example of what I gave her they know which specialists to send the patient to. There’s no doubt that Medicine has gotten more specialized than ever before. It’s been going that way for over a hundred years if I am not mistaken.

          • Suzi Q 38

            Thank you, Kristy.

            My point exactly.

          • Thomas D Guastavino

            What exactly did Suzi Q have in mind when she said “Take money from the specialists and give it to the PCPs. That would be fair, but don’t look to the specialists to be fair and generous” ?

          • Suzi Q 38

            I thought I should answer that question, since Kristy has a lot of insight, but is not clairvoyant.

            No one likes to have their wages cut, even specialists, who make over several hundred thousand dollars a year.

            If I am wrong, and most specialists are different, let us know.

          • Thomas D Guastavino

            If no one likes having their wages cut then why are you singling out specialists?

          • Suzi Q 38

            Thank you for responding.

            Their salaries are huge in comparison to the PCP or the Pediatricians.
            We could cut the CEO’s salary, and that would help also, but there is only one of those at every hospital.
            They need to be paid more.
            Do you have any other solutions?

            I am off to exercise and my Tai Chi class, so I will check in later.

          • Thomas D Guastavino

            Baseball players salaries are huge compared to Specialists. PCPs salaries are huge compared to teachers. There are malpractice attorneys whose salary dwarfs anyone in the health care field. I have a lot of ideas and possible solutions. The first step is for specialists and PCPs to stop fighting amongst themselves.

          • Suzi Q 38

            You are so right, except that they are not in the same business as health care.

            Why not target the business owners and computer engineers as well.

            Baseball and football players receive whatever they are willing to accept, given their abilities and what income from ticket sales are available.
            Why don’t football players receive more than baseball players since their risk of injury and long term body damage is greater?

            Sure there are some attorneys that make more than some doctors, as there are attorneys who make more the other attorneys.

            If you compare the doctors across the the specialty and non specialty spectrum within healthcare, the majority of the specialists do very well and they know it.

            I guess I am not surprised that you as probably being a specialist is not concerned with what happens to a fellow group of doctors as far as pay and viability.

            I understand.
            It is the survival of the fittest approach.
            It is up to them to get their own raise if they want it…true. Specialists are rooting for them as long as they don’t take a portion of any payment that was orignally intended for them.

          • Thomas D Guastavino

            Fair enough. You may replace “Baseball players” with “Pharmaceutical company executives” and “teachers” with “nurses”.
            At what time did I ever “not express my concern over what happens to a fellow group of doctors” ? Am I advocating that PCPs should be paid less so I can get paid more? Why are some PCPs convinced that an increase in their income has to come out of the specialists pockets? When did medicine become a zero-sum game? That is what I meant when I said that PCPs and Specialists have to stop fighting amongst themselves.

          • Suzi Q 38

            Big Pharma executives are not as plentiful as years past because of all the sales and mergers of companies. In essence, the numbers of such executives have decreased as have many, many pharmaceutical sales jobs.

          • Thomas D Guastavino

            I have made my point.

          • southerndoc1

            “The first step is for specialists and PCPs to stop fighting amongst themselves.”

            For the past twenty-five years, specialists have conducted an intentional, well-designed and well-funded, scorched-earth, take no prisoners campaign, via the RUC, the AMA and the halls of Congress, to destroy primary care in this country.

            I’m not aware of any comparable response on the part of PCPs. No more fighting? It’s up to you guys.

          • Thomas D Guastavino

            Funny, I have been in practice for 25 years and I never heard of any such campaign. I guess I was just kept out of the loop.

          • annette ciotti

            I’m a PCP and I’m not aware of such a campaign either. Higher powers want us at each others’ throats. That, I have been aware of for about 25 years. I have some excellent specialists that I refer to, and I do not begrudge them the money they make.

          • Thomas D Guastavino

            Thank you. All physicians have taken hits to their reimbursements over the years with no end in site. Specialists and PCPs need to be united.

          • southerndoc1

            The pay differential between primary care docs and specialists has consistently and increasingly widened over the past twenty-five years, a direct result of the actions of the AMA’s specialist-dominated RUC.

          • Thomas D Guastavino

            Wow, thats the first time in a long time someone has given the AMA credit for actually listening to physicians.

          • southerndoc1

            LOL!

          • Maddie D

            A surgeon is paid about $2000 to do triple bypass surgery, which includes 90 days of follow-up care (including the 4-6 days while the patient is hospitalized). Once you account for overhead (coders, billers, office staff, rent, EMR, and 6-figure malpractice insurance), the surgeon ends up making about $800. For a straightforward, relatively healthy patient, the surgeon makes about $90 an hour (factoring in the pre-op prep and monitoring of the patient, the actual procedure, EMR notes, monitoring the patient post-op, daily face-to-face visits while rounding, meeting with the family and answering questions, answering calls from nurses, reviewing labs and scans, seeing the patient in the office after discharge, etc.). Now that stents are commonly used to treat many of the “healthier” patients, surgical patients tend to be much sicker and have multiple comorbidities which result in longer operative time, more intensive follow-up care, and prolonged hospital stays. So it’s not unusual for compensation to come out to about $45 an hour or even less. My attorney friends charge $300-400 an hour, my friend who’s an accountant charges $250, and when we were thinking of hiring someone to help us with doing some landscaping of our backyard: $100 an hour for her to give us some ideas of where to put this flower and that flower (of course we just figured it out ourselves). So do you think these surgeons, with 4 years of college, 4 years of medical school, 5 years of general surgery training, and 2-3 years of cardiothoracic surgery training, should be paid less? Maybe PCPs should just be paid more, and we ought to reduce the waste elsewhere so that care is cheaper. It’s not just hospital CEO pay- there are countless VP’s, directors of this service line and that service line, multiple people to assure that this box gets checked and this regulation is met- most of these people with less training and experience than PCPs, but who make much more money. Drug and device companies, insurance companies, etc.- so many places where money could be saved, so I’m not sure why there is such an intense focus on reducing the 8.6% that physicians contribute to the nation’s healthcare spending.

