How much money do you think doctors should make?

[ddogark]

Reply to akinetopsia


Okay,,, I suggested building a system that is focused around patient outcomes. No doctors shouldn't be bashed because they had a few bad cases that, unfortunately, didn't work out. But if the patients from a particular doctor (outside of oncology) are cases consistently are not progressing, then his/her practices should be overhauled. Respond to #3: Say, Doctor A is in very high demand, due to his excellent work, then he should be rewarded. Yeah his request list will be long, but it forces Doctor B,C,D, and… to work harder and stay up on their medical fluency. I was just proposing a plan, not to say it is 150% the way to go. It needs tuning, definitely. We are just pre-med students we DO NOT know the secret to effective healthcare because we are not Doctors, yet. I was just addressing the issue of how doctors use their "in-and-out" quick procedures, and sometimes patients are getting the worst end of it. My intentions were to focus around the patients. Calm down!! I am entitled to an opinion without being vividly critiqued...right??

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[thefritz]

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

What are earth are you talking about? Everything you have said is a strawman. This was a hypothetical discussion. I never said, "this is the way it is in the USA." I never said there was a free market in healthcare, I said there should be (or "more free" since you seem so concerned with semantics). The term free market is not colloquially used as an absolute. Just because you have a tiny, tiny bit of regulatory oversight in an economy does not mean that the economy is "not free." Free market and 100% laissez-faire capitalism are not completely the same thing. Economies are not binary. They are neither 100% free nor 100% controlled. It is a sliding, indivisible, scale. This is a red-herring matter of semantics and isn't really important.

I still don't get the "joke" about the drug dealers, you're right.

When you're having a heart attack, you don't have time to haggle price either. It's your choice to sign a DNR prematurely to prevent situations where you don't want to be revived or only want to be treated by a certain provider. It is your right as a patient to do this. If you didn't do it beforehand and get extorted in your hypothetical free market world, it's your own fault.

The current system is actually a psuedo-cartel system (the AMA controls the licensing of medical schools and the government controls residency spots, thereby limiting supply).

That is an ad hominem attack against me about Ann Rand. I never mentioned Rand or alluded to her. Do you think you can just throw out the name Ann Rand at anybody who has a capitalist/free market ideology and automatically discredit everything they say because Ann Rand was a nutjob and she was a capitalist, and therefore all capitalists must be just like her? Do you think that is sound logical reasoning?

This is a jumbled mess, sorry. You are contradicting yourself left and right and throwing in buzzwords and dog whistles for effect.

 

[circulus vitios]

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.

I am entitled to an upper middle class life. See: the free market and the value of physician services.

 

[thefritz]

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.

The reply was regarding what should physicians be paid. That's all. Hypothetical situations have nothing to do with reality.

Suggest you start here:
http://en.wikipedia.org/wiki/Subjunctive_mood

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.

Thank you for telling me how real business actually works. I guess the successful business I ran in which I had an 70% profit margin simply due to the level of my service was not a real business. I will make sure I spend all my money on marketing next time instead of worrying about things like quality of service and product and reputation to attract business.

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.

This is insulting to both physicians and patients, and it is not true. You seem to believe you can get rich selling a crap product with good marketing. That is true, some people can do that. They are called scammers.

Your false dichotomy is red and smells like fish.

You are the pot calling the kettle black here.

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.

More time spent with a patient does not in and of itself equate to better care. Furthermore, the REASON doctors see so many patients in the first place with so little face time is because their compensation is, in fact, set through medicare and insurance re-reimbursements. The only way they can make more money is to see more patients. This is not anywhere near a free market. The solution you are arguing is in fact the problem that is purports to solve.

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.

Nope, I said they are either coasting or being exploited. And please explain how you extrapolated a hypothetical situation to mean "most western countries."

Firing is a capitalistic concept, not a socialist one. In your wonderful socialist world (or really at any job in which employees are salaried and have no opportunities for bonuses or incentives), the tendency is to work just hard enough not to get reprimanded. In a purely socialist world, you are entitled to a job, so it doesn't really matter anyway at what level you perform at because no one can prove that you have the capability to perform better.

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.

Please point to exactly where I mentioned Atlas Shrugged or Ayn Rand. I don't know why you are so hell-bent on identifying everyone you disagree with on economic policy as a Rand cronie (oh, wait, it's because doing so absolves you of having to logically respond to what they say - you can just be confident they are a nutjob like Rand and wag your finger at them and that is enough to discredit). Thank you for reminding me that real people don't quit there jobs and form magical secret societies in the mountains and defy the laws of physics. I really thought everything was just that simple and had no idea that we lived in a world full of dynamic personalities.

 

[BBender716]

Thank you JJ and, The Fritz, for clarifying my original position.

Sorry if you misunderstood me when I said "true free market". Just merely wanted to say more deregulation and promotion of a properly functioning free market. This includes strides toward perfect information and transparency so that decisions made by consumers can be as rational as possible . I'm not saying that all decisions would be perfect. I am saying that ensuring these market conditions exist is the place where government intervention is needed, in my opinion.

I agree that medical licensing also is a necessary regulation, though, to play devil's advocate, the free market would squash these people out as well. Insurance would not cover treatment from doctor's who did not obtain proper certification (which under this extremely hands off approach, would not be legally required but highly desirable for this fact). With the proper certifications, these doctors can be providers and command a higher wage than Joe Schmoe off the street, who, by the way, can also be held negligent if he decides to practice and causes damages, just like any other physician.

But again, I do NOT condone or believe in total deregulation of the licensing system. I do favor government intervention in order to provide conditions under which a free market can exist (through perfect information, removing asymetrical information, creating transparency, ensuring widespread access to physician's track records). This way consumers can make informed decisions and doctor's who fail will be forced out or forced to command lower fees and those who perform exceptionally well will be rewarded.

Next argument: "well than that means some people can't afford the top doctors and have to settle for a lower quality of care."

Alright, well first this curve is dramatically different from a straight linear cover of quality vs. money. It's a concave down, positive slope curve where you have severely diminishing returns near the top. This "top-half" is where the legitimate doctors who are licensed, have completed training, and maintained a relatively average track record reside. Most people with current insurance can afford participation somewhere in this top half.

"What about the uninsured?"

Well they would have to do what everyone has to do when they can't afford the best, settle for second best. That sounds ridiculous and harsh, but such is life and this system would actually provide them MORE access to some form of care, which isn't bad care at all, but licensed physicians who either have a less than stellar track record (but apparently not bad enough to have their license revoked) or no track record at all and are recent MDs.

Normally in our current market, these "below average" physicians would command the same rates as qualified physicians because there is no perfect information and consumers can't make a real decision when choosing a physician. Thus they cannot afford ANY.

Of course, these "charts" would occur independently for each speciality and be determined in similar ways.

In summary, free market in medicine is problematic because of lack of perfect information and transparency. Government should promote, i.e. require participation in a system for information sharing so that consumers can make informed decisions about what they are willing to pay for.

As for insurance, that's a whole different beast to argue about how insurance skews the market. I don't want to get into it now. In short, consumers need to "realize" the cost of procedures/going to different physicians. Therefore monthly premiums should be reduced, and deductibles for ROUTINE procedures should be increased. Insurance was created to cover unexpected, expensive procedures, not yearly checkups. Increase deductibles/share of cost on these categories of care so that patients have to choose if they want to spend extra money for a smaller increase in returns.

