The reality in anesthesia

[2win]

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Long time from my last visit 0 I didn't miss too much...
Planktoon and Jet and a lot of others - they are not present anymore.
As predicted few years ago, anesthesia took a hit. All was good when the benjamins were in the pocket.
Now ....NADA. Just provocative as it sounds -always I am waiting for arguments pro anesthesia/money.
Ye, ye - I know you greenhorns - you don't like to write notes and so on. But the hospitalist is making more than you. And pain medicine - just hope that you gonna make millions writing narcotics. GONE!
So - market in red for us. That's ok - maybe we gonna have a spine!
Great weekend and kill me on this board - or the crapbook ....

 

[aneftp]

The flip side is u will see a whole new generation only wanting to work 3-4 days a week. No weekends. No calls.

And don't worry about crnas. The beauty of crnas coming from the nursing field is the shift mentality. I have lots of crna friends. And the 40 hour week.

Almost to a tee. I tell them if hospital offered them 250k (instead of their $175k salary (they work 3-4 days a week, never past 5 pm). I tell them 250k with calls. Average around 50-55 hours a week with weekends. 90% of them won't take the 250k.

Crnas talk the good game. Yet there are only so many cush outpatient places they can work at.

Eventually the bottom of the market is reached. And I don't think the market will drop that much anymore.

People will just work less or cover less weekends.

It's already happening. My friends group sold out to American anesthesiology and almost all the new hires work the bare minimum. It's a trend he's noted the past several years. And these are guys (and gals) from top 5 anesthesia programs with fellowships

 

[Stank811]

I am pro anesthesia. Just will have to restructure how we operate within in a hospital system and essentially attempt to control the surgical interface from preop to ICU (aka surgical home)….and give the surgeons and the hospital what they want….surgical procedures, good outcomes, few cancellations, efficiency, high patient satisfaction scores….but of course that service is not free. If your group can provide such a service you will be rewarded.

 

[2win]

The flip side is u will see a whole new generation only wanting to work 3-4 days a week. No weekends. No calls.

And don't worry about crnas. The beauty of crnas coming from the nursing field is the shift mentality. I have lots of crna friends. And the 40 hour week.

Almost to a tee. I tell them if hospital offered them 250k (instead of their $175k salary (they work 3-4 days a week, never past 5 pm). I tell them 250k with calls. Average around 50-55 hours a week with weekends. 90% of them won't take the 250k.

Crnas talk the good game. Yet there are only so many cush outpatient places they can work at.

Eventually the bottom of the market is reached. And I don't think the market will drop that much anymore.

People will just work less or cover less weekends.

It's already happening. My friends group sold out to American anesthesiology and almost all the new hires work the bare minimum. It's a trend he's noted the past several years. And these are guys (and gals) from top 5 anesthesia programs with fellowships

Agree with you - the new generation is smarter!
The bottom is not reached - imo - see EU salaries for anesthesia ( but they have a better life than ours cause they didn't sell out).

 

[2win]

I am pro anesthesia. Just will have to restructure how we operate within in a hospital system and essentially attempt to control the surgical interface from preop to ICU (aka surgical home)….and give the surgeons and the hospital what they want….surgical procedures, good outcomes, few cancellations, efficiency, high patient satisfaction scores….but of course that service is not free. If your group can provide such a service you will be rewarded.

Really - how are you "pro anesthesia"? Just don't give me the political "preop physicians" crap. And the rest of your post goes like that - satisfaction, good outcomes , give what they want. I'll tell you what they want - cheap service!
Few cancellations - are you for real???

 

[Stank811]

I am for real…I have a game plan….seems like you already checked out….what is your strategy going forward? I don't see the surgical home as political crap…it is a viable solution. Tell me why it isn't.

 

[2win]

I am for real…I have a game plan….seems like you already checked out….what is your strategy going forward? I don't see the surgical home as political crap…it is a viable solution. Tell me why it isn't.

First of all please excuse me if I was rude.
My position is secure. I will elaborate about this later. The hospital is not your friend. They look for monkeys to work for cheap. they couldn't care less for your perioperative skills - this is a BS milked out by ASA just to create a physician from an MDA ( if you know what I mean). They did it to late when the stuff was on the wall. Compared with UK and Australia - where they had the spine to stand up and maintain their standards, here they sold us for few bucks. With extenders, using residents as worker bees, bending down and with the lube ready for everybody. Just remember that our beloved ASA supported the "Bama" reform. ...