          • Suzi Q 38

            Thank you for your information and argument with reasons to look elsewhere for the money. You make some good point that I was not even remotely aware of.

            Of course the same goes for almost any profession. The lawyers bill out $300.00-$400.00 an our, but they don’t get paid that. There are costs that come out of that fee. Also, I know a lot of lawyers who don’t get paid anywhere near that amount. There are several others who have no job at all and are not that hopeful to get one.
            Your friend who is an accountant, is that her net pay per hour, or only what she bills? If she can get it, all the power to her.

          • fatherhash

            Hahaha. Really? Surgeons are making about $45/hr according to your calculations. So then how many hours must the ones making $400,000/yr be working?

          • Maddie D

            Did you actually read the post? I said for the really sick patients, the hourly rate can end up being $45 an hour or less. Not every patient.

          • fatherhash

            Sorry, I should’ve explained more. I was trying to say that even if certain cases/patients(for PCPs and specialists) here and there result in less net pay, it’s what the total amount over the year that should matter(as long as the total yearly hours are about the same).

            The RVU system is the cause of these problems for why some specialists are paid way more than others. A neurologist salary averages more than $100k less than an opthalmologist, even though they have the same years of training usually.

            The RVU system is biased towards procedures compensation…but instead of fixing that, many that are venturing from that try to sidetrack the argument into “it shouldn’t be PCPs vs specialists. There’s plenty of money to go around. We should just increase PCPs salaries using blah, blah, blah(but do not touch my specialist salary).”

          • Maddie D

            I appreciate your explanation; however, I think comparing the total amount of pay over the year is misleading because I doubt that the total yearly hours are about the same between PCPs and many of the surgical specialties. I know that PCPs work long hours, but at least in my experience, they work much less than the cardiothoracic surgeons I know (due to call requirements, emergencies, etc.). And I do think it’s reasonable for there to be some differential in pay due to longer training periods (CT surgery residencies are almost 3x as long as family medicine), different levels of risk involved (and subsequently, much different malpractice rates), etc. With that said, I completely agree that the non-procedural specialists and PCPs are not adequately compensated for their time, and the cognitive work in medicine is undervalued. However, my purpose in breaking down the compensation for a surgeon into an hourly rate is to demonstrate that at least for some specialties, the higher annual salaries are not necessarily due to excessive compensation for the work done, but are at least in part, a reflection of more hours worked. With a healthy patient who has a smooth recovery, a surgeon likely does not make more than $90-120 an hour for a 3 vessel CABG (I think CABGs comprise the bulk of a CT surgeon’s work). Does that really seem grossly overpaid?

          • SteveCaley

            But you missed it – society is laying waste to the Cult of Professionalism, and now insists that everyone with a mind, or some semblance thereof, may make decisions equally. How DARE a rabbi interpret the Talmud, not me – even though I do not have a Talmud, nor fluency in Hebrew, nor am I even Jewish. Other than that, how are we different in these ways? I have the internet, too – AND I can use it on Saturdays! Call me Shabbat Reb and let’s go!

          • Patient Kit

            I would not have wanted my PCP to do the surgery on my badly torn Achilles tendon or my pathologic femur fracture. I would not have wanted my PCP to treat my ovarian cancer or now even monitor me for recurrence. I value my orthopedist and oncologist very much and they deserve to be paid more than what my PCP gets paid, considering what each of the three docs do for me.

            This sudden move by some primary care docs to downplay the need for and value of specialists feels suspicious to me — like they’re trying to take some territory back that they gave up years ago. After many years of referring us to specialists, now suddenly some PCPs are saying they can do a lot of the stuff that specialists do themselves. Maybe some can. But I’d have to ask: When was the last time you did this? How often have you done this? And what were the outcomes? I just don’t see how PCPs can be experienced in all the stuff they haven’t done for years.

          • Thomas D Guastavino

            Thank you!!

          • Patient Kit

            You’re welcome! This turf battle between PCPs and specialists cannot be good for patients. I see it coming especially from the DCP enthusiasts, who say that we can pay them cash and they can save us money by spending more time with us and doing a lot of the things that specialists do now. I value PCPs who see and treat patients as the whole people we are. But that doesn’t mean I think they can replace a lot of specialists.

            I’m still thinking about that detailed redesign of our healthcare system that you requested, btw — something that many smarter people than me haven’t been able to do yet. Need to study the details of how it works in many other countries and read all of Margalit’s posts before I can begin to formulate the details. You already know some of my major principles that I would hope to achieve — accessible affordable healthcare for all, the demise of healthcare as big business. In my redesign, I do know that I would want specialists to remain an important part of our system. Medicine is only getting more complicated from major medical advances, not simpler. I do not believe that PCPs can handle almost everything. They need to concentrate on doing what they don’t have time to do now — building relationships with whole patients. Personally, I have far better doctor/patient relationships with my specialists than with my PCPs.. I would welcome better PCP care. But that doesn’t mean I want PCPs to be specialists.

          • Thomas D Guastavino

            No one is arguing with the goal. The real issue is how you would design a system that would actually function and take everyones needs into account. A system that places an undo burden on one group is doomed to fail.
            Please give your detailed redesign some thought. I would be very interested.

          • Patient Kit

            When I have time, I will do some more detailed research on other systems, maybe starting with Switzerland and Germany. I do understand that it is very complicated and won’t be easy. I am thinking about this a lot. But I disagree with you about my stated goals of healthcare reform. Not only do some think they are impossible goals but, worse, some think they are possible but they do not want them. I start with the reality that some do not share my goal of good, affordable, accessible healthcare for all Americans. Even if it was easy, they would reject and work against that goal — because they see people as either deserving or undeserving. They believe the rich shouldn’t have to pay for healthcare for those who can’t afford it themselves. That would be unfair. But those same people are fine with a system in which those less fortunate than them pay with their lives because they can’t afford healthcare. That is somehow more ok than contributing to someone else’s healthcare.

