After compensating for loans (meaning you exclude the money needed to pay those), what percentile should physician income fall in relative to the population as a whole?
How much money do you think doctors should make?
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1 bajillion and nothing less
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I personally think that, for their worth for society and the skill/work it takes to be one, physicians are terribly underpaid. This is not to say that I'm not satisfied with physician wages, nor would I want to explain to my taxpaying patients why my wage is 2.4 mill a year. I think physician wages would be great where they are, with a little more to the primary care folks, if medical school was free or back to having a 40k price tag.
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Should make?
for the amount of training and benefit to the community and society I would say top 10....maybe 5%.
Physicians deserve it more than the wall street bankers, athletes, or politicians but we live in an imperfect world where idiots like Lady Gaga, Kim Kardashian, and John/Kate Gosselin make more in a month than most people will in their lives.
for the amount of training and benefit to the community and society I would say top 10....maybe 5%.
Physicians deserve it more than the wall street bankers, athletes, or politicians but we live in an imperfect world where idiots like Lady Gaga, Kim Kardashian, and John/Kate Gosselin make more in a month than most people will in their lives.
doctors already make a very decent wage. The real goal should be to get tuitions lower, or some kind of LRAP. Wall street bankers make crap nowadays. For every successful wall street business man there are plenty more of unemployed/low paid MBAs/engineers/phds; etc. Athletes shouldnt make more than physicians? Seriously? they generate millions and are the "top" atheletes in their respective categories.
And how many people actually make it to become a professional athlete?
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Channeling Friedman and Rand: whatever a true free market states.
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Bad answer.
In a true free market, there would be no central licensing bodies and no enforcement of prescription guidelines.
So, in a true free market, the best-paid "physicians" would probably be the ones with no degree prescribing morphine and amphetamines to any "patient" who asked.
Oh, and perhaps some income-based care providers, who'd be great at their jobs but would only treat patients with life-threatening conditions if those patients were willing to pay 75% of their total assets for the procedure, maybe with a $1,000,000 minimum. "Either pay up or die, your choice."
On the bright side, EM would quickly become one of the best-paid specialties
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Bad answer.
In a true free market, there would be no central licensing bodies and no enforcement of prescription guidelines.
So, in a true free market, the best-paid "physicians" would probably be the ones with no degree prescribing morphine and amphetamines to any "patient" who asked.
Oh, and perhaps some income-based care providers, who'd be great at their jobs but would only treat patients with life-threatening conditions if those patients were willing to pay 75% of their total assets for the procedure, maybe with a $1,000,000 minimum. "Either pay up or die, your choice."
On the bright side, EM would quickly become one of the best-paid specialties
You're mistaking the term "free market" with the broad sense of minimal government involvement. While the latter encompasses the former, it is much less specific.
In this sense the term free market means an economically unregulated system. While licensing and drug regulations certainly have a fiscal impact on the business of medicine, they are not strictly designed to control wages, or costs, or prices, but rather to keep people safe.
Most proponents of free market ideas still agree that the government should step in to enforce fraud and deal with criminals.
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Percentile is a silly way to look at it because it compares folks who go through crazy numbers of years of schooling and training to folks who get jobs after dropping out of high school. The average American isn't well off, so being in the upper percentage over someone who earns $30k a year laying dry wall is not instructive. Additionally, my biggest pet peeve is folks who ignore the very basic finance concept of "the time value of money". Earning something today is worth a LOT more than earning the same amount 10 years from now. Meaning a high salary after college, med school, residency, and fellowship is probably not such a high salary if you adjust it for the time value of money (ie decrease those dollars to net present value of today's dollars). Basically physicians are being compensated well in big part because their schooling and training makes them defer earning for a decade. Few other career paths do that to such an extreme. So yeah, if you take some of the top achievers from college, make them pay hundreds of thousands of dollars for school and sit out of potentially high income jobs for over a decade (between 4 years of med school, 3-7 years of residency, 1-2 years of fellowship), then sure, they probably ought to be compensated a nice, six digit income. Will Obama's plan see it like this? Who knows. But saying something like even if their salaries were cut in half they would still be in the top 5% of world earners is silly. Because 99% of the world earners didn't have the undergrad track record, and put in the learning and training time, and didn't give up other potentially more lucrative opportunities to get to where they ended up. You have to compare apples with apples.
