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Doctor Earning Potential

Discussion in 'Allopathic' started by cman06, Feb 13, 2012.

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  1. cman06

    cman06

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    Hi, I have seen several threads concerning physicians salaries, where they are headed, etc. I have a question about the earning potential of physicians. I know things like investments and stuff can vary greatly, but I am asking more about working more hours, on call, etc. For instance, I have seen where EM docs make a certain amount for a certain number of shifts (12 12hr shift/mo), but can these docs take extra shifts, work longer hours? I guess the official question is if doctors are on salary or paid per hours they work? Also, I know surgeons come in a lot and stuff, but is the reason they usually have such a higher median salary because they work more hours (on-call, long procedures, etc)? It seems, for instance, that an EM doc making 250k for 35hr work weeks can easily jump near surgeon potential with the same amount of work. I just feel that physicians make more than what is reported because there are a lot of potential income factors not taken into consideration, please correct me if I'm wrong. Thanks
  2. upright

    upright

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  3. D elegans

    D elegans Cheers

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    Physician income is multifaceted and highly variable. I would suggest searching old threads to answer a lot of your questions.
  4. countthestars

    countthestars Resident

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    I am really amazed at peoples perception of em...first off, working 35 hours in the er is similar to working 50 hours in clinic. It is a hard 35 hours one is working. Plus your body needs to recover from the stress put on it when working. Second, most em docs work about 40-45 hours to make 200-250. This is especially true in metropolitan cities like nyc where pay is a whole lot less per hour worked.
  5. link2swim06

    link2swim06 PGY-1

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    Cite your sources bro. I can cite otherwise...especially anywhere outside large coastal cities (like NYC and LA)... (remember most EM docs dont live in NYC/LA)

    Your number imply making $92 per hour on average...I have seen moonlighting gigs for residents at a higher rate than that...

    Go to the EM subforum, there are more threads than I can list which cite a ton of $140-200 per hour jobs available in most states. Those jobs dont require 45 hour work weeks either...


    But please cite otherwise...
  6. OveractiveBrain

    OveractiveBrain

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    What youre asking about is contractual obligations and RVUs. Some hospitalist gigs will have you work 26 weeks a year, but then forbid you from moonlighting, a stipulation you can negotiate out of the contract (non compete clause). Other places just need the docs so don't give a **** how many hours you work. Some places pay extra just if you see more patients, some pay extra if you bill better (justifiably higher), some places wont pay you extra at all.

    Location has a huge difference too. A Hospitalist out of training in NYC makes about 90. Yeah, 90. Translate that down here to the dirty south where a private hospitalist working 24/7 x 26 weeks makes 250, with RVU potential.

    Your pay (A) should not be your prime motivator for specialty or geographic practice, and (B) is dependent on location, hours worked, patients seen, billing potential, etc.
  7. Slaol

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  8. thomprya

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    Meh, call me the socialist pig of SD but I really dont see that big of an issue with specialist docs having to take a pay cut. You really can't cut the PCP docs salary since it is honestly too low now. There is very little interest in primary care among med students and a big factor in that is the pay differential. Call me crazy but orthopedic surgeons are still going to live well on 500k as compared to 600k. Too many specialty docs is one of the reasons medicine is so expensive in the US.

    Oh, and this is coming from someone who is not going into primary care.

    to the OP, docs will always be in need and there will always be doom and gloom on the internet, these are the constants of the universe.
  9. greyman21

    greyman21

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    True enough, that subspecialists will live just fine going from 600K to 500K. Though I don't know how I would live without that extra ferrari. However the problem that both causes problems for the patients and the doctors does not involve the actual people involved in delivering care but the system that they work in.

    Insurance companies are expensive, it costs a lot for people to get their insurance outside of medicare and medicaid and as we can see with the current health care crisis many that exist between the optimal income to purchase solid insurance and the threshold for public assistance will go without medical care.

    The government allows insurance companies to run around like crazy making hoops for patients to jump through, preventing doctors from practicing medicine with independent thought (though in some cases it makes sense that they remind us of the cost effectiveness of treatments, just not when you have already tried options/have reason to know they won't work). However medicare also limits what doctors get paid, because most private insurance companies use this as the market value considering the # of patients on medicare.