            So yes, working out the details on both the payer and provider sides of the system is complex and difficult. But I start with those who oppose the goals on principle. Everybody in this country does not agree that all Americans should have access to good healthcare. That reality cannot be ignored and it is a force to be reckoned with.

          • Thomas D Guastavino

            Do you actually know someone whose soul stated goal is to deny access to good healthcare to anyone? Who are they?

          • fatherhash

            I don’t think anyone was arguing to let the PCPs do more…just to compensate them more(for what they are already doing). I understand that your particular PCPs have not benefited you as much as your specialists, but I think the nation as a whole needs a bigger focus on primary care and prevention.

          • Patient Kit

            I don’t disagree with paying PCPs more, although I’m not convinced that they should be paid equally to many specialists, who have more training and take bigger risks doing more difficult things (cancer surgery, for example).

            I also agree that good primary care and prevention is important. But I think a lot of Americans probably don’t know what good primary care is anymore since many of us haven’t experienced it in a long time — if ever.

            What I have a problem with is this: In the many conversations here at KMD about DPC, doctors who are enthusiastic about that model keep saying that they can save money for patients by doing a lot of the things that specialists do, therefore, saving us the money of having to go to specialists. I want my experienced specialists to treat me, not a primary care doc who hasn’t done that sort of thing in a long time.

            I understand that PCPs are feeling squeezed on one end by NPs and PAs and on the other end by specialists. Plus many of us patients are self-treating a lot of the minor stuff. But medicine is continually getting more and more complex and I think we really need our specialists.

          • Suzi Q 38

            Your PCP does heart transplants, bariatric surgery, and hip replacements?
            Wow, I am really impressed.

          • Thomas D Guastavino

            If my PCP did all those things I would pay them handsomely.

          • Suzi Q 38

            Sure we will.
            I like mine and think that they are good at what they have focused their specialty on.
            As far as more general questions, I go right back to my PCP, whom I consider to be the “director” of what to do next. He usually has good and sound ideas.

          • Thomas D Guastavino

            I hope that he “directs” you toward the best specialists he can find.

          • Eric Strong

            Have you considered that if you had a good PCP, you might not need a heart transplant, bariatric surgery, etc…?

          • Thomas D Guastavino

            If I had a PCP that could do that I would pay them even more!

          • buzzkillerjsmith

            I can totally prevent the need for these. I’d like to tell you how but am worried you would spill the beans.

          • Thomas D Guastavino

            Then you must be being paid handsomely. I would keep it a secret as well.

          • PoliticallyIncorrectMD

            Do you know a surgeon who can treat diabetic ketocidosis, acute myocardial infarction or septic shock, Etc.…Etc.?

          • Thomas D Guastavino

            And do you know a PCP that can do heart transplants, fix a broken hip,or remove a cancerous tumor, Etc…..Etc.?

          • PoliticallyIncorrectMD

            No, I do not. Nevertheless, I do not see any less “value” (monetary and otherwise) in what they do.

          • Thomas D Guastavino

            “Value” compared to what?

          • PoliticallyIncorrectMD

            Compared to what the surgeon or the proceduralist does.

          • Thomas D Guastavino

            Why do you feel compelled to make a value comparison between Specialists and PCPs?

          • PoliticallyIncorrectMD

            It appears you are the one making this comparison. You made a statement earlier: “Do you know a PCP that can do heart transplants, bariatric surgery, fix broken hips, Etc….Etc.? I would be more then happy to pay such a person handsomely.” Why exactly being able to do all those things is a prerequisite to being payed handsomely?

          • Thomas D Guastavino

            As I said, A PCP that could all those things would be worth their weight in gold.

          • PoliticallyIncorrectMD

            I would pay any PCP handsomely!

          • Thomas D Guastavino

            Why stop with PCPs?. Pay anyone handsomely who has earned it.

          • PoliticallyIncorrectMD

            And “no”, they are not independent in the current system. RVUs – RELATIVE Value Units, remember?

          • Thomas D Guastavino

            Seems your issue is not with the specialists, but the RVU system. Shall we fight them together?

          • PoliticallyIncorrectMD

            Perhaps we should : ) But why a specialist, present company excluded, would fight the system that benefits them?

          • Thomas D Guastavino

            As a specialist I can tell you that I know of no one who believes the present system benefits them.

          • Brunhilde

            You are the one that made a “value comparison between Specialists and PCPs”.

          • Thomas D Guastavino

            Really? When?

          • fatherhash

            I see. So PCPs should only be paid handsomely if they can also do heart transplants, bariatric surgery, fix broken hips, etc?

          • Thomas D Guastavino

            I never said only, you did. Do you have no respect for what PCPs do now?

          • fatherhash

            You’re right, you didn’t say it…merely implied it. It seems fairly obvious which one of us has less respect for what PCPs do.

          • Thomas D Guastavino

            Your right, Its you.

        • Kristy Sokoloski

          SuzyQ,

          I can verify to an extent what you are saying about the specialists as to the really mostly knowing just that specialty. I saw my Podiatrist on Wed afternoon and during part of that discussion I asked him a question about when I need to have an idea that I need to know when I need to go beyond just looking at my feet alone. The reason is because I know there will come a point where with some of the stuff I have going on it’s going to be beyond just his caring for my feet. His answer was “that’s over my head” and then I explained why I asked that. And of course made sure to stick just to what I know for the rest of my conversation. But it’s funny because earlier in the day I also saw my Pain Management doctor. And because of her knowledge the way sometimes my conversations go with her there are days where she acts more like my Primary Care Physician than my Primary Care Physician.

          Interestingly enough, my PCP has been concerned about some other stuff I have going on gynecologic wise. He has asked me to go back to the doctor he referred me to back in March when I went to get an opinion for one of my female problems. Last year he had to send me to an allergist/immunologist to get an opinion on an issue I had going on with regard to Nursing School and also because of the fact that I have a peanut allergy so he wants to make sure that I am not having to deal with some other allergy issues. So yep, I have kept him pretty busy as well in the time he’s taken care of me. And like you I don’t have to wait 3 months to see him but if I need to be seen right now for some other things that just can’t wait then I don’t mind seeing the PA that’s there. I know this PA pretty well too so no problem there.