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over 9000
In this specific case, government regulation creates artificial scarcity, which drives up prices.
A true free market would allow for independent, competing, for-profit licensing and accreditation organizations, with organizations that offer degrees choosing which one(s) to use and consumers choosing which one(s) to accept.
There are some obvious problems with that approach, but those are problems with the concept of the free market itself. That do not mean that this isn't what a true free market requires.
Now, with it being the case that there is an artificial scarcity of physicians and an artificial scarcity of people with the ability to prescribe medication, physician salaries can not possibly be based on the free market - since the market that determines them is, in fact, not truly free.
As for what most proponents of free market ideas believe... yeah, most of them indeed do not support true free markets, because they are not insane. What they do tend to be is self-serving. For example, look at physicians who support "free market" based payment, but are vehement about stopping the DNP from becoming an "MD lite" with wide-reaching treatment licensing.
What exactly is preventing you from taking those crazy numbers of years of schooling and training into consideration when determining what a reasonable percentile would be?
Actually, it is - at least when combined with, for example, being above or under the lawyer in the 95th percentile, the fast food worker in the 10th percentile, etc.
When taking both the job itself and the required education into consideration, where do you think physicians should rank? It's really a rather simple question.
Again, you can take all of that into consideration when giving an answer. You can simply use the time spent without income as an argument for why physicians should be in a higher percentile than you feel they should be otherwise.
This thread isn't about world earners, and this thread isn't about Obama's health care plan. Nor is this thread about how physicians salaries should be lower or higher.
If you think physicians should be in the top 1% or even the top 0.01%, just say so.
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Upper middle class, in $ 125,000+ take home(after taxes). I don't think thats too bad really, its enough to pay off your loans and still take home around 80k+ a year.
They should make what the market bears for their services offered PERIOD
To say that because someone is a doctor he/she deserves to be compensated at least X amount or cannot be compensated more than Y amount is wrong on so many levels and so incredibly naive and short-sighted at best.
In an ethical and correct world, you don't just get to make X amount of money because you earn an MD diploma. Your compensation should be directly related to the level of service you provide.
This is an incredibly annoying and troubling question and discussion.
Price and wage (minimum and maximum) controls are unjust and oppressive. Socialism is evil. Reject it in all its forms.
If a physician is set a certain salary, please explain to me how that correlates to higher quality of care. When professionals actually have to earn a living and compete for business, they work harder and produce at a higher quality. When something is given to them because the state determines what they "should" do and earn, they just coast. Those that don't and work hard anyway are being exploited because someone else is profiting from their labor.
The truth is, in the real world (in a just world anyway), you aren't entitled to squat. Your degree means nothing, and unless you can produce, you are worthless. The sooner a young person realizes this, the more successful that person will be in life.
To say that because someone is a doctor he/she deserves to be compensated at least X amount or cannot be compensated more than Y amount is wrong on so many levels and so incredibly naive and short-sighted at best.
In an ethical and correct world, you don't just get to make X amount of money because you earn an MD diploma. Your compensation should be directly related to the level of service you provide.
This is an incredibly annoying and troubling question and discussion.
Price and wage (minimum and maximum) controls are unjust and oppressive. Socialism is evil. Reject it in all its forms.
If a physician is set a certain salary, please explain to me how that correlates to higher quality of care. When professionals actually have to earn a living and compete for business, they work harder and produce at a higher quality. When something is given to them because the state determines what they "should" do and earn, they just coast. Those that don't and work hard anyway are being exploited because someone else is profiting from their labor.
