Why do so many dislike primary care?

[old blue]

I would love to hear of specific reasons - I usually only hear vague ones.

One thing I do hear about is large amounts of paperwork. But isn't this now true of ALL specialties?

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[med4chi]

I would love to hear of specific reasons - I usually only hear vague ones.

One thing I do hear about is large amounts of paperwork. But isn't this now true of ALL specialties?

I think the main reason you hear bad things about primary care in pediatrics is the volume and homogeneity of the patients. You do a lot of well-child exams and see a lot of viral URIs, etc. And, yes, there is a lot of paperwork. However, I think one thing I have learned is that the importance of the generalist is underrated. It is really one of the most difficult jobs in that the majority of the patients do not have major pathology underlying their conditions, and the art of this position is being able to identify the ones that do.

 

[edmadison]

I would love to hear of specific reasons - I usually only hear vague ones.

One thing I do hear about is large amounts of paperwork. But isn't this now true of ALL specialties?

I think it is really about one thing: MONEY

Ed

 

[sjkpark]

I would love to hear of specific reasons - I usually only hear vague ones.

One thing I do hear about is large amounts of paperwork. But isn't this now true of ALL specialties?

Some people like knowing a lot about one thing rather than being "jack of all trades". Some people are, by the sheer nature of their brain wiring, crap at being generalists. I have enormous amount of respect for primary care physicians but it's not something I think I'll be good at.

 

[kristing]

Some people like knowing a lot about one thing rather than being "jack of all trades". Some people are, by the sheer nature of their brain wiring, crap at being generalists. I have enormous amount of respect for primary care physicians but it's not something I think I'll be good at.

This is a good point - People who are good at primary care are good at seeing the whole picture.

Also, realize the time/call difference in primary care vs a lot of specialties. The specialties a lot of times can have limited call (think ENT, OPtho, or Derm) vs primary care. Of course this is starting to change with the advent of hospitalists.

 

[daisygirl]

I think it is really about one thing: MONEY

Ed

You are the second attorney to make this statement on SDN (see general residency forum) .

I'm not convinced that money is the predominant deterrant for most. I think a lot of it has to do with people just not liking to deal with the same issues over and over (i.e. runny noses, headaches, back pain, tinkering with med doses for your typical chronic diseases, etc....).

I must say that what I have found very interesting in my *extremely limited* exposure to medicine is that most physicians who have specialized seem to be a hell of a lot happier. I found this striking in surgery- every single colorectal, vascular, SICU, put a category in here surgeon, was much happier in general and they all seemed to love to teach. The general surgeons were a miserable bunch (at least where I was).

The same has also applied to medicine- the derm people, cardio people, again put a specialty in here, were much happier and more willing to teach versus the family medicine physicians. I'm not saying that I've never come across a primary care doc that wasn't happy, it just seems that the docs that have specialized were much happier.

 

[bustbones26]

Since this is a pediatrics forum, allow me to steal a quote from Mr Krabs

"I like money!!!"

I tend to think of most med students as a bunch of Mr Krabs

 

[kas23]

Yes, I'll agree, that "money" statement is a bunch of bunk. PC docs can make a lot of money if they wish to. In my area, all family docs only work 4 days a week and I am sure they are making a good amount of money - certainly MORE than any primary pediatrician or the same as a specialized pediatrician. Now, what if they decided to work all 5 days of the week? Or even on Saturdays? Then they would be making a good amount of money.

And speaking of pediatricians, how can the "money" argument even surface on this message board? All of us who are going to be pediatricians will be making less or equal the amount of family docs, and you don't see us crying about the money issue. Most of us are not even thinking twice about peds.

And I also think the people who "hate" primary care are pre-meds. How can anyone who is on the verge of becoming a doctor "hate" primary care. I certainly don't "hate" it, I just wouldn't want to do it. The thing I love about medicine is that there is a place for everyone. So not everyone "hates" PC.

 

[KidDr]

Yes, I'll agree, that "money" statement is a bunch of bunk. PC docs can make a lot of money if they wish to. In my area, all family docs only work 4 days a week and I am sure they are making a good amount of money - certainly MORE than any primary pediatrician or the same as a specialized pediatrician. Now, what if they decided to work all 5 days of the week? Or even on Saturdays? Then they would be making a good amount of money.

And speaking of pediatricians, how can the "money" argument even surface on this message board? All of us who are going to be pediatricians will be making less or equal the amount of family docs, and you don't see us crying about the money issue. Most of us are not even thinking twice about peds.

And I also think the people who "hate" primary care are pre-meds. How can anyone who is on the verge of becoming a doctor "hate" primary care. I certainly don't "hate" it, I just wouldn't want to do it. The thing I love about medicine is that there is a place for everyone. So not everyone "hates" PC.

I generally agree with you, but there is one level on which I think *most* primary care physicians are frustrated about money: reimbursement.

For example: A parent may bring a child in for a typical "20 minute" acute care appointment because of "asthma--needs med refill." It sounds like a straight forward visit but when the child gets there I find out he's been in the ED 3 times in the last month wheezing, several family members are smokers, they live in substandard housing and have cockroaches, which they *think* their child is allergic to, and their landlord has refused to take care of, and along those lines, it comes up in the conversation that they're worried about being able to pay for heating this winter, and oh, we also got a letter last week that Kevin has been getting into physical fights at school (one actually requiring another ED visit for injuries he sustained) and his grades are poor, so do you think he has ADHD? And his eczema is getting worse too so he needs something for that.

Dealing with this child's asthma/eczema alone is going to take some time, counseling, and probably a phone call or a letter to the landlord later in the day, as well as maybe a referral to an allergist and a new prescription or two or three, which will require some teaching (the data on how many people actually use inhalers correctly is interesting...).

If I choose to also address this child's behavioral concerns (and it would be appropriate to ask the family to come back for another visit, but sometimes the family's social situation and the acuity of the situation makes that a difficult request), that's another 15+ minutes of questioning, arranging forms for the family/teachers to fill out, maybe another phone call to the school, and arranging for them to speak with the clinic's social worker.

As they walk out the door, I realize I forgot to refer them to the city's heating assistance program. And by that time, another 3 patients are waiting in their rooms, ready to be seen. When I sit down to bill for this visit at the end of the day, it's hard not to feel that the time I spent with this family goes a little underappreciated in the medical billing world.

Of course not all encounters are like this, but a significant number are. PC physicians feel they are the front line of medicine and that the work they do is important, but that they aren't reimbursed for a lot of the time they spend with patients. Procedures are easy to bill for, actual time with patients often is not. This has gotten somewhat better with some health plans recently, but we have a long ways to go.

This is nothing against subspecialists and surgeons, we obviously need them and it's not their fault billing works this way. And hey, some pediatric subspecialists are in the same boat because their subspeciality doesn't involve a lot of procedures (endocrine, for example).

At the end of the day, most PC physicians working in a clinic setting need to see patients in 15-20 minute blocks in order to see enough patients to bring in enough $$ for the clinic to cover overhead, pay all staff, etc, and from the above example, you can see that 15-20 minutes is almost never ideal.

In the end, PC physicians still make good $$, but I don't know a single PC physician who wouldn't love to be able to spend a more reasonable amount of time with each patient, and I don't know many patients who wouldn't appreciate longer, less-rushed visits with their PC physicians.

