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2011 Physician Compensation Report
The following links are consolidations of the discussion that took place in this thread:
How much money is $200,000 per year?
Pursuing a career in medicine "for the money."
The debt burden of medical school is increasing; physician pay is not.
What about differences in pay across specialties?
Cash-only practices
What options do physicians have to negotiate their pay?
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The Semi-Original Post
The issue of physician pay is a recurring theme on SDN, and it has come up a number of times in the past few days in several unrelated threads; I would like to consolidate the discussion here. I'll start by addressing two things that came up in the other threads, and we'll see where this goes.
The first issue is money as motivation for becoming a physician (bear with me, I'm not all up on a rant), and the second is the future of physician compensation and the implications of it changing. This is not an OMG O Noes! thread. Many of us are far enough along this path that we won't be avoiding the consequences of fluctuating income, so there might as well be some pragmatic discussion about it.
For housekeeping purposes, here are some things that go without saying, but I will laugh when someone says them anyway:
Anesthesiologists-------------------$211,750
Family and General Practitioners-----$168,550
Internists, General------------------$183,990
Obstetricians and Gynecologists-----$204,470
Pediatricians, General---------------$161,410
Psychiatrists-----------------------$163,660
Surgeons--------------------------$219,770
Physicians and Surgeons, All Other--$173,860
http://www.bls.gov/oes/current/oes_nat.htm#29-0000
Moving on from stats, but still housekeeping for the thread:
A short time ago, in a thread far, far away, I was provoked by the following comments, which had the making of a good discussion but never took off (I have removed the quote tags but linked to the comments):
I sort of get the points being made by each side, but where do we go from here?
We can't just end the discussion by saying "don't do medicine for the money." And if you disagree, at least state why. I will elaborate on my opinion about this if the discussion heads that way, but I won't take it there from the outset. For now, suffice it to say there are people for whom compensation is a large factor, there are people who don't really care at all, and there are people who are legitimately concerned about being able to pay back their loans and live comfortably doing a job they enjoy.
I no longer take it upon myself to judge motives, and I am not against making a lot of money. But I don't agree with the notion that completing medical school and residency entitles anyone to an awesome income. Education isn't the same valuable commodity that it once was. Having a bachelor's degree used to pretty much guarantee that you'd be paid well, but it doesn't anymore. It's not valued the same way in the job market, and now there's even a glut of people with Master's degrees moaning about their compensation. Can you read the writing on the wall?
The salaries in those charts above are what we used to be able to "expect," but in our lifetime this is going to change. Physician compensation will remain high enough to satisfy many, so this doesn't inspire panic.
If you *are* concerned about it, what do you plan on doing, besides "putting your foot down?" ... ... Making demands? Maybe throwing a temper tantrum? None of us will be able to waltz into the lifestyle of boats and hoez simply on the merit of having a medical degree.
[This is somewhat of an aside, but I wanted to work it in-- $200K/year is not really that much money, and this is coming from someone who lives well below the poverty line. It is about as much money per month as I live on in an entire year, but I don't get why so many of us consider "six figures," $200K, or even $400K to be the holy grail of incomes. Most of us are used to a lot less, but quite frankly I don't find $400K to be that impressive of a "goal" for anyone who acknowledges money as a motivator. This is just a curiosity of mine; ultimately whether or not the money-motivated have a chance at building real wealth through medicine is of little consequence to me.]
What's of plausibly more concern (but still not OMG ONOZ territory) is that the cost of medical education (as well as the undergraduate education you have to pay for first) will NOT decrease soon enough for the next generation of physicians to benefit. If the cost ever does go down, it will be well after most of us have paid somewhere in the neighborhood of $200K, plus the juice on our loans.
I don't lament this fact; I am confident in my own ability to generate a satisfactory income and pay back my loans, so in that respect I'm kind of sticking my head in the sand and waiting for the proverbial **** to hit the fan with physician compensation. When it does, I will act accordingly.
What about you? Especially those who continue deciding against the "opportunity" to GTFO and take your talent to another field? If your head isn't stuck in the sand, how are you thinking about handling this?
The following links are consolidations of the discussion that took place in this thread:
How much money is $200,000 per year?
Pursuing a career in medicine "for the money."
The debt burden of medical school is increasing; physician pay is not.
What about differences in pay across specialties?
Cash-only practices
What options do physicians have to negotiate their pay?
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
The Semi-Original Post
The issue of physician pay is a recurring theme on SDN, and it has come up a number of times in the past few days in several unrelated threads; I would like to consolidate the discussion here. I'll start by addressing two things that came up in the other threads, and we'll see where this goes.
The first issue is money as motivation for becoming a physician (bear with me, I'm not all up on a rant), and the second is the future of physician compensation and the implications of it changing. This is not an OMG O Noes! thread. Many of us are far enough along this path that we won't be avoiding the consequences of fluctuating income, so there might as well be some pragmatic discussion about it.
For housekeeping purposes, here are some things that go without saying, but I will laugh when someone says them anyway:
- I may not respond much during the next week (Finals).
- Don't bother bringing the Benjamin Brown article into this. If you want to reference it as the type of discussion we DON'T need to have, you can find it here (blah blah blah shenanigans) and if you enjoy the taste of fallacy enough for seconds: (you must be a glutton for punishment).
- If you take this discussion the way of tabulated net worth of X career vs. Medicine, I'm warning you now that you will get crapped on.
