Why Does the U.S. Make It So Hard to Be a Doctor?

[Proudfather94]

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Physician pay scale is merit based, as it should be, so I agree with the sentiment of the statement, but there is this prevailing sentiment among some physicians and trainees that there is this element of 'giving up' something that somehow entitles them to special consideration. If anyone is giving anything up, those are the mentors that guide and instruct in the clinical area to form an actual doctor. It takes years off our lives that would not otherwise be taken in private practice. You give up nothing. You are being given more than you've ever been given and if you are smart about your finances in the first 5-10 years of your practice, you'll end up having done very well.

I would still say you are giving up alot of time to become a physician and that the pay needs to reflect that. One is not making much money in undergrad, medical school, and residency which is a large period of time in one's life. They are agreeing to make that sacrifice on the condition that when they are an attending they will be compensated fairly for that sacrifice.

I do agree people in academia need to be paid more for what they do. It's absurd that one should have to take a pay cut in order to teach the next generation of physicians.

 

[Ganon]

Really important that everyone understands the concept of opportunity cost before commenting

 

[bGMx]

I'm going to comment that I don't understand this concept of "giving up" something to become doctor from a logical point of view. If I went into [insert industry here] I would be giving up the opportunity to become a doctor. Someone explain to me why I am entitled to claiming I sacrificed more than the next guy.

 

[Proudfather94]

I'm going to comment that I don't understand this concept of "giving up" something to become doctor from a logical point of view. If I went into [insert industry here] I would be giving up the opportunity to become a doctor. Someone explain to me why I am entitled to claiming I sacrificed more than the next guy.

To me it's not the job that's the important thing rather the time itself. The same concept could be made to anyone else. If someone spends 20 years of their life working on average 60-80 hours a week to make it to CEO of a company they deserve to get paid a few million a year. I am of the opinion that the amount of time and stress one dedicates to become a physician entitles them to a lifestyle like one we have today or better.

 

[bGMx]

To me it's not the job that's the important thing rather the time itself. The same concept could be made to anyone else. If someone spends 20 years of their life working on average 60-80 hours a week to make it to CEO of a company they deserve to get paid a few million a year. I am of the opinion that the amount of time and stress one dedicates to become a physician entitles them to a lifestyle like one we have today or better.

I agree completely that someone who provides something to society which is extremely worthwhile should be paid their worth. If you make a vaccine that cures malaria, in my view you should be one of the richest people in the world. The told and untold good such an action would do is incalculable.

I don't understand the language around sacrifice in the context of choosing a profession; doesn't seem to really fit since no matter what you do, you will sacrifice one thing for another thing. The only way I think someone could hold the "I gave up [insert x opportunity here] therefore I deserve money" is if they were forced into medicine against their will despite an equal opportunity to do the thing they otherwise feel they sacrificed in the name of a career in medicine.

 

[Proudfather94]

I agree completely that someone who provides something to society which is extremely worthwhile should be paid their worth. If you make a vaccine that cures malaria, in my view you should be one of the richest people in the world. The told and untold good such an action would do is incalculable.

I don't understand the language around sacrifice in the context of choosing a profession; doesn't seem to really fit since no matter what you do, you will sacrifice one thing for another thing. The only way I think someone could hold the "I gave up [insert x opportunity here] therefore I deserve money" is if they were forced into medicine against their will despite an equal opportunity to do the thing they otherwise feel they sacrificed in the name of a career in medicine.

I can't speak for everyone but for me my time is worth something. If I'm spending at least 11 years of my life being educated and then training to do something I want to be compensated for that. My question is if congress passed a law tomorrow that cut physician pay significantly because they believe that the time spent training and getting educated didn't matter, what do you think would happen to the quality and quantity of doctors? Do you think there would still be the same amount of people applying to medical school?

Noone is forcing anyone to be a doctor but we need highly skilled doctors. In order to prove that one has that potential one needs to have a degree, high GPA, MCAT, and lots of volunteer hours. Then 4 years of medical school and residency. I think that most people that undergo this expect to be compensated for all of it. This process weeds out all that are not the best of the best and those that make it want to be paid for it.

 

[bGMx]

My question is if congress passed a law tomorrow that cut physician pay significantly because they believe that the time spent training and getting educated didn't matter, what do you think would happen to the quality and quantity of doctors? Do you think there would still be the same amount of people applying to medical school?

This process weeds out all that are not the best of the best and those that make it want to be paid for it.