 

[2win]

The flip side is u will see a whole new generation only wanting to work 3-4 days a week. No weekends. No calls.

And don't worry about crnas. The beauty of crnas coming from the nursing field is the shift mentality. I have lots of crna friends. And the 40 hour week.

Almost to a tee. I tell them if hospital offered them 250k (instead of their $175k salary (they work 3-4 days a week, never past 5 pm). I tell them 250k with calls. Average around 50-55 hours a week with weekends. 90% of them won't take the 250k.

Crnas talk the good game. Yet there are only so many cush outpatient places they can work at.

Eventually the bottom of the market is reached. And I don't think the market will drop that much anymore.

People will just work less or cover less weekends.

It's already happening. My friends group sold out to American anesthesiology and almost all the new hires work the bare minimum. It's a trend he's noted the past several years. And these are guys (and gals) from top 5 anesthesia programs with fellowships

Just take a look
http://www1.salary.com/Physician-Hospitalist-Salary.html
250k - 2 weeks off a month
Huuh???????

 

[aneftp]

Just take a look
http://www1.salary.com/Physician-Hospitalist-Salary.html
250k - 2 weeks off a month
Huuh???????

Not sure what your angle is.

I was talking anesthesia income about 250k and crnas not wanting to work for that pay if it involved 50-55 hours and call.

As for hospitalists. My sister in law is one. She's works one week one. One week off. It's a young persons lifestyle. But that lifestyle isn't great once u get older and have more family responsibility. And she works essentially 7am-5-6 pm and sometimes longer with call backs. 7 days x 85 hours a week . Still means at least an average of 40 hours a week.

 

[okayplayer]

Just take a look
http://www1.salary.com/Physician-Hospitalist-Salary.html
250k - 2 weeks off a month
Huuh???????

They are highly trained physicians too, first of all. They are entitled to make a good living. Second of all, hospitalists are some of the hardest working people in the medical system. Those 7 days on are no joke. 7a-7p is really 6:30a-8p w/ 2 hrs of work at home. I should know - my wife is one.

 

[Stank811]

First of all please excuse me if I was rude.
My position is secure. I will elaborate about this later. The hospital is not your friend. They look for monkeys to work for cheap. they couldn't care less for your perioperative skills - this is a BS milked out by ASA just to create a physician from an MDA ( if you know what I mean). They did it to late when the stuff was on the wall. Compared with UK and Australia - where they had the spine to stand up and maintain their standards, here they sold us for few bucks. With extenders, using residents as worker bees, bending down and with the lube ready for everybody. Just remember that our beloved ASA supported the "Bama" reform. ...

I agree with your entire post. I understand that a hospital could care less about our self proclaimed peri-operative skills….but what they don't care less about is a group that can be efficient and move patients through the hospital door---into the OR---and out as efficiently as possible…this is what we do well and just need to extend our domain a little bit more. In a healthcare environment were a hospital no longer gets paid to have a pt take up an ICU bed for more than a couple days for a particular DRG…they want people who can take care of the critically ill as efficiently as possible with minimal bounce backs and meets SCIP and all the other BS guidelines produced by CMS tied to hospital billing….who is best equipped to do this for surgical patients…..surgeons, nope they need to be in the OR….pulmonologist, maybe but they are not the best with post surgical patients…obviously I am going to argue anesthesiologist. Just as hospitalist can find 250k for 2 weeks a month….I can go out and find a ICU job that pays 350k for 2 wks a month.

 

[scudrunner]

Yes, those 2 weeks are not easy, and the work SUCKS A FAT ONE. I am grateful there are people that enjoy general medicine and all the BS that goes with it so I can do anesthesia.

 

[2win]

They are highly trained physicians too, first of all. They are entitled to make a good living. Second of all, hospitalists are some of the hardest working people in the medical system. Those 7 days on are no joke. 7a-7p is really 6:30a-8p w/ 2 hrs of work at home. I should know - my wife is one.

My wife too brother!
They work hard - and I mean harder than the pain doc who's making 500K. And this one will find a resolution soon.
Regarding the "highly trained" - 3 years of internal medicine, no fellowship. Now - in your view everybody is "highly trained". Disagree.
Except my wife. And yours too.
I never said that they are underpaid. I said that WE are underpaid. That's one of the reasons that the application in anesthesia are going down. And the rest of the reasons are found in my previous post.

