"Devalued Doctors" Wash.Post 8-11 editorial

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Here is an interesting article from Washington Post editorial page:



Devalued Doctors


By Jean A. Schoonover

Monday, August 11, 2003; Page A17


The MTV show "Cribs" featured a special on celebrities' cars rather than, as was usually the case, their mansions. My husband and I were on vacation, and so we snuggled together in the basement and watched as basketball players and rap artists boasted six Bentleys or Lamborghinis with tires worth more than our Volkswagen Jetta. One celebrity, whose name I had never heard before this show, obliged us with a tag-along documentary as he car-shopped for another Aston Martin. He pronounced Aston "Austin," as in Texas.

My '94 Ford Escort had more than 120,000 miles on it before I finally took out a loan to buy a new Ford Escape. It is a great vehicle: the shiniest truck on the block in our modest light-blue-collar neighborhood in southern Maryland. From here my husband can make it to work in our nation's capital in about 45 minutes when the traffic complies. But it seems to be the new $400 monthly car payment that is the latest setback in our suffocating budget. Maybe I should have gone with the Honda Civic after all. But, then, I really did appreciate the big tires and the four-wheel drive this past winter driving to work in La Plata. And I certainly could not have afforded to miss work, given the money situation.

What is it that we do for a living, you might ask. Am I a waitress and my husband a bus driver? Do I perhaps clean houses while my husband surfaces driveways? Are we getting just what we deserve doing menial labor after goofing off and getting married right out of high school? Should we have planned better so that we would have two nickels to rub together?

My husband and I are both physicians. I am in private practice in internal medicine and he is an ophthalmologist. Our training consisted of four years of college, four years of medical school and four years of residency. Each. Our collective student loan debt is more than a quarter of a million dollars. Each month I pay Nelnet $1,003, Sallie Mae $300 and SunTrust $881, just as an example. Nelnet is a graduated payment. This is the lowest it will be as I pay it off over the next 15 years. When I am 47, I hope to be out of debt and to begin saving for retirement. It is not clear yet when we will be able to afford to have children.

Our mortgage is less than half as much as the loan payments: We save hugely by not living in the city. Some of my husband's loans are fortunately still in deferment, but they are collecting interest all the same. He has another year of residency before joining a practice. His colleagues inform him that the average starting salary for an ophthalmologist, a highly specialized surgeon trained to perform Lasik and extract cataracts, is less than $90,000 in the D.C. area. We have done the math at our dining room table many a Sunday night. His paycheck will not come close to covering his loan payments once his grace period ends.

Something is wrong with our nation's outlook on health care these days. I have come to name this phenomenon the "Devaluation of the Doctor." As I hear grumbling about Congress's making more Medicare cuts and my patients' complaints about $10 co-payments while they dig $300 cell phones out of their Gucci bags, I am getting just the slightest bit bitter. Somewhere along the way, as we sat back and let insurance companies turn caring for the sick into an industry, we lost sight of the importance of medical care and those individuals who sacrifice their entire twenties to learn how to save lives and keep us healthy. HMOs have bred a population more interested in paying for a cellular phone plan than a physical. It saddens me to meet a new patient who is "transferring his care" to me (after sticking loyally to the same doctor for 40 years) just because "Doc So-and-So stopped taking Mamsi."

It's a rainy day, and the neighborhood kids aren't playing basketball as usual. If they were, I'd be tempted to open the front door and holler to them, "You go, boys! Forget about algebra and focus on your three-pointer." After all, what have my hard-earned straight A's and Honor Society tassels gotten me but a fear of foreclosure?

The writer is a physician in Maryland.



? 2003 The Washington Post Company

 

[spumoni620]

I'm at a total loss for words...

Oh my. This was harsh....scary....less than $90k as an ophthalmologist? seems too low, esp for a city in the NE.

think i'm gonna look into attending med school in state...

 

[....]

90K for a starting optho? I dont belive it...


But I loved the article. Its true...whinning about a $10 while holding a 300 phone. The chick was stupid though...by her debt it looks like she went to a private school. But, for internal medicine. Too much debt/salary ratio.

 

[MacGyver]

that article is total BS.

I know dozens of opthos, and NOT A SINGLE DAMN ONE OF THEM MAKES LESS THAN 200K.

Whoever told this woman that ophthos make only 90k in DC is absolutely lying.

I am betting that she makes at least 70k as an IM doc, and with him making 200k at least, thats 270k in combined income, well in the top 1% of all income earners.

This woman either has a serious problem with spending money or has been foolishly misinformed as to what opthalmologists make.

Now, during residency absolutely there is going to be a financial struggle--everybody knows that.

But for her to claim that she's going to be struggling to make ends meet in a 2 doctor household, 1 of them being a highly paid specialist is just total bunk. The ONLY way thats possible is if they made extremely poor financial choices previously.

 

[TTSD]

It's possible. It all depends on the doctor and what type of practice they run. How much they take in, what they charge, their overhead and the HMOs.

I know of a neurosurgeon who only takes in about 70,000 dollars a YEAR. His wife, an opthamologist is the real breadwinner in their family. So why does he earn so little? Is it because he's bad and not well known? Not at all, he in fact holds the lowest insurance rate out there because of his spotless record and has patients flying in from all over the world to see him.

His take on medicine is "you can't pay for the surgery? I'll do it for free. Look, I'll loan you the money for the hospital stay as well, pay me back when you can."

Lesson learned? If you love medicine and want to practice like a philathropist, find a wife that makes money! :-D

 

[thaibonick]

I'm so sick and tired of docs having this false sense of entitlement. I work in a lab where the scientists around me are the brightest guys around. If you ask me, docs are just highly paid techs and salespeople peddling the stuff that researchers discover anyways. If anybody's underpaid it's these people.

To do the job that most docs do you don't need 7-10 years of post-graduate training. Treatment should not cost as much as it does, hence the need for health insurance. Overall, I think many docs are highly overpaid, but in a free market economy the terms over and under paid don't really make much sense. Given the fact that the admissions process is more or less a crapshoot, that doctors have job security unlike any other profession, and if you work your butt off and are in the top of your class you can make tons of cash if you chose the right field. I really don't see what all the gripe is about medicine these days.