          • Suzi Q 38

            Yes, the specialists are noted for their specialty.
            The ones that I have had have not been good enough to help me with other things outside of their specialty.

  • Eric Strong

    The average
    doctor’s salary is not too high considering the capital (in time, money,
    and personal sacrifices) needed to become a doctor, and considering
    average salary in other fields populated by individuals from the same
    talent pool (i.e. business, law, finance, etc…). However, there is a
    huge discrepancy in average salary between medical specialties,
    particularly considering differences in hours, amount of
    weekend/night/holiday call, overall benefit to society, etc… The
    fact that we compensate pediatricians, family medicine, and other
    primary care providers the least of all physicians is a demonstration of
    how dysfunctional our attitudes are regarding our health care. We
    value more highly the person who can surgically bypass our blocked
    coronary arteries, than the person who could have put us on the right
    meds and lifestyle changes to prevent our coronaries from ever getting
    blocked to begin with.

    I’m sorry to call out specific
    specialties, but there is no reason a 9-5, Monday-Friday, no-call
    dermatologist or ophthomologist or radiologist should be making twice
    that of an 8-6 Mon-Sat, every-other-weekend-on-call primary care doctor.

    (For the record, I’m a hospitalist, and feel that my middle of the road reimbursement is fair.)

    • azmd

      I agree with this sentiment. I don’t really hold any antipathy towards the dermatologist or radiologist whose compensation is out of scale for the level of stress or workload that they generally experience.

      However, the public’s general impression of what our lives are like tends to be informed much more by the specialist they see driving up in a high-end Mercedes to pick their kids up from an expensive private school, or whatever. Those of us whose compensation levels and lifestyles are much different than this are still judged the same by the public, and we encounter levels of resentment that we do not deserve.

      For that reason, I find the disparity in compensation levels among specialties to be a problem.

    • Kristy Sokoloski

      I agree with this statement and have thought so for quite some time.

    • SteveCaley

      Very good; although this argument still rests on the archaic fundamentals of professionalism, expertise and action which are largely discarded in today’s Modern World.
      Celebrities may do what they will; it is not arrogance. A single person, though, making a risky and dangerous decision on inadequate information, solely based on one’s own professional skill and training – well, that’s to be stepped on.
      We live by committee, and die by committee – and the more important the decision, the more slowly it should be approached, so that no individual can be particularly blamed for audacity.
      We regulate healthcare nowadays by viscosity; wait long enough, and all decisions become rendered moot.
      We mandate Reality to only allow for certain simple choices, and claim that Big Data will make the decisions for us, given enough rules.
      The argument of Specialist vs. Generalist has been one of Divide And Rule! for thirty years now, and it has helped to disintegrate any national physician organizations, like the AMA, into subservience. Like the Fox motto – “We resent – you deride!” it helps the rest of the public assert the doctors’ salary criteria forcefully. Strangely, the cries for increased funding of lower-paid specialties never does come about; pediatrics is as poorly paid as it’s ever been. So go ahead! Let’s cap it all at – $100,000′s fair, don’t we all think?

  • LeoHolmMD

    My pay is good, even as a PCP. That is not the issue. Most health care dollars feed waste. A lot of my education process was waste. Many PCPs are encouraged, and frankly intimidated to “use the hospital” and “order more ancillaries”. I can take care of a diabetic for several years for the cost of 1 MRI. It only takes a simple analysis of where the money is going to understand where the problems are. Many PCPs can easily make a 50$ office visit work, even today. Analyze overhead. That is where doctors/PCPs are suffering. The data mining fetishes of your insurance company and Medicare are currently driving costs. This is all unloaded on unsuspecting patients and then represented as higher costs. Your PCP is perhaps your only advocate in this mess. Find one you can trust.

    • Kristy Sokoloski

      I agree about finding a PCP you can trust. Especially as Medicine continues to further specialize itself even in spite of all the other things going on.

  • Markus

    Income is determined by market forces, period. An interventional cardiologists makes twice as much as a primary care doctor; Derek Jeter will make a hundred times as much as many internists this year. These outcomes do not reflect some Solomon sitting somewhere deciding the relative merit of these individuals. You get what you get based on market conditions and not on your worth as a person.
    The demand-supply curves do not exist as pure mathematical expressions but are heavily influenced by political processes. In many fields, not just in medicine, buyers try to whittle costs down and use governments monosopy power to do so. This process is resisted by vendors who restrict market entry by licensing and other restrictive acts.
    Are physicians’ incomes too high, too low, or just right? All of us, doctors and patients, have a bit of power to move the curve. It is wrong if one segment has disproportionate power, but that is often in the eye of the beholder.

    • SteveCaley

      No. Supply and demand determines market prices only in a free economy. Medicine and healthcare has been as tightly Sovietized as any other command economy for 30 years. Check that out.
      “The demand-supply curves do not exist as pure mathematical expressions but are heavily influenced by political processes.” That’s the definition of Soviet economy, the Power of Pull. It kept the ancient Kremlin fossils alive for the years after Stalin. If America wants a full open market in healthcare, let it be so. Remove prescription laws on all non-narcotic drugs, and remove prescribing laws. See how that turns out. It will be a kinder, gentler Third-World medicine.

    • Eric Goldberg

      Clearly you have no understanding of how medical care is reimbursed in this country. The American medical system in no way remotely resembles a free-market system. Supply and demand have no correlation with discrepancies in American physician incomes. Look up the CMS and their CPT coding system, then get back to me.

  • QQQ

    Tell that to the mainstream media! Their agenda has to be known by telling the general public that doctors are greedy and only care about their HUGE bank accounts! More of this will follow as time goes on!

  • Suzi Q 38

    This is a subject that everyone is an expert on.
    Doctors get paid a lot and make a good living.
    Many have also paid a very high personal price.

    I think most (with the exception of the solo, struggling, PCP) should quit whining. Our country is just now emerging from a deep recession and trying to implement a new health care whatever (ACA).