Regardless, it brings a tear to my eye to see a market vs. regulation discussion here on SDN. It's beautiful.

 

[circulus vitios]

I love the vicitim mentalities. I'm entitled to nothing, hell yeah! And you wonder why physicians are always bullied (compensation, work conditions, autonomy, etc)? Oh well, it'll make it even easier for me to take advantage and crush you in the long run.

 

[BBender716]

I love the vicitim mentalities. I'm entitled to nothing, hell yeah! And you wonder why physicians are always bullied (compensation, work conditions, autonomy, etc)? Oh well, it'll make it even easier for me to take advantage and crush you in the long run.

Be careful, you know what Keynes said about the long-run, lol

Name, that, QUOTE!

 

[TDX]

What are earth are you talking about? Everything you have said is a strawman. This was a hypothetical discussion. I never said, "this is the way it is in the USA." I never said there was a free market in healthcare, I said there should be (or "more free" since you seem so concerned with semantics). The term free market is not colloquially used as an absolute. Just because you have a tiny, tiny bit of regulatory oversight in an economy does not mean that the economy is "not free." Free market and 100% laissez-faire capitalism are not completely the same thing. Economies are not binary. They are neither 100% free nor 100% controlled. It is a sliding, indivisible, scale. This is a red-herring matter of semantics and isn't really important.

Look at the post you just quoted. Then look at the post that post quoted. Do that until you reach the post by some other guy that reads:

Channeling Friedman and Rand: whatever a true free market states.

That was the post that provoked my response, which provoked your response, which provoked my response, which you just responded to.

This little sub-discussion was about true free markets. Something you apparently failed to pick up on.

I still don't get the "joke" about the drug dealers, you're right.

See how you're using quotation marks to indicate sarcasm?

That's what I did, too: the phrase '"physicians" prescribing morphine and amphetamine to any "patient" who asks' merely referred to drug dealers setting up shop in a society without controlled substances.

When you're having a heart attack, you don't have time to haggle price either. It's your choice to sign a DNR prematurely to prevent situations where you don't want to be revived or only want to be treated by a certain provider. It is your right as a patient to do this. If you didn't do it beforehand and get extorted in your hypothetical free market world, it's your own fault.

That has got to be the daftest thing I have read today.

What you just said translates to the following:

"If you don't want to die and haven't specified your preferred care providers for every condition in every place in the world you ever visit, you deserve to be extorted."

The current system is actually a psuedo-cartel system (the AMA controls the licensing of medical schools and the government controls residency spots, thereby limiting supply).

Grats on at least getting one thing right.

That is an ad hominem attack against me about Ann Rand. I never mentioned Rand or alluded to her. Do you think you can just throw out the name Ann Rand at anybody who has a capitalist/free market ideology and automatically discredit everything they say because Ann Rand was a nutjob and she was a capitalist, and therefore all capitalists must be just like her? Do you think that is sound logical reasoning?

Ayn, not Ann.

And I'm comparing your thoughts to hers not because you're a capitalist, but because your arguments are as nutty as hers.

For example, how you called government intervention oppression, then just went ahead and equated it to be socialism, and judged that to be evil:

"Price and wage (minimum and maximum) controls are unjust and oppressive. Socialism is evil. Reject it in all its forms."

In case you're unfamiliar with the psychotic little duckling that was Ayn Rand, she too had a penchant for equating everything that was not strictly capitalist with socialism, and making dramatic ethical claims about the horrid, horrid oppression that is minimum wage.

But, to quote something you said in the very post I'm now responding to:

Economies are not binary. They are neither 100% free nor 100% controlled.

Now, that is certainly true...

...but apparently the controlled parts are unjust and oppressive, equate to evil socialism, and should be rejected in all forms?

Or did you mean to say it's perfectly alright for gov't to interfere with supply and demand and thereby influence or even determine prices and wages indirectly, just as long as they don't do anything to directly influence them - because that would be socialism and evil?

 

[BBender716]

Let's be civil.

Sorry for making the Ayn Rand reference in the first place.

 

[RedSHIFT]

Physicians should be paid at the point where the supply line intersects the demand line. Nothing more. Nothing less.

 

[TDX]

The reply was regarding what should physicians be paid. That's all. Hypothetical situations have nothing to do with reality.

Actually, they do.

If they didn't, the answer to every hypothetical question in the world would be "everyone should be healthy and happy and rich and we should all be able to take daily unicorn rides!"

Thank you for telling me how real business actually works. I guess the successful business I ran in which I had an 70% profit margin simply due to the level of my service was not a real business. I will make sure I spend all my money on marketing next time instead of worrying about things like quality of service and product and reputation to attract business.

And Phil Knight is a billionaire because Nike shoes are just great shoes which are totally better than other shoes. The reason Nike spends billions of dollars endorsing athletes and buying advertisements is that they just really like giving rich athletes money and providing television stations and magazines with extra income.

Also, companies pay millions of dollars for 30 seconds of advertising during the Super Bowl because they just really, really want to support the struggling TV stations. Nothing to do with advertising being a key requirement for corporate success. Gotcha.

This is insulting to both physicians and patients, and it is not true. You seem to believe you can get rich selling a crap product with good marketing. That is true, some people can do that. They are called scammers.

Have you ever actually eaten at McDonald's?

More time spent with a patient does not in and of itself equate to better care. Furthermore, the REASON doctors see so many patients in the first place with so little face time is because their compensation is, in fact, set through medicare and insurance re-reimbursements. The only way they can make more money is to see more patients. This is not anywhere near a free market. The solution you are arguing is in fact the problem that is purports to solve.

I'm not arguing any solution. In truth, I'm personally still undecided on what the best system to achieve optimal results would be.

That said, what you're saying here is complete nonsense.

More time spent with a patient does not automatically equate to better care, but the possibility to spend more time with a patient when needed without a financial punishment most certainly does.

Payment per procedure or case inherently involves such a punishment for spending more time with a single patient. That would be the same without medicare or insurance payments - if the patient himself were the one directly footing the bill, the problem would still exist and be exactly the same.

You see, in a system more closely resembling a free market, physicians could compete either on quality or on price. Since most patients are unable to adequately judge and compare the relative quality of procedures and physicians, the price of specific procedures would be the main determining factor for many. For the physician, this would mean that doing 10 boob jobs in an hour would be far more profitable than doing just 1.

Ergo, in a free market with the patient footing the bill, physicians would still be encouraged to create as much output as possible.

Nope, I said they are either coasting or being exploited. And please explain how you extrapolated a hypothetical situation to mean "most western countries."

In most western countries, a decent amount of physicians hold salaried positions. It's a bit presumptuous to say they're all either coasting or being exploited, don't you think?

Firing is a capitalistic concept, not a socialist one. In your wonderful socialist world (or really at any job in which employees are salaried and have no opportunities for bonuses or incentives), the tendency is to work just hard enough not to get reprimanded. In a purely socialist world, you are entitled to a job, so it doesn't really matter anyway at what level you perform at because no one can prove that you have the capability to perform better.