 

[NE_Cornhusker1]

If they're sooooo poor what are they doing on vacation? Unless she some how drug out an IM residency they only usually go three, not four years. And what's this about his loan payments totalling more than 7500 a month? Give me a break. Peace.

 

[jwin]

Originally posted by thaibonick
I'm so sick and tired of docs having this false sense of entitlement. I work in a lab where the scientists around me are the brightest guys around. If you ask me, docs are just highly paid techs and salespeople peddling the stuff that researchers discover anyways. If anybody's underpaid it's these people.

To do the job that most docs do you don't need 7-10 years of post-graduate training. Treatment should not cost as much as it does, hence the need for health insurance. Overall, I think many docs are highly overpaid, but in a free market economy the terms over and under paid don't really make much sense. Given the fact that the admissions process is more or less a crapshoot, that doctors have job security unlike any other profession, and if you work your butt off and are in the top of your class you can make tons of cash if you chose the right field. I really don't see what all the gripe is about medicine these days.

I am sick of basic scientists complaining that they do not make any money despite their being brilliant. When you go into a field, you know what the compensation is going to be, so get over the fact that post-docs and techs only make high 20s/low 30s. They knew the pay when they were getting into the field.

 

[carrigallen]

the trend has been happening: high-paid specialties may be gradually facing the same devaluation which primary care fields faced in the late 1980's. In a sense, it was only a matter of time.

Those who enter a residency expecting to make 200k fresh in practice may be in for a surprise. Specialty fields are not immune to reform by the healthcare industry. The role of specialists is slowly being re-conceptualized, and change is on the horizon. In general though, I think change will be taking place over the next 20-30 years.

Consider surgery, for example. A surgery practice often used to itemize each procedure for a single surgery, and charge a separate and somewhat variable fee for each. In an era of healthcare rationing, hmo's are clumping all these procedures together, for one set fee...ie a lap chole is 2,000, etc. This quantification facilitates a devaluation, because determined prices may be raised or lowered across the board. HMO's are constantly hungry to cut costs, and are currently looking at the disproportionate revenue obtained by high-paid specialties.

I don't think these trends will hold for the few pay-first specialties, namely plastics or some ent. Their goods & services are still paid directly by the patient.

 

[jenni4476]

I have to disagree with most of you-I find this story entirely believable. I used to be an accountant and did plenty of tax returns for physicians so I saw what quite a few were actually getting paid. Our firm had clients all over the country so this isn't an entirely localized picture (though the majority were local).

The pattern I noticed was that there were a very few physicians who made well into the seven figures. One couple was on staff at a prestigious teaching hospital. Another was a private practice plastic surgeon located in a very wealthy suburb. Another was an orthopedic surgeon who also owned several physical therapy centers that he sent his patients to.

Then, you have the majority (I would estimate 80-85% of the returns I did or saw), who mostly made right around the 100K mark as an average.

So, when you're looking at those AVERAGE salaries for physicians, remember the procedure used to arrive at those. Just as an example, if you have one making 1.5 million, it will take 15 others making only 100,000 to bring that average down to a reasonable 187,500.

I did a net worth statement for one IM physician seven years out of residency, and he had student loan payments of $4200 a month (this was on the graduated schedule so it was higher being towards the end-his total debt was only $80k to begin with but add interest over 10+ years) on a $8500 monthly salary (which after taxes dropped to about $6500/month). Try living on $2300 a month with a mortgage, car payment, retirement plan, health insurance, household expenses. It isn't easy, especially after you've spent so many years being poor through school and residency and are thinking it's about time for a payoff to be coming, as this physician told me.

I don't claim to know everything-this isn't a scientific study, but I also don't think that most of the previous posters on this thread have a realistic idea of what the situation is really like. Reading various stories and statistics is fine, but you have to remember that there's a lot going on behind the scenes that isn't included or comes across skewed. It's easy to quote them as an authority, but remember you're still at a distance when you rely entirely on them.

It would be really interesting to see a distribution plot of all the salaries that go into making up the average numbers tossed around-I'm willing to bet that it would carry out what I've seen on a smaller scale...

 

[jenni4476]

I have to disagree with most of you-I find this story entirely believable. I used to be an accountant and did plenty of tax returns for physicians so I saw what quite a few were actually getting paid. Our firm had clients all over the country so this isn't an entirely localized picture (though the majority were local).

The pattern I noticed was that there were a very few physicians who made well into the seven figures. One couple was on staff at a prestigious teaching hospital. Another was a private practice plastic surgeon located in a very wealthy suburb. Another was an orthopedic surgeon who also owned several physical therapy centers that he sent his patients to.

Then, you have the majority (I would estimate 80-85% of the returns I did or saw), who mostly made right around the 100K mark as an average.

So, when you're looking at those AVERAGE salaries for physicians, remember the procedure used to arrive at those. Just as an example, if you have one making 1.5 million, it will take 15 others making only 100,000 to bring that average down to a reasonable 187,500.

I did a net worth statement for one IM physician seven years out of residency, and he had student loan payments of $4200 a month (this was on the graduated schedule so it was higher being towards the end-his total debt was only $80k to begin with but add interest over 10+ years) on a $8500 monthly salary (which after taxes dropped to about $6500/month). Try living on $2300 a month with a mortgage, car payment, retirement plan, health insurance, household expenses. It isn't easy, especially after you've spent so many years being poor through school and residency and are thinking it's about time for a payoff to be coming, as this physician told me.

I don't claim to know everything-this isn't a scientific study, but I also don't think that most of the previous posters on this thread have a realistic idea of what the situation is really like. Reading various stories and statistics is fine, but you have to remember that there's a lot going on behind the scenes that isn't included or comes across skewed. It's easy to quote them as an authority, but remember you're still at a distance when you rely entirely on them.

It would be really interesting to see a distribution plot of all the salaries that go into making up the average numbers tossed around-I'm willing to bet that it would carry out what I've seen on a smaller scale...