 

[2win]

I agree with your entire post. I understand that a hospital could care less about our self proclaimed peri-operative skills….but what they don't care less about is a group that can be efficient and move patients through the hospital door---into the OR---and out as efficiently as possible…this is what we do well and just need to extend our domain a little bit more. In a healthcare environment were a hospital no longer gets paid to have a pt take up an ICU bed for more than a couple days for a particular DRG…they want people who can take care of the critically ill as efficiently as possible with minimal bounce backs and meets SCIP and all the other BS guidelines produced by CMS tied to hospital billing….who is best equipped to do this for surgical patients…..surgeons, nope they need to be in the OR….pulmonologist, maybe but they are not the best with post surgical patients…obviously I am going to argue anesthesiologist. Just as hospitalist can find 250k for 2 weeks a month….I can go out and find a ICU job that pays 350k for 2 wks a month.

Yes brother!
I am ccm - you see the light. Keep in mind that there is a fine line with the hospital adm.
I got a lot of offers for hospitalist/icu ( I don't knowwhat the heck means..) 250+ for 2 weeks a month.
I see that you know the biz of ICU - good for you!
Get the best of your training and be the best in your field -
2win

 

[Planktonmd]

Yes brother!
I am ccm - you see the light. Keep in mind that there is a fine line with the hospital adm.
I got a lot of offers for hospitalist/icu ( I don't knowwhat the heck means..) 250+ for 2 weeks a month.
I see that you know the biz of ICU - good for you!
Get the best of your training and be the best in your field -
2win

First of all glad to see you,
Second, I agree with everything you said!
The "surgical home" crap is a mutilated and late attempt to reclaim our position as physicians by the same *****s who sold out this profession many years ago.
It's just fluff that AMCs are selling to hospital administrators without a real plan of action.
To achieve that fantasy they are talking about you need to double the work volume of anesthesia personnel while maintaining or decreasing their pay, this is at least a 50% decrease of income under a shiny stupid name.
They want you to do the job of the primary physician, the consultants, the intra op anesthesiologist, the hospitalist and the intensivist for the same or less pay!

 

[deleted126335]

It's already happening. My friends group sold out to American anesthesiology and almost all the new hires work the bare minimum. It's a trend he's noted the past several years. And these are guys (and gals) from top 5 anesthesia programs with fellowships

I find that surprising given the current debt that many younger docs have. Our youngest docs are the hungriest and looking to pick up the most extra shifts. Exception for Mommy track.

 

[Bostonredsox]

Just take a look
http://www1.salary.com/Physician-Hospitalist-Salary.html
250k - 2 weeks off a month
Huuh???????

Have you ever worked 7 straight 12 hour shifts as a hospitalist at a heavy throughput community shop???

The burnout rate is astronomical and many look to reapply for fellowship after 3 years as a hospitalist.

Trust me.....the $250k isn't nearly enough...

 

[2win]

Have you ever worked 7 straight 12 hour shifts as a hospitalist at a heavy throughput community shop???

The burnout rate is astronomical and many look to reapply for fellowship after 3 years as a hospitalist.

Trust me.....the $250k isn't nearly enough...

Agree - but neither 300k for anesthesia with 4 weeks vacation and 60h/week. And to be bitched by hospital administrators. And push up stretchers all day long. Anyhow my plan is work for less time and much less money. I realized that I don't need so much and I appreciate my time off. The only thing left is to see how I am gonna do it. Maybe I am burnout too and sick of whatever is going on in our field. I had to vent and I appreciate your answers. thank you

 

[2win]

First of all glad to see you,
Second, I agree with everything you said!
The "surgical home" crap is a mutilated and late attempt to reclaim our position as physicians by the same *****s who sold out this profession many years ago.
It's just fluff that AMCs are selling to hospital administrators without a real plan of action.
To achieve that fantasy they are talking about you need to double the work volume of anesthesia personnel while maintaining or decreasing their pay, this is at least a 50% decrease of income under a shiny stupid name.
They want you to do the job of the primary physician, the consultants, the intra op anesthesiologist, the hospitalist and the intensivist for the same or less pay!

