Teachers earn the same per hour as Internists.......

[Blitz2006]

http://benbrownmd.wordpress.com/

Extremely interesting analysis...

Your thoughts?

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[McGillGrad]

In reality, we should be paying teachers more to attract more talent.

 

[smq123]

Moving to Topics in Healthcare.

 

[xenotype]

He got to those numbers by being overly punitive to the internist and overly generous to the teacher. Small issues add up to a relatively large difference. All opportunity costs into account, it isn't the 3-4x more pay that the lay public assumes, but it is almost a 2x increase before investments are taken into account.

From "FuzzyMath" in comments:

I have several issues with your calculation. Let me go through them here.

In calculating net teacher income, you include a pension benefit of 35,507 for 15 years. Yet, the assumption neglects the teacher contribution to this fund. In California, teachers are REQUIRED to contribute 8% of their pre-tax salary to the retirement system (http://tinyurl.com/69eevs2) . For the example given, that would be a contribution of 4,000 dollars. The equation changes slightly then.

(42,791 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

(39,840 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $28.70

If the contribution is more conservative, say 6% contribution and takes into account the loss of $3,762 in social security lost due to pension, the results look like this:

(40,596 x 43) + ((35,507-3,762) x 15)–(186,072)] / [(40x 38x43)+(6,400)] = $28.36

In contrast, the equation fails to account for retirement benefits given to doctors. Part of this is likely due to the fact they are far from uniform (401K matching, ownership of practice, etc) yet the benefit does exist. Therefore, ignoring the pension benefit for teachers seems to be the most reasonable.

[(42,791 x 43) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $23.05 Teacher/per hr

Perhaps you disagree with that notion. However, if 4,000 dollars per year is invested, compounded yearly and earns 5% in a tax deferred account for 43 years, the teacher would have $633,170, or 42K over the same number of years, a higher number than would be gained by the pension benefit calculated. If the doctor had this same investment, either through self funding or matching from company/ hospital it would not be included here. Therefore, I think it should be left out.
Next I call into question the math on total teacher hours worked. The author estimates 38 weeks worked per year, 10 week summer, 2 weeks Christmas, 1 week spring break. Subtracting from 52, the number should be at minimum 39, resulting in the following equation.

[(42,791 x 43) – (186,072)] / [(40 x 39 x 43) + (6,400)] = $22.50

Now, the author suggests that 10 weeks summers are the norm. In fact, 10 week summers are normal for students. However, teachers are typically expected to begin work 8-10 days prior to the first day of class. In addition, several days after school are required to finish paper work, clean up, and inventory the class room. A conservative estimate would have 10 weeks reduced to 8 on average.

[(42,791 x 43) – (186,072)] / [(40 x 41 x 43) + (6,400)] = $21.50

By these calculations, the difference between teacher and doctor is $12.96 per hour (34.46-21.50). In addition, with the number of teachers I know personally, I am amused by the idea that they work a mere 40 hours per week, but have no hard evidence to prove it. Perhaps I know only hard workers. The hours worked also do not account for other areas including student teaching, required continuing education courses, recertification and licensure, etc. In addition, the author points out that having a masters is not required for some high school jobs and does not include its pursuit (cost or hours) in his calculation. Using this filter, I next address the hours worked by doctors.

The author states clearly that 34,000 hours are required in training. It breaks down as follows: Undergrad + Med School (1,2nd yr) + Med school (3, 4th) + Residency
6400(40x40x4) +7680(48x80x2) +7680(48x80x2) + 12000(50x80x3)= 33760 Hrs

Some have regarded this as too little and some as too much. I have the following modification and my thought process. Firstly, the number of weeks of medical school should be adjusted. Based on the academic calendar from John Hopkins medical school http://tinyurl.com/62ajab ; 44 weeks are outlined for 1st and 40 weeks for 2nd year students. In addition, each of these years includes 3 weeks for Christmas and Spring break every year, leaving on average 39 weeks for each of the first two years. People have mentioned several other things expected of students including extra specialized classes, summer research and community service. But, just as a masters is not required for teachers, these extras should not count toward the averages necessary for doctors. Adjusted

6400(40x40x4) +6240(39x80x2) +7680(48x80x2) + 12000(50x80x3)= 32320 Hrs

Next, examining the 80 hour per week spent in the first 2 years of med school. Based on various sources, the class schedule has 3.5 to 6 hours of class on any given day. This is balanced out with patient time. In general, 6 hours of class/patient time seems to be a reasonable average. Adding additional study time to result in 80 hour weeks would require 5.5 hours of studying each weekday, plus 11 hours on each Sunday and Saturday (30hrs of class/50 hours of studying). While some people have responded this as accurate, this is unlikely to be everyone. Therefore, I have adjusted the calculation to 60hr/week; leaving an equal balance. Perhaps you disagree, but I argue, that 12 hours a day, 5 days a week is probably reasonable for the average medical student. Those at the top of their class may be higher, but again, this is not required to become a doctor.