    Now in a system where the market value is set by the government and they expect doctors to make less, but they sit down at the table with insurance companies and make promises of continuing business as usual who really suffers. The patient and the physician as I noted above. That argument dosen't even consider pharmaceutical companies and tort reform which also play a huge role in what the patient incurs as a cost and thus the cost of running an insurance company, and in what a physicians take home is after practice expenses, taxes and malpractice insurance.

    Frankly the willingness of a physician to take a pay cut without a fight is just symptomatic of how downtrodden the profession (that I love) has become. We are never the policy makers, there are whole separate schools on that, somehow in the long history of medical academics going back to greece, rome and leeches (and way before that) we lost our swagger, maybe we should go back to being barbers. My feeling is that the people who go into policy are for the most part not in love with clinical medicine or they are far removed from clinical medicine, thats why they administrate. They are willing to keep building on the foundations of a system that has seemingly been broken for 15 - 20 years because financially so much is invested in the current structure. Look at Howard Dean and Ron Paul they were both physicians but I didn't hear them rallying for their profession, we just aren't our best advocates.

    Anyway kudos to primary care, more money should go to it because I would rather spend 10K of the governments money keeping kids from smoking then 10K/day for an ICU bed (keep in mind that I want to be a medical intensivist), and this money should come from the procedural subspecialties that feasted on years off of a system that was built to reward interval data (# of diseases via capitation codes and DRGs) and not built to reward an individuals work towards the management of diseases (unlike law/accounting/wall street where you are paid by billable hours). Medicine will always be a good career, and a solid way to provide for a family, as long as the system dosen't go towards NP/PA independent primary care which at that point why would anyone go to medical school. The people who get filthy rich from medicine are those who get filthy rich in any other walk of life, by making wise and sometimes lucky investments. /end rant (sorry got carried away).

    edit: you can really see my momentum building as the paragraphs get longer o_O
  10. thomprya

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    Great post! Pretty much agree with everything said.
  11. Butler

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    Doctors taking any sort of pay cut from any specialty is a bad thing. The "not a big deal" attitude is what got us to this spot in the first place and if it continues, say hello to every physician being a government employee scraping by on 90K with $300,000 of educational loans. Not a place I wish to be or wish on any physician, regardless of specialty.
  12. Hashi

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    There are a ton of reasons why healthcare is expensive. Too many specialists is certainly not one of them. If anything, too much supply = a reduction in service cost, not the other way around.
  13. Hammergin

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    I think you need to rethink your economics there in terms of who controls the pricing/payouts in medicine. And on your point about specialists, if a PCP is too liberal with sending their patient to a specialist, it will of course increase healthcare expenditure (ie cost to insurance companies which is then passed on to the patient in the form of higher premiums).
  14. greyman21

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    Which calls back to the issue of tort reform, my big turnoff to the general practitioner work style is the number of consults they call. I understand knowing the limit of your knowledge but I also feel that most of it is just to cover your ass legally if you miss a zebra. Like every patient where I am with a elevated creatinine gets a Nephro consult (the general Cards service is most guilty of this), why do I need a nephrologist to do the workup of AKI and then tell me its nothing, as a GP I should know what nothing looks like and only consult/referr out if there is some sort of suspicion, not because I'm lazy or don't want to challenge myself.
  15. dreamweaver1988

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    Rand Paul has some pretty good ideas about fixing healthcare:

    http://www.youtube.com/watch?v=BugRMHaL3lU
  16. thomprya

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    Respectfully the 'not a big deal' is not at all what got us into this spot in the first place. Healthcare is a trillion dollar industry and can be views from many different angles about what is wrong with it. I currently look at the looming PCP crash coming due to utter lack of interest by us the med students. PCP docs have business coming out of their ears and some can barely crack six figures. I read somewhere that in order to raise interest in PC generalist's pay should be 85% or so of a specialists pay. I find that goal unrealistic but fairer then the 25% compensation rate they are getting now comparatively. I however am confident that the market will eventually speak and wages will increase.

