emd123

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As of 2014, Medicare payments (roughly, your salary) per "specialty":

Chiropractic- up 12% overall,
Clinical psych/social work- up 8%
Psychiatry- up 6%
Nurse Anesthesia- up 3%

If you are a doctor, particularly a specialist:

Pathology - down 6%
Interventional Pain- down 4%
Rheumatology-down 4%
Allergy/immuno- down 3%
Derm, GI, heme/Onc, ortho, ENT, rads, vascular, all- down 2% many others, down 1%


Source, US Government, Medicare, page 1285-1286

http://www.ofr.gov/OFRUpload/OFRData/2013-28696_PI.pdf
 
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why would one be limited to chiropractic when you could be doing academic homeopathy with the same level of education and much more $$$. Chiropractice is doomed i say.
 

TooMuchResearch

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As of 2014, Medicare payments (roughly, your salary) per "specialty":

Chiropractic- up 12% overall,
Clinical psych/social work- up 8%
Psychiatry- up 6%
Nurse Anesthesia- up 3%

If you are a doctor, particularly a specialist:

Pathology - down 6%
Interventional Pain- down 4%
Rheumatology-down 4%
Allergy/immuno- down 3%
Derm, GI, heme/Onc, ortho, ENT, rads, vascular, all- down 2% many others, down 1%


Source, US Government, Medicare, page 1285-1286

http://www.ofr.gov/OFRUpload/OFRData/2013-28696_PI.pdf
You realize psychiatry is a medical specialty, right?
 
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emd123

emd123

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You realize psychiatry is a medical specialty, right?
Yes, of course, and it's the exception that proves the rule. I have plenty of respect for psychiatrists, and they deserve a raise like the rest of us doctors and specialists out there. You missed the point, to prove a point.
 

notbobtrustme

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As of 2014, Medicare payments (roughly, your salary) per "specialty":

Chiropractic- up 12% overall,
Clinical psych/social work- up 8%
Psychiatry- up 6%
Nurse Anesthesia- up 3%

If you are a doctor, particularly a specialist:

Pathology - down 6%
Interventional Pain- down 4%
Rheumatology-down 4%
Allergy/immuno- down 3%
Derm, GI, heme/Onc, ortho, ENT, rads, vascular, all- down 2% many others, down 1%


Source, US Government, Medicare, page 1285-1286

http://www.ofr.gov/OFRUpload/OFRData/2013-28696_PI.pdf

The paradigm for the 21st century is downward pressures on all salaries, healthcare or not. Doctors aren't the only ones facing lowered salaries. Every career out there is facing the same prospect. Most of us here aren't trading several great jobs to become doctors, as prior generations might have, but we are choosing the least ugly girl at the dance. If it weren't for medicine, the vast majority of us would never sniff anything higher than 75k.

This isn't the '70s, where you can graduate high school and land a 50k/year job. Hell, it's not even the 90s, where a BS or BA basically guaranteed a 75k/year job.
 

Silent Cool

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The paradigm for the 21st century is downward pressures on all salaries, healthcare or not. Doctors aren't the only ones facing lowered salaries. Every career out there is facing the same prospect. Most of us here aren't trading several great jobs to become doctors, as prior generations might have, but we are choosing the least ugly girl at the dance. If it weren't for medicine, the vast majority of us would never sniff anything higher than 75k.

This isn't the '70s, where you can graduate FROM high school and land a 50k/year job. Hell, it's not even the 90s, where a BS or BA basically guaranteed a 75k/year job.
Cuppla points:

1) This is a bad economy. Everything sucks.
2) What will be the next big thing, technologically and economically?
3) If all careers are 'going down the tubes,' so to speak, where is the money going? Oh, that's right--to the government. You can stop that by voting for Rand Paul in the next election, thereby reducing the % of your taxes that go directly to federal and state government.