Glad to see that you're well!!!
I agree with you - how is life in the sunny state? We are freezing here ...
Yes - the push is huge to do more cases with less pay. I just read a survey of physician satisfaction and I can tell you that sucks.
I am wondering how O. care will impact us overall with a fixed fee for procedure + anesthesia + hospital. I am not worried - just curious.
I recently met some of the big names that sold us in the past - they are well and they are the one that are still in top position. This is just sad.

 

[countingdays]

Glad to see that you're well!!!
I agree with you - how is life in the sunny state? We are freezing here ...
Yes - the push is huge to do more cases with less pay. I just read a survey of physician satisfaction and I can tell you that sucks.
I am wondering how O. care will impact us overall with a fixed fee for procedure + anesthesia + hospital. I am not worried - just curious.
I recently met some of the big names that sold us in the past - they are well and they are the one that are still in top position. This is just sad.

I hope that works out for you. The retirement calculator is the main barrier to me against making a solid living working 3 days a week or taking a shared job with 26 weeks off per year. If your wife makes good money you could totally work half-time and still have a good lifestyle and early-ish retirement.

 

[Bostonredsox]

Agree - but neither 300k for anesthesia with 4 weeks vacation and 60h/week. And to be bitched by hospital administrators. And push up stretchers all day long. Anyhow my plan is work for less time and much less money. I realized that I don't need so much and I appreciate my time off. The only thing left is to see how I am gonna do it. Maybe I am burnout too and sick of whatever is going on in our field. I had to vent and I appreciate your answers. thank you

The gas attendings at my shop make way more than that and definitely are not working 60/week

 

[Maverikk]

Agree with you - the new generation is smarter!
The bottom is not reached - imo - see EU salaries for anesthesia ( but they have a better life than ours cause they didn't sell out).

What is the EU salary for anesthesia, is it that much lower?
And, FYI from someone on the front lines, med students are not applying for anesthesia because they see the threat. A first year student asked me if I thought CRNAs would cut the job market for anesthesiologists. My attendings still train CRNAs instead of moving to an AA model, this is where surgeons/hospitalists/ER basically everyone but us got smart: hire PAs or someone requiring supervision.

 

[deleted171991]

They were not smart either. NPs can already function as independent providers in the VA system. We are just one step away from having the CRNA problem in all the specialties.

The first big mistake was letting go of the medical direction for the non-medical healthcare state boards (and for the healthcare facilities). That was the beginning of the bolshevik revolution in American medicine, where a midlevel can behave like a physician's equal. We are all "healthcare providers". Not to speak about the college and masters educated RNs for something that used to be a vocational degree; now they are our "supervisors", who tell us what we can or can't do in the hospital. Also, there is no law blocking the use of the title "doctor", in a healthcare setting, for everybody who is not a physician.

The anesthesiologists who teach SRNAs, or let CRNAs do advanced procedures, belong to one or more of these categories:
- they have a significant (financial) gain from doing so
- they have enough money to retire anytime they want to
- they underestimate the CRNA problem
- they think their subspecialty, departmental position, or skill level will always protect them
- they have no choice and they are too coward to do something about it
- they are too lazy to do the work solo (this applies especially to academia).

 

[deleted171991]

That's the next-to-last category.

The road to hell is paved more frequently with compromises than with good intentions.

 

[kkinase]

So I'm a little confused, as someone applying for Anesthesia and making my rank list, I'm interested in CC, can you work a hybrid model of ICU and OR feasibly while making typical Anesthesiologist salary? I'm interested in staying in an academic institution as a career if that matters.

 

[thinkorswim]

So I'm a little confused, as someone applying for Anesthesia and making my rank list, I'm interested in CC, can you work a hybrid model of ICU and OR feasibly while making typical Anesthesiologist salary? I'm interested in staying in an academic institution as a career if that matters.

In academics, yes it is entirely possible. In private practice, maybe, but you would have to make compromises.

 

[gasdoc77]

Long time from my last visit 0 I didn't miss too much...
Planktoon and Jet and a lot of others - they are not present anymore.
As predicted few years ago, anesthesia took a hit. All was good when the benjamins were in the pocket.
Now ....NADA. Just provocative as it sounds -always I am waiting for arguments pro anesthesia/money.
Ye, ye - I know you greenhorns - you don't like to write notes and so on. But the hospitalist is making more than you. And pain medicine - just hope that you gonna make millions writing narcotics. GONE!
So - market in red for us. That's ok - maybe we gonna have a spine!
Great weekend and kill me on this board - or the crapbook ....