    Things are going to change. I have no idea if it will be good or bad.
    All I know is, there may be more competition for jobs from the PA’s and NP’s with all this whining and threatening from the PCP’s.

    The doctors voted for Obama and the ACA.
    It is so ironic that “CHANGE” (The President’s campaign slogan) would apply to the overhaul of health care.

    • Mengles

      Speak for yourself. Doctors never voted for Obama or the ACA. If any of them did, then they deserve what’s coming to them. The majority of doctors who didn’t, don’t deserve it.

      • Suzi Q 38

        Sure.
        How many doctors wanted a single payer system and thought Obama and his ACA would be a good deal?
        Maybe you are not one of them, so I will count you out.
        Yes, the ones that did have to now “embrace” or “brace” for the changes that are about to happen.

        I did not vote for him.

      • Patient Kit

        Speak for yourself yourself. According to a September 2012 survey, 42.3 % of physicians planned to vote President Obama for a second term, 32.7% said they would vote for Republican challenger Mitt Romney and 22.5 % were undecided at that point in time. (Source: Becker’s Hospital Review, 9/7/12).

        Like the rest of the country, doctors were/are split on President Obama and the ACA. And the majority of doctors did not vote against them. Maybe you did. Maybe every doctor you know did. But you do not speak for all doctors.

        • Suzi Q 38

          Thanks for finding the percentages for us!
          I knew a lot of doctors were positive and hopeful that the ACA would be good for patients and doctors alike.

          Not for my husband and me.
          The cost for the two of us to be covered with Kaiser under the “Silver” plan will be about $900.00 a month.
          I better have my house paid off to be able to afford these premiums.
          If my husband and I retired at age 62, we would not be eligible for Medicare for 3 years. Paying premiums like that as a retiree would be “painful.”
          And that is for the Kaiser plan with no choices of doctors….
          If I make it to 65 I can finally get rid of the insurance, use medicare for the emergencies, and pay cash for my PCP’s.

          If not, I’ll be working until I am at least 65, only because of the insurance costs.

          The ACA has not been good for us at all.
          I hope not to be on it for very long.
          Apparently, the way things are going, it remains to be seen if it is good for the doctors.
          Time will tell.

    • JR DNR

      I know someone with a business degree working for Chick-fil-a because that’s how poor the job market is right now.

      • querywoman

        Bizness dee-grees are a dime a dozen.

  • SteveCaley

    Doctors’ pay is a topic of public discussion, as doctors have become commodities. Some states publish the income of their doctors in state employment, along with all other state employee salaries.
    In commodity capitalism, the rule of price is simply a function of supply and demand. Doctors’ salaries are not a popular thing; we can pass certain restrictions and laws to reduce them. Why not? There are other “luxury taxes” on big-ticket items, designed to force people to more frugal purchases and think twice about such things as yachts and Maserati’s.
    If we are certain that doctors are paid far in excess of their value yielded, and the system of Adam Smith has become invalid in healthcare, just simply vote in a cap on physician pay, state-wise or nationally.
    We can fix the price of commodities, in the way that wheat and barley is managed by the Department of Agriculture. Doctors are a commodity – set the price and be done with it, then. If we are sure that the financial rules of David Ricardo and Adam Smith will not affect supply and demand, let’s go.
    But if those rules work – as in the old Soviet Union, where meat was cheap but you couldn’t get it – we could envision problems.

  • SteveCaley

    So cap them! See how it goes!

  • PrimaryCareDoc

    The dermatologist doing Botox all day is charging cash. People are willing to pay out of pocket for that, so it’s really a moot point in this debate.

  • Dr Sook

    Salary comps are confusing. In private practice there is huge overhead; vacation & sick days are not compensated, no shows not deducted as business ‘losses.’ Being responsible for patient care 24/7 is unlike any other profession.
    Geography matters as well: new law school grads can make over $100k in NYC. Different indistries have different standrads: the Tech world considers $250k chump change ! Moreiver- many young software types do not expect to work for 40 years; cashing out at 30 is their dream. MDs are both expected to stay in practice and epected to gain clinical savvy in 40 years !
    So is $190-$300k for full time MDs so egregious ? Do we want to ignore the pragmatics (education debt) and incentives that bring the best & brightest to medicine ? Do we want to have all MDs on a salary with benefits- w/o continuity of primary care realtionships (HMO style) ?
    Is replacing MDs with ‘cheaper’ providers going to reduce cost & improve quality ?
    The cost/benefit analysis shows no certain solution. Maybe the hybrid form will prevail, altho the concierge format for personal primary care seems the only way to sustain old fashioned private practice.

    • jennyct

      Well, cheer up, at least you’re not a post-doc chemist who can’t hit 80K.
      Truth is, there are other careers which require a lot of preparation, cost a lot of money and pay less (besides PhDs and post-docs). You have to go in it for the love of it. If you get out with 300k debt, that’s equivalent to about 2-3 years pay. A pharmacist gets out with 130K debt and recoups in 1-2 years, while a PA pays 100K+ to make around 70K per year.
      But when you’ve paid off the loans, you’re so much more ahead.

      • Dr Sook

        i am not uncheered nor do I regret the element of True Calling. I choose to make some sacrifices because income is not enough to justify a life.
        Pediatricians & psychiatrists make the least and probable sit with people the most. Most specialists are not able to get paid for getting to know their patients.
        The question I was addressing involved the pros & cons of seeing MD income as a problem. A post-doc does not collect the 17% fee reduction made by Medicare. If aan NBA star made a few million less- would that go to teachers ? No.
        Can the middle class & folks who do real work get better compensated thru taxing hedge fund managers ?
        I wish.

    • JR DNR

      Most people in the tech world do not make $250k.

      Tech support workers who have a bachelors in computer science? 28k.

      Junior Software Developers? About the same as a resident. Good luck getting your foot in the door – everyone is looking for experience. To get a position, you need to do a lot of volunteer and free programming for others to show you know what you’re doing, OR have connections.

      Full fledged PHP Software Developer? About 70k a year. Still a great salary – but no where near what a doctor makes.