The truth is, in the real world (in a just world anyway), you aren't entitled to squat. Your degree means nothing, and unless you can produce, you are worthless. The sooner a young person realizes this, the more successful that person will be in life.
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FALSE. Just because you went to school for a long time does not entitle you to a large salary. You aren't entitled to SQUAT. I am so sick of students who go to med school with the attitude that they can just suck all this up and once they get their degree, they can just coast.
Do you honestly think that the market (or state) determines price levels by how long someone was in school? Do you think insurance companies look at the average number of years to complete training when deciding how to reimburse a certain type of doctor? NOBODY CARES.
Physicians are generally compensated well because of the high demand for their specialized services and, most importantly, the degree of quality demanded in the work. I know a person with a PhD in Linguistics who studied for 13 years. Do you think someone is going to compensate him highly to consult on an OCR software development project just because he was in school for so long? How does that get put in the project budget? Contractor pay = $10/hr x 13 years of school? He is going to be compensated highly because he is extremely good at what he does, and there aren't many others who do it. If there were thousands of others who could do the same job, the compensation would go down to null despite the fact that they all spent 13 years in school. For example, look at chiropractors. They spend 8 years in school. Yet there is an enormous oversupply, their services aren't highly demanded, and the overall quality of service in the profession is not great. Consequently chiropractor graduates are struggling to even make $50,000 per year.
People need to lose this sense of entitlement attitude! Yes, school is long and hard and when I'm done, maybe I will feel similarly, but hopefully never feel entitled to a job or certain pay level. I'm nobody else's responsibility but my own.
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First of all, all docs should make more than Lil Wayne.
Second of all, I'm pretty sure a PhD in Linguistics doesn't have to pay for malpractice insurance, nor is he responsible for the life and well being of a couple hundred people.
Second of all, I'm pretty sure a PhD in Linguistics doesn't have to pay for malpractice insurance, nor is he responsible for the life and well being of a couple hundred people.
Bad answer.
In a true free market, there would be no central licensing bodies and no enforcement of prescription guidelines.
So, in a true free market, the best-paid "physicians" would probably be the ones with no degree prescribing morphine and amphetamines to any "patient" who asked.
Oh, and perhaps some income-based care providers, who'd be great at their jobs but would only treat patients with life-threatening conditions if those patients were willing to pay 75% of their total assets for the procedure, maybe with a $1,000,000 minimum. "Either pay up or die, your choice."
On the bright side, EM would quickly become one of the best-paid specialties
Badder answer.
First, the term free market does not necessarily mean absolute anarchy with no regulatory oversight from the state. Milton Friedman was not an anarchist. Far from it, in fact.
Second, you contradict yourself. If there were no controlled substances, there would be no need to see a doctor for a prescription.
Third, in a "free market" the extortionists providers you mention would not thrive because there would always be someone else willing to do the job for a fair price. These extortionist providers can only exist in a state-regulated environment (where you have no choice in provider or payer).
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Thats why the PHD makes less.. You however forget that the medicine your using to treat people, was mostly discovered and tested by PHD scientists. So PHD's in a way are there for the well being of society and in reality will make contributions which will outlasts the better good done by the practitioners (MD/DO).
That wasn't the point at all, but to digress, are you saying that doctors are entitled to high salary because they have to pay high malpractice insurance? Do you know anything about being an independent contractor? They are well advised to get insurance as well, because there is no reason the PhD linguist can't be sued if he makes negligent errors in his work costing the company its business and millions of dollars.
You aren't entitled to high pay just because you have high costs of doing business. That is ridiculous.
D
deleted116380
There are a lot of bad physicians out there that make more than they should because they have a license to practice medicine and charge what they please. Since there is no price transparency, customers (patients) can't shop for better prices or service. Then you have anti-competitive contracts some docs sign when they decide to work in an area. It's pretty much monopolized and pushes up salaries for the most part than they would be otherwise.