And I agree with carrigallen. HMO's and insurance companies keep coming up with new ways to cut costs, and will continue to. I think there is a backlash coming, though, because so many people are getting fed up with the endless restrictions, precertifications, waiting periods, etc. How to reform it is a problem I don't dare tackle-I don't know enough about it to have an educated opinion and I'm not about to follow a party line handed to me by someone else...there are too many special interests involved and most of the ideas flying around aren't trustworthy b/c they reflect someone's agenda for themselves instead of what's best for everyone.

Yes, medicine is changing, it's going to be up to us to try and do something about it. I can only hope that it's not in a severe crisis state when I get there....

 

[Nora]

I could not agree more. I've worked with medical researchers (all of whom were PhDs) for 5 years. Length and rigour of training should not be directly linked to one's pay because doctors will find themselves paid at the same rate as PhDs, lawyers, or any skilled tradespeople who spend 5-10 years learning their craft. It is public perception that links doctors with cures to ailments and improved overall health and longevity. While it is true that emergency care is done by doctors, EMTs have quickly filled this role in the past 30 years or so.

As for linking cures to doctors, a weak link at best, we should look at the researchers developing the medicine, engineers designing and building better diagnostic equipments, and chemists improving diagnostic tests. Doctors (and I hope to be one someday) should stop complaining about the length of training and how they should be adequately compensated given this training. They should, however, complain about HMOs and litigation lawyers making the practice of medicine feel like a walk through a landmine.

Originally posted by thaibonick
I'm so sick and tired of docs having this false sense of entitlement. I work in a lab where the scientists around me are the brightest guys around. If you ask me, docs are just highly paid techs and salespeople peddling the stuff that researchers discover anyways. If anybody's underpaid it's these people.

To do the job that most docs do you don't need 7-10 years of post-graduate training. Treatment should not cost as much as it does, hence the need for health insurance. Overall, I think many docs are highly overpaid, but in a free market economy the terms over and under paid don't really make much sense. Given the fact that the admissions process is more or less a crapshoot, that doctors have job security unlike any other profession, and if you work your butt off and are in the top of your class you can make tons of cash if you chose the right field. I really don't see what all the gripe is about medicine these days.

 

[DD214_DOC]

Insurance companies dictate the salaries of physicians. If HMOs and all that are reformed and overall costs of healthcare decline, the inflated salaries of physicians will deflate and average out.

As for the article, looks like I'll be doing HPSP. I've heard too many stories of horrible debt after medical school to risk it. Plus I actually WANT to serve my country.

 

[MacGyver]

http://www.physicianssearch.com/physician/salary2.html

Here's a physician salary survey for doctors in practice at 3 years.

The numbers for optho are:

Max: 417k
Average: 256k
Min: 161k

For an optho in practice to make 90k is so far below normal that anybody making such a pissant salary in that position simply did not complete a thorough job search.

That woman in the article is dead fu#$ing wrong. The average optho in DC makes FAR more than 90k. I'm telling you right now that anybody who told her that the average optho makes 90k in DC is an outright liar. The only opthos who make 90k or less in practice are those who 1) practice part time; or 2) choose not to charge fair market value for their services; or 3) give away lots of free healthcare.


Someone said above that they know a neurosurgeon making only 70k per year. A nuerosurg making that low of a salary is obviously doing something wrong or is not interested in making the market average salary.

Here are the numbers for neurosurg:

Max: 714k
Avg: 440k
Min: 280k

For a neurosurg to make only 70k would put him in the lowest paid neurosurgs in the country. Even neurosurgs starting fresh out of residency make far more than 70k per year. The fact that this neurosurg makes 70k is a testament that he is NOT charging fair market value for his service.

 

[Mike59]

Originally posted by TTSD
I know of a neurosurgeon who only takes in about 70,000 dollars a YEAR. ........ His take on medicine is "you can't pay for the surgery? I'll do it for free. Look, I'll loan you the money for the hospital stay as well, pay me back when you can."

OMG! Please use some icons next time so people know you're just bullsh*ting!

 

[evescadeceus]

Are there ways to avoid this fate?

I think there are. Sticking to subsidized and unsubsidized federal education loans is absolutely crucial. It is my understanding that a med student can borrow up to $38,500 each year, if they qualify for that amount. Get as high a ratio of subsidized to unsubsidized to possible. Private med schools are out. Private loans are out

I am currently carrying $30,000 of undergaduate debt, most of it locked in at 3.75%, amortied over 20 years. My current payment is $175 a month. I may have to borrow $38,500 each year of med school, because I have no trust fund or rich daddy or house to sell to pay for living expenses for four years while I'm not working. Assuming the same low interest rate on gov loans, I could borrow $180,000 and expect a monthly payment of a little over $1000 a month.

Part of the reason why their payments are so high could be because they're amortizing over 15 years. With the amount of debt they're in, they should be amortizing it over 30 years. Yes, you pay more out in the end. So what? If you don't start saving for retirement as soon as you're out of residency, you might as well not even bother.

Also, doctors with that kind of debt have to be aggressive and shrewd about tax write-offs. They have to use their practice to generate every possible deduction. If you're making monthly payments like that, you simply cannot afford to pay Uncle Sam very much on top of it.

Finally, and this sounds harsh and unfair, I realize - doctors with that amount of debt should have given a lot more consideration to marrying each other.

 

[Noeljan]

Hey guys
I don't think the point of this post was to argue about scientists vs doctors, I think it made a very good point about the value we as a society place on certain things such as professional sports teams and entertainment. I totally agree with the moral of the story, regardless if the numbers are correct or false. Just my opinion though.

 

[Fah-Q]

Originally posted by carrigallen
In an era of healthcare rationing, hmo's are clumping all these procedures together, for one set fee...ie a lap chole is 2,000, etc.

$2000 for a lap chole may have been a total guess. I will tell you that Medicaid pays between $400-800 for a lap chole. That's it. This includes all in-patient post-op care (whether there are complications or not) and one post-op office visit.

I bet if you ask a patient with gallstones how much he/she would pay the surgeon to remove the gallbag it would be a hell of a lot more than $400-800!!!

 

[carrigallen]

Fah-Q: heh, i guess i was estimating the total amount the hospital bills for, including surgeon's fees, operating room fees, etc. yeah, medicaid is no fun.