And again with the false dichotomy.

You seem to be unable to follow even your own arguments.

Let me quote you:

"Economies are not binary. They are neither 100% free nor 100% controlled."

Not only is your whole "either socialism or capitalism, and nothing in between" shtick utterly asinine, even you yourself evidently disagree with it.

Please point to exactly where I mentioned Atlas Shrugged or Ayn Rand. I don't know why you are so hell-bent on identifying everyone you disagree with on economic policy as a Rand cronie (oh, wait, it's because doing so absolves you of having to logically respond to what they say - you can just be confident they are a nutjob like Rand and wag your finger at them and that is enough to discredit). Thank you for reminding me that real people don't quit there jobs and form magical secret societies in the mountains and defy the laws of physics. I really thought everything was just that simple and had no idea that we lived in a world full of dynamic personalities.

As I said before, and as you showed once more in this post, your argument is on the level of Ayn Rand: "SOCIALISM! AAAARRRRGGGHHH!"

The only difference is that in her days, there actually were quite a few evil scary socialists. Meanwhile, I'm pretty sure that the last time I met a true socialist in the flesh was over 3 years ago.

 

[TDX]

Thank you JJ and, The Fritz, for clarifying my original position.

Sorry if you misunderstood me when I said "true free market". Just merely wanted to say more deregulation and promotion of a properly functioning free market. This includes strides toward perfect information and transparency so that decisions made by consumers can be as rational as possible . I'm not saying that all decisions would be perfect. I am saying that ensuring these market conditions exist is the place where government intervention is needed, in my opinion.

I agree that medical licensing also is a necessary regulation, though, to play devil's advocate, the free market would squash these people out as well. Insurance would not cover treatment from doctor's who did not obtain proper certification (which under this extremely hands off approach, would not be legally required but highly desirable for this fact). With the proper certifications, these doctors can be providers and command a higher wage than Joe Schmoe off the street, who, by the way, can also be held negligent if he decides to practice and causes damages, just like any other physician.

But again, I do NOT condone or believe in total deregulation of the licensing system. I do favor government intervention in order to provide conditions under which a free market can exist (through perfect information, removing asymetrical information, creating transparency, ensuring widespread access to physician's track records). This way consumers can make informed decisions and doctor's who fail will be forced out or forced to command lower fees and those who perform exceptionally well will be rewarded.

Next argument: "well than that means some people can't afford the top doctors and have to settle for a lower quality of care."

Alright, well first this curve is dramatically different from a straight linear cover of quality vs. money. It's a concave down, positive slope curve where you have severely diminishing returns near the top. This "top-half" is where the legitimate doctors who are licensed, have completed training, and maintained a relatively average track record reside. Most people with current insurance can afford participation somewhere in this top half.

"What about the uninsured?"

Well they would have to do what everyone has to do when they can't afford the best, settle for second best. That sounds ridiculous and harsh, but such is life and this system would actually provide them MORE access to some form of care, which isn't bad care at all, but licensed physicians who either have a less than stellar track record (but apparently not bad enough to have their license revoked) or no track record at all and are recent MDs.

Normally in our current market, these "below average" physicians would command the same rates as qualified physicians because there is no perfect information and consumers can't make a real decision when choosing a physician. Thus they cannot afford ANY.

Of course, these "charts" would occur independently for each speciality and be determined in similar ways.

In summary, free market in medicine is problematic because of lack of perfect information and transparency. Government should promote, i.e. require participation in a system for information sharing so that consumers can make informed decisions about what they are willing to pay for.

As for insurance, that's a whole different beast to argue about how insurance skews the market. I don't want to get into it now. In short, consumers need to "realize" the cost of procedures/going to different physicians. Therefore monthly premiums should be reduced, and deductibles for ROUTINE procedures should be increased. Insurance was created to cover unexpected, expensive procedures, not yearly checkups. Increase deductibles/share of cost on these categories of care so that patients have to choose if they want to spend extra money for a smaller increase in returns.

Regardless, it brings a tear to my eye to see a market vs. regulation discussion here on SDN. It's beautiful.

This is actually an interesting post, even if I disagree with much of it.

Medicine is fairly unique in its combination of direct relevance to everyday life and complexity. The former means it would be an important issue for consumers to make choices on, but the latter means it is an exceedingly difficult issue for them to make informed choices on.

The average person doesn't even know what a nephrologist is. How is he going to decide which nephrologist to visit? (Inter)national rankings might be of value there, but unfortunately, those don't contain info on the specific physician you will have as a patient. Moreover, unlike with businesses which can often relatively easily expand, the amount of patients who can get into any specific hospital is quite limited.

Another problem is that when it comes to health, people are naturally more inclined to blindly go for "the best" instead of "the best balance between cost and quality". The risk of buying a potentially bad tv is that it breaks down the day after the warranty expires. The risk of using a potentially bad doctor is that you die. This makes it quite hard to reach a choice which takes other factors than just perceived quality into consideration.

What's also a factor is the lack of time available to reach a decision when you need health care, which is quite different from other major financial decisions. When buying a house, people often shop around for months. With an acute health issue, you won't have nearly as much time - even though the total cost might end up being similar to that of buying a house.

Essentially, I think your theory works well for things like cosmetic surgery, but falls flat when it comes to actual health issues. Even perfect medical information may be hard to understand, the situation is not conducive to a rational weighing of cost vs benefits, and in many cases there simply isn't enough time to make a decision, let alone an informed one.

 

[DoctwoB]

Medicine is not a free market for oh so many reasons.

1. The moral hazard: People with health insurance seek out health care treatment much more often, meaning usage of health services is not a random event, meaning it doesn't properly fit a traditional (e.g. fire) insurance model.

2. Unequal access to information: Because physicians know so much more about medicine then patients, demand for physicians services is largely determined by the physicians themselves, and not by the patient as they must rely on the physicians judgement. There are studies showing that number procedures per person is directly proportional to the number of doctors per capita, and higher concentrations of specialists are associated with higher costs but not higher outcomes.

3. Government involvement: The government (via medicare/medicaid) can come in and say we will only pay you 50% of your normal fee for this patient, and if you don't like that, then you won't have access to the millions of patients on public health plans. This creates an oligopsonistic market (few purchasers of health care services, namely the government and large insurance companies) which distorts the supply and demand curves for physician labor from market levels.

4. Many other reasons

The people who say that the government shouldn' interfere and that the free market knows best are deluded when it comes to medicine. Even without government intervention, medicine will never be an efficient market due to the aforementioned moral hazards and supplier determined levels of demand.

 

[Dr Yiot]

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.

this thread is called how much do you think doctors should make not how much money doctors do make.

 

[BBender716]

This is actually an interesting post, even if I disagree with much of it.

Medicine is fairly unique in its combination of direct relevance to everyday life and complexity. The former means it would be an important issue for consumers to make choices on, but the latter means it is an exceedingly difficult issue for them to make informed choices on.

The average person doesn't even know what a nephrologist is. How is he going to decide which nephrologist to visit? (Inter)national rankings might be of value there, but unfortunately, those don't contain info on the specific physician you will have as a patient. Moreover, unlike with businesses which can often relatively easily expand, the amount of patients who can get into any specific hospital is quite limited.