Since docs can make more than they would in a competitive market, you have other fields (i.e. education) charging doctors-to-be more than they would in the past since they know the docs will make the money to pay it back in the end. For example, the UC schools increased tuition $1k a year for 14 years since they saw it as an opportunity to pay out less and save money. So what do the docs do? Charge more to make that money back. My tuition went up 20% over last year. How am I suppose to go into primary care when that happens + my loans are at a high 6.8%?
I would rather my tuition be as little as possible and then I wouldn't care if I made "only $100k," which is a sizable sum. However, $100k a year is pretty much nothing when you have $200k+ of debt growing at 6.8% a year. Don't worry, that 6.8% you will hear from the financial aid office will be given a pro of "it will be fixed so it will never go up!" The prime rate is like 4%...
cliffs: med system costs more than it should across the board (education, practicing, etc) than it would in a competitive environment.
Since docs can make more than they would in a competitive market, you have other fields (i.e. education) charging doctors-to-be more than they would in the past since they know the docs will make the money to pay it back in the end. For example, the UC schools increased tuition $1k a year for 14 years since they saw it as an opportunity to pay out less and save money. So what do the docs do? Charge more to make that money back. My tuition went up 20% over last year. How am I suppose to go into primary care when that happens + my loans are at a high 6.8%?
I would rather my tuition be as little as possible and then I wouldn't care if I made "only $100k," which is a sizable sum. However, $100k a year is pretty much nothing when you have $200k+ of debt growing at 6.8% a year. Don't worry, that 6.8% you will hear from the financial aid office will be given a pro of "it will be fixed so it will never go up!" The prime rate is like 4%...
cliffs: med system costs more than it should across the board (education, practicing, etc) than it would in a competitive environment.
Let me get this straight. To make a valuable contribution to society, you have to have a Ph.D. degree? Your inventions and creative thoughts don't matter unless you have the right credentials?
MDs and clinical physicians do not make important discoveries or have anything to do with the development of new medicines?
Are you sure you want to go with that?
What exactly are you trying to argue? I never said nor implied the PhD makes less than a doctor (there wasn't even a doctor in my example), my point was explaining why the PhD makes a lot of money. Where are you coming up with this stuff?
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alot more....
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Top 50% because I like being at least slightly above average...so 51st percentile? Or 50th? You get my point, yes?
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A better system would be to go to a system where the compensation made more sense. Because consumers are divorced from the cost, there is a lack of market pricing. In LASIK an average case will run 2K according to a friend who is a corneal refractive, you can go as low as $500. In LASIK the free market determines price which has been really decreased. We don't need to remove all regulations i.e. licensing, however essentially gutting insurance would decrease cost. Insurers determine pricing, which means meticulous surgeons and meatball surgeons get the same for the same case. In a free market people would compete, pricing would be efficient. Compensation should be more dependent on skill rather than on some actuaries figures. There is no fair wage other than the one commiserate with school.
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Umm let me see,
Well the current market pays health providers on a numbers basis. In general, the more patients a physician will see means more money he/she is bringing in. If one is a private or hospital base Dr., they will still have demands to be made. With this current system I really don't see any changes with salaries within the coming years. I think the best option, which will be well-worthy if implanted, is to pay Doctors on their quality of work. Meaning, doctors who consistently produce better patient outcomes should be paid more. That way no one is entitled to anything, and in return we will have an effective healthcare market. Trust me, even the worst doctors will work their *** off in this system. YOU gotta scrap to eat!!! And the bottom line is: patients will receive the best healthcare out there. Just my opinion.
Well the current market pays health providers on a numbers basis. In general, the more patients a physician will see means more money he/she is bringing in. If one is a private or hospital base Dr., they will still have demands to be made. With this current system I really don't see any changes with salaries within the coming years. I think the best option, which will be well-worthy if implanted, is to pay Doctors on their quality of work. Meaning, doctors who consistently produce better patient outcomes should be paid more. That way no one is entitled to anything, and in return we will have an effective healthcare market. Trust me, even the worst doctors will work their *** off in this system. YOU gotta scrap to eat!!! And the bottom line is: patients will receive the best healthcare out there. Just my opinion.