This is actually something I've been thinking about on my own, as someone who is so surprised that teachers and pediatricians aren't paid much much more...

Can't say for sure. But those who go into the "less compensated" specialties either really love the profession or couldn't cut it for something else "more competitive."
When we compensate physicians like we compensate athletes, we select for geniuses and those who are in it for the $$$.
Pick your poison I guess. Also, correct me if I'm wrong.

I'd go with the competition, though that does lead to greed which somehow must be kept in balance with other societal interests. Ideally a well-compensated genius who is passionate about the work and would do the job regardless of their yearly income.

 

[aldol16]

Two camps to this argument. One side will say it's to ensure quality control. You need to ensure that the people who get trained and licensed are cognitively able to do the job and won't harm patients. That doesn't exactly justify the current # of med school spots but it does justify some sort of cap on the number of training spots. Healthcare supply can't run in a laissez-faire market because the usual market mechanisms that drive firms in other industries out of market would result in unacceptable harm in healthcare. A restaurant might go out of business because of bad food. A bad doctor would inflict harm on patients. Also, it's very hard for laypeople to tell the quality of care they receive (hence the mid-level argument). So you need some indicator of quality and quality control.

The other camp will argue that the current bottleneck cannot be justified solely by quality control, i.e., there could be more people qualified to be doctors who are excluded under the current system. Their argument is that the lobbying groups are very powerful. If you restrict physician supply, you can increase salaries (basic economics). This side would argue that the limited supply can be traced all the way to specialty societies lobbying to keep the # of residency slots small. This necessarily restricts med school spots because med schools don't want to graduate more physicians than can match into residency - otherwise people would stop going to the med school because it would cause $$$ debt without the possibility of payoff.

The truth likely lies in the middle. You do need quality control, which the stringent training process helps to ensure. But there probably also is a component of artificially depressed supply to keep compensation high.

 

[jambro]

There is a difference between a physician's salary and the costs that are incurred by the healthcare system... salary and reimbursement are not the same. With more doctors you can have lower salaries, but overall a higher volume of reimbursements as more care is being given, so the healthcare system gets more expensive.

do people who talk about this really not realize that?

 

[Ganon]

There is a difference between a physician's salary and the costs that are incurred by the healthcare system... salary and reimbursement are not the same. With more doctors you can have lower salaries, but overall a higher volume of reimbursements as more care is being given, so the healthcare system gets more expensive.

do people who talk about this really not realize that?

I think the thought is that scarcity increases prices
Rural reimburses higher etc.

 

[jambro]

I think the thought is that scarcity increases prices
Rural reimburses higher etc.

Yes, salaries. But you have to flesh out the thought more. Salaries are basically the delta between what you bring in via reimbursements and what you keep, which is determined by your business acumen in PP or by what your employer negotiates. More physicians means your employer will get away with paying you less, but the reimbursements they're getting from your labor didn't necessarily change. And those reimbursements are coming from medicare or private payers, so if the reimbursements don't change, the healthcare spending doesnt either.

In addition, more physicians getting paid lower salaries would still probably result in increased healthcare costs simply because more reimbursable work would be performed.

 

[Proudfather94]

This is actually something I've been thinking about on my own, as someone who is so surprised that teachers and pediatricians aren't paid much much more...

Can't say for sure. But those who go into the "less compensated" specialties either really love the profession or couldn't cut it for something else "more competitive."
When we compensate physicians like we compensate athletes, we select for geniuses and those who are in it for the $$$.
Pick your poison I guess. Also, correct me if I'm wrong.

I'd go with the competition, though that does lead to greed which somehow must be kept in balance with other societal interests. Ideally a well-compensated genius who is passionate about the work and would do the job regardless of their yearly income.

I do think those specialties need to make more. I think people in general are too quick to call someone greedy, and that's actually helping the truly greedy by taking the attention off of them. When it's basically a witch hunt and physicians get lumped in the greedy pile for having some want for money that allows the ones who sell their practice out or do ethically questionable things to make money to stay hidden.

I think we do need the pay to reflect the competition as we are a capitalistic society that has very few safety nets for those who are not at the poverty line. The quality of ones families education, healthcare, and lifestyle are directly tied to how much money you make. Most physicians pay reflects the lifestyle that is reasonably expected for the amount of sacrifice and skill it took to become that specialty of doctor. Most physicians aren't living in a mansion and driving a Ferrari but they can live in a nice area, send their kids to college, and save for retirement.