-sc
 

Silent Cool

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Rand Paul will cut research funding.
I am a huge fan of science funding and research. I strongly believe that biotechnology and human medicine will be the source of the next great revolution in science. But when I was in college, I remember a professor telling me that a colleague of hers thought that ion channels and so forth didn't really exist and that, instead, the cell membrane just opened up randomly and 'swallowed' a whole bunch of ions. Yeah, my tax dollars paid for that $hit, that ridiculous research.

All federal spending needs to be cut. There is a lot of private money out there that is waiting to invest itself into (actually valuable) research--instead of the nonsense that I mentioned above.
 

dismorfik

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All federal spending needs to be cut. There is a lot of private money out there that is waiting to invest itself into (actually valuable) research--instead of the nonsense that I mentioned above.
Sure, cut the bull****. Just realize private sector money plays an important role in medical innovation but so does taxpayer dollars. Cut NIH funding and results are catastrophic for the future of medicine.

Rand Paul is also a Physician, which I would much prefer to a Lawyer.
Me, too.
 

dismorfik

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Also I typed bull**** and it shows up as bullcrap? That's bull****...
 

Silent Cool

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Sure, cut the bullcrap. Just realize private sector money plays an important role in medical innovation but so does taxpayer dollars. Cut NIH funding and results are catastrophic for the future of medicine.


Me, too.
I agree. I think the NIH is a great organization for the future of medicine but it, like all federal and any gov't organizations, needs to be cut to a certain degree. Honestly, I don't support cutting much in the way of science/research, etc..--it's more the military occupation abroad (bring the troops home), and contraction (elimination?) of other (worthless?) federal agencies through attrition by 10-20% that I support. I would actually like to divert some of that saving to medical research because it is far more important than stationing troops in Germany or Japan, etc....

Regarding medical innovation, etc.., what I would like to see is outsourcing of the FDA to an independent, non-governmental agency such that:

1) The numerous regulatory hurdles to creating a new drug or device are lowered or eliminated where appropriate
2) The efficiency of approving such a drug/device is increased and the expectations for said approval are clear from the beginning and that the approving agency/body provides counsel throughout the development process (efficiently and cheaply), and
3) That patients have access to experimental drugs--at their discretion and at the approval of their attending physicians.
 

notbobtrustme

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3) If all careers are 'going down the tubes,' so to speak, where is the money going? Oh, that's right--to the government. You can stop that by voting for Rand Paul in the next election, thereby reducing the % of your taxes that go directly to federal and state government.
Taxes are at record lows for the last 30 years, even for top earners. The money is basically going to corporations, who have been posting record profits for 5+ years now.

Rand Paul is a joke anyways.
 
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Mad Jack

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Taxes are at record lows for the last 30 years, even for top earners. The money is basically going to corporations, who have been posting record profits for 5+ years now.

Rand Paul is a joke anyways.
RAND PAUL is no joke. And the problem is that taxes are at record lows while spending is at an all time high. I support moderate tax increases coupled with moderate funding cuts, particularly in the area of military spending. Cutting the salaries of physicians and research while building multi-million dollar fighter jets that will likely never see combat is just silly. RAND PAUL would devastatingly cut everything, and actually stands a chance of election thanks to the "tea party." My future GME funding is why he is no laughing matter.

RAND PAUL.
 
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notbobtrustme

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Don't care who he is or what party, as long as research funding is returned to pre sequester levels if not more!
Unfortunately, that's probably not going to happen before 2020 when new districts can be drawn. Basically, the entire country is going to be on pause until 2020 due to the political structure of the US at the moment.
 

sinombre

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Unfortunately, that's probably not going to happen before 2020 when new districts can be drawn. Basically, the entire country is going to be on pause until 2020 due to the political structure of the US at the moment.
Why 2020?
 