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100 billion dollars.
Or what the market sets as the price.
Whichever.
Or what the market sets as the price.
Whichever.
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WHAT! no thanx........I would need at least twice as much that
true that. you can't ask use (pre meds) this question because lets face it, we havents stared 200k in loans directly in the face yet. also you cannot neglect the loans either, it comes with bibeng a physics, unless you go to med school in texas, uuuuhhh why didnt i live in texas
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Why does everyone keep saying that a MD doesn't entitle me to anything? I can't become a doctor by slacking off like a lazy ******* all my life. I'm smarter and more educated than the layman. That entitles me to an upper middle class life. This is apparent by the salaries doctors are paid.
I think a doctor should make however much he wants to. I would be happy with $250k take home (ie, after taxes.)
I think a doctor should make however much he wants to. I would be happy with $250k take home (ie, after taxes.)
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There are several problems with paying doctors on the quality of their work.
1) It is hard to objectively quantify a "good outcome" from a "not-so-good-but-not-bad outcome" and a "so-so outcome" but definitely easier to objectively quantify any of those from a bad outcome (death, dismemberment, disfigurement, disability, etc.).
2) If you are only being paid for good outcomes, how long is it before certain doctors screen their patients? Since the reimbursement is results-driven, do you not think that some would be motivated by stacking the deck in their favor and catering their practice to only those who are "healthy"?
3) Let's say it does work out, and #2 does not happen to any appreciable extent. Then you have certain doctors who are highly sought after due to a long history of consistently good outcomes. What happens then? Everyone wants to go to those doctors, but there are only so many hours in a day and so many hours in a week. Wait times will be exponentially worse. In the meantime, it's hard to build up a history of consistently good outcomes for younger doctors when they do not have any patients.
4) I don't think paying on outcomes alone is a good idea. Regardless of how well a patient is attended to and cared for, sometimes things just happen. I don't mean something like a nosocomial or iatrogenic infection, I mean just a turn for the worse, or a negative outcome. Everyone wants to be the patient with a good outcome (understandably), but sometimes things do not work out that way, there are complications and a bad outcome results. It isn't always the doctor's fault - they met or exceeded the standard of care (for all we know, it could be a compliance issue on the part of the patient).
As far as how much I think doctors should be paid - I think it should be reasonable and not exorbitant. It should be enough to have a good standard of living where they are not beneath the poverty line, able to pay off student loan debt, save a little, and definitely enough to have vacation homes in Florida and Hawaii, of course.
Just kidding about the last part. That's why there's CME in FL & HI.
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As much as the 12th man on an NBA team. These guys earn like $800K/yr and they play only a few minutes every 10 or so games. They get paid to sit at the end of the bench and be a cheerleader.
Meanwhile, that doc over there is trying to save somone's life... every day.
Meanwhile, that doc over there is trying to save somone's life... every day.
I think doctors are underpaid, especially the rural doctors. In my state, some rural doctors are barely living. They hardly have enough money to keep their practice afloat and live at the same time, which is why a lot of people don't practice in rural areas. There are three counties in Colorado that don't have single doctor and there are about five other counties that only have one doctor that stops by a couple times a week. The celebrities and the athletes get way overpaid, while many rural doctors barely make it. There is something wrong with that.
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1. You're not entitled to anything.
2. Doing well in school does not necessarily mean you are smarter than those that did poorly or did not attend school.
3.Your argument sucks.
Most docs don't make $400k per year.
This is exactly the attitude I was talking about. You want to become a doctor because you think by simply graduating, you will be rewarded with an "upper middle class life." You don't have to actually worry about every producing something of value that people will want from you, you just have to pass the tests and exams and you are done - you can do a terrible job as an MD and you will still get paid handsomely. No, sorry, you're not entitled to that. You should have to produce if you want to consume.
