7 ms·

I agree, why is it that doctors make such high salaries? Is it because of the long and relatively difficult education and training that they have to go through?

I agree, why is it that doctors make such high salaries? Is it because of the long and relatively difficult education and training that they have to go through? That is definitely part of it but in my opinion those salaries (which in many countries are publicly funded) could be reduced drastically by training more doctors. Professional societies have a strong interest in artificially keeping the supply of qualified doctors low in order to keep salaries high. University admissions for medical school continue to be extraordinarily low in proportion to the number of applicants yet there are still shortages in many parts of the country.

ng12 10y ago
In the US a lot of non-specialty doctors make around $150-$200k, meaning they're in line with some snot-nosed kid with a bachelor's in CS and an offer from Google. Becoming a doctor isn't the end-all it used to be unless you really love it and/or are really good.
- iheartmemcache 10y ago
  Plus, you know the whole 4 years of graduate work, 3 tiers of USMLE testing, 3 years of residency at what works out to be less than what you can make at Starbucks, a few more as a fellow before you can even start practicing. Even at the top end (cardiologists, anesthesiologists, neurologists), you're going to pretty much salary cap at around $750k pre-tax. There is a lot of waste in medicine, but the salary of doctors is pretty fairly priced. Imagine if cardiologists all of a sudden went 'value-based free market' in their pricing. With all the retiring boomers in their waning years, I could very easily see 6 hours of labor for a staff of ~6-8 in the OR performing a bypass being billed at $100k.
  - Retric 10y ago
    Most countries have doctors skip undergrad which makes a huge difference. The US problem is people become doctors late in life and retire relatively soon after that. In UK Medical school might be 4-6 years, but saving 4+ up front and possibly a 'gap' year is huge. No only do people work longer, but they also have fewer years of compounding interest effing them over. Net result is you simply need around 20% fewer people to go though medical school.
    - ng12 10y ago
      Absolutely. It's crazy to me that "pre-med" is a psuedo degree. 4 years of your life to take a handful of relevant classes.
      - _acme 10y ago
        How much physics should a doctor know? Do you not agree that there is value in a well-rounded liberal education before specialization?
        chii 10y ago
        isn't that what highschool is meant to be?
        hocuspocus 10y ago
        > How much physics should a doctor know? Most (all?) countries outside the US seem to agree that roughly one year of undergrad maths/physics/chemistry blended into their med school program is enough.
        ng12 10y ago
        None? I really, really don't care if the guy operating on my appendix can calculate torque. I care that he knows a lot about appendixes and has a steady hand.
        Retric 10y ago
        Is it worth ~50 billion per year for doctors to be well rounded? I am gong to say No.
- adrenalinelol 10y ago
  Society doesn't seem to take issue with screwing over kids who go to law-school (outside the top 3) with asinine levels of debt and low salaries. All salaries should be subject to market forces.
  - _acme 10y ago
    Bad lawyers also don't kill people as frequently as bad doctors.
    - AnthonyMouse 10y ago
      > Bad lawyers also don't kill people as frequently as bad doctors. You mean other than death row cases and suits to pay for life-saving treatments and suits that affect product safety and prosecutors who fail to convict violent recidivists and ... ?
      - M_Grey 10y ago
        About three quarters of a million people die each year just from HAI's... never mind all of the other problems, pain, expense, and poor outcomes. Lawyers do a lot of harm, but doctors are have unique access, and it would seem, shitty hygiene.
        AnthonyMouse 10y ago
        > About three quarters of a million people die each year just from HAI's Less than three quarters of a million people get HAIs each year. About 75,000 of them die. https://www.cdc.gov/hai/surveillance/ https://www.cdc.gov/hai/surveillance/ Meanwhile lawyers operate at scale. How many people do you estimate would have died if tobacco companies had won their challenge to laws prohibiting them from advertising to children? And that's the damage from one lawyer losing one case.
bpodgursky 10y ago
If you paid doctors less, there's no reward for spending your entire 20's and early 30s in training, already earning almost nothing. Nobody, especially nobody talented, will do it. It's already probably not worth it from a purely financial perspective, when you consider the options would-be doctors have (they are among the highest performing students already -- they could easily be lawyers, professors, engineers, etc). The real growth in medical costs are from administrative overhead and the vast new amounts of paperwork that doctors have to spend their time shuffling. If doctors spent 80% of their time in patient interaction or actual diagnosis, there would not be a perceived doctor shortage. Instead, it's 70% paperwork and filling out forms to check the right regulatory boxes. Increasing productivity by culling the paperwork and regulatory bloat will be vastly more productive than pumping out more low-quality doctors.
- Chathamization 10y ago
  In plenty of other countries doctors are paid substantially less and the quality of healthcare is better. I don't think it's impossible for the U.S. to do what everyone else is already doing.
  - throwaway2048 10y ago
    However, I doubt the quality of care is better BECAUSE they are paid less.
  - ethbro 10y ago
    The statistics in similar free market countries (labor, not health care) are curious. Interested in any links you have, but this NYT blog post [1] seems to show that, GDP-per-capita normalized (which seems reasonable; second chart), there isn't that large of a divergence between what I would assume would be comparable nations. Nurses make 0.9-1.4x, GPs 1.7-4.1x, and specialists 1.7-7.6x GDPpc. Certainly a range, but nothing jumps out at me as "the US is an order of magnitude outlier." I'd be fascinated to make a further breakdown of these numbers in terms of style of country's health care system, to see what correlations drop out though... [1] https://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ https://economix.blogs.nytimes.com/2009/07/15/how-much-do-do...
hockley 10y ago
I wonder if this a a compromise for tuition free education? Start with medicine.
Chathamization 10y ago
Dean Baker makes the important point that while our politicians are happy to support the outsourcing of manufacturing, they're in favor of protectionism when it comes to doctors and medicine[1]. This is part of what drives up costs for the average American. [1] http://www.huffingtonpost.com/dean-baker/the-tpp-and-free-trade-ti_b_12628906.html http://www.huffingtonpost.com/dean-baker/the-tpp-and-free-tr...
JustSomeNobody 10y ago
Yeah, sign me up to go see that $15.00 per hour doctor. /s If salaries weren't in line with the amount of time and dedication it takes to be a dr, we would all be worse off.
- squozzer 10y ago
  Not to pick on you, but your statement reflects a prejudice that many professions -- including doctors, but also lawyers, professional athletes, even hitmen -- are far too happy to exploit.
AlexCoventry 10y ago
> why is it that doctors make such high salaries? It could be relevant that, "The AMA has one of the largest political lobbying budgets of any organization in the United States." https://en.wikipedia.org/wiki/American_Medical_Association#Policy_positions https://en.wikipedia.org/wiki/American_Medical_Association#P...