      • Dr Sook

        I did not mean to suggest that ‘most people in the tech world’ make $250k. Most MDs do not make $400k net.
        In the Bay Area, most middle managers, IT supervisors, project directors as well as CTOs make big bucks without the demands of practicing medicine. Maybe the tech world is ruthlessly competitive, maybe the video game industry is volatile, but no one in tech faces malpractice litigation, loss of license, mandated professional fees, continuing education–let alone the fixed overhead costs of self-employment, life&death responsibility (24/7) and little hope of a big buy out at age 30 yielding $20M like whatsApp & SnapShot.

        • JR DNR

          Isn’t 190k the average for a doctor across the USA?
          An average IT Manager salary is 102k.
          Project director is 99k.
          CTO – 198k.

          Most tech jobs are paid more like nurses or technicians rather than doctors. I know someone who started their own tech company, sold it, makes a solid salary as an IT manager…

          He doesn’t make anywhere close to 190k a year.

          • Dr Sook

            so is your point that tech people should make the same income as MDs ?
            The job market is grossly unfair if measured as a meritocracy. The most crucial jobs are not paid the most; incentives to young folks skew them toward investment banking and start ups–with the goal of retiremnt at 40.
            Can society flourish with that ?

          • JR DNR

            My point is the average tech person does NOT make the same income as the average MD.

            You’re looking at the rare, the unusual, the ones who got lucky – but not the average.

      • Dr Sook

        To be clear- what I said was a bit broad but captures a POV – that in tech world $250k is considered chump change. That can be said of lawyer land, hedge fund village, finance farm, sports& show biz.
        I don’t know many MDs in practice who would consider $250k ‘chump change’- and of course this not an actuarial point- more a cultural one.

  • DeceasedMD

    I think most people are more upset about CEO salaries than doctors. How about an article on CEO of insurance companies or Big Pharma salaries? Times have changed.

  • buzzkillerjsmith

    Too much or too little? This is a trick question and, predictably, you lunkheads fell for it.

    It is obvious, to those who think deeply and seriously about these matters, that I am paid way too little and the rest of you motherscratchers at this blog are paid way too much.

    Next case.

  • DeceasedMD

    WAHOO! Hold onto your wallets. Medicare will now pay for PCP coordination of care for chronic illnesses. A whooping $42 a month.

    • PrimaryCareDoc

      Yes, with the caveat that you are available to them 24/7. No Thanks. They can keep their $42.

      • DeceasedMD

        Yes it is absurd and laughable. That was my POV as well. It is frankly insulting.

  • Suzi Q 38

    I remember when the Chernobyl nuclear accident happened in Russia.

    I was listening to a physician give a talk on traveling there to treat the injured people of that region. I saw pictures of so many physicians, many of whom were women. There were more women than men physicians in the picture….anyway, with all this talk about how much physicians are being paid I stumbled upon this article:

    http://www.profi-forex.us/news/entry4000001012.html

  • Suzi Q 38

    Thank you.

  • Ladyimacbeth

    My internist is paid too little. He charges $50 for a cash visit, and CVS in my area charges $79-99 for a visit. I would much rather see my internist than a NP or PA at CVS Minute Clinic. Considering that my internist has more training than a NP or PA, why is he charging so little?

  • Margaret Fleming

    Good, courageous post; So glad you mentioned hospital execs! In my whole life, I’ve heard people complain about hospital expenses, that $10 aspirin, etc. But I’ve never heard anyone complain that the doctor didn’t give him enough samples, or charged for taking his temp. Besides, working at CAP was not the last time I heard about amazing malpractice insurance premiums. PS Also heard some fancy $$s working for 9 years in the Burbank media district.

  • Ava Marie Wensko George

    I think that physicians salaries don’t impact health care costs in America to any significant degree. Can you imagine anyone using this very same argument in other fields? “We have to cut automobile CEO salaries because it contributes to the huge cost of cars in America!” No. Physicians work hard. They have practically been pushed into a production environment. They have to keep up with vast amounts of governmental regulation. I say let supply and demand work and focus on the real problems of rising health care costs…..(Let’s start with PhRMA.)

  • Aidian Holder

    In general I don’t think American doctors are underpaid. The problem is that they under perform. Even PCPs (who get shafted, bad) are making rock star money, and for that kind of money I expect rock star performance.

    The CNA can have an off day. I can’t get too worked up if the phlebotamy tech isn’t up on the cutting edge of medical science. Not so for M.D.s.

    • SteveCaley

      Rock Star Money. Hmm. Any references on where someone can get that? I can’t afford a new car, with student loans and mortgages.
      The “Rich Doctor” nonsense a prejudice, the same as saying Jews are this, or Blacks are that. It’s bigotry, in a different flavor. It’s used to discard and denigrate people. How about “Golfing on Wednesdays?”
      This is why we fear and hate much of the rest of the world – from our own blindness. And why many other countries loathe Americans. By their measures, we ARE getting rock-star salaries, all of us.

  • Suzi Q 38

    I have contemplated it, but not deeply.
    Why? I have heard it all before.

    Everyone else in the public sector gets paid more than physicians.
    I just do not believe it.

    My point is that law and business schools charge quite a bit for their tuition.

    It is not unheard of for an accountant pursuing a master’s degree have to pay almost $300K at Columbia for her advanced degree (2-3) year program. The young lady living across the street owes for her undergrad and law school and does not have a job.
    Here, she owes over $200K and has no job to pay the loans off with.

    Not all lawyers make $200K and up a year.
    What Kevin is talking about are the exceptions, rather than the average.

    i don’t think that PCP’s make enough, but as far as the specialist’s salaries, I think they are doing quite well.

    • Brunhilde

      You started by saying everyone is an “expert” on doctors’ salaries, but then tell doctors to “quit whining” because based on what you have seen people in other professions also pay a lot for their educations. I have noticed that you have a habit of inserting your uneducated and uninformed opinions into almost every discussion on this blog. Perhaps you should comment only on subjects of which you have some knowledge (ie pretty much no posts on this blog). Best of luck with your chronic fatigue syndrome…

      • Suzi Q 38

        I said “Everyone is an “expert” doctor’s salaries because everyone has their own opinion and thus, it is difficult to change that.