Being smart doesn't entitle you to anything unless you work. Passing your tests in school does not entitle you to a job. You can't become a doctor by slacking off all the time, but you CAN become a doctor without ever producing anything of value (you can go to school without paying anything up front). That entitles you to squat.
There are somethings in life you are entitled to as a citizen. You are entitled to legal and military protection from criminals and terrorists. You are entitled to personal liberty. As a taxpayer, you have more entitlements. You are entitled to use the roads and public works your tax dollars pay for. Your children are entitled to K-12 education. Military servicemen are entitled to housing, food, and healthcare. Nowhere does it say you are entitled to a certain standard of living because of how long you spent voluntarily in graduate school.
Your MD diploma entitles you to apply for a medical license and work for a minimum wage of $7.25 per hour if you choose. That's about it.
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way more than any entertainer. period.
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Rural doctors are definitely underpaid, but I'd rather target worthless docs (i.e. those that make the most money but contribute nothing beneficial to society) over celebrities and athletes. In a recent interview, my interviewer brought up the worthlessness of (among others) cosmetic plastic surgeons. We discussed it at length and agreed that they should either be paid less or not exist.
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If their work makes people feel better, and people are willing to pay for the service, why is that a bad thing?
Cosmetic surgery improves lives, just in a different way.
What does it matter to you?
First, in a free market price is a function of supply and demand. If either supply or demand is artificially influenced by government controls, the market is no longer free. In the case of the US, the government artificially influences both, among other things by funding residencies, setting regulations and by being the biggest healthcare customer in the country.
Ergo, there is no free market in health care. Both supply and demand are strongly influenced by the actions of the government, meaning the foundation needed for a free market simply isn't there.
Second, it seems you didn't get the joke about drug dealers.
Third, no, there wouldn't be. When you're suffering a heart attack, you don't have the time to shop around for the best balance between price and quality. Aside from that, without government intervention, there's also a very high likelihood of cartels being formed, removing customer choice altogether.
Relying on the market to do its job is a great way to maximize performance in many industries, but it isn't the answer to everything. In those parts of society where you don't have unhindered supply, unhindered demand and consumers with the ability to make an informed decision, the market by itself simply isn't enough.
Stop drinking the Rand Kool-Aid
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well 250k take home a year... means that your making nearly 450k a year before taxes.
how many doctors make 450k before taxes?.. That aren't plastic surgeons and radiologists.
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What does the market say about Medicare funding largely determining the number of residencies and thus the supply of doctors?
What does the market say about Medicare making healthcare accessible to many and thus increasing demand and driving up prices?
What does the market say about medical orgs limiting the residencies in certain specialties?
What does the market say about patent law preventing cheap generic drugs from replacing the big, expensive names?
What does the market say about malpractice laws?
What does the market say about...
I could go on for a while, but the point should be clear by now: there are countless factors in health care that artificially affect supply and demand either directly or indirectly. To speak of a free market in such an environment is disingenuous at best.
For someone who reveres the market so much, you sure know little about how it actually works.
In real business, only a small part of earnings is determined by level of service, since the product itself is only a small part of marketing in the broad sense.
In a true free market, the best doctors aren't the ones with the highest earnings. The ones with the highest earnings are the ones who are best at getting publicity and marketing their product to a broad audience.
Your false dichotomy is red and smells like fish.
Sure thing.
Mayo Clinic argue that their system removes the need from physicians to maximize the number of patients and procedures to maximize earnings, helping physicians to focus on what truly matters: patient care.
Did you just accuse the physicians in most western countries of "coasting"? Based on a flawed argument rather than observation?
Also, keep in mind that there's a wonderful little thing you can do when people don't meet performance and quality goals: firing them.
The truth is, Atlas Shrugged isn't the real world. It's a mediocre book. I know - I've read it.
The real world is complex and filled with nuances. If you take the time to actually look at it, you might find that out for yourself.
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