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notbobtrustme

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Why 2020?
That's when the HoR can get new districts drawn in and that's assuming that the country goes in the direction it's been going (eg bluer). The HoR is tilted heavily towards the GOP despite the total number of votes heavily favoring the Democrats (by about 2 million, that is, Democratic congressmen got 2 milion more votes than GOP congressmen, but still don't have anywhere near a majority in the house due to the way districts are drawn).
 

sinombre

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That's when the HoR can get new districts drawn in and that's assuming that the country goes in the direction it's been going (eg bluer). The HoR is tilted heavily towards the GOP despite the total number of votes heavily favoring the Democrats (by about 2 million, that is, Democratic congressmen got 2 milion more votes than GOP congressmen, but still don't have anywhere near a majority in the house due to the way districts are drawn).
Ah I see. Thanks.
 

dismorfik

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Why is primary care not listed as having increased reimbursement? I thought the whole purpose of healthcare reform was to encourage PCP and preventative healthcare?
 

tco

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Why is primary care not listed as having increased reimbursement? I thought the whole purpose of healthcare reform was to encourage PCP and preventative healthcare?
HAHAHAHAHA You thought that the politicians were going to help someone?!

HAHAHAHAHAHAHAHAHAHA

I remember when I was naive...
 

tco

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I'm glad you brought this up, reminded me of an article I read few weeks back:
http://www.aafp.org/news-now/practice-professional-issues/20130820np-pa-grahamcenter.html
Relying on them to fix the PCP issue is unrealistic, but just as we're saying that competition and demand are increasing, it will be altered by NP's being able to practice medicine. Good article, though. It goes to show that NP's aren't just trying to be a backdoor way into becoming a PCP.
 
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Agreed. The whole mid level provider debate is a whole 'nother headache. We need more residencies for medical graduates and hopefully with more demand/compensation, more qualified and competitive applicants won't shy away from FM.
 

mulberry

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The demand has been there for a while. Unless compensation increases by a significant amount, you aren't gonna have people beating down the doors for FM when they can go be a hospitalist or do EM and make 100K more. Primary care is going to go down first in the midlevel argument. It's the easiest (least scary) to break into and the hardest to compare outcomes for. What's easier, comparing surgery complications or how well we managed BP for 5 years?

Pathology is really going down the toilet though. Bad job market combined with a 6% RVU cut? Not gonna be fun to be looking for a path job out of residency.
Each year there thousands of IMG applicants from all over the world who would gladly take that FM/IM residency so there may be a shortage but the numbers will still be continuous each year.
 

thefritz

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DEAR LORD WHAT WILL I EVER DO WITH $366k/year INSTEAD OF 390k/year? HOW WILL I SURVIVE??? OMG IS IT TOO LATE TO DROP OUT?

These kind of posts crack me up. But also they are very sad. So sad.
 

notbobtrustme

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DEAR LORD WHAT WILL I EVER DO WITH $366k/year INSTEAD OF 390k/year? HOW WILL I SURVIVE??? OMG IS IT TOO LATE TO DROP OUT?

These kind of posts crack me up. But also they are very sad. So sad.
especially when the alternative is basically 50k-75k/year unless you are a hotshot "whatever". Medicine is the least ugly girl at the dance.
 

Anastomoses

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especially when the alternative is basically 50k-75k/year unless you are a hotshot "whatever". Medicine is the least ugly girl at the dance.
Could you point me in the direction of the least ugly boy at the dance?
 

thefritz

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RAND PAUL is no joke.
Yet he chooses to take the namesake of one of the biggest jokes of the 20th century.

Watch @ 27:50 = sociopath
30:00 = sociopath
"women's proper position is not to rule men"

34:00 = probably the best example of just how insane a megalomaniac she is.

Watching any of her interviews is almost as painful as watching the film adaption of atlas shrugged.
Yes, by all means lets elect someone who takes this person's name (yet curiously tries to deny it) and holds her philosophies in high esteem.
 

thefritz

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especially when the alternative is basically 50k-75k/year unless you are a hotshot "whatever". Medicine is the least ugly girl at the dance.
This is kind of sad that in every other field you have to be a 'hotshot' (know your stuff and work hard) to be successful, yet in medicine you are successful by just being in the field at all. Seems kind of screwed up, huh? Maybe it's changing now. Maybe that's not bad. My point is that people aren't going to stop wanting to do it because it only pays 360k/year instead of 390k/year. They'd still do it for 80k/year. When the other option is unemployment and minimum wage. Most med students and doctors don't know how bad it can really be out there. 80k/year attracts people in every other career field for jobs that require 60-70 hour workweeks. It will do so in medicine as well if that's what it comes to. Working all day every day is not unique to medicine. The only thing that is propping up the incomes is the lobbying power setting the reimbursement rates and the pipeline keeping the supply tight. Take one or both away and watch the bottom fall out. We could drastically reduce healthcare spending by slashing payments to providers and opening the floodgates of residency to FMGs to fill the gaps. Just my opinion.
 