In our practice the culture is reflective of every practice I have been to. Anesthesiologists are considered advanced nurses. In the OR we are made to wear bouffant scrub hats and long sleeve scrub jackets due to an "infection control" nursing policy. Meanwhile, the "Dr's", ie the surgeons, come and go in a white coat from the street with not a word said. In fact, I would even say the reps and first assists get greater respect because they are seen as extensions of the surgeon. If they walked by the front desk alongside the surgeon there is NO WAY the nurses would stop them and critique their attire. Anyone going into anesthesia better prepare for a career of discrimination and disrespect, sometimes subtle, sometimes overt, but ever present.

 

[sevoflurane]

Anesthesia has never been a glorified specialty. We've always been in the background (unless shait hits the fan). If you are going into it to be the hero in the patients and administration eyes, you are not going into the right specialty. On the other hand, if you want to become a well rounded doctor that does tons of procedures and has the ability to take care of and develop a plan for everything from newborns to the 100 year olds AND enjoy the OR, then you should still consider it.... even if you get paid less than today's rates. I'm 100% satisfied with this specialty. I choose wisely with regards to what I was looking for in medicine. My 2 cents.

 

[somedumbDO]

In our practice the culture is reflective of every practice I have been to. Anesthesiologists are considered advanced nurses. In the OR we are made to wear bouffant scrub hats and long sleeve scrub jackets due to an "infection control" nursing policy. Meanwhile, the "Dr's", ie the surgeons, come and go in a white coat from the street with not a word said. In fact, I would even say the reps and first assists get greater respect because they are seen as extensions of the surgeon. If they walked by the front desk alongside the surgeon there is NO WAY the nurses would stop them and critique their attire. Anyone going into anesthesia better prepare for a career of discrimination and disrespect, sometimes subtle, sometimes overt, but ever present.

If your hospital is really... Really that bad maybe you shud consider another place of employment

 

[gasdoc77]

I agree with you in theory. However, opportunities seem to be drying up overnight in the field of anesthesia. Smaller facilities and rural towns utilize mid-levels more and more, if not exclusively. Each one of these positions filled by a CRNA is one less job for an MD, thus increasing the supply. It is becoming where groups are only offering employed positions because they can. In such a case, your only value is the cost to replace you. Were you an associate professor at a top tier institution? Do you display excellence in regional and echo? Are you fellowship trained? Well get in line with the rest of the new grads and don't expect a different package. You may be the Michael Jordan of anesthesia, but you could find yourself on the bench hoping to get in the game. At best you might find 3+ years to partner, assuming you don't have to work for an AMC (which I have experienced as well). For a field that will see major change in 5 years (hopefully not extinction entirely), that's a little disconcerting. I tolerate the injustices because I joined a group of aging docs who, due to unforseen circumstances, had a sudden need for a partner. Therefore the package offered was unusually fair. It was a simple case of "right place right time", which these days is the biggest factor IMO. The environment is toxic, largely due to a culture that existed long long before my arrival. However, I merely grin and bare it. In many ways I consider myself a pro$titu+e, allowing said injustices in exchange for a handsome paycheck. Quitting this job would likely mean being someone's employee and thus subject to the associated fluctuations of income/stability.

 

[turnupthegas]

With the current doom and gloom would current attendings recommend a switch to surgery if given a chance?

 

[gasdoc77]

That poses an interesting paradox. If you are willing to even entertain it, it may be worth entertaining. Despite what some say about NP's doing surgeries, etc., that is a far far cry from the battle that is currently happening on the forefront in anesthesia. I have always felt that, as physicians, the most valuable thing we offer is with our mind and not simply our hands. Anyone of any background can learn a technical skill unless they have a physical disability. The best person in the hospital at starting IV's is probably some old ER nurse. It sure as **** ain't the hospitalist, even though he's a "Dr". I exaggerate, but my point is that anything strictly procedural could arguably be farmed out. One could make a case that pathology is the only field that relies strictly upon your education (radiology being close, but the information age has made it a different ballgame as well). As medicine continues to move toward flowcharts and algorhythms, the autonomy of the provider to make judgement calls is chipped away. Anesthesia has all but relinquished that autonomy. Ultimately, the most secure route is the one where you as a provider have to independently assess a patient (or with path, a condition) and plan the coarse of action with no outside influence. This is a large amount of responsibility, but it exemplifies the command we should take as physicians. To whom much is given, much is expected.