Another problem is that when it comes to health, people are naturally more inclined to blindly go for "the best" instead of "the best balance between cost and quality". The risk of buying a potentially bad tv is that it breaks down the day after the warranty expires. The risk of using a potentially bad doctor is that you die. This makes it quite hard to reach a choice which takes other factors than just perceived quality into consideration.

What's also a factor is the lack of time available to reach a decision when you need health care, which is quite different from other major financial decisions. When buying a house, people often shop around for months. With an acute health issue, you won't have nearly as much time - even though the total cost might end up being similar to that of buying a house.

Essentially, I think your theory works well for things like cosmetic surgery, but falls flat when it comes to actual health issues. Even perfect medical information may be hard to understand, the situation is not conducive to a rational weighing of cost vs benefits, and in many cases there simply isn't enough time to make a decision, let alone an informed one.

The understanding of information by patients needs to be facilitated by the government and by the patients and society themselves. These terms and other medical information needs to be understandable and relevant, but some of the responsibility also falls on patients. I don't mean that all patients need to even know what laproscopy is, but they need to know basic medical terminology. People understand and perform more complicated tasks that they are not precisely taught or easily understand, e.g. taxes.

How is this problem solved? Through education (consumer ed.), self-vigilance and research, and tax consultancy services. Perhaps, people with more complicated health issues can hire a consultant from a newly created market. This could be offerred relatively inexpensively, as tax preparation services are. It's merely one avenue.

Lastly, the balance that is in question is between the choosing an outstanding doctor for a higher price and an average/slightly below average doctor for a lower price. The frequency of bad doctors in this tradeoff is minimal. Firstly, the abhorrent doctors do not maintain their medical license or have it revoked. Secondly, the frequency of bad and below average doctors would be the same as the frequency that it currently is, difference is, with this transparency, people will be able to actually choose to NOT see these doctors and people with less money can afford to be seen by a physician due to lower compensation for these below average doctors (who are still providing a standard of care that is considered acceptable enough to maintain their license).

In a way, saying that people would be forced to see below average doctors, would merely be an opening of our eyes and being able to compare and make actual choices between the same doctors we'd still be seeing with or without this system.

With regards to the emergency situations, it's true, these are extremely difficult situations, but this should function similarly to insurance functioning except without the state-lines law. (have to go eat, more to come later)...

 

[BBender716]

Medicine is not a free market for oh so many reasons.

1. The moral hazard: People with health insurance seek out health care treatment much more often, meaning usage of health services is not a random event, meaning it doesn't properly fit a traditional (e.g. fire) insurance model.

2. Unequal access to information: Because physicians know so much more about medicine then patients, demand for physicians services is largely determined by the physicians themselves, and not by the patient as they must rely on the physicians judgement. There are studies showing that number procedures per person is directly proportional to the number of doctors per capita, and higher concentrations of specialists are associated with higher costs but not higher outcomes.

3. Government involvement: The government (via medicare/medicaid) can come in and say we will only pay you 50% of your normal fee for this patient, and if you don't like that, then you won't have access to the millions of patients on public health plans. This creates an oligopsonistic market (few purchasers of health care services, namely the government and large insurance companies) which distorts the supply and demand curves for physician labor from market levels.

4. Many other reasons

The people who say that the government shouldn' interfere and that the free market knows best are deluded when it comes to medicine. Even without government intervention, medicine will never be an efficient market due to the aforementioned moral hazards and supplier determined levels of demand.

I think the current argument doesn't involve 100% capitalism...

 

[TooMuchResearch]

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?

I said it was worthless, not bad (then again, I'm not checking my post, so feel free to correct me).

Cosmetic surgery only appears to improve lives because the world is a horrible, horrible place. Cosmetic surgery does not improve lives.

It matters because worthlessness disgusts me.

 

[TooMuchResearch]

I love the vicitim mentalities. I'm entitled to nothing, hell yeah! And you wonder why physicians are always bullied (compensation, work conditions, autonomy, etc)? Oh well, it'll make it even easier for me to take advantage and crush you in the long run.

You don't understand the concept of entitlement.

 

[MsTaco]

I'm really bored of pre-meds whining about physician salaries. I'm even bored of pre-meds whining about the cost of medical school...even though I'm not exactly happy about it. I don't really want to read all these posts...I'm just going to post some basic numbers.

The average american made about $28k in 2005.
The average physician made about $200k.

So let's take an average american that works say, from the time they are 20 until the time they are 70. So 50 years, making ~30k/year = 1.5mil in lifetime earnings.
Ok, let's take an average physician. They do spend a lot more time in training...let's just say they don't start making the big bucks until they're 30. And let's just say they retire when they're 70. So 40 years, making ~200k/year = 8mil in lifetime earnings. Now let's be fair...let's subtract the cost of undergrad + medical education, and say they (or someone) paid ~300k for their training. Overall, still making about 7.7mil...about 5x the amount of the average american.

I completely agree that physicians provide a valuable service. I completely agree that they are highly skilled, and that high levels of skill should be rewarded. And pleeeaase don't try to say that physicians work harder than the average american...I don't think we could quantify that anyways, but I do know that some of the hardest working people I know make less than 20k/year. They'll work as hard or harder than I will their entire lives, and they'll still make a fraction of what I'll earn in my lifetime. Fair? My point is simply, physicians are rewarded. Greatly. Even if I lost ~10 years of earning potential, and paid ~300k for my education, I still come out waaaay more on top than the average american. So stop whining. Please. Physicians are paid enough. Just be grateful you're in a position to pursue this career.

 

[Average Joe]

For the people who say athletes and actors etc, shouldn't make more than a doctor. Do you realize how insanely competitive it is (more than medical school in fact) to become an athlete, actor or singer/musician? These people work very hard for their money. Could you imagine how boring the world would be if we didn't have these type of people? However, I would guess most people on SDN wouldn't, since there isn't anything outside of academics.

 

[JJMrK]

This is actually an interesting post, even if I disagree with much of it.

Medicine is fairly unique in its combination of direct relevance to everyday life and complexity. The former means it would be an important issue for consumers to make choices on, but the latter means it is an exceedingly difficult issue for them to make informed choices on.

This is the old "the people aren't smart enough to make their own decisions, so government should do it for them" argument.

Coakley made it the day before she lost to Scott Brown

 

[circulus vitios]

You don't understand the concept of entitlement.

You don't understand the concept of self-worth. I am smart, capable, and motivated. I am worth so much. I am entitled to so much.

 

[akinetopsia]

Reply to akinetopsia


Okay,,, I suggested building a system that is focused around patient outcomes. No doctors shouldn't be bashed because they had a few bad cases that, unfortunately, didn't work out. But if the patients from a particular doctor (outside of oncology) are cases consistently are not progressing, then his/her practices should be overhauled. Respond to #3: Say, Doctor A is in very high demand, due to his excellent work, then he should be rewarded. Yeah his request list will be long, but it forces Doctor B,C,D, and… to work harder and stay up on their medical fluency. I was just proposing a plan, not to say it is 150% the way to go. It needs tuning, definitely. We are just pre-med students we DO NOT know the secret to effective healthcare because we are not Doctors, yet. I was just addressing the issue of how doctors use their "in-and-out" quick procedures, and sometimes patients are getting the worst end of it. My intentions were to focus around the patients. Calm down!! I am entitled to an opinion without being vividly critiqued...right??