ng12 10y ago

In the US a lot of non-specialty doctors make around $150-$200k, meaning they're in line with some snot-nosed kid with a bachelor's in CS and an offer from Google. Becoming a doctor isn't the end-all it used to be unless you really love it and/or are really good.

iheartmemcache 10y ago
Plus, you know the whole 4 years of graduate work, 3 tiers of USMLE testing, 3 years of residency at what works out to be less than what you can make at Starbucks, a few more as a fellow before you can even start practicing. Even at the top end (cardiologists, anesthesiologists, neurologists), you're going to pretty much salary cap at around $750k pre-tax. There is a lot of waste in medicine, but the salary of doctors is pretty fairly priced. Imagine if cardiologists all of a sudden went 'value-based free market' in their pricing. With all the retiring boomers in their waning years, I could very easily see 6 hours of labor for a staff of ~6-8 in the OR performing a bypass being billed at $100k.
- Retric 10y ago
  Most countries have doctors skip undergrad which makes a huge difference. The US problem is people become doctors late in life and retire relatively soon after that. In UK Medical school might be 4-6 years, but saving 4+ up front and possibly a 'gap' year is huge. No only do people work longer, but they also have fewer years of compounding interest effing them over. Net result is you simply need around 20% fewer people to go though medical school.
  - ng12 10y ago
    Absolutely. It's crazy to me that "pre-med" is a psuedo degree. 4 years of your life to take a handful of relevant classes.
    - _acme 10y ago
      How much physics should a doctor know? Do you not agree that there is value in a well-rounded liberal education before specialization?
      - chii 10y ago
        isn't that what highschool is meant to be?
      - hocuspocus 10y ago
        > How much physics should a doctor know? Most (all?) countries outside the US seem to agree that roughly one year of undergrad maths/physics/chemistry blended into their med school program is enough.
      - ng12 10y ago
        None? I really, really don't care if the guy operating on my appendix can calculate torque. I care that he knows a lot about appendixes and has a steady hand.
      - Retric 10y ago
        Is it worth ~50 billion per year for doctors to be well rounded? I am gong to say No.
adrenalinelol 10y ago
Society doesn't seem to take issue with screwing over kids who go to law-school (outside the top 3) with asinine levels of debt and low salaries. All salaries should be subject to market forces.
- _acme 10y ago
  Bad lawyers also don't kill people as frequently as bad doctors.
  - AnthonyMouse 10y ago
    > Bad lawyers also don't kill people as frequently as bad doctors. You mean other than death row cases and suits to pay for life-saving treatments and suits that affect product safety and prosecutors who fail to convict violent recidivists and ... ?
    - M_Grey 10y ago
      About three quarters of a million people die each year just from HAI's... never mind all of the other problems, pain, expense, and poor outcomes. Lawyers do a lot of harm, but doctors are have unique access, and it would seem, shitty hygiene.
      - AnthonyMouse 10y ago
        > About three quarters of a million people die each year just from HAI's Less than three quarters of a million people get HAIs each year. About 75,000 of them die. https://www.cdc.gov/hai/surveillance/ https://www.cdc.gov/hai/surveillance/ Meanwhile lawyers operate at scale. How many people do you estimate would have died if tobacco companies had won their challenge to laws prohibiting them from advertising to children? And that's the damage from one lawyer losing one case.

