All right, I'm biased. I'll admit it. I think doctors, especially me, should make a gazillion dollars. Now that we have that disclosure out of the way, I'd like to explore five reasons why we (as a society) shouldn't want physician pay to go lower.
1) Physicians provide a valuable service
Most importantly, what doctors do is valuable. In all the whining about the high cost of health care, few people would argue we should just bag the whole thing all together. The day to day work of a doctor is valuable. Worries are extinguished, lives are lengthened, and quality of life is improved. Does medicine have lots of problems? Sure. Are there some bad doctors out there? Of course. But overall, physician services have a high economic value. Those who provide them deserve appropriate compensation for the value provided. We don't think twice about plunking down $200 for an iPhone, but balk at $200 to get a specialist's opinion on treating a serious condition? Where are our priorities?
2) Physicians Lost A Decade Of Their Life In Training
The 20s and early 30s are the prime of life. You typically enjoy good health, can run on little sleep, can bounce back easily from a hard day, and are often free from burdensome family responsibilities. Many physicians come out of residency feeling as though they checked out of life for 5-15 years. They've lost friends, missed opportunities, and often times suffered through the loss of important romantic relationships. They've missed weddings, funerals, vacations, reunions (I was in my first month of internship during my 10 year high school reunion) etc. If there is no financial compensation for this loss (i.e. a light at the end of the tunnel), the intelligent people you want to go into medicine won't.
3) Being a Physician Is A Difficult Job
When I was growing up in Alaska, everyone understood that you had to be paid well to do a difficult job. Commercial fishermen didn't risk their lives on the Bering Sea for minimum wage. Oil men didn't work a two-weeks-on-two-weeks-off schedule on the North Slope for lower middle class wages. If your corporation wanted to send you to Alaska, it had to pay you a lot of money to do so. There was a well-known relationship evident in everything people did. If a job required hard work, long hours, odd hours, and/or a great deal of stress, it paid more. Enter medicine- long hours, constant stress of not diagnosing or treating someone properly (leading to the patient getting sick or even dying), and the bureaucratic hassles imposed by government and other payors, and you've got a hard job that deserves to be paid well. How many times have you been told by friends and family “I could never do that, I can't stand the blood.” (Or the rectals and pelvics, or sick people, or the stress, or the call, or the crazies.) More importantly, it's a hard job that requires compassion, difficult decision-making, leadership, intelligence, continuous learning, and decades of dedication. That deserves appropriate compensation.
4) Doctors Have Constant Liability
I never thought about this much as a pre-med, or even a medical student. Becoming involved in two suits during my first two months of residency (I was dismissed from both thankfully) really opened my eyes. Ever since then I constantly think about and worry about legal liability for my actions. I worry more about doing the right thing for my patients so they actually get better and don't die, but you better believe I never fill out a chart without thinking about how I would defend it in court. You think your grocer worries about that? Or your mortgage broker? How many times a day do you suppose a teacher worries about getting sued for $5 Million? Don't you think having to deal with that constantly hanging over your head deserves a little bit bigger paycheck? I do. I used to think I'd be a doctor even if it only paid $50K. Now? No way. And the constant liability is a major part of it.
5) Physicians Have Long, Costly Training
If it takes a few months of training to learn to do something, it should pay more than something you can pick up in 10 minutes on the job. But what if something takes more than a decade to learn? And requires you to take on levels of debt that many wouldn't consider for a mortgage they plan to pay off over 30 years. Isn't that worth something? It's gotten to the point where the typical graduate of many medical schools simply cannot afford to go into the lower-paying specialties. That's just not right. Some argue that the problem is that other specialists are paid too much, stealing part of the income of a lower-paid specialist. Having worked in a system where no specialists are making more than the very low six figures, and watching people quit that job at the first available opportunity, I just don't believe that lowering the pay for all physicians to the lowest common denominator is the solution.
If our society demotes doctors from their status as professionals and business owners to that of unionized workers, our society is going to get what we deserve. The medical training pipeline is long enough that it will take a while to see the effects, but in the end, we'll rue the day we decided quality health care wasn't worth paying for.
as a reasonably well paid specialist (exorbitant by the standards of the median wage in the US) I have mixed feelings on this topic.