Who isn't calm? I don't think I vividly critiqued you, or your opinion. I just analyzed it and came up with counterarguments for why compensation based on outcomes could potentially be a bad idea. These boards are for discussion, just as you are entitled to your opinion, I am entitled to examine your plan and offer my own opinion on it. It isn't personal when someone argues against your opinion when they are arguing on the merits of it and what they perceive as flaws.

"Medical fluency" ? Part of licensing requirements is keeping up with CME.

Being a doctor does not magically give you insight into a real or imagined "secret to effective healthcare." I would wager there are plenty of people that are not doctors that have a sophisticated view and are well educated about effective healthcare, healthcare delivery and physician compensation. The fact that we are pre-meds does not mean we cannot educate ourselves on the previously mentioned things, give yourself a little more credit.

 

[ChiDO]

I'm really bored of pre-meds whining about physician salaries. I'm even bored of pre-meds whining about the cost of medical school...

I completely agree that physicians provide a valuable service. I completely agree that they are highly skilled, and that high levels of skill should be rewarded. And pleeeaase don't try to say that physicians work harder than the average american...I don't think we could quantify that anyways, but I do know that some of the hardest working people I know make less than 20k/year. They'll work as hard or harder than I will their entire lives, and they'll still make a fraction of what I'll earn in my lifetime. Fair? My point is simply, physicians are rewarded. Greatly. Even if I lost ~10 years of earning potential, and paid ~300k for my education, I still come out waaaay more on top than the average american. So stop whining. Please. Physicians are paid enough. Just be grateful you're in a position to pursue this career.

I

I'm tired of pre-meds pretending the word is very shiny place and everyone holds hands and there are rainbows in the sky with pots of gold everywhere. I hate pre-meds who think they know everything and know how real life is outside of what mommy and daddy have given you for the last 20 years.

Also, just to point out, the average american household income is $50k/year (not $20k).
Source: http://www.justice.gov/ust/eo/bapcpa/20090315/bci_data/median_income_table.htm


Physicians, on average, I would say work MORE, LONGER, and HARDER then the average american. Many physicians not only put in 50-60 hours per week, but also spend countless hours after their "work hours" to complete piles of paperwork so that they can get paid, get insurance companies to pay for their patients and to approve their treatments.

Furthermore, as L2D stated in the first page, money earned TODAY, RIGHT NOW, is worth a LOT LOT MORE then money earned 15 years down the road. Thus, physicians do "catch up" like you said, but the value of money is different; thus comparing apples and oranges.

I am grateful that I am in this position, but it's not like I was selected out of a pot of gold and am the lucky one who gets to go through medical school which btw is SOOO EASY, I'm not sure why they don't start paying me right now...

Getting to medical school is a TOUGH journey, you have to be constantly on your game in college, do well on the MCAT and then get through the admissions process (18k selected each year out of 50k.). Once you are in medical school, you spend countless hours studying, which continues for the REST OF YOUR LIFE.

On a side note, we had one clinician recently come lecture to us and he was saying how the public really doesn't understand how much work physicians put in. We are portrayed as making $400k, working 30 hours, and enjoying life, when in reality it's the furthest thing from the truth. You have to do CME every year, recertificastios, ect. Being a doctor, he said, is a lifelong journey of working hard and continuing to learn and study.

Thus, I am grateful, but I put myself in a position to succeed; no one else did. Thus, by spending ~15 years in training to become an attending, spending the 20s and the better part of my 30s learning, I do expect to be compensated very well for my time. I have many friends who went to the workforce straight from college and they are all making $60-$100k, while I spend $50k/year to learn.

 

[Shasan546]

Getting to medical school is a TOUGH journey, you have to be constantly on your game in college, do well on the MCAT and then get through the admissions process (18k selected each year out of 50k.). Once you are in medical school, you spend countless hours studying, which continues for the REST OF YOUR LIFE.

On a side note, we had one clinician recently come lecture to us and he was saying how the public really doesn't understand how much work physicians put in. We are portrayed as making $400k, working 30 hours, and enjoying life, when in reality it's the furthest thing from the truth. You have to do CME every year, recertificastios, ect. Being a doctor, he said, is a lifelong journey of working hard and continuing to learn and study.

Thus, I am grateful, but I put myself in a position to succeed; no one else did. Thus, by spending ~15 years in training to become an attending, spending the 20s and the better part of my 30s learning, I do expect to be compensated very well for my time. I have many friends who went to the workforce straight from college and they are all making $60-$100k, while I spend $50k/year to learn.

So you think spent a tough journey? Lets take other professionals into account. You think people who go into business its easy for them? top jobs wants high grades from there undergrads also (obv. these people arn't science majors). You think its easy making 60k a year busting your ass over 50 hours a week kissing ass trying to get up the corporate ladder for a maybe position in the future that MIGHT pay better? Or is it easier for people to bust their ass at a job (lets take a finance job) and then go to B school while working and not even have a guaranteed salary increase after getting your MBA?

Or how about lawyers? You think its easy for them? They have to get top grades for 4 years of undergrad and than go to law school for 3 years (Which costs almost 150-180k) Than when they graduate they have to search everywhere for some resemblance of a well paying job. Most lawyers don't start out at $100k+. They start out at like 40-70k. They are going to make the same you will make during your residency. Except when you graduate your residency your guaranteed a $100k+ salary.

Engineers? They do a BS at competitive top 50 undergrad schools taking the same or tougher classes than pre-meds and then do their MA and some their PHD. You think they all make atleast $100k? Your dreaming.

There are alot of people who go to school for 7 years atleast and are making less than $100k.

Their are no guarantees when your in another profession. The bottom 5th percentile of Doctor salaries are higher than most professional career's 75th percentiles.

And yes doctors do work long hours and have some pretty difficult work. However, a lot of lawyers (the ones who make the same as doctors, and some less) work 60-70 hours a week. Same in Finance, business; etc.

And yes doctors do some great work and other people in society might not be able to do what you do. But do you think you could do what they do? Do you think you could do a legal analysis hundred and hundreds of pages of precedent cases? Or manage a company of X amount of people. Make financial decisions that pretty much determine your career success?

Most people in other fields would die for my sister's position. Works EM, 4 12 hour shifts one week rotating with 3 12 hour shifts the 2nd week. Makes about $250k.

 

[ddogark]

.

Personally, I just think its kinda rude for someone to to say NO, NO, NO, AND NO to other opinions. Its just my opinion. If you read my previous response precisely I said I KNOW it's not the perfect solution, but it’s only my two cents!!! Just an opinion, not a law. From my experiences, those who have a tendency to demise other views, have a selected # of friends (Maybe a gerbil, cat, or parrot lol). I’m NOT saying this pertains to you by means any way, whatsoever, but it's my opinion, again.

 

[MsTaco]

I

I'm tired of pre-meds pretending the word is very shiny place and everyone holds hands and there are rainbows in the sky with pots of gold everywhere. I hate pre-meds who think they know everything and know how real life is outside of what mommy and daddy have given you for the last 20 years.