TooMuchResearch

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This is kind of sad that in every other field you have to be a 'hotshot' (know your stuff and work hard) to be successful, yet in medicine you are successful by just being in the field at all. Seems kind of screwed up, huh? Maybe it's changing now. Maybe that's not bad. My point is that people aren't going to stop wanting to do it because it only pays 360k/year instead of 390k/year. They'd still do it for 80k/year. When the other option is unemployment and minimum wage. Most med students and doctors don't know how bad it can really be out there. 80k/year attracts people in every other career field for jobs that require 60-70 hour workweeks. It will do so in medicine as well if that's what it comes to. Working all day every day is not unique to medicine. The only thing that is propping up the incomes is the lobbying power setting the reimbursement rates and the pipeline keeping the supply tight. Take one or both away and watch the bottom fall out. We could drastically reduce healthcare spending by slashing payments to providers and opening the floodgates of residency to FMGs to fill the gaps. Just my opinion.
Physicians make up 10-20% of health care costs. You know what happens when you cut 10% off a bloated cow? Not much. It leaves a bleeding, still pretty bloated cow.
 
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notbobtrustme

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This is kind of sad that in every other field you have to be a 'hotshot' (know your stuff and work hard) to be successful, yet in medicine you are successful by just being in the field at all. Seems kind of screwed up, huh? Maybe it's changing now. Maybe that's not bad. My point is that people aren't going to stop wanting to do it because it only pays 360k/year instead of 390k/year. They'd still do it for 80k/year. When the other option is unemployment and minimum wage. Most med students and doctors don't know how bad it can really be out there. 80k/year attracts people in every other career field for jobs that require 60-70 hour workweeks. It will do so in medicine as well if that's what it comes to. Working all day every day is not unique to medicine. The only thing that is propping up the incomes is the lobbying power setting the reimbursement rates and the pipeline keeping the supply tight. Take one or both away and watch the bottom fall out. We could drastically reduce healthcare spending by slashing payments to providers and opening the floodgates of residency to FMGs to fill the gaps. Just my opinion.

Other jobs don't have the same responsibilties that a physician has. That's why physicians command high salaries. If I **** in most any other job, nothing truly terrible will happen. The program gets delayed, maybe some bugs pop up, but for the vast majority of applications, no one will be at risk. Very few professions have to go into debt 200k+, train for an additional 3-10 years working slave labor hours before receiving their first job. Physicians are the most highly trained professionals in the work force. Just about every physician is a hotshot if you translated their expertise to another sector.

80k/year is great when you go to school for 4 years and work your way up. It's not that great when you have a minimum of 11 years (4 years undergrad, 4 years med school, minimum 3 years residency) of schooling and the huge amount of responsibility that a physician has.
 

Cyal

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DEAR LORD WHAT WILL I EVER DO WITH $366k/year INSTEAD OF 390k/year? HOW WILL I SURVIVE??? OMG IS IT TOO LATE TO DROP OUT?

These kind of posts crack me up. But also they are very sad. So sad.
Actually the salaries in the survey were $200K. Not that $200K is bad, but the trend is towards a decrease in compensation while costs continue to rise. I think this raises cause for some concern.
 