 

[Browns99]

I agree completely that someone who provides something to society which is extremely worthwhile should be paid their worth. If you make a vaccine that cures malaria, in my view you should be one of the richest people in the world. The told and untold good such an action would do is incalculable.

I don't understand the language around sacrifice in the context of choosing a profession; doesn't seem to really fit since no matter what you do, you will sacrifice one thing for another thing. The only way I think someone could hold the "I gave up [insert x opportunity here] therefore I deserve money" is if they were forced into medicine against their will despite an equal opportunity to do the thing they otherwise feel they sacrificed in the name of a career in medicine.

Let's see....4 years of college, 4 years of medical school, one possible gap year for research, 6 years for residency( Speciality), possible 1 year of fellowship....I did not even include the crazy amount of study time, prep for various boards, cost to attend, etc., etc. I would say that's a sacrifice in terms of time required to just start your profession, does that help you understand what " sacrifice" means in terms of becoming a medical doctor? I understand that you will basically "sacrifice" for one thing or another, but the US medical profession sacrifices a whole lot.

 

[NITRAS]

Let's see....4 years of college, 4 years of medical school, one possible gap year for research, 6 years for residency( Speciality), possible 1 year of fellowship....I did not even include the crazy amount of study time, prep for various boards, cost to attend, etc., etc. I would say that's a sacrifice in terms of time required to just start your profession, does that help you understand what " sacrifice" means in terms of becoming a medical doctor? I understand that you will basically "sacrifice" for one thing or another, but the US medical profession sacrifices a whole lot.

It isn’t nearly so simple. There are doctors that went straight through, went to public college to public medical school, to a short residency to working. There are also doctors who went to private undergraduate, private masters, gap years, private medical school, changed residencies did fellowship and now have the same job as the first doctor.

Should they be paid more just because they “sacrificed” more? People buy things because of the benefit they perceive. People also don’t see or feel the cost of the medical care because 3rd parties pay for the vast majority of care.

Also remember that NPP’s spend way less time in training. Also that reimbursements are often arbitrary in ways that the goal is to reduce total expenditure, rather than provide the most good.

My overall point is that no one really cares how much you sacrificed. Your compensation will be based on how much you do of what gets you paid. It changes based on things that don’t always make the most sense. It will likely be different in 10 years than it is right now.

 

[Browns99]

It isn’t nearly so simple. There are doctors that went straight through, went to public college to public medical school, to a short residency to working. There are also doctors who went to private undergraduate, private masters, gap years, private medical school, changed residencies did fellowship and now have the same job as the first doctor.

Should they be paid more just because they “sacrificed” more? People buy things because of the benefit they perceive. People also don’t see or feel the cost of the medical care because 3rd parties pay for the vast majority of care.

Also remember that NPP’s spend way less time in training. Also that reimbursements are often arbitrary in ways that the goal is to reduce total expenditure, rather than provide the most good.

My overall point is that no one really cares how much you sacrificed. Your compensation will be based on how much you do of what gets you paid. It changes based on things that don’t always make the most sense. It will likely be different in 10 years than it is right now.

Well, if people knew more what physicians went through, maybe they wouldn't be so apt to complain about the cost of medicine(I know the high cost is driven by other factors as well), so my point is, maybe people should be aware. Those in primary fields may not sacrifice as much (in terms of time spent and other prep) as my previous example with specialities, but nonetheless, they also did not have a necessarily "easy road," unless they were the type that "barely got by" and were ok with it.

Either way, everyone is going to have their opinion, but to dismiss the sacrifice that physicians make, regardless of what they do later to be compensated is IMHO not right.

 

[Proudfather94]

Well, if people knew more what physicians went through, maybe they wouldn't be so apt to complain about the cost of medicine(I know the high cost is driven by other factors as well), so my point is, maybe people should be aware. Those in primary fields may not sacrifice as much (in terms of time spent and other prep) as my previous example with specialities, but nonetheless, they also did not have a necessarily "easy road," unless they were the type that "barely got by" and were ok with it.

Either way, everyone is going to have their opinion, but to dismiss the sacrifice that physicians make, regardless of what they do later to be compensated is IMHO not right.

Honestly physician pay doesn't contribute much to the healthcare bill. I just used the calculator on my phone to figure out that if a physician saw 20 pts a day, each pt pays 75$ for the year, and that physician works 200 days a year (weekends off plus 61 days vacation) they would make 300k.