 

[kas23]

I agree, but the patient you described (admitted by yourself) is very complex. It also depends on where you are practicing. In the suburbs, you may see just one of these patients every third day. Most are just easy in, easy out, and the main problem is the parents complaing their child needs an antibiotic for a sniffle. Maybe in a poverty-striken community, you may see 2-3 of these patients per day. And yes, this doc should get paid for their time. But, they chose to practice within this community. They knew what they were getting into and are (mostly) happy they are practicing there.

And as I said before, there is a different piece of medicine for everyone. You don't see the ortho type wading through society's social ills, you see the type of person who was interested in social work even before going into medicine. These types (I'll admit, I am not one) love to fight through all the crap to really change the living situations of people. In fact, I think that fighting to get someone assistance for their heating bill is a lot more important than operating on someone's knee (sorry I am picking on ortho). And many people share this view and they end up going into primary care. They get "rewarded" in different ways and they still make good money, or could if they decided to move. Some rural areas in the South are paying ungodly amounts of money for PC physicians to move into their communities.

 

[Disciple]

When I sit down to bill for this visit at the end of the day, it's hard not to feel that the time I spent with this family goes a little underappreciated in the medical billing world.

But you do bill according to the complexity of the visit, right?

 

[buddym]

Guys, let's not kid ourselves. We can talk all day about people not doing primary care because of boredom (compared to the exhilirating typical day of a dermatologist), not wanting to see the same things over and over (GI sure does have a lot of variety!), or wanting to become a master in one particular area. But it comes down to this: MONEY AND LIFESTYLE.

First, money. People in general, and medical students in particular, are greedy. How many of you know a medical student that refuses to go into Peds, FP, etc even though they like it because of "poor reimbursement"? Even though 150,000 is more that 90% of the country makes. Like I said, greedy. Offer that 150,000 to a school teacher and see how they react. Call me cynical, but I guarantee you that if doctors got paid like teachers, at least half the people applying to medical school would no longer do so. THis is proven in the fact that whenever other areas of creating money (technology, business) are doing well, the number of med school applicants goes down. If the average salary for a peds doc was raised to 250,000, all of a sudden no one would mind the 'repetitive work" and paperwork. Competition would be as high as rads, etc.

Second, lifestyle. This is second only to money. Some people will take the crappy hours in exchange for money (cards, GI, etc.). Some won't. If a field has good lifestyle and money (derm, EM) then competition goes through the roof.

So, in the end, in my own humble and overtly cynical opinion, I believe that when most students decide on a residency, 99.9999999% of them do so based on money and lifestyle. If you are actually interested in the work, that is a bonus (how do you guys keep from laughing when a derm applicant states his/her "calling" to practice derm to help improve people's self esteem). I hope that I have not offended anyone with this post, this is just how I see it and I call it as I see it.

 

[kas23]

I am not offended by this, but just don't agree with it. Now, I do go to a state school and we may have a totally different mentality than the student going to a private school (since our loans are relatively insignificant).

That being said, I have never talked to one single individual who told me that they were going to pick a field based on "reimbursement rates." Who really knows what is going to reimbursed and what isn't (unless you have taken some kind of medicine business classes).

Second, I have done a derm elective and it is an extremely intellectual field, especially if you are in a tertiary center. Go to the derm board, say it is boring, and then get flamed. Arguing with some fat, old, type 2 diabetic about why one month of a "water pill" treatment will not cure HTN is hardly intellectually stimulating.

Lastly, most family med docs and PC pediatricians have an equally good "lifestyle" as ENT, derm, or radiology, simply because either they work PT or only 4 day weeks, and are in large enough groups so they take call 2 days q6 wks.

 

[sjkpark]

So, in the end, in my own humble and overtly cynical opinion, I believe that when most students decide on a residency, 99.9999999% of them do so based on money and lifestyle. If you are actually interested in the work, that is a bonus (how do you guys keep from laughing when a derm applicant states his/her "calling" to practice derm to help improve people's self esteem). I hope that I have not offended anyone with this post, this is just how I see it and I call it as I see it.

Hmmm....

It all depends on how much time you are willing to put in for the pursuit of money. There's a guy in my class whose father is a GP but owns the biggest private hospital in his hometown. Then again I know an ophthalmologist who drives a tiny Daihatsu. Smart investment - not working your guts out to bill people - are the way to earn money these days. And you need to put TIME AND EFFORT into make money out of investing.

I think you can have great lifestyle whatever specialty you go into. It is just that it is easier (i.e. more practical and accepted) to go into part-time practice in some specialty then others.

 

[edmadison]

Don't get me wrong, I was exaggerating. But if you don't think that a great number of people pick specialties based on money and lifestyle, you're nuts. Do you think you need a 240 Step I score to go into Derm because people are "called" to it? Look at some of the threads around here. I routinely see people say "I could never live on less than 250K" .

I'd love to know how you can easily augment your income doing general peds. Its not like we can do botox injections. Other than moonlighting or nickling and diming your patients, I can't see how.

One reason I like peds is that people do go into it for the right reasons.

Ed

 

[buddym]

Hey everyone! I did not mean for my post to be a knock to any field, including derm. I myself considered rads, EM and a lot of the other so-called lifestyle specialties. To address some of the contentions made by others:

1. First, I agree that FP and other PCP can have just as good of a lifestyle as ENT, derm, etc and make good money but that is the exception to the rule. Most FPs, for example, only work 46 hrs per week (not bad), but "only" make $140,000/yr. Derm and EM work the same hours and make over 200,000. Trust me, if FP had a average salary of over 200,000, then competition would be just as high as the more competitive specialties.

2. As far as knowing what reimbursments are, just take a look at regional salary surveys. I know that these can be misleading, but they give you a general idea of what each specialty makes. BTW, you will notice while you are looking at those that the most competitive specialties just happen to be the ones that make the most money. Coincidence?

3. Finally, I agree that you can see some fascinating pathology in academic derm (I guess). But the private practice derm docs that I have followed dealt with about 90% acne and chemical peels/botox. How interesting is acne? To me not very! And is all these applicants are so intrigued by the field, why do most go into private practice and put cream on zits? And why do they spend only 40 hours a week doing something that they love so much? I am not trying to be offensive, but anyone who thinks that top dogs are going into derm because of it's intellectual challenge is kidding themselves.

4. Finally, I know that being a PCP can be boring as well. Never said it couldn't. My point is that that is not what keeps people from doing FP. It is the fact that they don't earn as much as other physicians that keeps people out. Most people won't say that they avoid PC because of lack of reimbursement because it kind of makes you look like a greedy guy.

Anyway, I certainly respect everyone's take on this, and hope that the debate rages on. Maybe one day peds will be paid 300,000/yr and then we can see who is right??

Thanks

BTW I do think that peds is the exception to my greed rule. Some people just love kids. I still think a lot of the applicants would go into derm if they had the numbers

 

[bustbones26]

We all know hat not everybody in medical school "seeks the holy grail" or is in it for the money, but lets face it, somewhere along the way, a lot of us do get greedy & lazy, and I do not see how anybody can deny this??

Why, please somebody tell me why when the average salary of a given specialty rises, so does the residency applicants and its competitiveness?? Can anybody deny that money drives this?

And can anybody tell me why when a competitive high paying specialties reach their max, that all of the sudden average paying specialties with cushy lifestyle start to see a surge of applicants?