    Very wrong. 70% of America's docs are specialists 30% generalists where in other countries those numbers are inverted. PCP's drive down costs by providing low cost per visit and catch problems like diabetes before an Endo doc needs to see them. Perventative medicine is one of the best methods to drive down long term costs and specialists are simply not equip to do that (and neither should they be).
  17. Shnurek

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    The government wants to pay public rates but wants docs to educate themselves privately. I say screw that ****. At least do it like France where the medical education is fully subsidized but they only make double of an average worker aka that would be a little under 100k here in the states but no student debt!
  18. JacobMcCandles

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    You'd see a mass exodus from medicine if that were to happen. The quality of physicians would also likely to decline as well as the medical schools material students (best of the best) will Lebron James everyone and take their talents elsewhere.
  19. cman06

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    Hey guys, thanks for the response. The reason I asked this question has more to do with curiosity and lack of knowledge on the subject of being paid as a physician. I work at a medical school/hospital and while logging my timesheet recently, I noticed a pay selection for 'on-call'. Thus, my goal, sole motivator, etc for going into medicine is not money. I would have just went into computer tech with my friend (who graduated the same time I did, May 2010, and has had 3 promotions and is currently having a house built). I am genuinely just trying to gain an understanding of the system with which physicians are paid. It is not like most jobs where you are paid by your department a certain salary despite amount of time, work, etc, unless you have an hourly paying job. I've seen so many different things, I was trying to get clarification on the subject. I've seen physicians bringing in a certain amount per year, but was wondering how true those values were since being on-call and stuff would need to be factored in for most specialties. I've also seen were physician would try to see more patients, come in more, take others call, etc and was wondering if they were doing this out the kindness of their heart :laugh: , or to get extra money. Also, residents are not paid for on-cal time are they :xf:?
  20. cman06

    cman06

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    How exactly is the system set up to provide such great discrepancies in earning of a PCP and specialist? Is it reimbursement amounts? Cause it seems that even if say specialists get 40% and PCP get 25%, with the surplus of business a PCP gets it should even out somewhere (albeit more work).

    specialist: 5 patients getting procedures at $100.
    Physician get 40% - 5x$100=500; 40%x500=$200 from 5 patients

    PCP: 10 patients getting procedures/visits at $50
    Physician get 25% - 10x$50=500; 25%x$500=$125 from 10 patients

    I'm sure PCPs see more than twice the number of patients, but then again they do not have to do the specialized procedures or as in depth visits (from my opinions based on observations so please take with a grain of salt). So shouldn't it even out or at least not be as wide a gap.

    So why are specialist averaging so much more (at least twice as much) income than PCP? And would there reimbursements be different? Are my calculations totally wrong? I went based on seeing another post state that reimbursement rates are about 37% now and the 25% figure from the above post for PCP.
  21. greyman21

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    Most PCP visits are way more in depth than a subspecialist visit. When I said before that we have a reimbursment system based on interval data I was referring to ICD codes and Procedures. Doctors get paid x$ for a cardiac cath vs y$ for a well visit. Now I don't know real prices but a cath will pay out more and will need 5 - 6 well visits to cover the Doctors payment for the cath (other payments going towards facilities, the hospital and the staff that is usually paid by the hospital rather than the doctor).

    Now those 5 - 6 patients may be easy or they may be hard patients, the easy ones take maybe 10 minutes listen to heart lungs quick abdomen, everything going great no complaints? quick labs and next patient. But if you throw in a tough patient it can take 1/2 hour to 1 hr to work through all of the issues, collect data from recent ER visit or admission, get imaging etc. These patients net you some more money but not as much as doing a procedure. That one tough patient is the time that you spend doing the cath, when you consider it in terms of doing a egd/colonoscopy its even worse because you can do maybe 3 colonoscopies in an hour and even more egds in an hour.

    Subspecialists get paid more need a lower patient volume and focus on one issue, in addition all of them have some procedure available to them Cards/GI are obvious, nephro gets paid by owing /running dialysis (and dosent' get paid as well as the others), pulm has bronchs, sports/rheum has joint injections (gets paid like a PCP still) etc. Thats where people make more money, and primary medicine really lacks these procedures (unless you do family in the sticks and then you do joint taps/injections and skin biopsies, pap smears etc).

    To put this in perspective GI was one of the least competitive specialties in the 90s because no one paid for screening colonoscopies so no one got them, and GI didn't make enough for it to be worth touching poop. Then Katie Couric's husband died (i sh_t you not) and insurance companies tried to save face by paying for screening scopes after she outed them in the news. GI exploded in popularity because of reasonable lifestyle with big bucks.