This doesn't include taxes or overhead costs but my point is that each patient on average would have to pay what like 200 year to pay for all of that? Our family health insurance is more than that in a month.

 

[aldol16]

Honestly physician pay doesn't contribute much to the healthcare bill. I just used the calculator on my phone to figure out that if a physician saw 20 pts a day, each pt pays 75$ for the year, and that physician works 200 days a year (weekends off plus 61 days vacation) they would make 300k.

This doesn't include taxes or overhead costs but my point is that each patient on average would have to pay what like 200 year to pay for all of that? Our family health insurance is more than that in a month.

That's not how physicians are paid. Here's a (still watered down) scheme of the process, via 2 separate interactions. First. Patient visits doctor. Doctor provides evaluation and management service. Patient leaves. Patient's insurance receives a bill for an E&M visit with some charge. This charge is always inflated relative to what the insurance company has negotiated with the physician. The company processes the claim and pays the reimbursement, which is around $100-200 for an E&M visit. Since this was a physician visit, only a physician's professional fee was incurred. Now, that physician is probably not in solo practice. They're probably in a group practice or very large practice. So that reimbursement is put into the pool and the physician is paid a salary, which has been determined by the pool but may still be related to productivity in terms of RVUs. If your whole practice is E&M visits, then that's your pay.

Second. Patient visits doctor. Doctor performs some procedure on the patient. Let's assume for illustration purposes that this procedure was done in an ambulatory surgical facility. Patient leaves. The patient's insurance will then get 2 bills - one for the physician's professional fee and another for the facility fee (for use of the facility and resources). It will pay out the two claims - ranges widely depending on what the procedure is and what its RVU is.

Note that inpatient admissions work very much like the second case above. There are professional fees for physicians, which are typically low, and facility fees that are paid to the hospitals. That's the wedge that people are referring to. We spend a lot of money as a society on hospitalizations and things that require hospitals because hospitals are expensive to run - hence the high facility fees.

 

[Proudfather94]

That's not how physicians are paid. Here's a (still watered down) scheme of the process, via 2 separate interactions. First. Patient visits doctor. Doctor provides evaluation and management service. Patient leaves. Patient's insurance receives a bill for an E&M visit with some charge. This charge is always inflated relative to what the insurance company has negotiated with the physician. The company processes the claim and pays the reimbursement, which is around $100-200 for an E&M visit. Since this was a physician visit, only a physician's professional fee was incurred. Now, that physician is probably not in solo practice. They're probably in a group practice or very large practice. So that reimbursement is put into the pool and the physician is paid a salary, which has been determined by the pool but may still be related to productivity in terms of RVUs. If your whole practice is E&M visits, then that's your pay.

Second. Patient visits doctor. Doctor performs some procedure on the patient. Let's assume for illustration purposes that this procedure was done in an ambulatory surgical facility. Patient leaves. The patient's insurance will then get 2 bills - one for the physician's professional fee and another for the facility fee (for use of the facility and resources). It will pay out the two claims - ranges widely depending on what the procedure is and what its RVU is.

Note that inpatient admissions work very much like the second case above. There are professional fees for physicians, which are typically low, and facility fees that are paid to the hospitals. That's the wedge that people are referring to. We spend a lot of money as a society on hospitalizations and things that require hospitals because hospitals are expensive to run - hence the high facility fees.

I understand what you're saying I was just trying to show that the amount that physicians charge patients isn't a large part of their Healthcare bill.

 

[winder333]

Sorry for reviving this one. Read the discussion, thought maybe others would like to add something.
For me, it's hard because of all the lawsuits risks. How can I work if it can happen anytime?

 

[Goro]

Sorry for reviving this one. Read the discussion, thought maybe others would like to add something.
For me, it's hard because of all the lawsuits risks. How can I work if it can happen anytime?

That's why you have malpractice insurance. Keep in mind there are states that have caps on awards, and also while it's very easy to sue a doctor, very few people actually win the lawsuit

 

[LucidSplash]

Sorry for reviving this one. Read the discussion, thought maybe others would like to add something.
For me, it's hard because of all the lawsuits risks. How can I work if it can happen anytime?

What Goro said. And I’m not sure we needed to bump this thread to say this. A lot was said already in the original thread.

 

[lioneljohn]

The audits, those scare me the most. I'd be better off them. There are some tips and strategies on how to pass them without problems, like described here. But they still scare me.