Making around mid mid 6 figures, with incredible job security reasonable (not perfect) hours, and a general long career is not to be taken lightly.
A typical specialist can look at 300k x 25 yrs in real dollars. So that’s basically a 25 year contract for $7.5 million, before taxes. Many specialists make much more than that – usually though the aggregate is around the same, just a shorter total time working is the difference.
Society should determine our worth. There are some niches in certain fields that get paid exorbitantly, and for no particular societal value. Certain fields (like primary care) are way undercompensated despite their critical importance.
The problem is not that doctors are overpaid. The problem is that some of us are way overpaid for relatively little or no, additional value added. I may be one of those (?)
I don’t know. What I do know is that society has NOT determined my wage based on demand, skill, quality, service, or need. It has done so due to a byzantine mess of lobbying, government, insurance, turf wars, and regional variations that are both illogical and harmful to not only the health of patients but the ethics and morals of our field. Our system is also part (but far from all of the reason that health care costs are out of control, with little hope of being reined in.
Should I make less? Probably. Should certain other specialists make less – almost certainly. Should primary care be paid more? yes. Should quality of care matter to payment. Absolutely.
An MLB relief pitcher soft tossing 84 mph meatball strikes with a 10.00 ERA won’t get the same contract as a nails closer. In medicine though, a over treating, over testing doctor in Texas might be paid multiples of a more efficient, higher quality specialist in New York State.
So yes, as a whole, doctors may be paid correctly in aggregate, but how those dollars are being divvied up is an absolute mess, and serves to threaten our own salaries and more importantly, the career we chose and the patients we are trying to help. Our nation deserves better, and right now, physicians are largely leading from behind, working to protect themselves, not to help our field or each other.
Soon the decisions will be made for us….
Yes, doctors should be part of the solution for high health care costs, not part of the problem. I believe the statistic is that physician salaries make up something like 8% of our health care costs.
I don’t know if the average doc should make $150K, $250K, $350K or what. But I do know they should be making more than $50K and sometimes fear that I am alone in that knowledge.
No expert, just some random layperson thoughts here: I don’t begrudge doctors their pay, and I sure hope all of mine are making more than $50K/year, but there is clearly a lot wrong with the health care system, and doctors presumably have to take some part of that blame, under the heading of leadership that you mentioned. If the stats I’ve read about the number of unnecessary infections and mistakes made in hospitals are anywhere close to being true, then that’s one area that seems to need work. In college years ago, I wrote a paper proposing an intergrated computerized patient charts/drug tracking/billing system to reduce costs, provide better continuity of care, avoid patients getting accidental doses of things they are allergic to or already got from the prior nurse or doctor – that was decades ago, and I’m not even sure hospitals have these systems in place today? Another is, I’m not sure how to put it, result-based pay or orientation, e.g., when the doctor’s answer is, ‘I dunno, could be stress,’ an answer like that is something most other professions might have a hard time charging for with a straight face. Whereas, if a doctor successfully diagnoses or removes a brain tumor, perhaps a success bonus/fee is called for. As far as the payment side of things, HSAs seem like a step in the right direction, and Obamacare, unfortunately, has moved away from these, actually limiting instead of promoting them.
Great comment. You’ll be disappointed to see what EMRs still don’t do well.
One issue with medicine is that it pays a lot more for success bonus/fee and so no one wants to do some very necessary things where the answer is sometimes “I dunno, could be stress.” Frankly, a lot of times that’s exactly the right answer, even if the patient doesn’t want to hear it. It’s ridiculous how much more I get paid to repair a small laceration compared to doing a huge work-up on vague symptoms that ends “I dunno, could be stress.”
