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NYtimes on Derm residency
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It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time, said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
LOL. Unfortunate, yes, but are you really sorry? Doubtful.
LOL. Unfortunate, yes, but are you really sorry? Doubtful.
Hmm, interesting to see this coming to the public forefront. It's particularly interesting because I'm sure it's going to get a lot of lay people up in arms: "Those greedy med students. Why can't they be GP's! Harumph harumph", but this exodus to fields with great hours and good money is fault of the American medical system and it's insane ideas about how doctors should be compensated.
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The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol, Mr. Hocker said. But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.
A bit arrogant for my taste and opinion.
A bit arrogant for my taste and opinion.
check out the interactive graphic that accompanies the article.
http://www.nytimes.com/interactive/2008/03/19/style/20080317_DERM_GRAPHIC.html
http://www.nytimes.com/interactive/2008/03/19/style/20080317_DERM_GRAPHIC.html
Wow they basically republished the NRMP match report and threw in some crazy salary numbers from that MGMA thing. I don't think the public is ready to see and interpret such things.
yeah some of those salaries look higher than what i'm used to seeing.
oh, the good old nytimes, as always, madly in love with the medical profession 😡 👎
I already f***in hate the New York Times anyways for a variety of other reasons.
The end.
Interesting how Internal Medicine and General Surgery were the most competitive/sought after specialties 25 years ago.
I think the article is ignoring the elephant in the room. Just why are alot of medical students running away from primary care? Because PC docs work alot of hours (most of us are alright with that) and they BARELY get paid for it (most of us don't like that). And just why aren't primary care docs getting paid as they should? BECAUSE MEDICARE VALUES PROCEDURES MORE THAN PREVENTITIVE CARE AND THE INSURANCE COMPANIES FOLLOW IN SUIT.
I really wish they would focus on that problem and not worry about how medical students are compensating. There is no other professional profession in the world where you may bill for $100, and the consumer can decide to only pay $30. But in medicine, docs most times don't get what they bill. There are alot more important issues than what this article is highlighting, and I would hate for the public to paint us in a bad light because of it.
One part of the article I found funny was this quote:
"Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today."
I think this is quite true. Heck, alot of old school pediatric surgeons didn't have half the research experience that the surgery residents are having to have to get in. Times are just harder...but still doable.
I really wish they would focus on that problem and not worry about how medical students are compensating. There is no other professional profession in the world where you may bill for $100, and the consumer can decide to only pay $30. But in medicine, docs most times don't get what they bill. There are alot more important issues than what this article is highlighting, and I would hate for the public to paint us in a bad light because of it.
One part of the article I found funny was this quote:
"Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today."
I think this is quite true. Heck, alot of old school pediatric surgeons didn't have half the research experience that the surgery residents are having to have to get in. Times are just harder...but still doable.
They seriously couples matched in derm? Talk about picking the exception to the rule for the news story.
I didn't see anything in the article that wasn't true or even was misleading. True, it didn't delve deeply into all the economic reasons for this phenomenon, but that would have been a much longer, different article.
Maybe it'll shed some light as to why their dermatologist is always smiling and why their GP is perpetually muttering dirty words under his/her breath 😛
Actually, if you read the last line it sounds like they didn't couples match. But we really could be anywhere in the country, together or not together.
I have to say, I admire the couples who are willing to endure separation for training, but I really think that it's wrong to do when there are kids in the picture.
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I agree. One of them will have to bend if things don't pan out well enough.
Match day is tomorrow. How would they know today, especially when the article was probably written and edited a while ago?
You find out if you matched the Monday before Match day, just not where yet. Since the article was published on Monday (I think,) the NYTimes may have gotten a last minute update from the couple before the article went to press.
They're not ignoring it. They're shoving the elephant under the rug. Did you see the numbers they quoted? It seems to me like they're trying to say that med students these days are greedy and that's the reason why they're fleeing from internal medicine and primary care.
What's crazy is that even when you look at the people that are matching into Internal Medicine these days, very few are doing it for primary care. I just matched into Internal Med and I'm doing it to get into Pulmonary/Critical Care. The majority of people that i talked to on the interview trail had the IM subspecialties in mind, not primary care. We're seriously going to hit a primary care drought very soon.