Money and lifestyle are the only explanations for this. In honesty, I really don't care, I know what I want to do and will do it. But I do think that it is a shame that I have to consult and work with other physicians that hate their jobs but are in it for the cash or lifestyle, ultimately, it will make my life as a physician less pleasant. Allow me if I may to share some quotes I have gathered over my clinical years as a 3-4 year student

"Don't go into surgery, I went into it because my Dad was one and he made great money! Now I hate it, I'd have to close my office if I didn't moonlight on the trauma service"

"These patients are driving me crazy! Its days like this that I wish I went into something else, but lets face it, psychiatry has a nice lifestyle, doesn't it!"

"When I was a kid, my Dad used to take me on weekend trips with his private plane, man we had it good, that is when I knew I wanted to be a surgeon too"

" I really like gastroenterology, but then I figured, hey, I'd make more money in cardiology so that is what I am applying for"

"Why one earth would you ever want to do anything different than what I do (ophthalmologist). I make great money and I almost work part time!!"

So what I am saying here is this, in the above quotes, nobody say, I went into X because I am fascinated by it, because I think it is intellectually stimulating, etc etc.

 

[TexasRose]

So, in the end, in my own humble and overtly cynical opinion, I believe that when most students decide on a residency, 99.9999999% of them do so based on money and lifestyle.

If that were the case, there wouldn't be any PC docs.

I realize that there are quite a few med students out there who are more interested in how much money they can earn than anything else. I disagree, however, that that is the sole or even prime motivator for most of us. I know a bunch of people in my program that are interested in fields that will not make them $250k/yr. They really do care about the patient population they will be serving or the diseases they will be treating. Yes, some of them are in it for the money, but the generalization is pointless and wrong, in my opinion.

And I agree that very few people would apply to med school if the annual income was 30k, but a good chunk of the reason would be that you could never hope to repay the loans or make up for the lost years of earning potential while in training. Plus, there's a tremendous lack of respect in our society for people who don't make a ton of money. Sad, but true.

 

[oldbearprofessor]

Hi:

I spend a good bit of time talking with pediatric residents who are interested in fellowships (not just neo) about the pros and cons of this decision. Now, clearly, this is a biased group that already has an interest in subspecialty pediatrics and of course, I am a bit biased. However, my observation has been that their number one concern is often "Can I survive the fellowship in terms of money and lifestyle?" Generally, they want to do a fellowship because they like what they see the faculty in that field doing, but are concerned that delaying becoming an attending for at least 3 yrs will affect their family life (i.e. having and raising kids) and delay repaying substantial loans. In other words, in the short-term, for those finishing residency, the money issues are tougher if you choose to specialize. Whether or not this is worth it, financially or personally, is something each person has to decide.

With regard to the actual original question, I can only say that I enjoyed the primary care aspect of my residency, but knew that I preferred taking care of sick patients and babies. I think that described most of the people who did their training with me - that is, they didn't hate primary care, but just recognized that what they liked best and were best at was specialty care. Of note is that, especially in pediatrics, many specialty fields (e.g. rheum, endo) have lots of follow-up outpatient work and aren't all that different in day-to-day routine than general peds, excpet the patients usually have a (single) significant underlying chronic illness.

Regards

OBP

 

[notstudying]

One reason I like peds is that people do go into it for the right reasons.

Ed

 

[iatrosB]

One reason I like peds is that people do go into it for the right reasons.

Ed

This is certainly one of the many points drawing me to the field, sincere collegues.

 

[CJMPre-Med]

Let me address some clear nonsense:

First, money. People in general, and medical students in particular, are greedy. How many of you know a medical student that refuses to go into Peds, FP, etc even though they like it because of "poor reimbursement"? Even though 150,000 is more that 90% of the country makes. Like I said, greedy.

Yet any physician, including those who go into primary care, do more work, and sacrifice more to get where they are, than 99% of the population. So...not greedy. Think about what the word "greed" means. Hint: it doesn't mean "desiring commensurate compensation."

Offer that 150,000 to a school teacher and see how they react.

Have teachers go through what physicians do to earn that $150K (both in med school and residency as well as in undergrad) and I'll bet dollars to doughnuts that they react in exactly the same manner.

Call me cynical, but I guarantee you that if doctors got paid like teachers, at least half the people applying to medical school would no longer do so

Err, of course not. Not sure exactly what you're trying to "prove" with such a remark. Are all physicians supposed to be Mother Teresas? Should they solely do what they do for the love of it all and not desire proportionate compensation? Who in their right mind is going to sacrifice in undergrad, sacrifice their 20's in med school, and then slave away at an 80-100 hour/week residency for minimum wage for 3-7 years only to come out making $40K? I think it's hysterical that this is your "criterion" for judging whether people are "greedy" or not.


Ever done any human resources work? Ever heard of a thing called "compensable factors"? How about "market forces"? Physicians are woefully underpaid based on any compensable factors job analysis you can make, and even the market forces which normally would serve to correct such a sad state of affairs are circumvented due to third-party payors (i.e., insurance companies) and governmental interference.


Please do some research before you start spouting nonsense such as "physicians are greedy" (I guess stockbrokers, accountants, lawyers, and mutual fund managers must be INCREDIBLY greedy then, since many of them make well over $250K yet undergo much less schooling, training, and possess less valuable, irreplaceable and specialized expertise (not to mention much less socially valuable jobs).


Physicians desiring to be adequately compensated-- just as we do for every other profession-- does not make them "greedy". It just means that they have a functioning brain. News flash: do you think that any other profession or occupation would have allowed their incomes to drop off so precipitously as physicians have without mass protest and strikes? Christ, teachers and nurses and civil servants strike at the mere mention of a reduction in pay or benefits, never mind seeing their net incomes drop off 50+% for some specialties (and at least 30% for all physicians) in under 15 years. But yeah, doctors are "greedy". You should thank your lucky stars that they're not greedy, or else they would have just went on a nationwide strike like everybody else does when their compensation is threatened in some way. Note that I feel that teachers and civil servants etc. are also underpaid, but the points I've made hold.

 

[iatrosB]

Let me address some clear nonsense:




Yet any physician, including those who go into primary care, do more work, and sacrifice more to get where they are, than 99% of the population. So...not greedy. Think about what the word "greed" means. Hint: it doesn't mean "desiring commensurate compensation."




Have teachers go through what physicians do to earn that $150K (both in med school and residency as well as in undergrad) and I'll bet dollars to doughnuts that they react in exactly the same manner.




Err, of course not. Not sure exactly what you're trying to "prove" with such a remark. Are all physicians supposed to be Mother Teresas? Should they solely do what they do for the love of it all and not desire proportionate compensation? Who in their right mind is going to sacrifice in undergrad, sacrifice their 20's in med school, and then slave away at an 80-100 hour/week residency for minimum wage for 3-7 years only to come out making $40K? I think it's hysterical that this is your "criterion" for judging whether people are "greedy" or not.


Ever done any human resources work? Ever heard of a thing called "compensable factors"? How about "market forces"? Physicians are woefully underpaid based on any compensable factors job analysis you can make, and even the market forces which normally would serve to correct such a sad state of affairs are circumvented due to third-party payors (i.e., insurance companies) and governmental interference.


Please do some research before you start spouting nonsense such as "physicians are greedy" (I guess stockbrokers, accountants, lawyers, and mutual fund managers must be INCREDIBLY greedy then, since many of them make well over $250K yet undergo much less schooling, training, and possess less valuable, irreplaceable and specialized expertise (not to mention much less socially valuable jobs).