 

[countingdays]

With the current doom and gloom would current attendings recommend a switch to surgery if given a chance?

Yes

 

[pgg]

With the current doom and gloom would current attendings recommend a switch to surgery if given a chance?

1) If you want to be a surgeon, sure.
2) The word "surgeon" is almost as vague a term as "doctor" ... world of difference between a spine surgeon and a urologist. (I wouldn't want to be either, but that's beside the point.)

 

[jjoo915]

.

 

[deleted171991]

With the current doom and gloom would current attendings recommend a switch to surgery if given a chance?

Absolutely, if you like surgery. Switch to a specialty you like, where you can stand out based on your intelectual or procedural skills, enough so that the patients would follow you to a different location if needed. Do not count on the fact that certain specialties will "never" be encroached by midlevels. ALL of them will be. It will be a matter of who can do what, when/where, and for how much.

Regarding path or radiology, I foresee automated diagnosis becoming the norm within 10 years, with a doctor signing off on it (like EKGs nowadays). That means more work and more responsibility for less money. Again, it's a matter of supply and demand, as other posters pointed out.

 

[deleted171991]

It's a shame that anesthesiologists did the hard work of building the house so safely and systematizing the practice of anesthesia only to let nurses waltz right in and squat in their living room. While you're still holding the door for them.

What's a shame is to hear my Ivy League department chair address them all the time as "our CRNA colleagues". I would be surprised to hear a surgeon talk about his PA in the same terms. 😉

 

[periopdoc]

There is still no other branch of medicine that I would rather work in . I LOVE my job. There is something to be said for job satisfaction and there is no other field that would give me equivalent satisfaction.

We can't completely ignore the financial aspects, but we shouldn't forget the other side of the coin of how our time off is structured. When we get time off, we are completely off with no office worries etc. I take more time off now and make less money and this is fine by me.

- pod

 

[deleted126335]

What's a shame is to hear my Ivy League department chair address them all the time as "our CRNA colleagues". I would be surprised to hear a surgeon talk about his PA in the same terms. 😉

There are lots of weak department chairs out there. Not just in academics. Supply has finally met demand regarding CRNAs. There will never be a better time for anesthesiologists to reassert their authority over their CRNAs on an individual local basis.

 

[Notanerd]

It's the reality of every field. The US system is turning into europes. The US is turning into Europe. It's called globalization. It's happening.

 

[deleted171991]

There are almost no midlevels in Europe, and as a doctor you still get tons more respect and less malpractice.

American healthcare is going to hell, exactly like it happened everywhere where the state decided to cut costs by touching doctors' salaries. The best and brightest will do something else. This won't happen overnight, but 20 years from now it will be evident. You will get the mediocre level of care you can expect today from a NP. It will be OK for 80% of the population, and the remaining 20% can go blip themselves.

For politicians, everything is about quantity, not quality. Make as many *****s as possible happy, while politicians stuff their and their masters' pockets. And the masters are those who put/keep them in power, either by group vote or financial contributions. By being too skimpy with our lobbying contributions in the last few decades, we doctors have lost most healthcare wars (with the malpractice attorneys, with the Medicare/Medicaid/free healthcare population, with Big Health etc.). United we stand, divided we fall; we have a history of being the latter (just look at union membership levels among those 70% of us who are employees, or the POS that is AMA).

 

[CodeBlu]

There are almost no midlevels in Europe, and as a doctor you still get tons more respect and less malpractice.

While this may be true... aren't the salaries of physicians markedly reduced in Europe?

 

[Postictal Raiden]

While this may be true... aren't the salaries of physicians markedly reduced in Europe?

They are. That what happens when you don't have midlevels and, instead, flood the country with doctors. Proportionally speaking, most European countries have 1.5x the number of physicians that we have in the U.S.

 

[deleted171991]

When comparing salaries, please use the gross hourly income. The difference might not be as striking as one would think, especially after the ACA.

Also, European doctors (and employees in general) work 1.5x less than we do, hence their increased numbers. Which results in less unemployment, among other things.

The average European doctor's salary is 2-3 times the average European employee's salary. In the US, the number is about 4-5, if one corrects for the difference in working hours. In addition, the European doctor has an incredibly better social network to take care of him and his family (starting with the free or much cheaper medical education). The differences are less and less impressive, as time passes and American healthcare migrates to corporate capitalism and populism.