6400(40x40x4) +4680(39x60x2) +6240(48x80x2) + 12000(50x80x3)= 30760 Hrs

Next, tackling the last two years, we return to the Hopkins schedule. Again 40 weeks are outlined for yr 3 and 40 weeks in year 4 with 3 weeks for Christmas and Spring break each year. Therefore 37 weeks for med school year 3 and 4 (down from 48). I will not quibble with 80 hours per week, however, the requirement varies greatly by rotation. Some will have very reasonable (read 60) others will approach and surpass 80 hours. Overall, I think the number maybe high for most, but low for some, therefore a reasonable "average" to use.

6400(40x40x4) +4680(39x60x2) +5920(37x80x2) + 12000(50x80x3)= 29000 Hrs

Previous Calculation
(140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)]=34.46

The adjustment bumps the total up nearly a dollar. A pittance you may argue, but a over 6% increase per hour for a teacher.

(140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (29,000)]= 35.83

Now to tackle the biggest issue: investments, upfront and future. Much is made of the high cost of attending medical school. With nearly 300,000 estimated in initial cost (undergrad + med school), the final tally ends at nearly 700,000 dollars in debt to be repaid. This takes the nearly 5.2 million dollars earned and $41.30 per hour average down to $35.83 after adjusting for debt payment. This number is indeed a staggering debt and reduces after tax total from 140939 to a mere 106,939. But imagine instead, that the doctors chose to limit themselves to the salary of a teacher until the debt was repaid. This would mean taking the extra $64,148 and apply it towards your loan principle. The result would have the loan repaid in a mere 4 years from start. The total cost, including accruing interest during residency, would total $430,624 (370,000 for principal plus added interest during residency, $60,624 in added interest). This savings in interest by living at a teachers wage for the first 4 years after residency adjusts the doctors cost per hour.

(140,939 x 36) + (120,000) – (430,242)] / [(56 x 48 x 36) + (29,000)]= 38.05

Now, you argue that the doctor had to defer income during med school and residency and the teacher was able to get ahead there. Therefore, the next few years, the doctor should catch up. In the 7 years, the teacher made $299,537 while the doctor made $120,000 during residency. Now, the doctor also had 15,000 used for living expenses during med school that was added to the loans and teachers have living expenses too, so we will add the 60,000 to the doctors total and the equation (changing the total to $38.53/hr). The discrepancy is made up in a single year. You may argue that the teacher was paid in more valuable dollars from the past. Controlling for that the roughly 120,000 dollar difference over that time would equate to roughly $147,000 given 3% inflation year over year. This is a simplified equation, but roughly illustrates the loss due to later payment. Still, 1 months has the doctor even to the teacher in terms of cost.

Having reached this point the doctor earns on average $38.53 while the teacher earns $21.50. Is this a sufficient spread for the doctors?

But one more point remains. Several people have commented on the opportunity cost of going to med school in terms of return on investment, that not investing early costs the doctor. What is not calculated is the return on investment for the extra money the doctor has during time. If the doctor chooses to live like a teacher (in wage) what return on investment is the teacher missing out on that the doctor is privy to. With this in mind, the doctor having broken even with the teacher at year 12 (34 years old), will continue to live like a teacher until he retires and invest the extra $98,000 per year for the next 31 years in various investments. Now again, the doctor must live like the teacher in terms of wage. He has everything he needs, much like the teacher, but cannot have an expensive house, cars, vacations, etc. The following totals are if his returns are 5, 7, 10% over the next 31 years.

5%= 7.7 million dollars 7%= 11.5 million dollars 10%= 21.5 million dollars

Taxed as a long term capital gain, each of these totals would be reduced by 15-20% depending on how your state taxes it if it were not tax sheltered. Assuming a 20% tax rate the numbers for adjusted pay per hour equals the following

((140,939 x 36) + (180,000) – (430,242)+(5% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 87.33/hr

((140,939 x 36) + (180,000) – (430,242)+(7% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 111.50/hr

((140,939 x 36) + (180,000) – (430,242)+(10% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 174.47/hr

Even a 3% return on investment (ROI) would average $72.06 per hour. Now if unlucky (3%) , average (5%), or lucky (10%), the doctor would earn $50.56, 65.83, or $152.97 more per hour than a teacher respectively. Assuming they could live at the wage of a teacher. Is this sufficient for the doctors?

While I see a problem with recruiting people to medicine, most notably primary care, simply increased pay and payout will not alleviate the problem in my opinion. Options should be discussed. In dragging teachers into this discussion, I feel you hurt your case by implying you deserve more than teachers (as some commenters have voiced) rather than saying that doctors should not be a target for the "tax the rich" consortium. Highlighting the plights of doctors is important, but there are many people who work just as hard and get paid less per hour. In addition, there are several people, myself included, who chose not to go into medicine for the reasons you've outlined. We as a society need to decide if that is what we want. Simply put, you should've used a government employee (read IRS agent) as your model rather than a teacher.

 

[NotAProgDirector]

They also calculate the number of hours in residency as 50 weeks x 80 hours per week x 3 years. That's insane. Although the most intense rotations may be 70+ hours per week, plenty of outpatient and elective rotations are much, much less. And, most programs have 3-4 weeks of vacation/CME time.