MacGyver: maybe take a look at your source, an online survey...anyone could go in there and post a 1 mill salary.

 

[MeowMix]

Here's the point: most premeds never work out the numbers and calculate what they will have to make as doctors, in order to pay off their student loans in a reasonable amount of time.

This couple probably made some bad decisions based upon unrealistic expectations, and have continued to make some more bad decisions. Maybe they're just like a lot of other people in the U.S. who aren't very good about managing their money; they lived beyond their means, with no coherent plan for repaying a huge debt.

Re low salaries for research scientists, bear in mind that many PhD science programs at top universities come with full support for grad students (at least mine did). I graduated with zero debt; I also never expected to make a huge pile of money in an academic environment, because I knew exactly what the field offered. If you want the big bucks, you go to industry. I don't think any of my peers as grad students or postdocs had any illusions about this or felt that our brilliance would result in great financial gain in academia.

Finally, if we want to talk about people with a huge amount of responsibility, a job that most people don't want, and low wages despite their years of training, let's be sure to include teachers.

 

[Paws]

Alright, Paws throws in her 0.02 worth here. Unfortunately, I am going to side with the people who agree with the writer. I have definitely seen the rough side of student loans and having paid off a small mortgage's worth of my own already, I really do know the drudgery and grinding sense of futility that comes from way too much month at the end of my money - as someone's tag line says.

These statistics about salaries are hard to quantify, and I think since so many of us are PRE-meds, we really don't always know what the real MED side is like. It can be glorious and wonderful, but the financial concerns are very real. Why is it that Mt Sinai Hospital here in NYC is going dow the tubes so fast yet Cornell is all polished and renovated? Sandy Weill's Investment Banking money, and Greenberg's millions from Insurance (AIG), really saved the *ss of that hospital, no question !

Now, it's right that they did that and philanthropy is a good thing, but the deeper issues are in our healthcare system that could let this chaos occur in the first place.

National Health isn't perfect, but you don't see Canada's hospitals or physicians spiralling down, nor are the citizens drowning in no insurance or HMO hell. I think the citizens pay much less per capita for healthcare than we do, and receive a much higher quality of care - mostly because everyone is eligible, unlike here.

I am a HUGE advocate of National Health and am not too shy about it, except with my secondaries, must be careful ... 😀

 

[premyo2002]

Originally posted by MacGyver
http://www.physicianssearch.com/physician/salary2.html

Here's a physician salary survey for doctors in practice at 3 years.

The numbers for optho are:

Max: 417k
Average: 256k
Min: 161k

For an optho in practice to make 90k is so far below normal that anybody making such a pissant salary in that position simply did not complete a thorough job search.

That woman in the article is dead fu#$ing wrong. The average optho in DC makes FAR more than 90k. I'm telling you right now that anybody who told her that the average optho makes 90k in DC is an outright liar. The only opthos who make 90k or less in practice are those who 1) practice part time; or 2) choose not to charge fair market value for their services; or 3) give away lots of free healthcare.


Someone said above that they know a neurosurgeon making only 70k per year. A nuerosurg making that low of a salary is obviously doing something wrong or is not interested in making the market average salary.

Here are the numbers for neurosurg:

Max: 714k
Avg: 440k
Min: 280k

For a neurosurg to make only 70k would put him in the lowest paid neurosurgs in the country. Even neurosurgs starting fresh out of residency make far more than 70k per year. The fact that this neurosurg makes 70k is a testament that he is NOT charging fair market value for his service.

Do you think that the author of the article could have been lying to prove her point??? Maybe this is not true in her case but, with the way things are going, it may someday be our reality.

 

[ducam]

Why does everyone think that what a person makes is the check they take home at the end of the month. There are a great many things that doctors with reasonable intelligence can do to keep their money and not get screwed because they let some one else do it for them.

When i'm a doctor i am going to have two jobs, one being a doctor, the other being my own freaking CPA. If you can get through med school and say you should be making more then lawyers because doctors know more then you can take the time to understand some very simple tax laws and HMO policies where you get to keep your money and stop letting yourself think that people are taking what they are supposed to.

The world is money hungry, everyone wants your money and if you don't fight back to keep it then you'll end up making $70,000 a year as a neurosurgeon because you are freaking dumba$$.

There are so many ways to pay 0 interest on student loans, on deferring, on doing it right but so many people do it wrong that everybody thinks that it is the life a young doctor must live.

So as a lesson to everyone: Be smart, do your own taxes and once in awhile take an HMO out to a nice lunch and screw them.😉

 

[....]

"The world it money hungry, everyone wants you money and if you don't fight back to keep your money then you'll end up making $70,000 a year as a neurosurgeon because you are freaking dumba$$"

word...

 

[jay c]

Originally posted by MacGyver
that article is total BS.

I know dozens of opthos, and NOT A SINGLE DAMN ONE OF THEM MAKES LESS THAN 200K.

Whoever told this woman that ophthos make only 90k in DC is absolutely lying.

I am betting that she makes at least 70k as an IM doc, and with him making 200k at least, thats 270k in combined income, well in the top 1% of all income earners.

This woman either has a serious problem with spending money or has been foolishly misinformed as to what opthalmologists make.

Now, during residency absolutely there is going to be a financial struggle--everybody knows that.

But for her to claim that she's going to be struggling to make ends meet in a 2 doctor household, 1 of them being a highly paid specialist is just total bunk. The ONLY way thats possible is if they made extremely poor financial choices previously.

The problem with pre-meds these days is that you are so focused on getting into med school that you do not know what lies in wait on the other side.

1) STARTING salaries are SIGNIFICANTLY lower than the income that you get once you make partner. even orthopedics STARTS at 100-150 in the northeast. GI, the field that I am in, makes $300k and over, in private practice, in the rural areas. in cities, the income for partners in practice is 200-250, and starting is 100-150.

2) Do not be so quick to state that others are foolishly spending money. You forget that:
a) not everyone lives in a state where tuition is cheap for "public" schools. In PA and Michigan, public tuition is quite expensive.
b) if you attend med school, even with state tuition, you have to borrow for room and board, and also, the interest you don't pay back gets capitalized. So your principal amount gets larger.
c) you will not be able to pay back anything in residency or fellowship. More capitalization.