Also, just to point out, the average american household income is $50k/year (not $20k).
Source: http://www.justice.gov/ust/eo/bapcpa/20090315/bci_data/median_income_table.htm


Physicians, on average, I would say work MORE, LONGER, and HARDER then the average american. Many physicians not only put in 50-60 hours per week, but also spend countless hours after their "work hours" to complete piles of paperwork so that they can get paid, get insurance companies to pay for their patients and to approve their treatments.

Furthermore, as L2D stated in the first page, money earned TODAY, RIGHT NOW, is worth a LOT LOT MORE then money earned 15 years down the road. Thus, physicians do "catch up" like you said, but the value of money is different; thus comparing apples and oranges.

I am grateful that I am in this position, but it's not like I was selected out of a pot of gold and am the lucky one who gets to go through medical school which btw is SOOO EASY, I'm not sure why they don't start paying me right now...

Getting to medical school is a TOUGH journey, you have to be constantly on your game in college, do well on the MCAT and then get through the admissions process (18k selected each year out of 50k.). Once you are in medical school, you spend countless hours studying, which continues for the REST OF YOUR LIFE.

On a side note, we had one clinician recently come lecture to us and he was saying how the public really doesn't understand how much work physicians put in. We are portrayed as making $400k, working 30 hours, and enjoying life, when in reality it's the furthest thing from the truth. You have to do CME every year, recertificastios, ect. Being a doctor, he said, is a lifelong journey of working hard and continuing to learn and study.

Thus, I am grateful, but I put myself in a position to succeed; no one else did. Thus, by spending ~15 years in training to become an attending, spending the 20s and the better part of my 30s learning, I do expect to be compensated very well for my time. I have many friends who went to the workforce straight from college and they are all making $60-$100k, while I spend $50k/year to learn.

Thank you for blatantly ignoring my point, and making assumptions about me as a person. I never said becoming a doctor isn't tough...personally, I've been through hell to get here, and I don't estimate it will get easier anytime soon. But I worked 80-100 hours a week as a teacher, and got paid less than 40k for it. Life is tough...doctors aren't the only ones that have it tough, and you can't quantify that. Assuming that you know what anyone else goes through in their life is just ignorant, and assuming that you go through more is just arrogant. As for your numbers, I chose to go by median, not mean, as outliers (ppl making ridiculous amts of money) will drastically skew the average salaries, so I stand by my original estimation. I don't understand why you feel entitled to make 5x more than the average american, when you definitely will not work 5x harder than the average american. Harder...well, maybe, and maybe even significantly so over the course of a lifetime when you count medical school, residency, etc. But what I'm trying to argue against is the sense of entitlement that so many pre-meds seem to feel to making 5-10x more than the average american. I never said you don't deserve your salary...I said I'm tired of people whining about it not being enough. It's damn good money, and if you want to whine about the sacrifices...well you chose this.

And ps...I live 1000 miles away from my parents, I support myself, and I've had 2 careers outside of medicine. So well I certainly don't know everything, I've not lived inside my parent's shiny happy world for the last 20 years.

 

[Drrrrrr. Celty]

So you think spent a tough journey? Lets take other professionals into account. You think people who go into business its easy for them? top jobs wants high grades from there undergrads also (obv. these people arn't science majors). You think its easy making 60k a year busting your ass over 50 hours a week kissing ass trying to get up the corporate ladder for a maybe position in the future that MIGHT pay better? Or is it easier for people to bust their ass at a job (lets take a finance job) and then go to B school while working and not even have a guaranteed salary increase after getting your MBA?

Or how about lawyers? You think its easy for them? They have to get top grades for 4 years of undergrad and than go to law school for 3 years (Which costs almost 150-180k) Than when they graduate they have to search everywhere for some resemblance of a well paying job. Most lawyers don't start out at $100k+. They start out at like 40-70k. They are going to make the same you will make during your residency. Except when you graduate your residency your guaranteed a $100k+ salary.

Engineers? They do a BS at competitive top 50 undergrad schools taking the same or tougher classes than pre-meds and then do their MA and some their PHD. You think they all make atleast $100k? Your dreaming.

There are alot of people who go to school for 7 years atleast and are making less than $100k.

Their are no guarantees when your in another profession. The bottom 5th percentile of Doctor salaries are higher than most professional career's 75th percentiles.

And yes doctors do work long hours and have some pretty difficult work. However, a lot of lawyers (the ones who make the same as doctors, and some less) work 60-70 hours a week. Same in Finance, business; etc.

And yes doctors do some great work and other people in society might not be able to do what you do. But do you think you could do what they do? Do you think you could do a legal analysis hundred and hundreds of pages of precedent cases? Or manage a company of X amount of people. Make financial decisions that pretty much determine your career success?

Most people in other fields would die for my sister's position. Works EM, 4 12 hour shifts one week rotating with 3 12 hour shifts the 2nd week. Makes about $250k.

Some will be lucky and get a pay in the top 75%, some the bottom 25%.. what you say is true not every one will make a amazing pay..
but we generalize based of the 50% mark, Not all enginners make 100k+ but a good deal will, not all lawyers make 100k+ just as some doctors will not make 400k+ a year.

we can just hope we will be somewhere in the middle and make a decent enough life style.

 

[akinetopsia]

Personally, I just think its kinda rude for someone to to say NO, NO, NO, AND NO to other opinions. Its just my opinion. If you read my previous response precisely I said I KNOW it's not the perfect solution, but it’s only my two cents!!! Just an opinion, not a law. From my experiences, those who have a tendency to demise other views, have a selected # of friends (Maybe a gerbil, cat, or parrot lol). I’m NOT saying this pertains to you by means any way, whatsoever, but it's my opinion, again.

I can read.

AFAIK, I did not say "NO, NO, NO, AND NO." I pointed out the potential problems with basing physician salary on outcomes, in a mature way.

I didn't "demise" your opinion and I'm not entirely sure you meant to use that word, "denigrate" or "dismiss" works in that context, all though I feel like I was not dismissive of your opinion, nor did I really denigrate it. People can be civil and disagree with each other, that's what I thought I was doing. You stated your opinion, I thought there are problems and potential pitfalls with it, I can acknowledge and move on.

The last passive aggressive bit is really charming, BTW. Why bring it up if you did not think it applied to me? Instead of a rebuttal to my observations on the potential problems with basing reimbursement on outcomes, you are saying (paraphrase), "Calm down, learn to read, you have no friends!!!" when you could be arguing to support your opinion.

 

[Rickybobby]

6 goats and a prostitute. Nothing more, nothing less. Amen.

 

[ddogark]

"Calm down, learn to read, you have no friends!!!" when you could be arguing to support your opinion.