        Quit whining if you are a specialist; you do just fine compared to the PCP’s and the pediatricians.

        I am definitely not as educated as you, but my right to state my opinion which (BTW) does not need to be highly educated as a requirement to do so. Also, I am informed as I want to be.

        Best of luck to you too, as it would help to understand that not all of us need to be of the same education level to talk to each other.

        In other words, I don’t ask people what their education level is on an internet site.

        Most people check their diplomas (or lack thereof) and egos at the “door.”

    • morebuzzkills

      You are using anecdotal evidence to support your argument. I could just as easily counter with my own personal anecdote: I actually studied accounting at the master’s level before going to medical school! I did this at a state school where my tuition was around $2,200 per semester. In addition to school, I tutored and worked in a restaurant! I was actually making money while going to school (something that is much more difficult, if not impossible in medical school). I was subsequently offered a job with a six-figure salary. If your neighbor spent 2-3 years at Columbia studying accounting, she must have not studied very hard. Also, if she is having trouble finding a job, it is likely that she is not looking in the right places. New York City is a notoriously tricky place to find a job in the financial sector. Sure, you might have to look harder and move to a place you find less desirable in order to find good jobs in the financial and legal sectors. Furthermore, law and financial schools have not restricted their admissions the way that medical schools have. Therefore there are many more people with these degrees, hence there is a larger “bottom of the pack.” Are these people entitled to well-paying jobs just by virtue of finishing their training?

      Let’s move away from the anecdotes and look at the bottom line: medicine requires somebody to sacrifice 10+ years at the beginning of their career (usually taking out 6-figures of debt at a very unfavorable interest rate; ask your accountant neighbor about the time value of money and why this is so important). It is all but impossible to work in medical school these days. In fact, many schools have a requirement that you cannot hold a job while enrolled without special approval! These 10 years of sacrifice not only wipe away the interest that could potentially be earned at the beginning of an alternative career, but they actually cause the student to accrue interest on loans borrowed to pay for school! This all occurs in the setting of a less-than-stellar quality of life. My average wake up time while in medical school and residency was before 5 am (as I’m sure was most others). From the very second I woke up, I was working in one capacity or another. So, not only is medical education and training an enormous financial sacrifice (and indeed risk), it is also an enormous quality of life sacrifice. The general public is not aware of this and it is quite simply impossible for them to be adequately informed on this issue. You cannot fully understand it unless you have lived it. Complicating matters is the way that physicians are portrayed in the media. Also, many physicians finally finish training and feel so fed up that they begin spending recklessly, buying fancy cars and large homes (furthering the perception of physician exuberance). However, if you look at the balance sheets of many of these physicians, they are less than pretty. Most who choose to live this way are paying out their large monthly salaries to various lenders.

      I agree with you that PCPs are very underpaid. However, I don’t think specialists are overpaid. The extreme sacrifice of medical training (and indeed life as a physician) has to be made up for somewhere.

      • Suzi Q 38

        “You are using anecdotal evidence to support your argument….”

        True, I am as it is what I know as far as personal.

        The young lady who went to Columbia for a Master’s of some sort did so because she hated accounting. I have no idea specifically what her master’s degree will focus on. The $200K-$300K was for her master’s.
        She worked for a well-known national firm here in California and hated it. She was working about 80+ hours a week on a salary for for definitely less than $100K as she was just starting out. In addition to her horrendous work hours, she had to travel to different parts of the country at the request of her boss. Now, on top of the tuition she paid for at her undergrad school, she will owe for her advanced degree.
        She is not the one having trouble finding a job. She is the one that won’t work for the $100K because she spent way too much time at it for the $100K. She felt she was working two jobs.
        I am sure she is not paying her SL’s while going through this Master’s program, so her loans are accruing rapidly as well.
        In comparison to medical school, this program falls short a year or two. You are right, there is a difference there of 1-2 years.

        Next come the residency programs for beyond…would this time be equivalent to a professor getting h/her Phd? If so, the professor with the doctorate has struggles, too. Also, so I can fully understand this, do physicians have to pay for the residency training? If so, how much is it? Also, how much are you paid during this training? Not much, I know, but as an accountant, you realize the value of money coming in rather than money going out. My point with the residency training part is that few programs (in other sectors) will pay you while you to go to school.
        The neighbor across the street is another matter. I don’t know how aggressive she is about finding work.
        I do hear lawyers complain about the hours that they work for the money. There salary at first sounds high, but when you factor in the long hours it is not so high.
        I think for law degrees, there are 4 years of undergrad and two years of law school. Do they also have to intern for free somewhere?
        So, not only is medical education and training an enormous financial sacrifice (and indeed risk), it is also an enormous quality of life sacrifice sure.

        “…..So, not only is medical education and training an enormous financial sacrifice (and indeed risk), it is also an enormous quality of life sacrifice……”

        BTY, Your description of your educational and career journey is nothing short of extraordinary. You should be proud of yourself.

        I would have to agree with you here. I always put doctors on “pedestals” in the past because of this. Many give up valuable time for their work and the patients they serve.

        My problem with a few jaded doctors (they are not an isolated group) is that their attitude has changed towards their patients, and we know the difference in the way our visits go with them (rushed and not focused). This rushing and not being focused caused them to make “near-miss” mistakes with my care which could have been avoided, if they had only done their job a little more thoroughly.
        The result is constant pain for me, numbness, and a weak right side. I also walk with a slight limp…good thing I finally realized that my problem was with two bad doctors (specialists) so I fired them and got two more who were more interested in my care.
        Too bad that my nerve damage is permanent.

        “…..Complicating matters is the way that physicians are portrayed in the media….”

        True. Many of the doctors in the media “circus” deserve it. There are more and more out there. One by one, this will further point out the greedy and reckless and continuously
        lower the public’s opinion of this former noble profession. The media attention is real and reaches millions of people at a time. It is not one newspaper story in one area of the U.S.
        It is worldwide reporting of a serious medical events gone awry. Doctor’s have to get used to it.