    The point I made before is that no one pays us to take time and think, for some reason they can't quantify this which is why primary practice is so hit or miss. Many practices will close not because of available patients but because the turnover of volume in the practice is not sufficient to generate revenue, other practices find ways around this but still cannot touch procedure based specialties simply because the people who design the pay out structure cannot put a number on a persons thought process, so Doctors don't get paid as well to think as they get paid to do which in my opinion is why bad Doc's do procedures unnecessarily to get paid (See: Scoping for Dollars) and good Doc's do procedures when indicated.
  22. JackShephard MD

    JackShephard MD

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    While I agree that the healthcare industry earns an enormous amount in our country and that things like tort reform or limiting insurance companies profits are great starts, I think these attitudes show how spoiled we've become.

    As a professional in America, you're income is likely in the top 5th percentile (I know, you've earned it through years of sacrifice, hard work, and mountains of debt). Whatever the exact statistics, the following can't be far from true. Half of the world is living on $2 a day. The bottom 5% of income earners is richer than most of India, China and Brazil. Our poor (bottom 5%) are the world's rich. Now we move to physicians, who are in the top 5% for American's and somehow we are still "scraping by" and "downtrodden." Step back and gain some perspective. You're likely in the top 1% of the world as far as income, disposable income, and lifestyle. I know it would suck if you moved from the top 1% down to the top 3 or 4% in the world by getting a huge paycut, but I think you can manage.
    http://economix.blogs.nytimes.com/2011/01/31/the-haves-and-the-have-nots/
    [​IMG]

    If you've come into medicine to get rich or for lifestyle, then paycuts will shake your reality. But if you're here because you enjoy the profession, I think you'll be fine. I sympathize with those who had to take on lots of debt, but I still think you can do very well. This is the richest country in the history of man, and you're in the top 5% of that group. Wow.

    I do think programs that pay back loans for PCPs are great, which addresses the problem of lower income physicians remaining in business.
  23. Butler

    Butler

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    I would like to have a sit down with you in about 10 years should Obamacare go through. Coming off your 4th consecutive shift from the hospital, where you are a gov't salaried employee working for a pittance while manacled to insurance/govt' "EBM-based" algorithms all day with rationing and managed care. I have a feeling you won't share the same opinions on that day. At least you'll have great benefits though right? :laugh: If doctors as a group don't start sticking up for ourselves in the healthcare industry and in legislative avenues, this is where our profession is heading in my opinion.

    It is all well and good to want to help people and serve patients, but plain in simple, Healthcare is a business and doctoring is a job. If we don't make a point to help shape the changes of our business (that are most certainly coming) then our job will become a whole lot less profitable and a whole lot less fun. Never forget that power follows money and vice versa. Once you lose money, you lose power and once power goes...the control of your business and job goes. Guess what disappears with control? Job satisfaction. If that happens, say hello to the future; your new "doctor" is the NP, because no one is dumb enough to enter medicine.
  24. greyman21

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    I think I'm being a little misquoted here. The statement of being downtrodden didn't refer to finances, I stated it that we were never millionaires and just needed to invest wisely to make a ton of money. The downtrodden comment was more about autonomy than anything else.

    We are controlled by insurance companies, we now have to compete with NPs and PAs (to a lesser extent) over who is more qualified to be the entry point to the health care system and the "the sky is falling" attitude toward government involvement in health care is that the institute of medicine and CMS will be auditing all of our patient panels for patient outcome markers and determining if we are doing a good job. There used to be a trust that Docs would work with best interest and best practice and the fact that people need to check up on the profession speaks to the degree of "swagger" that we have lost in the past few decades. Some of this is our own fault, we give clowns like Conrad Murray (the michael jackson doc) medical licenses and they inappropriately use their abilities it reflects badly on the profession and we end up with more oversight.

    My biggest problem is our lack of organization, Big Pharma, Big Insurance and Hospitals all have the ear of the government. Their financial interests outweight ours in terms of both union/lobbying ability and the degree to which their participation in the economy effects our country. I wish we had more of an ability to police ourselves then be policed by Insurance (who isn't anymore honest) or government (the same).

    Comparing our economic standing to the rest of the world is apples to oranges. Look at the occupy wall street movement, go there and tell them that statistic about people living on 2$ a day and see if that quells their anger. America is not any one of those nations, our poorest people would live like kings in some of those countries (see the Simpsons or Family Guy for some real life examples ;)). But thats not where they live, they live in America where the cost of living can be quite high we are taxed by not only at the national but also at the state level (is this an issue in Europe? I don't know if you pay county and national taxes that would be an interesting comparison). Yeah people complain about not having the latest tech or newest car but you can't expect people to react in one socioeconomic reality as though they were living in a completely different one.