Cyal

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This is kind of sad that in every other field you have to be a 'hotshot' (know your stuff and work hard) to be successful, yet in medicine you are successful by just being in the field at all. Seems kind of screwed up, huh? Maybe it's changing now. Maybe that's not bad. My point is that people aren't going to stop wanting to do it because it only pays 360k/year instead of 390k/year. They'd still do it for 80k/year. When the other option is unemployment and minimum wage. Most med students and doctors don't know how bad it can really be out there. 80k/year attracts people in every other career field for jobs that require 60-70 hour workweeks. It will do so in medicine as well if that's what it comes to. Working all day every day is not unique to medicine. The only thing that is propping up the incomes is the lobbying power setting the reimbursement rates and the pipeline keeping the supply tight. Take one or both away and watch the bottom fall out. We could drastically reduce healthcare spending by slashing payments to providers and opening the floodgates of residency to FMGs to fill the gaps. Just my opinion.
Since you think doctors are so rich, how about you donate your salary when you become a physician and leave the rest of us alone?

Total compensation for physicians accounts for ~10% of healthcare costs. Moreover, for the cost it takes to become an MD, nurses are doing pretty good compared to physicians. So why don't you think NPs make too much? Canada and the Netherlands pay their doctors fairly well too yet their healthcare costs are usually referred to as a model to which every nation should aspire.

In your world if medicine paid $30K per year while one amassed $300K in debt, everyone would still do it :laugh:
 

thefritz

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Other jobs don't have the same responsibilties that a physician has. That's why physicians command high salaries. If I **** in most any other job, nothing truly terrible will happen. The program gets delayed, maybe some bugs pop up, but for the vast majority of applications, no one will be at risk. Very few professions have to go into debt 200k+, train for an additional 3-10 years working slave labor hours before receiving their first job. Physicians are the most highly trained professionals in the work force. Just about every physician is a hotshot if you translated their expertise to another sector.

80k/year is great when you go to school for 4 years and work your way up. It's not that great when you have a minimum of 11 years (4 years undergrad, 4 years med school, minimum 3 years residency) of schooling and the huge amount of responsibility that a physician has.
Eh, I don't want to get in the argument of whether physicians deserve to get paid more because they went to school longer (it's not like everyone else was taking vacation during those extra 7 years and learning nothing). But, I would argue that there are a lot of jobs with high responsibility. For example, the railroad. Somebody builds that train, somebody is responsible for operating it, and somebody is responsible for managing the safety. If anyone drops the ball, people get killed. A lot of people who get paid low hourly wages have people's lives in their hands. That's not unique to doctors. What is unique to doctors is the sense of dependency. Most doctors can't just call in sick or take off vacation for two weeks because they want to spend some more time at home. These things have to be arranged far in advance. But still, when there is a broken railroad track, somebody gets called and has to go fix it immediately before it hits the fan.

A lot of people forget about the workforce that keeps the infrastructure of this country going because you never see it. Granted, I will be a doctor in a few months and would like to think I'm pretty important, but there are a lot of other things out there that are pretty important too. This is why a lot of people think doctors are arrogant. You just never think about the power company until your power goes out.
 

thefritz

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Since you think doctors are so rich, how about you donate your salary when you become a physician and leave the rest of us alone?

So why don't you think NPs make too much?
I didn't realize I said NPs aren't overpaid. Oh, that's because I didn't.

In your world if medicine paid $30K per year
Apparently I said this also?
 
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First, if you read any major paper of record, you'll see that there is an emerging popular movement against the healthcare establishment, including physicians. It's hard to read an article in the NYTimes (see today's online featurette) or WaPo that isn't starting to break down, in layman's terms, the absolute lack of reasonable market forces inside healthcare. You could essentially break them all down in the following manner:

"IV bag cost $120.00. BAD. 3 stitches cost $2,000.00. BAD."

The problem is that these articles are very populist and they often fail to really emphasize the larger reasons for such high cost. They may devote a single sentence, typically a quote from an insurance executive, to describing the overall reasons why costs are elevated (unequal payer schemes, non-payers and EMTLA care, low Medicaid and Medicare reimbursements, etc." Yes, greed is definitely present, but it is not the single factor causing our healthcare spending to balloon. The average reader doesn't get the nuanced message.