3) You will soon see, that a large number of your patients have a huge sense of entitlement. They will demand everything, and want to pay nothing, and will sue you at a minute's notice for anything. All this results in increased overhead for you, and higher insurance rates, ESPECIALLY for fields like surgery.

 

[jay c]

Originally posted by premyo2002
Do you think that the author of the article could have been lying to prove her point??? Maybe this is not true in her case but, with the way things are going, it may someday be our reality.

Again, the published salaries are for those people that are partners in private practice. starting salaries are SIGNIFICANTLY lower.

also, academic medicine pays nothing. starting for medicine and medical subspecialties ranges between 60k to 100k, and surgery from 100-120k.

 

[....]

"Again, the published salaries are for those people that are partners in private practice. starting salaries are SIGNIFICANTLY lower.

also, academic medicine pays nothing. starting for medicine and medical subspecialties ranges between 60k to 100k, and surgery from 100-120k."

You clearly know jack shlt. Say hi to him for me.

my dad is a doctor and all of our friends are doctors. I know their complete stories. where are you getting your whacked information?

 

[MacGyver]

Originally posted by jay c
Again, the published salaries are for those people that are partners in private practice. starting salaries are SIGNIFICANTLY lower.

That survey was based on people in practice for only 3 years.

Are you telling me that its common to go from 90k the first year to 260k after 3 years?

Thats almost a 300% salary increase over those 3 years, or a 100% raise EACH YEAR.

I seriously doubt thats the case. Remember, the survey was based on relative newcomers, not people who had been in practice for 20 years already.

Something doesnt jive here. Either the woman who wrote the article is being disingenuous about the salary that opthos make (she has no reason to complain if they start out at 90 but then shoot up to over 200k within 3 years) or somebody outright LIED to her when they said the average optho in DC makes only 90k per year.

also, academic medicine pays nothing. starting for medicine and medical subspecialties ranges between 60k to 100k, and surgery from 100-120k.

sure academics doesnt pay much, but thats beside the point. There is a huge demand for all kinds of doctors in the private sector.

Clearly, somebody has misled this woman, she is lying, or she is being totally disingenuous as to the future salary earnings of her optho husband.

ANY optho in ANY area of the country who makes only 90k per year is an outlier, pure and simple.

 

[jay c]

Originally posted by hightrump
"Again, the published salaries are for those people that are partners in private practice. starting salaries are SIGNIFICANTLY lower.

also, academic medicine pays nothing. starting for medicine and medical subspecialties ranges between 60k to 100k, and surgery from 100-120k."

You clearly know jack shlt. Say hi to him for me.

my dad is a doctor and all of our friends are doctors. I know their complete stories. where are you getting your whacked information?

uh, hightrump, i am a doctor as well, and trained at Harvard for internal medicine. my attendings made $60k starting at harvard. i'm now at Univ of Penn. The attendings make $80k starting. This is in medicine.

My friend is an ENT surgeon at Mass Eye and Ear. he makes $150 starting.

this is where i'm getting my "whacked" information. and i think i know a bit more than "jack ****"

medicine is quickly changing. in major metropolitan areas in the northeast, the pay is dropping quickly. the southeast and the midwest still do pretty well, but the west coast is not doing too well.

academics pays less than private practice. and, for your information, starting salaries in internal medicine (primary care) are about 100k in the northeast.

 

[jay c]

Originally posted by MacGyver
That survey was based on people in practice for only 3 years.

Are you telling me that its common to go from 90k the first year to 260k after 3 years?

Thats almost a 300% salary increase over those 3 years, or a 100% raise EACH YEAR.

I seriously doubt thats the case. Remember, the survey was based on relative newcomers, not people who had been in practice for 20 years already.

Something doesnt jive here. Either the woman who wrote the article is being disingenuous about the salary that opthos make (she has no reason to complain if they start out at 90 but then shoot up to over 200k within 3 years) or somebody outright LIED to her when they said the average optho in DC makes only 90k per year.



sure academics doesnt pay much, but thats beside the point. There is a huge demand for all kinds of doctors in the private sector.

Clearly, somebody has misled this woman, she is lying, or she is being totally disingenuous as to the future salary earnings of her optho husband.

ANY optho in ANY area of the country who makes only 90k per year is an outlier, pure and simple.

This concept is very similar to law firms and investment banks. I used to be in investment banking, and all my friends are senior VP's now. My wife is an attorney.

In top NYC law firms, you start out at $140k, and after 8 years, as an associate, you make $250k. but once you make partner after 9 years or so, your salary jumps to $1mill. the difference is that as an associate, you get a salary. as a partner, you share in profits.

Investment banking is similar. salary for non-principal or partner VP's is about 100k or so with bonuses between 1-2x salary. once you're managing director and have shares in the corporation or buy into the partnership, your bonus skyrockets.

Same with private practice. A doctor graduating residency or fellowship is hired by a practice as an "associate" and works for 3-5 years. This doctor gets a salary, usually starting about 100k, give or take depending on specialty (less for primary care, more for specialties, and maybe $150k for radiology, surgery, etc). When the physician works for 3-5 years, gets along with the group, he may be given a chance to buy into the partnership. This usually requires an up front outlay in some capital. Then, the physician gets to share in the profits. At this point, there is a sharp jump in "income." As an example -

internal medicine -
year 1 - 100k or so
year 2 - 120k or so
year 3 - 140k or so
after partnership - 200k or so

GI - years 1-3 about 150-200k
after partnership - 300-400k

there are not "raises" per se that increase salary, but rather, a sharp jump when partnership is attained.

 

[ckent]

Originally posted by hightrump
"Again, the published salaries are for those people that are partners in private practice. starting salaries are SIGNIFICANTLY lower.

also, academic medicine pays nothing. starting for medicine and medical subspecialties ranges between 60k to 100k, and surgery from 100-120k."

You clearly know jack shlt. Say hi to him for me.

my dad is a doctor and all of our friends are doctors. I know their complete stories. where are you getting your whacked information?