And then everyone will come to see us in the ED for their primary care!
Most all of the above is true, but I found the bolded part to be a bit disingenuous. I'm just using the figure quoted in the article, so it may not be exact, but earning on average 190k hardly qualifies as "barely getting paid." That's in the top 1% of salaries in this country. Now I certainly don't think that what a primary care doc does is worth so much less than the specialist, and it's a problem that should be addressed, but let's just please have some perspective on what barely getting paid would really mean. It's framing the argument like you did there that never gets us anywhere with the general public.
MedGoatTX, it's nice to hear optimistic comment like this. But the point is not that medicine is getting paid at top 1% of salary - the point is the trend (now going for a very long time now) of compensation continuing to go downward while majority of other comparable career compensations trending up or stable.
While it is naively optimistic, such complacency is exactly what is helping lead our profession to what the trend described by the article. There is no one (not the insurance companies, pharmaceutical executives, or congressmen) who will take care of your salary at top 1% or top 10% as long as you think it is good enough.
I am not advocating that every doctor is entitled to be paid like wall street bankers do, but understand that financial investment, time, and dedication that goes into this noble profession - it is your duty, our duty of this generation to protect this profession so that when for the next generation, medicine is still a desirable, rewarding profession that compelled you and I to enter and serve.
Btw, for those of you premeds or in medschool, feel free to PM me for any questions or advice. I am one of the fourth years waiting for the match result , and would love to help with anything that I can now that I see the light at the end of tunnel.
CY
👍
At a recent meeting of academic surgeons, an entire 45-minute lunch talk was devoted to the idea of physician reimbursement and educational/personal debt. People had lots of great ideas about what the NIH, or the government etc. could do to help improve our situation. Someone finally pointed out this was all nice, but no one cares because:
a) Politicians are not interested because a lot of physicians make a higher salary than they do. We also do not contribute on a proportion basis anywhere near what other "important groups" such as trial lawyers do (I don't have exact numbers, but the ACS political action committee website probably does).
b) The Median Household income in the US is 48,201.00 (2006). Is it reasonable to ask them to help us earn more money? Especially when physicians (residents and attendings) also carry high levels of personal debt (esp. credit cards)- not just the educational debt we complain about?
Ideas that came out of the meeting (paraphrased):
1) We need to donate more to political campaigns through physician action groups (AMA, ACS, AAP, etc.). I know that is not possible in med school, but to change anything with reimbursement you need to grease the wheels of medicare/medicaid. Insurance companies may be able to compete with physicians at a funding level, but they can't vote.
2) Vote early, and vote often (I live in Texas, so that's legal)
3) Press through student and physician groups to offset tuition fees for medical school. These are usually a very small part of med school budgets, but constitute an enormous financial burden to the individual as well as being a turn-off for potential applicants.
4) Learn about personal finance and debt management in medical school. If your school doesn't offer this, PUSH FOR IT. While this has nothing per se to do with reimbursement, it will help you maximize the earnings you do make as a physician.
I can't stress the last point enough. While it doesn't address the OP, I can tell you that this knowledge is crucial early not just for those who are 140K+ in the hole (like me), but even those who may be coming out debt-free.
Sorry for the rant...
If the average primary care physician made 190k there would be fewer complaints. Unfortunately the NYTimes went with the biggest number they could find rather than the most accurate. First, notice that they chose internal medicine instead of family practice. Internal Medicine is including many hospitalists who make more money than primary care physicians. Second, the MGMA survey is a survey of very large group practices. This skews the number up in at least three ways. First, it over represents the better paid hospitalists since they tend to work in large groups covering hospitals. Second, large groups have resources available to streamline the process (like affording expensive EMR systems) and cross cover call to allow for more patient visits. Third, the large groups are predominantly multi-specialty groups, and as there is a growing shortage of primary care physicians many groups will subsidize their salaries from revenue of better paid specialists to keep the referrals coming. These large groups are not the norm of practice and thus not representative. 120-150k sounds more reasonable for a 50 hour work week.