Physicians desiring to be adequately compensated-- just as we do for every other profession-- does not make them "greedy". It just means that they have a functioning brain. News flash: do you think that any other profession or occupation would have allowed their incomes to drop off so precipitously as physicians have without mass protest and strikes? Christ, teachers and nurses and civil servants strike at the mere mention of a reduction in pay or benefits, never mind seeing their net incomes drop off 50+% for some specialties (and at least 30% for all physicians) in under 15 years. But yeah, doctors are "greedy". You should thank your lucky stars that they're not greedy, or else they would have just went on a nationwide strike like everybody else does when their compensation is threatened in some way. Note that I feel that teachers and civil servants etc. are also underpaid, but the points I've made hold.

I like it! Well said.

 

[buddym]

Wow CJMpre-med!! You used a lot of big words, let me see if I can defend myself some here!

You do not seem to understand what I am arguing in my posts. Did I ever say at any point in my post that physicians do not deserve to earn the money that they make? I did not. My problem is that this is a lot of money to other people, and it is insulting when we as med students act like 150,000 is chicken feed. The original question in this post in why do so many people go into specialties instead of primary care. My reasoning for this is money and lifestyle considerations, you did not argue against this in any part of your post.

1. people in general (note I said all people) love money, and always want more than they need. You asked about how I define greed. I define it as someone who wants more than what they need. My main beef about medical students was not that we expect to make big money when we get out, my beef is that that is all most of us care about, and that we always want more.

2. Do you really think that ANY physician works harder than 99% of the population? I hope you don't say that kind of stuff at dinner parties. Work is not just about getting an education, or the number of hours per week you put in. Trust me, if you spent a year in the life of a construction worker, you would be begging to go back to that 60 hour work week as an internist. Which life would you rather lead for 150,000 a year? The lifestyles of a physician are not as bad as these posts make it sound.

3. What was I trying to prove by my comment that a lot of people would not go to medical school if we got paid less? Well, I was not really trying to prove anything, I was just giving some observational confirmation that most people become doctors to make a lot of money. If a person was genuinely interested in medicine, they would go into despite the pay, just like people in other professions do. What kind of person would go to medical school and make all those sacrifices just to earn 40,000 a year you ask? Well, I guess someone that was sincerely in medicine just to heal people and did not worry about how much money they would make. Since you are asking that question, I assume that does not apply to you. I think that many time we put our financial concerns/desires over the well-being of our patients. Go to the EM forum and observe the absolute jubilation over the current EM shortage. Even though an EM shortage is bad for patients (more doctors from other fields in ER, longer wait times,etc), we as medical students love it because it allows us to buy a bigger house if we do EM!

4. You mention a lot of data about how physician deserve the money that they get, and that it is only a commensurate income (where did you get your percentages by the way??), and again, I completely agree. I want to make this clear, my argument was never that physicians or med students are greedy because they want to make a lot of money. My argument is that many people lose sight of how much money they really need, and that money becomes the main reasoning behind their career choices. I do not think that this is a good thing.

Later

 

[kas23]

Wow, this is proof that some posts just don't die. Yes, people are greedy, by most definitions. Ever see the Seinfeld episode about how everything people do is for selfish reasons? Same as going into medicine, same as going to work in construction (a la Will Hunting). Primary Care physicians don't make shabby money, neither do garbage men, and yes, H & R Block employees make good money for 4 months of "season" work. Everyone wants money and to help people, as proved by all the pre-meds working at a soup kitchen or doing social work. Hmm, how else can I beat this to death.... Sorry in advance if I offended anyone.

 

[jdog]

The original question was "Why do so many dislike primary care."

My answer is that so many people DO NOT dislike primary care. Even from the most hardcore tertiary care and quaternary care Peds residencies, over 1/2 of residents go into primary care. It has been decreasing somewhat over the last few years, but overall at least 2/3 of Peds residents go into primary care, actually more than 15 or 20 years ago.

As to why peopole choose not to go into primary care, in my opinion, at least in pediatrics, it has very little if anything to do with money as many subspec pay less than a successful peds private practice.

The reasons are many that people don't llike primary care.
Many people think it is extremely boring. For example, typical day in a gen peds office may be 50 percent well child checks, during which many have to have forms filled out, answering tons of questions about mundane things, and many people find development stuff painful.

For example, the typical day of a neonatologist will include interpreting ABG's, running ventilators, resuscitating babies, doing invasive lines and intubations.

It is easy to see the difference.

Also, in many ways primary care is much more difficult than subspecialty because you are on the front lines, getting dozens of calls a day, dealing with frustrated parents of kids who have a cold that are not getting better. You really never actually diagnose many things that you see and call them "viral illness". The way things are today in many big cities, gen peds docs do not see their patients in the hospital because of reimbursement issues, so they lose their inpatient and acute management skills and procedure skills.

In this day and age also, so much of peds is ADD, parents worried about autism, etc. that you really have to be good at this stuff, and frankly many people just hate it.

Hope this helps.

 

[CJMPre-Med]

buddym:


I don't mean to be argumentative, but I won't lie when I say that I take serious issue with several things you've said. Allow me to explain (sorry about the "big words", btw ):

Did I ever say at any point in my post that physicians do not deserve to earn the money that they make? I did not. My problem is that this is a lot of money to other people, and it is insulting when we as med students act like 150,000 is chicken feed. The original question in this post in why do so many people go into specialties instead of primary care. My reasoning for this is money and lifestyle considerations, you did not argue against this in any part of your post.

Perhaps you didn't say such things explicitly, but I would argue that by your comments about how "greedy" physicians are for desiring proportionate compensation you've made precisely that point implicitly. They're one and the same imo.

You're correct that I didn't argue against the point that people go into the specialties for money and lifestyle considerations, because it's quite correct in my opinion (obviously, barring instances where a person actually truly LIKES that particular specialty; I don't think it's a stretch to say that fewer people would be applying for derm if the net income was halved, however). Allow me to continue...

1. people in general (note I said all people) love money, and always want more than they need. You asked about how I define greed. I define it as someone who wants more than what they need. My main beef about medical students was not that we expect to make big money when we get out, my beef is that that is all most of us care about, and that we always want more.

First off, your conception of "greed" is horribly malformed, no offense. A greedy person is "someone who wants more than they need"? No offense, but that's just untenable hogwash. Fact is, nobody "needs" more than $25-30K per year; so you're indicting every single person who desires to make more than that-- no matter if that increased income is deserved or not-- by invoking such an overly broad definition. You want my conception of greed? Fine: a greedy person is someone who desires more than they deserve, above and beyond some minimum threshold. Therefore, a CEO making $20M per annum who desires a $10M raise is greedy. A physician of ANY sort who's making $130K desiring to earn $200K is not greedy.


An obvious charge that can be leveled against such a notion is that it's inherently subjective-- after all, who determines what is "deserved"? Ignoring purely philosophical considerations, I'd say that the established HR (human resources) criteria regarding compensable factors and market forces should determine such a thing as far as they go ("as far as they go" because I think after a certain point, the acquisition of wealth becomes obscene; therefore I would not philosophically defend a CEO or movie star making $60M per year in income no matter if a legitimate job/market analysis states that this is fine and proper. But I digress...). The notion of "compensable factors" and other job analysis techniques dictate that those who are more skilled and more valuable be paid more than their less skilled and less valuable (to society) counterparts. Period. The point is that unless you're going to change our entire society around into something akin to communism (after all, as I've shown, nobody needs more than $30K in reality-- should we all make $30K and call it a day? Not trying to put words in your mouth here, but certain statements you've made lead to unsupportable situations imo), then physicians deserve to earn quite a bit more than they currently are-- regardless of the fact that they earn several times the national median income already. That has no bearing at all on the issue of proper compensation. That's not greed, that's their due.