- The purpose of this thread is not to help people decide between medicine and another career. If it ends up helping with that, great but let's not tailor the discussion that way. It is meant to be a thread for people who have already wrestled with the decision and have chosen to go into medicine--in spite of the uncertainty of our futures, and recognizing that pessimistic forecasts, while not guaranteed to come true, may indeed and probably have legitimate foundations.
- Any reported physician income is likely to be contested by someone on the forum, regardless of whether the source is anecdotal or actually resembles data. However,
- Correcting a gross misconception about physician income is different than splitting hairs about the current figures. The former is constructive, the latter is not. For current figures, start with the 2011 Physician Compensation Report, or from a different source:
Anesthesiologists-------------------$211,750
Family and General Practitioners-----$168,550
Internists, General------------------$183,990
Obstetricians and Gynecologists-----$204,470
Pediatricians, General---------------$161,410
Psychiatrists-----------------------$163,660
Surgeons--------------------------$219,770
Physicians and Surgeons, All Other--$173,860
http://www.bls.gov/oes/current/oes_nat.htm#29-0000
Moving on from stats, but still housekeeping for the thread:
- Not all physicians are "salaried." Some are, others are reimbursed by insurance companies/Medicare/Medicaid based on treatments they administer and procedures they complete, and still others operate on a fee-for-service basis where patients pay cash for (or finance) procedures. While this is usually for elective procedures, there is at least one instance of a general surgeon doing this for cholecystectomies and such, discussed in one of Gawande's books (I believe it was Better, but could have been Complications, and I'm not going to dig it up for you). The prevalence and the administration of these payment modalities is quite likely to shift in the future. Let's not overcomplicate that portion of the discussion, but let's also avoid oversimplifying it by talking about all compensation as if it were a "salary" that materializes out of thin air every two weeks.
- This is not a hijack of the healthcare reform discussion, so let's get two pertinent points out of the way and then leave it alone. First, dipping into physician income is not going to pay for a solution to the healthcare crisis. Don't bother suggesting it, and don't assume that someone else did suggest it. It is still important to note that physician income is simply not speculated to increase (which is the second of the two points from the reform discussion):
- Reform is interested in increasing access to treatment and decreasing its cost. Of all the proposed methods to do this, the suggestions that have any chance of being implemented do not involve an increase in physician reimbursement. This thread is not about solving the healthcare reform Rubik's cube, nor is it about solving the "problem" of declining physician pay. It is about discussing the implications. Also,
- Don't molest me by bringing Ayn Rand or Ché Guevara into the discussion. And finally,
- You will make a terrible doctor. I will make a terrible doctor. Glad we got that out of the way.
A short time ago, in a thread far, far away, I was provoked by the following comments, which had the making of a good discussion but never took off (I have removed the quote tags but linked to the comments):
Wait, so some docs won't be making 400k anymore? How terrible, everyone needs a summer house and a maid!
I have a great idea. How about all the doctors who DON'T care about their salary going down take the hit, and subsidize those who DO care.
I sort of get the points being made by each side, but where do we go from here?
We can't just end the discussion by saying "don't do medicine for the money." And if you disagree, at least state why. I will elaborate on my opinion about this if the discussion heads that way, but I won't take it there from the outset. For now, suffice it to say there are people for whom compensation is a large factor, there are people who don't really care at all, and there are people who are legitimately concerned about being able to pay back their loans and live comfortably doing a job they enjoy.
I no longer take it upon myself to judge motives, and I am not against making a lot of money. But I don't agree with the notion that completing medical school and residency entitles anyone to an awesome income. Education isn't the same valuable commodity that it once was. Having a bachelor's degree used to pretty much guarantee that you'd be paid well, but it doesn't anymore. It's not valued the same way in the job market, and now there's even a glut of people with Master's degrees moaning about their compensation. Can you read the writing on the wall?
The salaries in those charts above are what we used to be able to "expect," but in our lifetime this is going to change. Physician compensation will remain high enough to satisfy many, so this doesn't inspire panic.
If you *are* concerned about it, what do you plan on doing, besides "putting your foot down?" ... ... Making demands? Maybe throwing a temper tantrum? None of us will be able to waltz into the lifestyle of boats and hoez simply on the merit of having a medical degree.
[This is somewhat of an aside, but I wanted to work it in-- $200K/year is not really that much money, and this is coming from someone who lives well below the poverty line. It is about as much money per month as I live on in an entire year, but I don't get why so many of us consider "six figures," $200K, or even $400K to be the holy grail of incomes. Most of us are used to a lot less, but quite frankly I don't find $400K to be that impressive of a "goal" for anyone who acknowledges money as a motivator. This is just a curiosity of mine; ultimately whether or not the money-motivated have a chance at building real wealth through medicine is of little consequence to me.]
What's of plausibly more concern (but still not OMG ONOZ territory) is that the cost of medical education (as well as the undergraduate education you have to pay for first) will NOT decrease soon enough for the next generation of physicians to benefit. If the cost ever does go down, it will be well after most of us have paid somewhere in the neighborhood of $200K, plus the juice on our loans.
I don't lament this fact; I am confident in my own ability to generate a satisfactory income and pay back my loans, so in that respect I'm kind of sticking my head in the sand and waiting for the proverbial **** to hit the fan with physician compensation. When it does, I will act accordingly.
What about you? Especially those who continue deciding against the "opportunity" to GTFO and take your talent to another field? If your head isn't stuck in the sand, how are you thinking about handling this?
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