When you finish medical school with greater than $200,000 worth of debt and then residency with $220,000+ worth of debt, getting paid $190,000 a year before taxes and probably malpractice is barely getting paid. If you met me, you would truly know that Im not in medicine for the money. But no other profession works as many hours, has as much debt, and has as much responsibility as we do. If nursing salaries were going down, I would feel better. If PA salaries went down, I would feel better. If the hospital administrator salaries went down, I would be ok too...I would not mind taking a hit also. But for us to take the hit while others are saving for their kids college tuition and other stuff is just a mess.
So yes, $190,000 (which is probably quite above average) is barely getting paid.
Yeah, you find out if you have to scramble ahead of time, this avoids spoiling match day for everyone else by someone getting shafted with an empty envelope.
If you go to public schools the debt is a lot less troublesome.
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Not if you're out of state.
D
deleted77919
Really? Check out the in-state tuition at UVa (yes, it is a public school).
http://www.healthsystem.virginia.edu/internet/financial-aid/costs.cfm
$31,305/yr for tuition alone. Total in-state budget is $50k+/yr.
Also not if you go to Wayne State and pay over 30k in tuition and fees. Thankfully, I don't have to pay 57k like the OOS students pay.
I've been in med school less than a year and I am already tired of people saying "you'll be making $500k in a few years." When I hear that, I sigh, and then explain to them the years and years of training, the massive debt, malpractice, and the reality of physician salaries. They are usually left with this face 😱.
The article didn't really mislead the reader, but they did put a lot of focus on the benefits of certain specialties (pay and hours), while only briefly mentioning the debt. And did they say anything about malpractice? I agree with those saying the average Joe will finish the article and think we are greedy.
The article didn't really mislead the reader, but they did put a lot of focus on the benefits of certain specialties (pay and hours), while only briefly mentioning the debt. And did they say anything about malpractice? I agree with those saying the average Joe will finish the article and think we are greedy.
One other major chunk of change that is almost ALWAYS neglected here is the opportunity cost of medical school and residency. If you estimate that the average person with a bachelors degree earns $60,000 and medical school + residency is 9 years... that is $540,000 - subtract off the average residency salary of $45K x 5 years.. and that leaves you with another $315,000 of money you in lost wages that you can factor in.
I will have ~$250K in student loan debt when I graduate + the $315K in lost wages... so tell me again how rich I am going to be when I am STARTING over half a mill in the hole?
Actually, the average salary for an American with a bachelor's degree is $45k, according to the Census Bureau. And of course $250k is way above the average med school debt (though mine will be at least that as well). But I do agree your point is well taken, even thought your figures are inflated.
Malpractice is irrelevant, as the salaries quoted in the article are after expenses.
I think even most doctors would agree with the article's perspective that it is money and lifestyle that make derm and plastics so competitive (yes, plastics isn't 9-5 but it is better than most surgical fields). A reasonable person would say that if that's not what's best for society, we need to change the economic incentives. (A communist would say that we need to change human nature so that med students are less greedy.)
His numbers aren't that inflated.
Using the average American salary with a bachelor's degree would underestimate the average a medical student could have made over 9 years if he/she decided to work instead. A 60k average over 9 years is more than a fair estimate (people do move up in the ranks..add to that raises). Also, science degrees are usually worth more in general.
250K might be a bit much, but not really for us out of staters. People don't factor in interest. Having a tuition of 30K-40K/year plus 10-15K/year living costs will get you there if you pay all of that with loans and accumalate the interest. State schools are definitely less, but with so few seats available I find it arrogant to tell a medical student that, "he/she should have gone to a cheaper school."
I agree with your sentiment, but blaming medical students as greedy is highly unfair. No other professional schooling puts their students in such a financial hole as medical school. Wanting a higher pay day afterwards is a natural reaction to the system.
Law School: 3 years.
PhD: 5 years(but no tuition + a ~25K stipend)
MBA: 2 years
Dentistry: Much shorter residency.
I didn't say med students were greedy. That word was used to illustrate an unreasonable response to the situation.
I do agree it is normal to want to be able to repay one's loans and make as much money as possible, but that's not the central issue here.