As for your issue being about the fact that "money is all most medical students want, and they always want more", well, two points:

1) I don't think at all that money is the primary motivation for most people going into medical school nowadays. There are FAR less arduous career paths one could take and make the same or better money for far less of an investment in terms of time, energy, and financial investment (loans etc.). Now, obviously money is an issue for most medical students, but that's the way it is in any cost-benefit analysis: you have your "cost" matrix (time invested, the rigors of the endeavor, the effect on one's personal life, financial cost etc.), and then you have your "benefit" matrix (feelings of personal satisfaction/worth resultant from said endeavor, intellectual jollies, feelings of prestige/accomplishment, and, yes, compensation). Deciding to do things based on the outcome of these analyses is entirely rational and defensible.

Now, while it's your right to deride those who give ANY consideration at all to their future remuneration, please realize that not all those who do are "greedy" (under the normal, sane person's definition that I've put forth above, which most everyone adheres to-- not under the clearly misguided definition you've proffered ). For instance, as you noted later on in your post, I freely admit that I am not interested in medicine just to heal people, though helping others is a BIG motivation for me. Money is a factor, and, quite honestly, if physicians earned $70K per year, there's no way in hell I would do it-- and that's not because I'm greedy, but for my future family's sake. I don't need money for myself, but I'd like to be able to take care of my future family in a comfortable manner, and $70K per year after the time invested/lost and the rigors of the job (being a physician puts a strain on one's family life, without question) is entirely unacceptable. But if you were somehow prescient, and could tell me with certainty that I was fated to live a solitary life, I personally wouldn't care if I made $60K as a physician, because I don't need to drive around in a Benz, quite frankly. So am I greedy, or do I just place a higher priority on my future family's comfort than on pure altruism (i.e., "healing people regardless of the pay")? I'd say the latter-- and I don't think that I, or anyone else, can rightly be criticized for that. Medicine is a profession (indeed, he most difficult profession)-- it's not meant to be social work.


2) The fact that we (i.e., medical students/physicians) "always want more" is first off not unique to physicians/med students, as you noted. Secondly, I'd say that most of them "want more" because they're currently being grossly undercompensated in all fields. Dude, the really greedy people DON'T go into medicine, they go into business or law in the hopes of hitting it big with far less effort. Do surgeons deserve to be making only $230K, as many now do? Hell no-- they're among the most expert, skilled, and dedicated professionals in the world, yet somehow we as a society can justify paying them less than some '**** MBA mutual fund manager making $600K at age 29. Right-- that makes perfect sense. Point being that if physicians were being paid commensurate with their training and value (as all other professions are-- at least to a greater degree than physicians are), I don't think you'd see nearly as much carping about compensation. Any person who can get into and survive med school and residency could certainly have been successful in any field they chose to go into, and if all they wanted was the money, as you assert, there are far more lucrative fields they could have entered to get it. Your statement doesn't hold water on any level, quite frankly.


Let me turn this question around and ask you this:

Do you honestly think that you'd get the same quality of physician is they were paid $70K? The short answer is "no", because believe it or not, no reasonably intelligent and industrious person (as most med students are) is going to sacrifice what doctors have to sacrifice to earn such a pittance. The more intelligent people (again, barring those who have a true passion for the field and are purely altruistic) will realize that whatever noble intentions they may have had will have to take a back seat to MAKING A LIVING. And though yes, you will get those rare, purely altruistic persons who will still do it, good luck finding enough of them to keep up with demand. Further, standards will inevitably be eroded as the bulk of the applicants become less intelligent/hard-working, leading to lesser quality physicians (all other factors-- bedside manner, empathy, communication skills etc.-- being equal). The fact is that no ("no" meaning a negligible percentage) person with a 130+ IQ will kill themselves strictly for idealism. You can believe that; this is why you're starting to see the breakdown of various socialized systems around the world-- physicians striking because they are in some countries being paid what postal workers are being paid. This is indefensible-- human beings can perceive when things are unfair, and they will act on that perception.

In other words, idealism is good as far as it goes (and I'm as idealistic a person as any), but it has its limits. Just as the notion of communism has its good points, so does capitalism and its attendant features (proportionate compensation etc.); you're skirting the line here imo, and it's not only an untenable stance, but it would be unpalatable to the majority of the nation because it's too extreme to expect physicians to basically be Jesus Christ for the sake of others and forgo any sort of financial reward.

 

[CJMPre-Med]

2. Do you really think that ANY physician works harder than 99% of the population? I hope you don't say that kind of stuff at dinner parties. Work is not just about getting an education, or the number of hours per week you put in. Trust me, if you spent a year in the life of a construction worker, you would be begging to go back to that 60 hour work week as an internist. Which life would you rather lead for 150,000 a year? The lifestyles of a physician are not as bad as these posts make it sound.

First, define "work". If you define it as strictly physical labor, then obviously physicians do not work as hard as construction workers and other manual laborers do. But I'd submit that dedicated medical school candidates do, in fact, work orders of magnitude more than construction workers do. They work in high school, they work in college (sacrificing the normal "college life" in many cases to pursue their dream), they totally erase their 20's with med school and residency, neglecting their personal lives in many instances (hobbies, friends, relaxation time, putting off starting a family etc.), they are severely overworked in residency and paid minimum wage for 3-7 years despite their expertise, they are deprived of adequate amounts of sleep for nearly a decade, and then when they finish it all may have such a strained familial relationship due to the nature and rigors of the work that physicians have the highest divorce rates of any professionals. Tell me what a construction worker does again? Oh yeah...he finishes high school after slacking off and then starts working 10-12 hour days while being able to enjoy his time off, has no responsibilities, no work-related stress (inherent in the job; neglecting interpersonal stress due to one's superior etc.), and then can eventually earn up to $100K per year despite having no discernible skills, expertise, or socially redeeming value (speaking of the nobility of the job here-- obviously construction workers perform essential functions). Yet pediatricians and FP's should be earning $100-120K, as nearly 40% of them do? Doesn't compute...


This is not to rag on construction workers, obviously, as I have nothing against them (or anyone), and don't "look down" on them at all-- just please don't try to tell me that they "work" as hard as a physician has in their life to get where they are, because that's simply FALSE. Physicians not only work harder than nearly every other person in the country (with the possible exception of dedicated research scientists, who are ALSO woefully underpaid), but they sacrifice more than ANY other person in any other occupation. Ignoring these facts while setting compensation rates is foolhardy imo.


As for "which life I'd rather lead for $150K per year", I'd certainly like to lead the construction worker's life-- no intense schooling, volunteer work and sacrifice needed, no neglect of one's personal life for over a decade (college ---> residency), no 60 hours/week with one's head buried in a book detailing some obscure pathology, no 30+ hour rotations while getting paid minimum wage during residency for 3-7 years, no need for continuing education throughout the rest of one's life in order to stay current (another factor that's often overlooked), no needing to retake certification exams periodically, no pager going off on days off or at 3 AM etc.


You get the picture. I'm not saying that construction workers have any easy life, but come on now...it in no way compares to what physicians have to go through their entire lives. I've done construction work before, so I'm not blowing smoke.