    The pressure of being a 1st world nation are different from living in China or South America, we live longer we have higher expectations for our children our parents live longer and we need to care for them. Do you require car insurance and emissions checks in some low income regions, is a cell phone a requirement to be effective at your job; these are all the expenses that come with being successful in America. Yes there is a lot of bull**** that we want, with clothes and cars and technology, but its expensive to raise kids in America (kids that maybe just work for the family business or farm in countries you have cited, or sadly die) its expensive to get old (again these people die in some of the places you mentioned, some by choice rather then burden the structure of their society). No one said that there would be no food on the table if you are a doctor, but the reality is that its harder and harder to hold on to the middle class distinction (which most health care used to be firmly entrenched in) some docs get super rich and some struggle to get by, and we need to give our kids even better opportunities to maintain the middle class because of the disparity between the top 5% vs the 95% and the top 1% vs the top 5% has grown steadily.

    The whole American Dream story (which I have thankfully been a part of) is walking the edge of a knife right now and it is intellectually dishonest to compare struggles here with a country who limits families to one child and a country riddled with leprosy, starvation and poverty. The example I like to use is that of my parents telling me to clear my plate when I was a child because there were starving children in Africa, the kids in Africa were never gonna get that food so why should I clear the plate, and clearing the plate when I wasn't hungry just makes more issues like childhood obesity. We are not China, we are not India we are America for better or for worse and comparing ourselves with other nations should not be our focus because there are real financial problems here which will effect those smaller countries and throw them into even more turmoil.

    I'm sorry about all of the long posts I hope they are for good discussion, the lack of work in 4th year has made me pedantic. I'm going over to the meme thread lol.
  25. Druggernaut

    Druggernaut Lifetime Donor

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    If you can catch them before they become diabetic and can convince them to make the proper lifestyle modifications to avoid progressing into DM, sure. But that's not much of primary care. I'd wager that a cath or two is much cheaper than 40 years of pills, lab work, regular check-ups, and so on. Sure, the quality of life will likely be worse, and they'll die 20 years earlier (more cost savings!), but I'm not convinced primary care is the cash saver we're all led to believe.
  26. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Residents get a set salary (eg 48k annually) for the up to 80 hours a week they will work. Medicine, in general is not a per hour pay kind of field. The surgeon you see coming in at night for a complication or call isn't getting extra because he's coming in. He's usually earning a salary, which will be a function of the revenues he generates based on the reimbursements he is paid. If he does 10 of X procedures, he gets paid the same whether the patients are all fine and go home that day, or whether he gets called in ten times in the middle of the night. Folks in practice groups thus take turns being on call, but they aren't getting paid extra for that. So no, hours are not factored in in any meaningful way outside of per diem employees or shift workers.
  27. JackShephard MD

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    While I agree that pharma and insurance profits are huge problems that take away from patient care, my point was this: Be grateful for what you have. No, you don't have to finish your plate but be grateful that there will always be one there, night after night, from cradle to grave. It's not intellectually dishonest to compare your lot to the majority of human beings on earth. It is reality.
  28. thomprya

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    Agreed for some diseases, however if someone doesn't take care of themselves with medication what are the chances they will need another cath or stint or surgery down the line? The real cost to the system is when a chronic illness becomes acute and the pt has to spend time in the hospital or ER. Those costs exponentially increase the overall cost to the system. Things like being overweight and smoking should be addressed by a PCP. In my opinion by the time a pulm doc is seeing that pt the damage is already done.

    Also, I agree that that is not much of what PCP's do, but they should. Something I enjoy about Obamacare is it changes the dynamic of insurance company's profit algorithm. Previously it was 'accept the healthiest and cut the rest.' With mandated coverage it is now 'make everyone as healthy as possible.' This provides an incentive to pay for screenings and wt loss/smoking cessation advocacy by docs.
  29. valkener

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  30. thomprya

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  31. Bartemius

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    One of the biggest problems I have with this article is how Dr. Brown calculates hourly wage for a teacher versus an internist. Including loans, interest, total time spent working, pensions, etc., he arrives at $30.47/hr for teachers and $34.46/hr for internists. But he assumes that teachers only work 40 hours per week, which I think is a gross underestimation.