I think that's sound advice. It makes little sense to have our best and brightest administering botox and boob jobs.
The question is, how do you make fields that were once prestigious (IM/Gen Surg) more profitable and more lifestyle friendly?
I just don't see it happening.
I don't either in the short term, but further out who knows. The pay is very cyclical and influenced by things a lot of people don't know about. Read this blog post for a good example:
http://allbleedingstops.blogspot.com/2007/11/ranting-on-ruc.html
The lifestyle of IM and GS to some extent depends on pay, since if you are getting paid more then you don't need to work as hard to see so many patients. However, they also deal with issues that cannot wait. Someone has to actually be in the hospital at 3am to take care of those hospitalized patients. That's just not the case with derm.
However, I don't think this is such a big deal compared to other problems we're facing. And it's not ALL of the best and brightest that go into derm. Many people do choose to go into IM, surgery, and everything else even though they have the stats for anything.
D
deleted77919
Malpracticie is somewhat relevant to the discussion. Even if malpractice insurance costs are taken out before salary is listed there is quite a bit of time and hassle associated with any suit. Malpractice considerations for different specialties are not just "what does the insurance cost" but also "how often is the average practitioner sued?" "How often will I be sued (am I taking higher risk pts?)?" and "what will the toll in time and emotional resources of even an unsuccessful suit be."
Malpractice insurance rates can be used as a proxy (albeit a rather poor one) for how much these concerns weigh upon the average practitioner in a given field.
Malpractice insurance rates can be used as a proxy (albeit a rather poor one) for how much these concerns weigh upon the average practitioner in a given field.
The numbers you quote are nearly 10 years old, and are an average, and not the median. If you look here http://www.nsf.gov/statistics/infbrief/nsf06304/
you can see that the median for science majors is $67,000 suggesting that I UNDERestimated.
I also wonder why you think $250K is way above average? It is nearly impossible to get clean data on med student indebtedness as all the published numbers from schools are grossly underestimating their averages (by fudging the numbers by including the small percentage of students who have zero debt due to family assistance, they bring the number down quite a bit).
The average would tend to be higher than the median. Also your data are broken down by type of employment, not type of degree. However, given that data, $60k doesn't seem unreasonable as an estimate.
I think $250k is way above average because the AAMC says the average is $130k. Yes, that includes people whose parents are paying, which I think is more common than you imply. I too would like to know the median indebtedness, but obviously the schools don't want us to know.
Anyway, this is a pretty pointless argument (and mostly my fault). Back to the thread:
- derm and plastics are very competitive, probably because of money and lifestyle
- that's not the fault of the med students
- it's probably not ideal for society but it's the system we have
- since all of this is almost universally acknowledged on and off SDN, I don't see how the NYTimes is wrong for reporting it
I think $250k is way above average because the AAMC says the average is $130k. Yes, that includes people whose parents are paying, which I think is more common than you imply. I too would like to know the median indebtedness, but obviously the schools don't want us to know.
Anyway, this is a pretty pointless argument (and mostly my fault). Back to the thread:
- derm and plastics are very competitive, probably because of money and lifestyle
- that's not the fault of the med students
- it's probably not ideal for society but it's the system we have
- since all of this is almost universally acknowledged on and off SDN, I don't see how the NYTimes is wrong for reporting it
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Anyone know where these lovebirds matched?
This is totally true. I was told this by at least a dozen interviewers in radonc this year.
pseudoknot said:
I agree with this, and I think it's a big issue. I agree that "greedy" is not the word I would use for the students but at the same time I think if the primary care docs were making the big bucks, the health of our country would be very different. Can you imagine if the best and brightest all went into FP? Of course there are a lot of people who go into these fields for the right reasons, but it is also true that there are many who do because they are not strong enough applicants to get into another field they would prefer.
I happen to be going into a lucrative specialty and when I chose my field I actually had to work this through in my mind a little bit to make it all click and feel right. Of course I chose it because I found it interesting and will enjoy doing it for the rest of my life, but at the same time the good $$ and lifestyle is there, and I really had to take a look at my motivation. I like to think that I would do it regardless of what it paid. At the very least it is easier for me to feel passionate about curing cancer for a living than treating acne and burning off warts. Not to say that we don't need dermatologists or that some of the people going into derm are really passionate about skin, but come on, how many of them do you think really go into it for that? Feel free to disagree.