        Take the Catholic priests…. a lot of media stories about several bad ones…but is that all priests?
        I think not. We can go on and on…politicians, city managers, school counselors, teachers, parents, etc.
        No one is exempt from negative media attention.
        Unfortunate, but “business as usual.”

        My jaded view of some doctors comes from my own person anecdotal experiences as a patient old enough to see the changes of the last 50 years.
        “……Also, many physicians finally finish training and feel so fed up that they begin spending recklessly, buying fancy cars and large homes (furthering the perception of physician exuberance)….”

        I am glad that you have brought this up. We definitely see this, and wonder why they do this. Physicians are a highly intelligent group and a general whole and to see so many of them do this recklessly is sad. This is their choice, and hence the public reaction.

        I also want to point out that many of the doctors have married other doctors (understandably, as they meet each other at school and work where they spend so much of their time), so the money does not stop at just one $300K-$400K+ salary. If they can’ “make it” financially with TWO high salaries..they are not that bright in real life.

        I am glad we both agree that PCP’s are “very underpaid.” I am just not sure that the pay (about double that of the PCP) is warranted given the type of work and the time given in comparison to the PCP.

        This next decade should be very interesting, and not in a good way. The PCP’s need to be compensated because if not, we will lose very good doctors who deserve more pay. They will be replaced with PA’s and NP’s, because they can not afford to have a business.
        There may be also areas of specialist physicians seeing their jobs replaced with NP’s in their specialty. We see this now with nurse anesthetists, gyn NP’s, and pediatric NP’s.

        Do I really think that the PCP’s deserve less than half the pay of the specialists? Heck no.

        As to where the money is going to come from to compensate them, your guess is as good as mine. A hefty $400K salary for one of many physicians may be a target.

  • SteveCaley

    So – remove medical licensure restrictions, and prescription restrictions on drugs. Let the market decide. Please – that’s the way it’s going, so go with it!

  • SteveCaley

    Does anyone notice that the rapid gender shift in medicine coincides with the rapid decline in physician esteem? If you want to make a problem invisible, put a dress on it.
    “Here in Washington, new lawyers just starting off in a major law firm can get an end-of-year bonus that is larger than the whole year salary of a new public school teacher. That’s evil.”
    No, that’s just honesty in action. We have a society and we make our priorities. You need a Brand, a Name to make money – and Washington sells access to Brand Names.
    Washington will dictate the rules to the women-doctors, and the women-doctors will follow the rules. 30% savings on the gender rule by switching to women. Beware fake feminism – sometimes it’s a wolf in sheep’s clothing. Are there single-mom doctors struggling to make ends meet? Sure there are – and that’s something unheard of 20 years ago. But could a single-mom doctor possibly hope to get alimony? Not if the ex has a decent lawyer. So, as we sail towards campesino medicine, we put the pink collar on the profession and kiss’m good luck.
    In the old days, fathers handed their practices down to their sons. We’ve got it rigged to get rid of all that privilege and fanciness – so moms can’t do that with their daughters.

    • Barbara Piper

      Hi, Steve, and thanks for the good comment. I also think it will be interesting to see what happens to various aspects of medicine as it continues to become a female profession. Certainly, as you imply, public school teaching got to be a relatively low-paid profession in the U.S. when it became dominated by women, and the slight rise in teacher salaries in recent years may be part of the entry of more men into that profession. The same gender history drove men away from nursing to create social work, and now the new job of ‘physician’s assistant.’

      But “honesty in action” is not exactly how I’d think about it. Public policy is often at odds with social reality. My ‘that’s evil’ comment was made with a rueful smile — we’d like to acknowledge the value of teachers but when they became essentially government employees many years ago they lost control of many aspects of their work, including incomes; physicians, by contrast, at least according to Paul Starr’s history of medicine in the U.S., retained control over practice for long enough to establish more control until they, too, became dependent upon government programs such as Medicare and Medicaid (on the one hand) and for-profit health care systems (on the other).

      Thanks again. Barbara

      • SteveCaley

        I figure that a few people like Francis Peabody MD stood valiant on the ramparts to hold off the rapine of medicine for fifty years. The Modernists have been trying to manufacture Machine Medicine since the beginning of the 20th century.

        It is interesting that the think-tank which brought teaching to what it is today was the Carnegie Educational Foundation – the same one that funded Mr. Flexner’s report.

        The approach to every entity is to term it an industry, and divide it into sales, manufacture and financial. The actual doing of the work is divided up á lá Taylorism – mechanize, disempower, and when possible, feminize the production workforce.
        See John Taylor Gatto’s work on “Weapons of Mass Instruction.”
        Best, Barbara, and keep’m offya.

  • Suzi Q 38

    “…..First, Kevin should remember that members of many other professions spend an average of 10 years — after college — to get their doctoral degrees, which entitle them to a couple of hundred thousand in debt and an average academic salary of about $80,000. The whole argument about how much time is spent in training is something of a red herring, since it implies that there is a target or externally established goal that is being deferred by long years of education or training, yet that is never really specified very clearly, and it applies equally to other professions that make a fraction of what the average physician makes….”

    THANK YOU.
    I appreciate your post, because your paragraph sums up what I have known all along.
    That the physicians are not the only profession who have spent long years and accrued considerable debt in order to work in the career of their choosing.

  • morebuzzkills

    The simple answer is no physicians are not overpaid, absolutely not. Junior investment bankers (i.e.. 22 year olds just out of college) at top Wall Street firms can expect to make around $120,000 per year. This amount is actually expected to go as high as $175,000 this year as firms are in a bidding war for top talent junior bankers. Many of my undergrad classmates who went to Wall Street get quarterly bonus checks that any physician would be overjoyed with if it was their annual salary. This seems incredulous to the newly minted pediatrician who has just toiled through 12 years of higher education and training and makes as much as a 22 year old on Wall Street. It is only a matter of time before the training in medicine becomes too ridiculous and salaries become so low that top talent will look elsewhere.