This is probably further off-topic, but … (1) ER: The one time I ended up in the ER as an adult, happened to be about 30 days after I had just switched to a high-deductible HSA plan, so, this being my first visit to a doctor/hospital of the year, nothing was covered, and I had to pay everything out of pocket. They took and “ran” my insurance, but it just came back, “APPLIED TO DEDUCTIBLE”. So I ended up with a rack rate bill. Subsequently, I have heard and read the medical industry defend these rates for cash buyers as rates that “no one pays”, but my limited attempts at questioning the bill got absolutely nowhere. The best I got was 10% off for paying in one lump sum rather than on a payment plan. Maybe if I had been willing to make up some story about how I didn’t have the money or who knows what, or let the bill age to 60+ days, I might have been able to negotiate it better. but the hospital and doctors were there to provide service for me when I needed it, so I wanted to pay the bill, don’t want my credit damaged, etc. Also, the bill didn’t come with any fine print stating, “You don’t have to pay these amounts, and can negotiate them.” It just said it was due in X number of days. I had no problem with the ER facility charge, X-ray charges, or doctor charges. The part of the bill I found completely ridiculous was the arm sling I was provided for $235. Given that this item is a piece of fabric and velcro and sells on Amazon.com for about $23, I thought there was a mistake so called to inquire. The billing dept. confirmed the price was right. My response, which got nowhere with them, is that I came into the ER with a makeshift sling and would have gladly worn that home until I was able to find the nearest drug store and buy a $30 arm sling, had I known the egregious price they were going to charge for it. It was like ordered market price salmon at a restaurant, and then the market price turns out to be $350. No restaurant could get away with that, but the hospital can apparently get away with this, without any informed consent on my part (I would have passed on this purchase and signed any resulting liability waiver, had they told me. Of course, my experience with asking doctors how much this or that procedure might cost – relevant with a high-deductible insurance plan – has been they almost never have any idea. If most folks had a high-deductible insurance plan with an HSA, they’d get asked this all the time, and would have to find out the costs.) The billing department acknowledged it was probably the same sling sold on Amazon.com and said the prices reflect that not everyone they provide service to is able to pay. So I am the only one out of 10 others that is paying!? This hospital now sends me charitable donation soliciations.
(2) While I’m here, WCI, if I am need of returning to an ER one day, what priority should I put on making it to the nearest Level 1 Trauma Center that I always hear about, vs. just the nearest ER? Of course, if I’m bleeding out, I’ll take the latter, but not all ER visits (including the one I mentioned above) are that urgent. Ironically, I’m guessing that the L1TC is more important in a bleed-out, life-or-death situation, than in a broken arm situation like mine above?
PS – The arm sling is even cheaper now than it was when I was researching it following my receipt of the ER bill years ago – I just checked, it’s now $11! http://www.amazon.com/OTC-2460-Cradle-Arm-Sling/dp/B000JNRHJ0
Lack of transparency is a serious issue increasing the cost of medical care. Level 1 trauma centers are wonderful if you have a level 1 trauma, i.e. a gun shot wound to the chest or an ejection through your windshield. For less significant trauma or any medical issues, your community ER is likely fine.
That’s 4 reasons too many. I totally agree that good and efficient MDs should be well compensated for a very good quality service, for saving lives or for improving the life of others. However, let’s not forget that doctors are human beings, even though some of them falsely think they are god. And as such human beings, some of them would still cash in the fat check and still provide crappy medical services without any kind of empathy and any kind of respect for their patients. And I met a lot of them, that think that they are the ones holding the absolute truth.
The idea of paying _all_ members of a certain practice well only because they studied hard, because they lost a lot of years in school, or because the job is hard has unfortunately one root idea: communism = everyone is equal no matter what they do, and no matter if they do it well or not. And that is a complete theoretically utopia.
But the truth is, that in practice people are not equal. They have equal rights, but some of them provide more to the society than the others, and those need to be compensated as such.
The moment you give someone a lot of money no matter how he does his job, he will start thinking he deserves more and inevitably will do a worse job and want more money… unfortunately this is greedy human nature. I do not imagine that anyone (even godlike Doctors) is perfect.
Therefore, I cannot agree with the post, I can only agree that those physicians that are providing a good quality, should be equally very good compensated. Give and take…
There is no standard for “ good quality “. The fact is that primary care is not compensated for its value. The current corporatized system is unable to recognize quality or value except as it pertains to money generated. Think about the comment that reimbursement is more for a lac repair than discussing a complex or vague issue. talk is cheap compared to procedures so in a twisted way knowledge is valued least.