To play devil's advocate for a minute, on the other hand is there truly anything wrong with going into derm based solely on wanting a lot of money and a good lifestyle? People go into other professions for those reasons all the time and no one balks at them. True there are other roads that would lead you to these ends that would be much less painful than med school and residency, but is it actually immoral to have no other goals than to work nice hours and provide a good living for your family?
When one critically looks at derm and to a lesser extent plastics in a economic perspective, some less attractive aspects of these specialties come out. Consider:
1. The reimbursement of most specialities are very cyclical. For example back in the late 70's, early 80's, rad was considered the dumb people speciality. But then lots of new (and unpredicted) technology like CT and MRI came along that increased demand for radiologist. Since there was a supply shortage, salaries went up. However, as radiologists started driving around their beamers, payers (insurance, govnt) started getting pissed so they started slashing reimbursements. So less people will go into rads, which will create a future supply shortage ad infinitum. Derm and plastics are the two most popular specialities now and its way over capacity for what this society needs even with low residency spots. Eventually, the supply will exceed the demand and prices will fall. For example, Its not easy to set up shop in NYC these days as a plastics and except to make money real soon.
2. Some would argue that derm and plastics are specialities that are immune to government and insurance reimbursement decreases since patients pay out of pocket. However, these people fail to recongize that medicine as a field is deeply interconnected. Lets be honest here, it doesnt take a super specialist to inject botox and do some fancy acne peel, almost any IM or GP can do it with just a little training. Even plastic surgery can be done by ENT, optho, urology (for down there) and maybe even general surgery. Now if reimbursements started to drop for IMs, many of them will start to cash in on cosmetics which is happening right now. Derm and plastics are trying to defend their turf by saying that only they can take care of people properly, patient safety blah blah blah, but eventually they can't stop an economic damn (same issue with mid tier providers vs. PCPs). Thus derm and plastics rates will eventually be pulled down by decreasing reimbursements in other parts of the medical system.
3.I like to use a stock analogy to describe derm and plastics. These two specialties are way too overvalued right now after years of growth. The price you pay to get into these specialities (in terms of grades, boards, research) has been incredibly inflated. If you can match into derm and plastics you are probably smart and hard working enough to get into any other speciality. Because the competitive nature of the field, matching into a third rate derm residency is probably more difficult than matching into IM at MGH or JHU. Thus if you "buy" derm, you are matching into a speciality whose price has grown so ridiculously high that it can have no where to go but down (consider above two points).
4. On the other hand, generally neglected specialities like IM or Surgery are like stocks of great companies that have suffered some set backs but are still the bread and butter of american medicine and will never go away. We all know that there will be a huge shortage of PCP's and surgeons ( and IM and surg subspecialties) and of course Americans aren't getting any younger or thinner. Andof course, technology is increasing at a rapid pace requiring more and more knowledge. Eventually the demand will exceed the supply by so much that prices for IM and Gen Surg will start to rise again. And also, getting younger skin is an elective procedure, getting treated for cancer is not. So people will gladly pay more for saving their life but may not pay much higher for popping pimples.
5. Obviously, derm and plastics are great fields, but ONLY if you enjoy them intrinsically and not "doing it for the money." These predictions may very well prove wrong, but I guess I am just offering it as food for thought to those tempted by the NYT article.
1. The reimbursement of most specialities are very cyclical. For example back in the late 70's, early 80's, rad was considered the dumb people speciality. But then lots of new (and unpredicted) technology like CT and MRI came along that increased demand for radiologist. Since there was a supply shortage, salaries went up. However, as radiologists started driving around their beamers, payers (insurance, govnt) started getting pissed so they started slashing reimbursements. So less people will go into rads, which will create a future supply shortage ad infinitum. Derm and plastics are the two most popular specialities now and its way over capacity for what this society needs even with low residency spots. Eventually, the supply will exceed the demand and prices will fall. For example, Its not easy to set up shop in NYC these days as a plastics and except to make money real soon.