    I helped out in a high school chemistry/physics classroom for a service learning class, and the teacher I served under worked on average 55-60 hours per week, including school meetings, trainings (several in the summer), conferences, grading/class preparation, staying before/after school to tutor students and proctor make-up tests/labs, etc. Based on her assessment of her colleagues, and a quick bit of online research, I'd estimate that this is the norm for high school teachers in most (but certainly not all) cases (i.e. 55-60 hours per week).

    Recalculating with these hours, most high school teachers earn a median salary that equates to between $20.94 and $22.71 per hour over the course of a lifetime.
  32. notbobtrustme

    notbobtrustme Crux Terminatus

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    Don't see too many high school teachers driving Porsches or living in gated communities.
  33. Bartemius

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    Exactly. Even if Dr. Brown is somewhat right about the hourly wages part (IMO he's not even close), it only makes sense that doctors make a lot more money since on average they work WAY more than any high school teacher in the course of a lifetime, plus get reimbursed for a higher percentage of those hours compared to their secondary ed professional counterparts.
  34. link2swim06

    link2swim06 PGY-1

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    Not to mention his numbers are pure hyperbole. He quotes near 100K undergrad debt, the majority at my med school have little to no undergrad debt. Then tries to claim that you will never be able to refinance lower than 7% on the entire term of the loan...give me a break.

    He quotes 80 hours per week as a med student, haven't got to M3 year but I spend maybe 40-50 a week hours right now. Plus reading my pharm book is much less work than teaching for 8 hours straight.

    Also from what I have been told, nobody spends 80 hours a week during 4th year and the same goes for most 3rd year rotations.

    Not to mention he negates that most teachers need a masters degree too. Actually most professions need more than a bachelors now. So you cant compare bachelors to med school, it should be MBA / masters vs. med school.

    In addition to the above cherry picking, he picked a very expensive state (which penalizes the doctor more than the teacher), a high hour/ low paying specialty, his federal tax rate is completely wrong and picked a resident who never moonlighted.

    Oh and finally as you noted...nobody works 40 hours a week anymore, including a teacher.

    The articles raises good points in the deceptive cost/ time of training, but it sucks he had to cherry pick everything to make it seem worse than it is...
  35. greyman21

    greyman21

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    Not sure how many doctors actually drive Porsches, probably not that many, also not sure how many teachers work 60 hours a week. I've said elsewhere that most people don't work a 40 hour week anymore but teaching is one of the few that it should still be possible. 7 to 3 5 days a week covers most school hours. Sure you grade papers, write tests etc, maybe that creeps you up towards 50 hours. I have teacher friends that spend all the time bitching about doing lesson plans for the week. They take 4 hours on the weekend watching NFL Red Zone and they are done.

    How much MCAT time did you spend watching red zone? On the other hand how many times has call prevented a resident/attending from seeing their kids first step?

    Maybe its just a premed thing, you havent collected all of your loans yet so you are still optomistic. But on the other end looking at residency w 200K debt @ 8 something % having to pay rent for you and your wife while shes still in school, food, all types of insurance and bills and then the eventual rugrat that blesses your life it starts to feel daunting. I'm a doctor in 2 months but I am way less financially comfortable than my teaching friends at this point, what the future holds remains to be seen. The big question is whether the tradeoff is worth it for you as an individual.

    This is mean...but I can't resist just had to put it here

    http://www.youtube.com/watch?feature=player_detailpage&v=xokthY5zuPU#t=53s
    Last edited: Feb 16, 2012
  36. greyman21

    greyman21

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    I feel like a jaded old man here. It seems to be mostly preclinical medical students and premeds in this forum anyway. You will see when you do the clinicals there are a lot of sacrifices made to be in this profession and a lot more of them are financial sacrifices then they used to be(though not at the expense of putting food on the table).

    I promise this is my last post. If you could just do me ONE favor if you read all of my rants in the time capsule that is the internet. If you join AMSA and want to do one of their lobbying things that they like to do please, please please ask yourself 2 questions.