I was just giving some observational confirmation that most people become doctors to make a lot of money.

Yet they DON'T make a "lot" of money for what they do and what they endure, so your point is moot; besides, it was spoken to earlier in this post.

If a person was genuinely interested in medicine, they would go into despite the pay, just like people in other professions do

This is faulty reasoning, and here's why:

People entering these "other professions" (say, teaching) operate under the SAME EXACT cost-benefit mentality that everyone else does. They say, "hey, these are my costs" (4-year education degree, not exactly arduous-- my sister's a teacher, I know what I'm talking about; time invested outside of class, which can be a lot depending on the dedication of the teacher, but is largely what you make of it; relatively low starting pay), and these are my benefits (respectable occupation, personal satisfaction from helping children, fairly good to excellent compensation after time, including a generous pension after 30 years-- i.e., age 52-- of $80K/year including FULL health benefits; a TDA account that many teachers retire with that has over $750K in it-- true stuff).


Now, based on these matrices, a person makes a decision. If you were to take away the guaranteed pension and lifetime health benefits (physicians get none of this, remember), or were to increase the requirements to mandate a Ph.D before entering even elementary education, you would see FAR fewer teachers than would be needed to keep up with demand. Yes, some would still do it-- the ones who "truly loved" it (i.e., the mini-Christs). My sister is probably such a person-- she graduated from NYU with an education degree with a minor in math (one year of calc, stats, linear algebra etc.) with a 3.9 GPA; she could've done anything she wanted with herself, but she always knew she wanted to teach children, as that was her passion. You can bet your ass that there aren't many like her, though, however touching or compelling her story may be...


So I submit that physicians (or future physicians) are NO DIFFERENT than people considering ANY OTHER line of work, and that they operate based on the same considerations and analyses that everyone else does. Thinking that "other professions" all just do it because they "love it" is just...shockingly naive, frankly. Why do we allow cops to retire after 20 years in most states? Because there's a risk to one's life there that factors into the cost-benefit analysis; extend that mandatory minimum to 40 years, and you change the entire equation-- far fewer applicants would endeavor to become police officers. It's a fact that nearly every city and union worker (mostly the bureaucrat paper-pushers, but cops and firefighters as well) are induced to fill those jobs by the benefits and pensions they receive, whatever other motives they may have. To assert that everyone else in the country performs their jobs "out of love" while physicians don't is a joke.

What kind of person would go to medical school and make all those sacrifices just to earn 40,000 a year you ask? Well, I guess someone that was sincerely in medicine just to heal people and did not worry about how much money they would make

Fine, I'll grant that that's who you'd end up getting as a physician. Good luck making due with the 7 physicians per year you'd get, though. Also good luck with the fact that the ones you'd get would by and large not be as intelligent and capable as the ones we get currently, due to the factors previously discussed-- most intelligent people desire a reasonably comfortable (not rich, comfortable) life where they're paid commensurate with their skills and value. Also please realize that, as noted earlier, not all people for whom money is a factor DO NOT want to genuinely help/heal people-- the two considerations are not mutually exclusive (as in my case); unfortunately, one must take precedence over the other, and since the other investments one must make in order to become a physician are quite daunting, it's unreasonable to hold the fact that people desire a comfortable life over their heads, as if they're not as "morally pure" as these other folks. As I said, how can you reasonably say that when I desire money solely for my future family's sake and not my own? That's not moral?


Also note that if you were advocating changing society in general, to where everyone else was paid more in line with the $70K figure, then perhaps you could pull such a thing off (neglecting the capitalism vs. communism thing here-- I'm more of a capitalist, though I decry its excesses) and pay physicians $70K and still get the most qualified applicants. But as it stands, when you have ****head lawyers and day traders earning $200K, and two-year MBA grads earning $700K as portfolio managers, you're going to bear the fruit of that discrepancy between the way the REST of society is compensated (i.e., based on compensable factors/market forces), and the way you're advocating paying physicians (or, rather, not that you're "advocating it", per se, but you're saying that lack of adequate compensation would weed out those motivated purely for financial reasons-- which I submitted is very small number given the nature of the profession-- the point is that you couldn't do this unless you changed the entirety of society; since that's not going to happen anytime soon-- nor is such a thing necessarily sensible-- we should stop with the overly idealistic pap for now ).

 

[CJMPre-Med]

I think that many time we put our financial concerns/desires over the well-being of our patients.

I disagree-- I would say that physicians go OUT OF THEIR WAY, above and beyond the call of duty, to meet their personal demands of themselves vis-a-vis patient care. I would challenge you to find another profession which allows itself to be so abused (financially and interpersonally) by its patrons and yet still serves them with unfailing dedication; another profession which has allowed its net income to drop off some 30-50+% over the last 15 years with not a single mass strike (contrast this to other professions/occupations) or other action. If physicians didn't put their ethics and the well-being of their patients ahead of their financial concerns, you can bet your ass that there would have been a nationwide walk-off over what has transpired in the health care field over the course of the last decade or so-- you're kidding yourself if you think that's not the case. The fact that there hasn't been widespread revolt and striking tells me a LOT about the character and motivations of physicians as a whole, and it should tell you a lot too.

Go to the EM forum and observe the absolute jubilation over the current EM shortage. Even though an EM shortage is bad for patients (more doctors from other fields in ER, longer wait times,etc), we as medical students love it because it allows us to buy a bigger house if we do EM!

Actually, they're probably jubilant because it makes them stand a better chance of being paid commensurate with their skills and value, just as everyone else in the country is-- not because they can "buy a bigger house". There's a difference. People being happy that they will be compensated adequately for their expertise and sacrifice is not something to be chastised, however much you'd like to make it into some "physicians vs. patients" thing. Why is there an EM shortage, btw? Riddle me that...

I want to make this clear, my argument was never that physicians or med students are greedy because they want to make a lot of money. My argument is that many people lose sight of how much money they really need

Again, nobody needs more than $30K per year. Your argument is fundamentally flawed in that respect.

and that money becomes the main reasoning behind their career choices. I do not think that this is a good thing.

I disagree for the reasons previously stated. If money were the sole criterion, they could have picked a hell of a lot easier way to go about obtaining it; couple this with the aforementioned facts about physicians staying silent while their income dropped off precipitously over the past 15 years as well as the fact that they ALREADY do more stuff for free (calling patients off-hours, dealing with insurance BS which they are not compensated for etc.) and the argument is incredibly suspect.


Answer me this: can a person desire to lead a comfortable life, believe that people deserve to be compensated commensurate with their expertise and value, AND genuinely want to help people very much? Answer carefully, because I'm such a person.


In short, I feel you're making far too many assumptions about certain groups, and creating quite a few false dichotomies in the process. Anyway, it's finals week, so I'm off.