bpodgursky 10y ago

If you paid doctors less, there's no reward for spending your entire 20's and early 30s in training, already earning almost nothing. Nobody, especially nobody talented, will do it. It's already probably not worth it from a purely financial perspective, when you consider the options would-be doctors have (they are among the highest performing students already -- they could easily be lawyers, professors, engineers, etc). The real growth in medical costs are from administrative overhead and the vast new amounts of paperwork that doctors have to spend their time shuffling. If doctors spent 80% of their time in patient interaction or actual diagnosis, there would not be a perceived doctor shortage. Instead, it's 70% paperwork and filling out forms to check the right regulatory boxes. Increasing productivity by culling the paperwork and regulatory bloat will be vastly more productive than pumping out more low-quality doctors.

Chathamization 10y ago
In plenty of other countries doctors are paid substantially less and the quality of healthcare is better. I don't think it's impossible for the U.S. to do what everyone else is already doing.
- throwaway2048 10y ago
  However, I doubt the quality of care is better BECAUSE they are paid less.
- ethbro 10y ago
  The statistics in similar free market countries (labor, not health care) are curious. Interested in any links you have, but this NYT blog post [1] seems to show that, GDP-per-capita normalized (which seems reasonable; second chart), there isn't that large of a divergence between what I would assume would be comparable nations. Nurses make 0.9-1.4x, GPs 1.7-4.1x, and specialists 1.7-7.6x GDPpc. Certainly a range, but nothing jumps out at me as "the US is an order of magnitude outlier." I'd be fascinated to make a further breakdown of these numbers in terms of style of country's health care system, to see what correlations drop out though... [1] https://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ https://economix.blogs.nytimes.com/2009/07/15/how-much-do-do...

hockley 10y ago

I wonder if this a a compromise for tuition free education? Start with medicine.

Chathamization 10y ago

Dean Baker makes the important point that while our politicians are happy to support the outsourcing of manufacturing, they're in favor of protectionism when it comes to doctors and medicine[1]. This is part of what drives up costs for the average American. [1] http://www.huffingtonpost.com/dean-baker/the-tpp-and-free-trade-ti_b_12628906.html http://www.huffingtonpost.com/dean-baker/the-tpp-and-free-tr...

JustSomeNobody 10y ago

Yeah, sign me up to go see that $15.00 per hour doctor. /s If salaries weren't in line with the amount of time and dedication it takes to be a dr, we would all be worse off.

squozzer 10y ago
Not to pick on you, but your statement reflects a prejudice that many professions -- including doctors, but also lawyers, professional athletes, even hitmen -- are far too happy to exploit.

AlexCoventry 10y ago

> why is it that doctors make such high salaries? It could be relevant that, "The AMA has one of the largest political lobbying budgets of any organization in the United States." https://en.wikipedia.org/wiki/American_Medical_Association#Policy_positions https://en.wikipedia.org/wiki/American_Medical_Association#P...