    1) will this really truly help PATIENTS or will it help insurance companies and give politicians more to mentally masturbate over or make you feel like you are being more involved but really be betraying the profession (see: students who agreed with and lobbied for Obamas hasty and far too large to implement all at once care plan)

    2) How will this decision effect my standards of practice/job security and financial security 5, 10 and 20 years down the road

    Thanks :)
  37. operaman

    operaman

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    Couple things...

    First, Dr. Brown's calculations are skewed to make a point. If you recalculate assuming zero student debt, it doesn't affect lifetime hourly rate by much at all. However, where the biggest disparity comes into play is how he handles retirement income. For the teacher, he adds on all the retirement income in the numerator but doesn't do this for the doctor. This alone accounts for much of the shock value of these numbers and also why they aren't really true.

    Secondly, even in countries with socialized medicine, things aren't as dire for physicians as some seem to think they will be here in the US. Even in countries where doctors are government employees drawing a relatively modest salary, this fails to take into account the private practice income that many of them have as well as state pension benefits.

    I'm worried about a lot of things in medicine too, but I don't think socialized medicine is as scary a doomsday scenario as some make it out to be.
  38. valkener

    valkener

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    It's not a doomsday scenario. My father-in-law is German and has been working as an IM (GI) for 20 years in a large hospital in Germany. He makes about 100k before taxes (I'll admit they're high), but is covered completely for health insurance, malpractice insurance, and retirement. Once he retires at age 65 (minimum age) he will get 100% of what he's making per year at this point.

    Surely, if he would have been doing the same thing in the US he would have been a millionaire by now and honestly at this point I would rather do US medicine, which I am doing, but it's certainly not a doomsday scenario. Interesting discussion though, keep it coming.
  39. copes

    copes

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    That is a great attitude to have, but money and lifestyle are very important to most of the med students and residents I have met.

  40. Dr Love

    Dr Love

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    A few thoughts on this discussion:
    1. The shortage of primary care physicians is an oft-repeated statement with zero evidence to back it up. Specialists actually provide medical care. Primary care physicians only refer patients to specialists. Their economic value to the healthcare system is that by acting as a gatekeeper, they can stop some healthcare spending. Of course, it would be easier to just not to provide healthcare at all rather than pay a PCP to tell you, no, you can't see a cardiologist just yet.
    2. I am amazed that the same people who complain about physician salaries also support government involvement in healthcare. Of course government involvement will lead to lower salaries. How can the government afford to provide healthcare for all, while still supporting private health insurance companies, without decreased physician reimbursement???
    3. The only "fair" salary for a doctor is market value. The idea that a few bureacrats should sit around and say "Specialists have too much money, let's slash their salaries" or "primary care doctors are so nice, let's give them more money" is ridiculous.
  41. TheMan21

    TheMan21

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    :laugh:
  42. SteinUmStein

    SteinUmStein

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    :confused: Do you actually know what a primary care physician does? Have you been to a primary care clinic before?
  43. Dr Love

    Dr Love

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    No, never in my life have I been to a primary care doctor, either as a patient or a medical student. :rolleyes:
  44. TheMan21

    TheMan21

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    evidently you have not, if you honestly believe that PCPs don't deliver care. :rolleyes:
  45. JackShephard MD

    JackShephard MD

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    PCPs are not only gatekeepers, they provide a valuable service to our healthcare system by managing chronic conditions, providing preventative care and providing a variety of other services. That's an arrogant and uninformed stance you've taken. It's poor form to show such lack of respect for your colleagues.
  46. Dr Love

    Dr Love

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    Nurses also provide a valuable service to our healthcare system (as do physician assistants, pharmacists, etc). In fact, the data show that nurses can do the same job as PCPs just as well, maybe even better.
    http://jama.ama-assn.org/content/283/1/59.full
    So, why are people saying that PCPs need to be paid so much more, or that we have such a shortage of them? It's an unsubstantiated myth repeated so often you'd think it was a fact.
  47. preDoGuy24

    preDoGuy24

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    Fail

    Congrats bro, you have won the stupidest thing ever said on SDN award, its actually more of an accomplishment then it sounds like it should be, you should be proud.

    NP/PA's will never be equal to a PCP period. Not in any aspect of knowledge or clinical accumen, they have less training in every aspect of clinical sciences and don't receive 10% of the training a PCP does in Medical school + residency.
  48. SteinUmStein

    SteinUmStein

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    Are you serious? I don't want to waste time arguing with you if you're just trolling for a laugh.

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