 

[novacek88]

1. less compensation when compared to other fields of medicine IN GENERAL
2. less prestige


These are the two main reasons. I don't think monotony is the primary reason for why primary care fields are unpopular. Every field has it's fair share of monotony. In a private practice setting, you will see the same thing repeatedly regardless of what field you are in. The difference is you don't have to work as hard in a specialized field as you have to in a primary care field to earn the same type of money. For example, a cardiologist can work in a large groups and earn 200-250K working 4 days per week with limited call. A dermatologist can easily make close to 300K per year working 40 hours per week and have basicaly no call. A busy FP, Pediatrician or IM would have to see many more patients, work longer hours, deal with more paperwork and take more call to earn this same income

So you can earn a lot as a primary care doc but you must be willing to see more patients in a day and thus work longer hours to accomplish this. There are primary care docs who earn a lot of money but these docs have exceptional business acumen; are practicing in a location that can provide the large patient population they would need, and work longer hours to handle the large volume of patients.. They probably own their building and lab instead of leasing an office and sending out samples to outside labs to analyze. And these docs see a crazy number of patients and by crazy I mean in excess of 60 patients per day by themselves. I know an FP who makes close to 7 figures. He sees about 70 patients per day himself and has 2 PA's and 2 FP's working underneath him who see an additional 150 patients per day with him. Combined his office sees over 200 patients per day. That is an insane amount of patients. He works from 8 AM to 9-10 PM at night 5 days per week and doesn't take lunch.

 

[novacek88]

I would challenge you to find another profession which allows itself to be so abused (financially and interpersonally) by its patrons and yet still serves them with unfailing dedication;

Police officers, Firemen, Nurses, School teachers, factory workers, farmers, day laborers

another profession which has allowed its net income to drop off some 30-50+% over the last 15 years with not a single mass strike (contrast this to other professions/occupations) or other action.

Physician salaries have actually increased. When adjusted for inflation they have slightly decreased. Still when 92% of the U.S. population earns less than 40K per year and when less than a 1% of the U.S. population earns 200K or more(a salary which the average physicians earns when accounting for all physicians), you wonder why people don't sympathize with physicians.

Furthermore, I challenge you to find another profession which artificially keeps their numbers low regardless of market demands. I challenge you to find me a physician who is unemployed and cannot find work anywhere in the country? How physicians suffer from age discrimination? How many physicians can't find work because they are overqualified like many middle aged workers? I know plenty of lawyers, MBA's and engineers who have spent nearly a year interviewing all over the country yet still can't find employment. And if they do get hired, it's usually at a job that pays a lot less and offers far less responsibility. Even those obstetricians who can't afford high malpractice premiums can still practice gynecology or move to a zip code which offers drastically reduced premiums. Even the general surgeon in Dade country, Florida can move to another part of the country and earn more money and pay lower malpractice premiums. How many I-bankers, programmers and lawyers do you know of that can move to an underserved 30,000 population town and earn twice what they did in the city? Unlike these jobs, physicians are not geographically limited to certain urban areas to be able to thrive.

If physicians didn't put their ethics and the well-being of their patients ahead of their financial concerns, you can bet your ass that there would have been a nationwide walk-off over what has transpired in the health care field over the course of the last decade or so-- you're kidding yourself if you think that's not the case.

You must not remember the 1980's. This is the entire reason why insurance companies initially took efforts to place limits on reimbursement because physicians and hospitals were abusing the system at times. I agree that it has gotten out of control and insurance companies have done the opposite and are preventing patients from receiving full care so they can save money but remember what caused this whole mess in the first place.

Why is there an EM shortage, btw? Riddle me that...

Because there are not enough residency positions to keep up with the growing demand especially with more and more hospitals being built. EM is still a very competitive field and a lot of people don't match into EM despite their efforts. Why is it the highest paying fields are the most competitive to match? Radiology is a classic example. 15 years ago, radiology was not competitive at all. Many FMG's were matching radioloty. As technology improves and the supply of radiologists dwindled in the 90's. the demand for and thus the average income of radiologists skyrocketed. Radiology is now one of the most competitive fields to match in. Do you think this is because a new generation thought it was suddenly cool to look at X-rays all day?

I disagree for the reasons previously stated. If money were the sole criterion, they could have picked a hell of a lot easier way to go about obtaining it

What are these "easier" routes that you speak of? Investment banking is as hard to enter as medical school itself. I-banks only interview students with high GPA and from a selected list of schools which include the Ivy League schools and a few reputable liberal arts and academically oriented state schools like UCLA, Michigan and Virginia. Have you seen the hurdles it takes to become an I-banker? . I-banking interviews not only include a series of tests; they include IQ and special task tests they ask you to complete on the spot. Imagine if your med school interview asked you to do a random physicis problem they created at the drop of a hat to test your critical thinking skills. And even after they get hired, I-bankers get layed off all the time regardless of their performance. If the market takes a hit, I-bankers get cut. Most lawyers don't earn over 60K per year. Ask any stockbroker, mutual fund manager and others you listed as making a lot of money how typical that is for them to earn over 250K. I was a broker, headhunter and conultant upon graduating from college. With all due respect, you have no idea what you are talking about. Most brokers quit. The brokers that make a lot of money are the ones who are fortunate enough to inherit a "book." There are so many brokers that cold call people that it is nearly impossible to get enough clients to make ove anywhere close to 150K. A mutual fund manager is usually someone in their 40's or 50's. It's extremely difficult if not impossible to become one of these. It's like comparing it to becoming a neurosurgeon. The lawyers that earn large incomes are the ones who attend top ranked law schools which are arguably as difficult to gain acceptance as medical school or they have finish in the top 10% of their class at a lower tier school. That too, there is no job security after being hired by a large firm. Many are layed off or quit after learning they won't make partner which only accounts for a few people a year. When a firm hires 50 to 100 associates and only 5 ore so will make partner, your odds are not good. So these lawyers have to go into solo practice or join a small partnership and compete with the millions of other lawyers in existance. MBA's are a dime a dozen these days and if you want to stand out, you better go to a top MBA school which usually means you better have attended a top undergraduate school as well.

Answer me this: can a person desire to lead a comfortable life, believe that people deserve to be compensated commensurate with their expertise and value, AND genuinely want to help people very much? Answer carefully, because I'm such a person.

This is the only aspect of your response that I agree with. Physicians deserve the success they earn; there is no doubt about this. However, physicians still experience many rewards that others don't. Those docs or med students who feel the grass is greener on the other side are usually the ones who straight to medical school after college. Those of us who held full time jobs in other avenues know it's not easy to attain the type of income and job security of physicians.There is no doubt that physicians work hard but at least they are well compensated for their efforts. Yes, maybe other professions are compensated better for their effort and time such dentists and pharmacists. However, there are several jobs that require a lot of hard work and will never offer the type of rewards that physicians receive.

 

[jdog]

Buddy M,

Let me ask you a question.

You say that teachers are in their profession for the right reason because they only make 40 K a year. First of all, that is a load of garbage. I don't know where you live, but as the son of a schoolteacher who used to teach in New York, the teachers are heavily unionized, and have at times gone on strike for higher pay. A school teacher with decent experience can make up to 75 K a year. They may start low, but teachers make more than 40K with experience, even in the south where there are no unions. But even if they did only make 40K .......

My question is this.
If shcoolteachers had to take organic chemistry, biochemistry, do summer research, get a 3.8 GPA, spend 1000 bucks to take the TeachCAT, go to 4 years of Teachers School after college, incur 100K plus of debt, then do 5 years of Teaching residency working 80 to 100 hours a week trying to pay back the 100K that you spent on your teaching school, taking q 4 teaching call, work year round with very few holidays off, watch people die...

DO YOU THINK THEY WOULD STILL DO IT FOR 40K?????????????
HELL NO THEY WOULD NOT.

Your argument is intolerable, naive, and foolish. Your statement about need vs. want is garbage.
Did you really NEED to go to college, or did you go because you wanted to.
Did you really NEED to have a car, or do you have one because you want one.

For you, in this, a free country to try and tell another american citizen what they should NEED or WANT is hilarious and disrespectful. It means you think you are smarter than everyone else.