Your dad and your friends are the ones giving you "whacked" information if you think that those numbers are off. Don't be so eager to tell someone that they "know jack ****" until you know what you are talking about first.

 

[....]

Partnership?! Please....

Anyone with half a brain would never levt someone else take 2/3 of his income like that. Start you own practice. I plan on screwing other doctors out of their money by hiring them into my practice too, but not more than 10-20%.

BOTTOM line. Anyone who makes 100K doing surgery is a *****.

 

[jay c]

Originally posted by hightrump
Partnership?! Please....

Anyone with half a brain would never levt someone else take 2/3 of his income like that. Start you own practice. I plan on screwing other doctors out of their money by hiring them into my practice too, but not more than 10-20%.

BOTTOM line. Anyone who makes 100K doing surgery is a *****.

good luck

 

[....]

"Your dad and your friends are the ones giving you "whacked" information if you think that those numbers are off. Don't be so eager to tell someone that they "know jack ****" until you know what you are talking about first."


HA....right...all of their cars are secretly made of painted styrofoam. My car....stolen.....The general surgeon i shadowed who took me out on his 60 foot boat, he just got me high on peyote and threw me in a canoe.

I have been decieved!

 

[ckent]

Originally posted by hightrump
"Your dad and your friends are the ones giving you "whacked" information if you think that those numbers are off. Don't be so eager to tell someone that they "know jack ****" until you know what you are talking about first."


HA....right...all of their cars are secretly made of painted styrofoam. My car....stolen.....The general surgeon i shadowed who took me out on his 60 foot boat, he just got me high on peyote and threw me in a canoe.

I have been decieved!

Do me a favor. Ask your father and your dad's friends what salary they started at when they first became an assistant professor, or ask them what they think or know a general surgeon or internal medicine doctor would start on if he were to join Hopkins or Yale. Professors for major universities spend significant amounts of their time doing research, which does not generate as much income then if they were to be in the OR all day. Senior people and chairperson's do well, but the original post was referring to starting salaries in academics. To give you a few examples, one of my professors is a cardiologist who makes around 120,000 as an associate prof, another is a general surgeon who told us all that she started at 80,000 as an assistant prof fairly recently. Before you respond with some idiotic comment telling me how they are idiots for agreeing to work for so little, I will respond with that's just the sacrifice people who want to work in academics take. JAMA publishes an academic average salary chart every now and then and those numbers are very consistent with starting salaries. You will be in for a very rude awakening if you expect to be able to purchase a 60 foot boat on the starting salary of an academic general surgeon after you finish your training.

 

[dara678]

Is there something I'm not getting here?

I don't see how y'all can complain about starting salaries at $90 or 100K a year. That is a HELL of a lot of money. My parents make less than $40K a year, COMBINED, and it's barely enough to send me to school (minus loans and whatnot). If I'm even able to touch $90K a year I'd think I was rich.

Besides, we're going into this not because of the money, but because we have the drive to help people who are sick. At least, that's the way it should be. I don't think anyone should be complaining about the compensation, especially when there are tons of other professions who make less.

As for the point of having years of training -- I think it's well worth it. Don't know about you, but being in school for eight years (undergrad + grad) seems like heaven to me. You don't have to pay taxes or worry about getting fired. Cherish it while it lasts. Doctors have it a lot better than other professionals; there's no need to complain.

 

[Paws]

Good points Dara; and HighTrump - life is very different when you live it, than when it's your parents' friends. Somehow that rosy glow of someone else's experience vanishes when it's you own *ss on the line and you might be fired at any minute and no one gives a **** who you know.

Times are definitely changing and we would all be wise to listen to the different posters and gather the information available. Medicine is having a really terrible time in alot of ways, which isn't to say that it won't recover. But right now there are definitely difficut things that need to be dealt with.

I guess we're the generation of medical people who will be having an impact on its direction ...

 

[....]

Do me a favor. Ask your father and your dad's friends what salary they started at when they first became an assistant professor, or ask them what they think or know a general surgeon or internal medicine doctor would start on if he were to join Hopkins or Yale. "

If the OP was asking for the salaries of doctors TEACHING i have no idea what they make. My dad and friends are in private practice. But to give you an idea, my dad came from Nova a DO school, and since the hospital in our town was loosing business to a neighbooring bigger city because there was no OB on our town they agreed to pay off his 250K in school loans and help him get loans for his office to start up. They also garunteed him and his partner that they would make 250K each their first three years. My dad and partner never came close to having to call the hospital on their bet. The only differnce i see is that he went to a smallish town that needed his service. Your not going to find such generous loan forgiveness in NYC or anything. This is not at all remarkable. 100K is ludacris for a starting private. A teaching doctor...who cares what they make..



"I don't see how y'all can complain about starting salaries at $90 or 100K a year. That is a HELL of a lot of money. My parents make less than $40K a year, COMBINED,"

You parents are obviously not making much money, does that mean you shouldn't?


"but being in school for eight years (undergrad + grad) seems like heaven to me"

You forgot residency...and no a general surgery residency is HELL...HELL....

But lets say that I grant you that the 12+ years of post highschool education is fun and exciting (which i think it is)
You cannot compare salaries of doctors to other proffesions.
Im not going to bore everyone with the math here, but it doesnt take much though to realize that a person who makes 60K for 30 years in a career makes more money that a person who makes 100K for 20 (time lost to residency) and owes 200K in loans (intrest for 10 years).

If you want to be a communist and say that everyone in the US should do their best and we all split the money evenly, (which it sounds like you do) you can forget it.

But this kills me....."you dont have to pay high taxes" in medicalschool/residency....

Of all of the backward logic. Taxes are a percent of income...it is impossible to ever "make less" by being in a higher tax bracket.
To pay 10% on 30K, or 50% on 100K.....hmmm think about it.


"when it's you own *ss on the line and you might be fired at any minute and no one gives a **** who you know."

What the heck does that mean? Are you talking about being a doctor. Get fired?! MAYBE a radiologist or gasman can get fired but you are aware the like 90% of doctors dont work for anyone but themselves.

But i like the rest of your post....we do have trying times ahead. regardless of the #'s that are being argued, the fact remains that things are getting worse.