Dude we are just pre-meds. That is it. We have not been through medical school. We have not been on call, and we are not doctors. What do we know other than those selected, wonderful shadowing experiences? On the contrary, those who have not experience the life as a doctor should not even make a comment on this topic (Including gov’t). This is just my opinion again. We can discuss things intellectually and yada, yada, yada... But more SDN'rs need to start being more supportive than judgmental. But to add on the OP question: I believe doctors should be paid by their work quality. Doctors who really give a d*** should really be rewarded. For example, if you have a leaky faucet and a plumber comes out and fixes it, but weeks later the drip comes back. You would be very pissed at the plumber. Now I’m not comparing doctors and plumber, just work quality. As a doctor, you are working for the patients. If there were too many doctors or too little patients then this discussion would be completely different. But this is not the case. Why do doctors work 50-60?? To serve the patients and yeah the demand is high enough that one will have to work that long but it’s the people who needs healthcare. Those doctors who really care, should be the ones which is compensated fairly. In general, PCPs (Im not saying other specialties do not care as much as PCPs, but they are really making some sacrifices). But that is just one lonely man’s opinion. Is this better? Well I did not make a opinion, earlier, it was a paraphrased suggestion toward a solution. Nothing more nothing less? What is your intake?

 

[rHinO1]

I don't know what they deserved to be paid but gold bullion, jewels, fatted calfs, concert tickets, hotel accommodations, and ferraris would be awesome. Come to think of it maybe I should just go on the price is right and skip med school.

 

[thefritz]

Not only is your whole "either socialism or capitalism, and nothing in between" shtick utterly asinine, even you yourself evidently disagree with it.

As I said before, and as you showed once more in this post, your argument is on the level of Ayn Rand: "SOCIALISM! AAAARRRRGGGHHH!"

The only difference is that in her days, there actually were quite a few evil scary socialists. Meanwhile, I'm pretty sure that the last time I met a true socialist in the flesh was over 3 years ago.

You are using strawmen over and over again and effectively arguing nothing. I never said "either socialism or capitalism, and nothing in between." I never said that if something is not 100% socialist, then it MUST be 100% socialist. You are attacking things I never said in an attempt to discredit my statements. The reason why you are doing this is because they threaten you. The idea that you are not automatically entitled to a certain minimum pay in your chosen profession threatens and scares you.

I hate to break it for you, but socialist ideals and programs actually exist outside of pure Marxist regimes. Socialism is prevalent in western europe (where they, gasp, actually have socialist parties with elected leaders). It is also gaining a strong foothold in the USA (and has been for quite some time).

You seem to care about Ayn/Ann Rand a lot more than I do. If you haven't seen socialist flesh in 3 years, then I think it's probably time to get a new mirror.

I really regret stumbling on this discussion. I expressed the simple opinion that one should have to earn his living through producing high quality work rather than expecting to be given a high standard of living simply for achieving a certain educational status. I did not imagine such a morally basic idea would be met with such disdain and criticism.

If you're so hell-bent and obsessed with Ayn Rand, then I suggest you study her characters more closely. Honestly, I never really studied the books because their corniness irritated me, but it sounds like they really struck a nerve with you since you mention her in every one of your posts. If I remember correctly, the president of the railroad in A.S. was one of the bad guys... "But...But...I'm the president of a railroad...a RAILROAD!!! --- I deserve these parties and this lifestyle I have! It doesn't matter how well the railroad works - I'm the president of it and I deserve all this stuff!" If I remember correctly, that was the jist of it.

Sound familiar?

"But, but, I'm a doctor, a DOCTOR!! I deserve this certain type of life!!! Doesn't matter what I've done as a doctor, just matters that I am a doctor!"

Drop the entitlement attitude and you will go far. Lots of people other than doctors work hard in life to accomplish their dreams and do the kind of work they want to do. Most of these people never become rich or live an extravagant lifestyle. But they are happy because they are doing work they love and that they excel at, and they don't feel bitter or tired because they don't drag around a boatload of entitlement whereever they go.

The secret to success is to become very good at what you do. The secret to happiness is to enjoy your work and to take pride in what you do. Pursue the work, hobbies, and people in life that make you happy, and you will be happy. If you pursue work you hate in order to achieve a lifestyle you think will make you happy, you won't be happy (people becoming doctors solely for money). If you pursue people you hate in order to achieve a certain job you want, you won't be happy (people winning friends and brownnosing to climb the ladder). If you pursue hobbies you hate in order to achieve people you want in your life, you won't be happy (selling out your own interests in order to please others).

Achieving an MD entitles you to the chance to prove yourself in the medical field. It doesn't entitle you to a certain pay level. Deal with this fact and you'll be better off. The happiest doctors I have met have been the ones who enjoy their work and enjoy doing it well. And they are all very successful because of that. The ones who are obsessed with pay, feel entitled, complain about NP pay or whatever, envy those who make more money in other fields, etc, they are generally the most miserable and are generally the worst doctors.

I'm done with the banter here and have work to do. I hope you get your **** together for your own and everyone's sake.

 

[DrHiner]

Stop drinking the Rand Kool-Aid

Boo. Rand "Kool-Aid" is some of the most rational stuff that's actually been said on this forum

And anyway, the length and difficulty of obtaining a medical degree/training actually does contribute to the shortage of doctors, incidentally causing the length of education affecting expected wage.

However, many years of school doesn't in and of itself make someone worthy of earning money. They must actually be productive and earn the money. No entitlement.

Interestingly, medical training almost always provides someone with a marketable skill. How many unemployed doctors (still holding their license and not just a shiny, useless degree) are out there, really? Most doctors are employed (assuming no gross incompetence; that tends to weed itself out anyway at some stage).

 

[loveoforganic]

You don't understand the concept of self-worth. I am smart, capable, and motivated. I am worth so much. I am entitled to so much.

Self-worth doesn't pay the bills.

I'm really bored of pre-meds whining about physician salaries. I'm even bored of pre-meds whining about the cost of medical school...even though I'm not exactly happy about it. I don't really want to read all these posts...I'm just going to post some basic numbers.

The average american made about $28k in 2005.
The average physician made about $200k.

So let's take an average american that works say, from the time they are 20 until the time they are 70. So 50 years, making ~30k/year = 1.5mil in lifetime earnings.
Ok, let's take an average physician. They do spend a lot more time in training...let's just say they don't start making the big bucks until they're 30. And let's just say they retire when they're 70. So 40 years, making ~200k/year = 8mil in lifetime earnings. Now let's be fair...let's subtract the cost of undergrad + medical education, and say they (or someone) paid ~300k for their training. Overall, still making about 7.7mil...about 5x the amount of the average american.

Law2doc already made a post about the time value of money in this thread on the first page, so that's something to consider in your numbers. Something else to consider, in addition to time value, is the amount of expendable income. 28k in 1990 is only worth a lot more than 28k in 2010 if it's being invested, and those on the low side of the income spectrum don't have nearly as much expendable income to invest than physicians do.

 

[mangareader]

About the low pay for people with a Ph.D brought up in the thread...

When it comes to people with a Ph.D (academia not private) I think things are a little tricky. Yes, they do get paid pretty low; assistant professors in sciences salary range from 60k - 100k depending on the institution. But that doesn't include the benefits they receive. The key one is the free tuition their kids will receive if they attend one of the participating universities. With college costing 20k - 50k per year, that is a pretty good deal. I have heard of some primary care physicians who can barely send their kids to top universities if they get accepted. There are also other perks, which make being a professor better than it initially looks.