2. Some would argue that derm and plastics are specialities that are immune to government and insurance reimbursement decreases since patients pay out of pocket. However, these people fail to recongize that medicine as a field is deeply interconnected. Lets be honest here, it doesnt take a super specialist to inject botox and do some fancy acne peel, almost any IM or GP can do it with just a little training. Even plastic surgery can be done by ENT, optho, urology (for down there) and maybe even general surgery. Now if reimbursements started to drop for IMs, many of them will start to cash in on cosmetics which is happening right now. Derm and plastics are trying to defend their turf by saying that only they can take care of people properly, patient safety blah blah blah, but eventually they can't stop an economic damn (same issue with mid tier providers vs. PCPs). Thus derm and plastics rates will eventually be pulled down by decreasing reimbursements in other parts of the medical system.
3.I like to use a stock analogy to describe derm and plastics. These two specialties are way too overvalued right now after years of growth. The price you pay to get into these specialities (in terms of grades, boards, research) has been incredibly inflated. If you can match into derm and plastics you are probably smart and hard working enough to get into any other speciality. Because the competitive nature of the field, matching into a third rate derm residency is probably more difficult than matching into IM at MGH or JHU. Thus if you "buy" derm, you are matching into a speciality whose price has grown so ridiculously high that it can have no where to go but down (consider above two points).
4. On the other hand, generally neglected specialities like IM or Surgery are like stocks of great companies that have suffered some set backs but are still the bread and butter of american medicine and will never go away. We all know that there will be a huge shortage of PCP's and surgeons ( and IM and surg subspecialties) and of course Americans aren't getting any younger or thinner. Andof course, technology is increasing at a rapid pace requiring more and more knowledge. Eventually the demand will exceed the supply by so much that prices for IM and Gen Surg will start to rise again. And also, getting younger skin is an elective procedure, getting treated for cancer is not. So people will gladly pay more for saving their life but may not pay much higher for popping pimples.
5. Obviously, derm and plastics are great fields, but ONLY if you enjoy them intrinsically and not "doing it for the money." These predictions may very well prove wrong, but I guess I am just offering it as food for thought to those tempted by the NYT article.
A few points:
- derm and plastics are not the most popular specialties, only (maybe) the most competitive to get into
- derm is not over capacity; published research shows that wait times for a derm appt are often 90 days. We actually need a lot more dermatologists but they aren't growing the residency spots, probably to maintain their status
- it's "bimmer" if you're talking about the car, or "beemer" if you're talking about the motorcycle, but never "beamer"
- yes, cosmetic patients do pay cash and so your reimbursement arguments are wrong, and your #2 is wrong because you can't get malpractice insurance if you are operating outside of your training
- I don't even know what you are saying in #3
- cosmetic procedures will always pay more than lifesaving ones because insurance doesn't want to pay more than they have to
- neither residency spots nor insurance reimbursements have anything to do with supply and demand, so all this econ 101 stuff is too simplistic to be relevant
- derm and plastics are not the most popular specialties, only (maybe) the most competitive to get into
- derm is not over capacity; published research shows that wait times for a derm appt are often 90 days. We actually need a lot more dermatologists but they aren't growing the residency spots, probably to maintain their status
- it's "bimmer" if you're talking about the car, or "beemer" if you're talking about the motorcycle, but never "beamer"
- yes, cosmetic patients do pay cash and so your reimbursement arguments are wrong, and your #2 is wrong because you can't get malpractice insurance if you are operating outside of your training
- I don't even know what you are saying in #3
- cosmetic procedures will always pay more than lifesaving ones because insurance doesn't want to pay more than they have to
- neither residency spots nor insurance reimbursements have anything to do with supply and demand, so all this econ 101 stuff is too simplistic to be relevant
Oh also something that most people in this thread are missing is that dermatology doesn't pay extraordinarily well on an absolute basis. What makes it so unique is the lifestyle (I'd argue that psychiatrists can enjoy a similar lifestyle, but their pay is lower and there is the stigma of mental illness).