The next thing you see in this articles are small, subtle jabs at physician fees/income and then usually some discussion about how awesome mid-levels are. There is a growing sentiment in this country that physicians are overpaid. If you read the comments in some of these articles, with the exception of physician commentators, you'll see that there is a huge misunderstanding surrounding medical education and the value of physicians within society. The word I increasingly see thrown around is "guild," followed shortly by protectionism. The implication is that physicians are overpaid because they create artificial shortages due to unrealistic and unnecessary admissions standards. To these people, the success of mid-levels is direct evidence that the majority of the job can be done with less training. Surely others think, "Sure, I could do that. If only the admissions standards weren't so ridiculous." I see this all of the time.

Simply put, Americans value the entrepreneur risk-taker over the steady slog and tremendously difficult journey of becoming a physician. They have absolutely no problem with the guy from their high school class who opens a local tire shop and makes $300k a year. He could even be a blatantly overpriced swindler and they'd respect his income as "earned." To a surprising number of people, spending 12 or more years in higher education isn't smart, it's a waste of time. They don't see this as sacrifice. If you think otherwise, then you haven't spent time with a large swath of this country. This attitude is becoming pervasive and I think it has a lot to do with our own inability or unwillingness to educate America on the value of physicians and physician-lead care. Physicians need to establish themselves as leaders within their communities and our national organizations need to get in the advertising war.
 
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Eh, I don't want to get in the argument of whether physicians deserve to get paid more because they went to school longer (it's not like everyone else was taking vacation during those extra 7 years and learning nothing). But, I would argue that there are a lot of jobs with high responsibility. For example, the railroad. Somebody builds that train, somebody is responsible for operating it, and somebody is responsible for managing the safety. If anyone drops the ball, people get killed. A lot of people who get paid low hourly wages have people's lives in their hands. That's not unique to doctors. What is unique to doctors is the sense of dependency. Most doctors can't just call in sick or take off vacation for two weeks because they want to spend some more time at home. These things have to be arranged far in advance. But still, when there is a broken railroad track, somebody gets called and has to go fix it immediately before it hits the fan.

A lot of people forget about the workforce that keeps the infrastructure of this country going because you never see it. Granted, I will be a doctor in a few months and would like to think I'm pretty important, but there are a lot of other things out there that are pretty important too. This is why a lot of people think doctors are arrogant. You just never think about the power company until your power goes out.
You're seriously equating operating a train and physicians taking care of sick people?
 

mulberry

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You're seriously equating operating a train and physicians taking care of sick people?
You're seriously using his inference as literal? He has a solid point that many people fail to realize.
 

Wordead

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You're seriously using his inference as literal? He has a solid point that many people fail to realize.
No, his point holds no water. There is 0 thought given in a power company worker's life to whether or not someone will die if he messes up. Or a railroad worker. It's a horrible moronic point. The fact that other jobs are integral to society is not relevant.
 

notbobtrustme

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Simply put, Americans value the entrepreneur risk-taker over the steady slog and tremendously difficult journey of becoming a physician. They have absolutely no problem with the guy from their high school class who opens a local tire shop and makes $300k a year. He could even be a blatantly overpriced swindler and they'd respect his income as "earned."
I disagree. If you put up a general poll, chances are any profession that earns more than 100k will be thought as being overpaid. CEOs, rap stars, basketball players and doctors have one thing in common; they make more money than the average person. When that income exceeds a certain threshold (I use 100k since it's a nice round number and frankly makes sense), then there will be a general sense that those people are overpaid, regardless of the difficulty, training and worth to society.

To a surprising number of people, spending 12 or more years in higher education isn't smart, it's a waste of time. They don't see this as sacrifice. If you think otherwise, then you haven't spent time with a large swath of this country. This attitude is becoming pervasive and I think it has a lot to do with our own inability or unwillingness to educate America on the value of physicians and physician-lead care. Physicians need to establish themselves as leaders within their communities and our national organizations need to get in the advertising war.
Again, I disagree. Doctors are highly respected throughout society. That respect have gone down a couple notches, but the profession, as a whole, is still one of the most trusted and most respected in the nation.