 

[merovingian]

MONEY MONEY MONEY MUHHHHHHNEEEEEY

 

[dara678]

Originally posted by hightrump
Do me a favor. Ask your father and your dad's friends what salary they started at when they first became an assistant professor, or ask them what they think or know a general surgeon or internal medicine doctor would start on if he were to join Hopkins or Yale. "

If the OP was asking for the salaries of doctors TEACHING i have no idea what they make. My dad and friends are in private practice. But to give you an idea, my dad came from Nova a DO school, and since the hospital in our town was loosing business to a neighbooring bigger city because there was no OB on our town they agreed to pay off his 250K in school loans and help him get loans for his office to start up. They also garunteed him and his partner that they would make 250K each their first three years. My dad and partner never came close to having to call the hospital on their bet. The only differnce i see is that he went to a smallish town that needed his service. Your not going to find such generous loan forgiveness in NYC or anything. This is not at all remarkable. 100K is ludacris for a starting private. A teaching doctor...who cares what they make..



"I don't see how y'all can complain about starting salaries at $90 or 100K a year. That is a HELL of a lot of money. My parents make less than $40K a year, COMBINED,"

You parents are obviously not making much money, does that mean you shouldn't?


"but being in school for eight years (undergrad + grad) seems like heaven to me"

You forgot residency...and no a general surgery residency is HELL...HELL....

But lets say that I grant you that the 12+ years of post highschool education is fun and exciting (which i think it is)
You cannot compare salaries of doctors to other proffesions.
Im not going to bore everyone with the math here, but it doesnt take much though to realize that a person who makes 60K for 30 years in a career makes more money that a person who makes 100K for 20 (time lost to residency) and owes 200K in loans (intrest for 10 years).

If you want to be a communist and say that everyone in the US should do their best and we all split the money evenly, (which it sounds like you do) you can forget it.

But this kills me....."you dont have to pay high taxes" in medicalschool/residency....

Of all of the backward logic. Taxes are a percent of income...it is impossible to ever "make less" by being in a higher tax bracket.
To pay 10% on 30K, or 50% on 100K.....hmmm think about it.


"when it's you own *ss on the line and you might be fired at any minute and no one gives a **** who you know."

What the heck does that mean? Are you talking about being a doctor. Get fired?! MAYBE a radiologist or gasman can get fired but you are aware the like 90% of doctors dont work for anyone but themselves.

But i like the rest of your post....we do have trying times ahead. regardless of the #'s that are being argued, the fact remains that things are getting worse.

As for the point about taxes and education ... all i was talking about was actually being IN medical school and undergraduate college. They can't tax you when you aren't making any money.

And I don't know where the heck you thought I was being a communist from. That was very offensive; I hate it when people put words into my mouth. You need to read people's posts more carefully. I said that doctors do make a significant salary, and that arguing about 100K vs. 150K a year is pointless because no matter what, it's still enough to buy you that house in the burbs and that Ford Explorer. What I am saying, hightrump, is that you are a getting a bit too focused on the money here. Becoming a doctor should be more than that ... I know you know that, but you can't let the money obscure it from your view. We all know that if we wanted to make more money we'd go into something else.

 

[....]

"We all know that if we wanted to make more money we'd go into something else."

Like what?

I apologize about the communist thing. I am just a beliver that you should get what you work for. A person who is smart enough and works hard anough to become a neurosurgeon and sacrifices half of the earning years of his life to do it deserves 500K a year.

Money doesnt blind me, I am just arguing a point. Now because im fanatical about macking money but because I just enjoy meaningfull debate.

 

[jay c]

Originally posted by dara678
Is there something I'm not getting here?

I don't see how y'all can complain about starting salaries at $90 or 100K a year. That is a HELL of a lot of money. My parents make less than $40K a year, COMBINED, and it's barely enough to send me to school (minus loans and whatnot). If I'm even able to touch $90K a year I'd think I was rich.

Besides, we're going into this not because of the money, but because we have the drive to help people who are sick. At least, that's the way it should be. I don't think anyone should be complaining about the compensation, especially when there are tons of other professions who make less.

As for the point of having years of training -- I think it's well worth it. Don't know about you, but being in school for eight years (undergrad + grad) seems like heaven to me. You don't have to pay taxes or worry about getting fired. Cherish it while it lasts. Doctors have it a lot better than other professionals; there's no need to complain.

Dara,

we are not saying that 100k is not a lot of money. if you follow the thread, we are responding to hightrump's comments that these salary ranges are off target.

 

[Biodude]

Yo, hightrump,

I realize that you're just trying to keep a conversation on physician salaries going, but there's no need to insult other people...no need to call anyone communist (yes, I know you apologized, but still...), no need to call anyone stupid, or a *****, etc.

Why do you have to be so hostile anyways? Just because you can't see things from someone else's perspective doesn't make you somehow superior to them in knowledge. There are better ways and more intelligent ways of keeping a discussion going, you know.

 

[LipGloss]

Originally posted by thaibonick
I'm so sick and tired of docs having this false sense of entitlement. I work in a lab where the scientists around me are the brightest guys around. If you ask me, docs are just highly paid techs and salespeople peddling the stuff that researchers discover anyways. If anybody's underpaid it's these people.

To do the job that most docs do you don't need 7-10 years of post-graduate training. Treatment should not cost as much as it does, hence the need for health insurance. Overall, I think many docs are highly overpaid, but in a free market economy the terms over and under paid don't really make much sense. Given the fact that the admissions process is more or less a crapshoot, that doctors have job security unlike any other profession, and if you work your butt off and are in the top of your class you can make tons of cash if you chose the right field. I really don't see what all the gripe is about medicine these days.

oh sure,
a bunch of self important PhD's peddling the irrelevent research ( all of the work having been done by their asian lab techs, and post docs, and premeds volunteering ) so they can go to their meetings and pat each other on the backs....and then write a grant where they BEG for money so they can feel self important for another 5 years

oh sure, the life cycle of fruit flies, and the factors that cause mutation in mice that have their DNA changed artificially, yes that's very important.
much more so than some MD that works 80 hrs a week patching up bullit holes or delivering babies

 

[....]