This doesn't include the fact that pay has continually increased for professors in the sciences over the last decade. I wouldn't be surprised if all assistant professor at a top 25 private school starts out making 100k+ ten years from now. I will even go as far and say, being a professor will be more prestigious than being a doctor fairly soon.

But, back to the point of the thread...

Hmm...

150K - 200k avg take home for primary care.

200k - 250k avg take home for a specialist.

 

[ddogark]

Drop the entitlement attitude and you will go far. Lots of people other than doctors work hard in life to accomplish their dreams and do the kind of work they want to do.

The secret to success is to become very good at what you do.

Achieving an MD entitles you to the chance to prove yourself in the medical field. It doesn't entitle you to a certain pay level. Deal with this fact and you'll be better off.

Im agree with you all the way. I hear this tooooooo much, people saying they are entitled to___________!!! Listen people, you EARN what you have, nothing is given to you in the real world (unless mom and dad is giving you everything. Im most cases, this is not the issue. Be proud that you have made it this far, and yes you will be in a position to do better than others. Personally, doctors should not be placed on a pedestal. Yes, they do commit a lot of hours, years, and $$$ by which they should be fairly compensated. But, they are just as important as: teachers, law officers, sanitation workers, nurses, and…………………………………..

 

[circulus vitios]

About the low pay for people with a Ph.D brought up in the thread...

When it comes to people with a Ph.D (academia not private) I think things are a little tricky. Yes, they do get paid pretty low; assistant professors in sciences salary range from 60k - 100k depending on the institution. But that doesn't include the benefits they receive. The key one is the free tuition their kids will receive if they attend one of the participating universities. With college costing 20k - 50k per year, that is a pretty good deal. I have heard of some primary care physicians who can barely send their kids to top universities if they get accepted. There are also other perks, which make being a professor better than it initially looks.

This doesn't include the fact that pay has continually increased for professors in the sciences over the last decade. I wouldn't be surprised if all assistant professor at a top 25 private school starts out making 100k+ ten years from now. I will even go as far and say, being a professor will be more prestigious than being a doctor fairly soon.

But, back to the point of the thread...

Hmm...

150K - 200k avg take home for primary care.

200k - 250k avg take home for a specialist.

There's a caveat that becoming a professor is nearly impossible. It's not uncommon for a science PhD to go through 2 or 3 "prestigious" post docs then just barely get an adjuct professorship at a small crappy school in the middle of no where. There is no ACGME of science PhDs to regulate the student/job slot ratio or to limit the amount of international PhD students applying to American professorships.

Self-worth doesn't pay the bills.

True. But it will when I'm done with school and training. A meritocratic society and the free-ish market are great.

 

[bannie22]

You guys are all insane.

 

[DrHiner]

You guys are all insane.

Takes one to know one, bannie

Just kidding and trying to lighten up this forum a bit

And anyway, economics is AWESOME!

 

[ACSurgeon]

way more than any entertainer. period.

I'd actually settle for making as much as any entertainer who PRETENDS to be a doctor. Mind you, that is with me working full time for 30-40 years and the entertainer only working to make their ~20 episodes a year for 8-10 yrs.

 

[ACSurgeon]

I don't know what they deserved to be paid but gold bullion, jewels, fatted calfs, concert tickets, hotel accommodations, and ferraris would be awesome.

and free haircuts of course....

http://www.youtube.com/watch?v=wiojQsrs4MA&feature=related

(fastforward to time 2:00)

 

[womp]

More than the average corporate lawyer and any other profession that spends more than 50% of their time on Microsoft Outlook.

 

[bannie22]

Takes one to know one, bannie

Just kidding and trying to lighten up this forum a bit

And anyway, economics is AWESOME!

No offence taken, anyway I wasnt suggesting a insane-insane, but a more... insane.

But nice to see the passion.

 

[GH253]

Bad answer.

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."

This is intellectual excrement. Physicians have to compete for clients just like all businessmen- if some charge exorbitant fees, they will leave the market wide open for providers offering less expensive services, and the less expensive physicians will get most of the business. COMPETITION prevents scenarios like the one you proposed.

 

[GH253]

way more than any entertainer. period.

Entertainers make life what it is. Some entertainers are crude and untalented, but that doesn't diminish the value of entertainment as such. What would life be like without music, movies, etc.? All labor and no fun? Doctors make life possible, entertainers makes life worthwhile. Entertainers who are successfull on a large scale deserve to make more than doctors.

 

[mangareader]

There's a caveat that becoming a professor is nearly impossible. It's not uncommon for a science PhD to go through 2 or 3 "prestigious" post docs then just barely get an adjuct professorship at a small crappy school in the middle of no where. There is no ACGME of science PhDs to regulate the student/job slot ratio or to limit the amount of international PhD students applying to American professorships.

True, but I don't think it is THAT difficult. If you make sure you get into a top 10 private graduate school, and do some successful research, you will most likely get a position as an assistant professor within 5 years of graduating. The problem is if you don't go to a top graduate school. Even if you do a great postdoc, it doesn't really matter since schools strongly look at where you got your ph.d from. Look at various universities and look at where the professors got their degree from. It isn't like medical school where a person can go to a no name medical school and land a top residency if they have great step 1 scores, grades, etc. A easy solution would be for lower tiered universities to stop offering ph.d programs to make the process more competitive and selective.

Person from no name school = many postdocs to build credibility.
Person from ivy league = maybe do one postdoc and will get an A.P. job somewhere.

Also, getting into a ivy league graduate program isn't that difficult, especially compared to getting into an ivy league medical school. Most premeds with high gpa/mcat scores could probably do well if they are creative when it comes to doing new research.

 

[TooMuchResearch]

You don't understand the concept of self-worth. I am smart, capable, and motivated. I am worth so much. I am entitled to so much.

Yes, I do, and I think it's BS. Being smart, capable, and motivated is completely worthless unless you do something worthwhile.

 

[TDX]

This is the old "the people aren't smart enough to make their own decisions, so government should do it for them" argument.

Coakley made it the day before she lost to Scott Brown

Thing is, when it comes to medicine lots of people indeed do not know enough about the subject to make good decisions.

Quackery is a multi-billion dollar industry. Many of the victims get sucked in through pseudoscientific babble which they simply do not understand.

Just try to explain to a random less-than-gifted person why monoclonal antibodies are great and "healing" with supposedly magnetized crystals is nonsense. Or try explaining to someone with borderline intellectual functioning why "doctor of chiropractic" means rather less than "doctor of medicine".

There's no shortage of deaths due to quackery, so clearly, many people indeed are not equipped to distinguish the good from the bad.

 

[TDX]

This is intellectual excrement. Physicians have to compete for clients just like all businessmen- if some charge exorbitant fees, they will leave the market wide open for providers offering less expensive services, and the less expensive physicians will get most of the business. COMPETITION prevents scenarios like the one you proposed.

You are assuming the patient is a rational, well-informed consumer with enough time to make a balanced decision.

What you seem to be forgetting is that in medicine, we have these things called "emergencies".

If you were having a heart attack, would you go with the insanely expensive ambulance that's already there, or with the reasonably priced ambulance that should arrive "any moment now"?

Price quickly ceases to be a factor when your life is at stake.