 

[medicinesux]

First off, I think that analysis should be required reading by every pre med college student even contemplating going on to med school. Yes, I believe it is THAT good.

Secondly,....

overly generous to teachers? LOL. In suburban NYC, teachers are pulling down six figures a year. An old dumb as rocks classmate of mine from high school is easily making more than $100 an hour teaching friggin "Health". He's got no massive student loans to speak of (got some lame online masters degree), drives a Beamer, flies out to Vegas and takes trips to Hedonism in Jamaica like every other weekend it seems. The guy just announced on facebook that he is gearing up to spend 2 months this summer to go surfing in Indonesia! Like a doctor will ever find the time to ever do that! And he is only in his 30's. And yes, that is JUST his salary. I couldn't believe it myself until I looked up his name on the NY State education site. And that salary does NOT include pension, getting paid extra for teaching an extra period or coaching soccer after school. With all the add on's he is right up there with the poor internist slaving away his life for a mere 150K.

A teaching job in the right school district in the right locale is one amazing sweet gig! For example, don't teach in rural Oklahoma unless you are content making peanuts. Also, stay away from the inner city schools unless you are planning on being the next Jaime Escalante. The kids will wear you down faster than the crack addicts are capable of doing to an ER doc. And scantrons are your friend! Combo this with recycled tests (or just use the electronic testbank that comes with the textbook to quickly crank out a test) and you will be uber efficient churning out and entering test grades into the computer before the bell rings for the day at 2 oclock!....Anyone up for a round of golf?....No?.....Oh sorry, I forgot that you are on call until 8 in the morning! ........Of course, if you dislike kids then everything I said above is moot. However, if you have the RIGHT likeable personality (unfortunately, this is where a large fraction of physicians would fail...I couldn't stand just being in the same room with a good number of them when I was a resident) and love working with kids AND they love you back, teaching can be as easy as breathing. It will be the easiest money you ever made. On the other hand, if your students come to despise you, your worklife will be utterly miserable. You will work for every cent.

 

[MOHS_01]

They also calculate the number of hours in residency as 50 weeks x 80 hours per week x 3 years. That's insane. Although the most intense rotations may be 70+ hours per week, plenty of outpatient and elective rotations are much, much less. And, most programs have 3-4 weeks of vacation/CME time.

My how times have changed....

 

[Dirt]

First of all, who has time to run these numbers?

overly generous to teachers? LOL. In suburban NYC, teachers are pulling down six figures a year. An old dumb as rocks classmate of mine from high school is easily making more than $100 an hour teaching friggin "Health". He's got no massive student loans to speak of (got some lame online masters degree), drives a Beamer, flies out to Vegas and takes trips to Hedonism in Jamaica like every other weekend it seems. The guy just announced on facebook that he is gearing up to spend 2 months this summer to go surfing in Indonesia! Like a doctor will ever find the time to ever do that! And he is only in his 30's. And yes, that is JUST his salary. I couldn't believe it myself until I looked up his name on the NY State education site. And that salary does NOT include pension, getting paid extra for teaching an extra period or coaching soccer after school. With all the add on's he is right up there with the poor internist slaving away his life for a mere 150K.

A teaching job in the right school district in the right locale is one amazing sweet gig! For example, don't teach in rural Oklahoma unless you are content making peanuts. Also, stay away from the inner city schools unless you are planning on being the next Jaime Escalante. The kids will wear you down faster than the crack addicts are capable of doing to an ER doc. And scantrons are your friend! Combo this with recycled tests (or just use the electronic testbank that comes with the textbook to quickly crank out a test) and you will be uber efficient churning out and entering test grades into the computer before the bell rings for the day at 2 oclock!....Anyone up for a round of golf?....No?.....Oh sorry, I forgot that you are on call until 8 in the morning! ........Of course, if you dislike kids then everything I said above is moot. However, if you have the RIGHT likeable personality (unfortunately, this is where a large fraction of physicians would fail) and love working with kids AND they love you back, teaching can be as easy as breathing. It will be the easiest money you ever made. On the other hand, if your students come to despise you, your worklife will be utterly miserable. You will work for every cent.

You clearly don't know any teachers. Teachers making six figures are a rarity. Teaching jobs in the "right school district in the right locale" as you put it, are a rarity too. More often than not one has to work for years as a sub or a teachers aide (making $10/hr) in desirable districts to even get a sniff of a job. Calling teaching as easy as breathing is laughable. I guess it might be if you are a terrible teacher, don't give two $hits about your kids, and are checked out all the time.

The truth is teaching is hard and teachers are underpaid and under appreciated. My wife works 8.5 hour days which does not include lesson planning, report cards, parent-teacher meetings, buying school supplies, and many other tasks that she has to do at home. It also doesn't take into account the never ending headaches caused by over-eager parents, behavior problems, and ridiculous educational and testing milestones that get in the way of actual education.

I can assure you that your friends are as much of an anecdote as an internist making >$300,000 in a cushy upper class practice working 40 hours a week with no call.