I'll bet you are a democrat.

 

[novacek88]

Buddy M,

Let me ask you a question.

You say that teachers are in their profession for the right reason because they only make 40 K a year. First of all, that is a load of garbage. I don't know where you live, but as the son of a schoolteacher who used to teach in New York, the teachers are heavily unionized, and have at times gone on strike for higher pay. A school teacher with decent experience can make up to 75 K a year. They may start low, but teachers make more than 40K with experience, even in the south where there are no unions. But even if they did only make 40K .......

40K is being generous. In many parts of the country, teacher pay starts in the low 20's to 30's. In some rural areas of the South, starting pay is in the teens. I don't think there is anything wrong with one wanting to earn a lot of money. I know what you are saying because teachers don't have to endure the hurdles a doc does to become qualified. At the same time, people do go into teaching for very noble reasons. No one attends college with the aspiration to start at 22K per year for the perks and free lunches. Some people are genuinely more selfless than others. I'm not one of those people and I can admit that but give props to those educated people who are willing to live near the poverty level

 

[buddym]

Buddy M,

Let me ask you a question.

You say that teachers are in their profession for the right reason because they only make 40 K a year. First of all, that is a load of garbage. I don't know where you live, but as the son of a schoolteacher who used to teach in New York, the teachers are heavily unionized, and have at times gone on strike for higher pay. A school teacher with decent experience can make up to 75 K a year. They may start low, but teachers make more than 40K with experience, even in the south where there are no unions. But even if they did only make 40K .......

My question is this.
If shcoolteachers had to take organic chemistry, biochemistry, do summer research, get a 3.8 GPA, spend 1000 bucks to take the TeachCAT, go to 4 years of Teachers School after college, incur 100K plus of debt, then do 5 years of Teaching residency working 80 to 100 hours a week trying to pay back the 100K that you spent on your teaching school, taking q 4 teaching call, work year round with very few holidays off, watch people die...

DO YOU THINK THEY WOULD STILL DO IT FOR 40K?????????????
HELL NO THEY WOULD NOT.

Your argument is intolerable, naive, and foolish. Your statement about need vs. want is garbage.
Did you really NEED to go to college, or did you go because you wanted to.
Did you really NEED to have a car, or do you have one because you want one.

For you, in this, a free country to try and tell another american citizen what they should NEED or WANT is hilarious and disrespectful. It means you think you are smarter than everyone else.

I'll bet you are a democrat.

Calm down man! You make me sound like a card carrying communist! Did you read my post or just that part of it?

First, I am having to repeat something for about the 100th time: I AGREE THAT DOCTORS SHOULD BE PAID WHAT THEY ARE GETTING. NEVER IN ANY OF MY POSTS DID I SAY THAT DOCTOR'S OR MED STUDENTS ARE GREEDY BECAUSE WE EXPECT TO MAKE A LOT OF MONEY.

The only points that I made on this is that people who make over 150,000/yr (whether they be lawyers, doctors, or anyone), has a 2 story house, a luxury car, and a membership to the local golf course sounds awful silly and selfish when the are complaining to anyone who will listen about little they are getting paid. THe posts on this forum make it sound like PCP are starving. That is not the case, that is all I am saying. Physicians have great job security, good hours (you do not have to work crazy hours or holidays in medicine to make a comfortable salary- you do have to if you want 300,000/yr), benefits, and average 200,000/yr. As physicians, we still have a great gig, and we should. Let's just not make it sound horrible.

Next, I agree with everything that you guys are saying about how teachers would not still teach if they had to go through all the education that doctors do. I NEVER SAID THAT PHYSICIANS SHOULD NOT GET PAID MORE THAN TEACHERS OR THAT THEY WERE GREEDY FOR WANTING TO DO SO! Please stop implying that I said this. Most teachers (grade school, not college professors) make less than 40,000/yr. My only argument was that they must sincerly love teaching because they are entering a career where they know that they will not make much. With the same years worth of education, they could undertaken any number of career paths that earn as much or more (engineering, computers, accounting, business, etc).

BTW, I do not think that I am smarter than everyone else and that I should tell people what the need or want. I simply think when students talk about 200,000$ like it's crap, we sound selfish. I plan on going into IM or Peds or FM and make ~150,000, but I'm not going to gripe because I don't make 300,000$ instead.

Also, I am not a democrat. I am not even a liberal, believe it or not.

This is the last that I have to say on this debate. We will just have to agree to disagree.

 

[novacek88]

Calm down man! You make me sound like a card carrying communist! Did you read my post or just that part of it?

First, I am having to repeat something for about the 100th time: I AGREE THAT DOCTORS SHOULD BE PAID WHAT THEY ARE GETTING. NEVER IN ANY OF MY POSTS DID I SAY THAT DOCTOR'S OR MED STUDENTS ARE GREEDY BECAUSE WE EXPECT TO MAKE A LOT OF MONEY.

The only points that I made on this is that people who make over 150,000/yr (whether they be lawyers, doctors, or anyone), has a 2 story house, a luxury car, and a membership to the local golf course sounds awful silly and selfish when the are complaining to anyone who will listen about little they are getting paid. THe posts on this forum make it sound like PCP are starving. That is not the case, that is all I am saying. Physicians have great job security, good hours (you do not have to work crazy hours or holidays in medicine to make a comfortable salary- you do have to if you want 300,000/yr), benefits, and average 200,000/yr. As physicians, we still have a great gig, and we should. Let's just not make it sound horrible.

Next, I agree with everything that you guys are saying about how teachers would not still teach if they had to go through all the education that doctors do. I NEVER SAID THAT PHYSICIANS SHOULD NOT GET PAID MORE THAN TEACHERS OR THAT THEY WERE GREEDY FOR WANTING TO DO SO! Please stop implying that I said this. Most teachers (grade school, not college professors) make less than 40,000/yr. My only argument was that they must sincerly love teaching because they are entering a career where they know that they will not make much. With the same years worth of education, they could undertaken any number of career paths that earn as much or more (engineering, computers, accounting, business, etc).

BTW, I do not think that I am smarter than everyone else and that I should tell people what the need or want. I simply think when students talk about 200,000$ like it's crap, we sound selfish. I plan on going into IM or Peds or FM and make ~150,000, but I'm not going to gripe because I don't make 300,000$ instead.

Also, I am not a democrat. I am not even a liberal, believe it or not.

This is the last that I have to say on this debate. We will just have to agree to disagree.

Excellent post. I too think it's silly when physicians try to complain about their compensation. yes, physicians are working harder for less pay but they are still earning more than 98% of the U.S. population on average.

 

[Mr. Slave]

It's about the money

You say primary care, and I get

Here is some realistic logic 4 u ..

Pass = C = 182 Step 1 = FP = family practice, fallopian prober (Ob-GYN), can-uFeel Physician (neurology), forensic psychiatrist, fed-up pediatrician, or foreign pathologist

No one wants to wipe old people, clean runny noses, check for hernias, or give abx to a viral infx for 125,000 a year @ upwards of 60 hours a week or more. Sorry, no thx, but perhaps u can have your socialist hippy dream of primary care being supreme like every medical school professor and administrator at all the crappy schools; Bring back capitalism to the system so docs aren't screwed, and when primary care salary goes up and hours go down (yes, that is how capitalism works, comrades) , you will see more people doing it.

Money money money.....MONEY (BE THE DONALD)