"Just because you can't see things from someone else's perspective"

We are talking about objective facts. There is a REALITY of how much doctors make. It not like we are arguing over what is the most tasty white meat or what specialy of medicine is better. We are trying to measure money.

As far as being inflamatory, i suppose i was....though i never said anyone on this board was a ***** or anything but communist. I said surgeons in private practice who only make 100K are *****s. does that apply to anyone present. As far as being a communist, if i belived that we should all just do our best and be happy with whatever we get, i would be proud to say i was a communist. If no one belives that, and we belive in freemarket competition, the money going to the fittest, than we have no commies among us. Its not the 50's, no one is going to shoot you or even hate you if you do.

 

[OrthoFixation]

I agree with hightrump, I think the $100K - $150K being thrown around is ridiculous. All of my doc friends started out much more than that all now making >$500K. Granted that certain areas have seen decreases in compensation. One friend is shifting fields to avoid the trend line.

As for academic docs, the only info I have is reading the job postings at UTMB where they were needing physicians to teach. I recall that all were in the $300K - $340K range DOE. I can't believe that such a disparity would exist between NYC or whatnot vs. Galveston, TX.

Dara, bless you. You have a great attitude. But you must admit that you have led a sheltered life. Your parents are hard workers, I'm sure. It is all about educated decisionmaking. Sure, we should choose something we like, but you should look down the road to see where it leads. I made $36K in 1990 fresh out of college as an engineer with little experience. Rich is relative to what you make and have. I have two friends making $1M+ a year that keep themselves mentally broke. It is part of goal setting and a pattern of achievement. In 1990, I thought $100K was a ton of money. But after you make that much, it doesn't really go that far.

Money is about 3rd on my list of importance, with job satisfaction being #1. You will be much happier if you do what you enjoy for work. If you highly compensated as well, then great. However, all "jobs" are based on supply and demand. Being a doc does not entitle you to XXX dollars, even if it took you 20 years to get the credentials. Check out the nursing shortages and all the perks they are getting. Heck, here in Dallas, if a nurse signs on for a multiyear contract, one hospital is giving away VW Beetle's. $3K to $5K signing bonuses are standard fare.

Part of the economic decisions that any student makes is what will this education prepare me for and how much am I likely to make. Then the cost of the training vs. return can be detailed. Just don't forget all the lost earnings while you are training.

 

[....]

"Money is about 3rd on my list of importance, with job satisfaction being #1"

Dara i think most everyone will agree with ortho that job satifaction is #1. the reason why money comes up alot is that it is a topic that can be researched NOW, and beacuse decisions we make NOW will impact how we are compensated (and as such, where or kids can go to school ect) tommorow. Knowing the satifation your job will give you is impossible untill you are truly doing it. And therfore, there is not mush to talk about in the present regarding job satisfation.

 

[WatchingWaiting]

Originally posted by LipGloss
oh sure,
a bunch of self important PhD's peddling the irrelevent research ( all of the work having been done by their asian lab techs, and post docs, and premeds volunteering ) so they can go to their meetings and pat each other on the backs....and then write a grant where they BEG for money so they can feel self important for another 5 years

oh sure, the life cycle of fruit flies, and the factors that cause mutation in mice that have their DNA changed artificially, yes that's very important.
much more so than some MD that works 80 hrs a week patching up bullit holes or delivering babies

This post is truly embarrassing. If you don't see the correlation between one hundred years of basic science research, coupled with fifty years of rapid engineering (esp. ee and cs) progress, and the rapid march forward of medical science and human life expectancy and quality of life during/after illness, you are either a fool or an idiot.

 

[fiatlux]

Originally posted by LipGloss
oh sure,
a bunch of self important PhD's peddling the irrelevent research ( all of the work having been done by their asian lab techs, and post docs, and premeds volunteering ) so they can go to their meetings and pat each other on the backs....and then write a grant where they BEG for money so they can feel self important for another 5 years

oh sure, the life cycle of fruit flies, and the factors that cause mutation in mice that have their DNA changed artificially, yes that's very important.
much more so than some MD that works 80 hrs a week patching up bullit holes or delivering babies

Are you for real? 😡 I would go so far as to call you absolutely naive and foolish! You just shrugged off the discoveries of the past 2 centuries as nothing but "self important"---discoveries like insulin (yea that was some "self important PhD peddling...irrelevent research" that didnt save millions of lives), antibiotics, vaccincations. Where the F**K do you think things like that come from? Unbelievable. 😡 And the possibility of saving millions of lives by advancing research in AIDS treatments or cancer discovery today... oh no thats not important to the world right now.

Research is equally as important as any trauma MD or ob/gyn but in a different context. Yes, research requires patience and a different mindset then clinical treatment but by no means can one ever make the claim that it is irrelevant. Obviously it isn't for everyone as you so eloquently have shown us by your ignorant understanding of the most basic concepts of science. By its very definition, science is the methodical analysis of discovery with some set of rules aka... the freaking SCIENTIFIC METHOD!! Now if you dont think a physician needs science in his/her clinical management you definately need to re-assess your views about medicine.

Hopefully you saw the link: Research--->science--->medicine
Without it, its back to the days of Galen and his counterparts in antiquity.

Fiatlux

--helpful hint: save the $30 and be sure not to apply to hopkins or other top 25 NIH funded school with that attitude towards research 🙄

 

[fiatlux]

to OP--

An Elegant Solution (too bad it has no chance)

How about a national healthcare system coupled with a national medical school training sytem that elminates high cost post-grad loans at the expense of physican salaries (they'd be capped at an arbitrary #, say, 75K). This is a similar model of European systems- i think. And while im making this utopian model of American healthcare, lets throw in a max 40 hr work week.

--Im thinking Harvard and other private schools wouldnt like that too much but hey 75k with no loans is still plenty of money to be living off comfortably (and yes by that I mean enjoying time at home with ur wife and kids -- not having a beemer, a jag and a H2 getting 9 mpg, and a 5000 sq ft house on newport beach).

But im guesssing you'd still have a boat load jumping ship to MBA or JD for that six-figure gain and options packages.

Fiatlux