21 ms·

The Problem of Doctors’ Salaries

• notliketherest 9y ago
  most of the health care cost is NOT due to doctors salaries. the reason health care costs are so high in America is due to the way Providers (Hospitals, small clinics, and large Systems) charge insurance companies. Several decades ago when insurance really started getting big, they realized they had huge groups of people they could send to "in network" hospitals. they choose which Providers are in their network. therefore they have leverage over the Providers, and use it to negotiate the price they pay for all claims (the bill the provider sends the insurance company). They negotiate huge discounts on the "listed" price for a claim. Therefore, every year for decades, hospitals have been jacking up their prices in order to actually be able to stay in business (given that the large majority of costs are paid for by insurance companies, who are getting a huge discount). So 2 tylenol go from $3 to $10 to $100 to $500 over time, as the insurance companies negotiate bigger and bigger discounts. This is why the "cost of healthcare" is so high, even those it's not really the true cost. Unless you're not insured, in which case you have to pay the "actual" rate (ie $500 for 2 tylenol). Here's an article that explains further http://www.npr.org/sections/health-shots/2014/11/15/364064088/they-paid-how-much-how-negotiated-deals-hide-health-cares-cost http://www.npr.org/sections/health-shots/2014/11/15/36406408...
  • QAPereo 9y ago
    Salaries make for a great distraction though, like hosepipe bans in California when 80% of the water use is agricultural.
    • jhowell 9y ago
      $500 Tylenol anecdotes make for an even better distraction. The likely problem is a little of both.
      • jessaustin 9y ago
        Do you mean to suggest that physicians' incomes should be several orders of magnitude less than what they are currently? If not, I'll continue to be "distracted" by the Tylenol.
        • vonmoltke 9y ago
          No, it means to suggest that the number of people who have actually paid anywhere near $500 for a couple Tylenol pills is so small as to be an irrelevant rounding error in the grand scheme of things. Note I said paid, not billed.
    • crimsonalucard 9y ago
      20% is still a problem. Putting a cap on the the 20% contributes to the solution. If it was 1% of the problem then hosepipe bans would be inn-effective.
      • QAPereo 9y ago
        ...While refusing to even entertain regulations on or reduction in the 80%? When the problem is truly massive, far exceeding what home use can hope to change?
        • crimsonalucard 9y ago
          I never said that. If political walls make it impossible to reduce the 80% then do what is possible. All I'm saying is that 20% contributes to the solution. I would imagine that farmers will start revolutions if you cut off their water supplies, while city folks won't care too much if the lawn isn't watered. 20% is an easy target... hit it first and slowly work on the other problem.
  • jstewartmobile 9y ago
    Make an objectively true statement, watch it get voted to the bottom. You are now my Punxsutawney Phil for US healthcare: Six more years of overpriced healthcare.
  • titzer 9y ago
    > most of the health care cost is NOT due to doctors salaries. It bothers me that people continue to oversimplify problems and spin yarns about how "these people did this" and "those people did that" and that it's all due to one or two groups of bad or greedy actors. The problem is so huge and so complex that it's worth considering that all of the proposed causes are contributing factors. There is now a systemic dysfunction that is broad, multi-faceted, and tough to dissect and study. Ultimately, many incentive systems are misaligned. The fact that the problem does have so many facets seems to always give rise to these distracting conversations where well-meaning commenters drive the discussion away from the actual findings to their favorite hobby horses instead. RTFA. Doctor pay is an actual issue. They did not claim it is the whole problem. But it is a problem, and there are things we can do to tackle it. And no, for the record, I am not disagreeing with you. But please, don't distract. Solve problems instead.
  • Gustomaximus 9y ago
    I feel a simple solution would be a law hospitals/clinic etc have to publish prices and all people/companies have to pay those prices. It would stop this dual pricing and encourage healthy competition. And private insurance companies would negotiate better rates for the market as a whole.
  • sjg007 9y ago
    The Centers for Medicare & Medicaid Services (aka the government) is the largest payor in the country and it sets floor prices for care per region. This is what primarily drives reimbursement rates.
• qxmat 9y ago
  So... adopt the UK model then?
• tryingagainbro 9y ago
  I remember in one clinic...7-8 nurses at one docs office. 4-5 minutes time with the doctor and probably a $150 bill. A lot of money also goes for people to process insurance claims
• seibelj 9y ago
  Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing schools to crank costs to astronomical levels (“don’t worry, you’ll make enough to pay it back”). One thing that would help is letting non-MD’s, such as nurses or physicians assistants, do more “doctor” things. Dentists, a similar profession, is going apeshit that states are trying to let specially licensed assistants (but non-DMDs) do slightly more advanced work like fill cavities.[0] The entire health system from top to bottom would benefit immensely from free market forces. [0] http://www.mercurynews.com/2017/07/01/dental-lobby-bares-teeth-on-care-laws-2/ http://www.mercurynews.com/2017/07/01/dental-lobby-bares-tee...
  • briholt 9y ago
    Let psychologists prescribe common, low-risk psych drugs (instead of scarcer psychiatrists), let optometrist prescribe glasses, etc.
    • electriclove 9y ago
      Please let me buy contact lenses or a CPAP without a prescription
      • skizm 9y ago
        You can get the same brands of contacts from UK websites shipped to the US very easily (and cheaply). I know a few people who do this and they haven't had any problems yet.
      • gruturo 9y ago
        You need a prescription to buy contacts? Weird. In 3 European countries I’m familiar with they are a supermarket item (literally) or anyway simply an over the counter item from pharmacies and opticians’ shops
    • greedo 9y ago
      Optometrists can prescribe glasses...
• electriclove 9y ago
  "The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors’ organizations." Wow, just wow..
  • priam 9y ago
    More students are accepted to medical school than there are residency spots available. See "Figure 1" http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Re...
    • giarc 9y ago
      That's by design, and not in some secretive, nefarious way. People will drop out of med school. There is also a lot of residency spots that go unfilled. I know infectious disease is struggling to get bodies into spaces.
      • priam 9y ago
        Yes some drop out and residency positions go unfilled, but please see Figure 1! http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Re...
      • sxg 9y ago
        The drop out rate for med school is under 5%. Infectious disease is a 3 year fellowship that's done after completing a 3 year internal medicine residency. Oddly, the average salary for infectious disease specialists is lower than that of internal medicine physicians. Economically, it doesn't make sense for internal medicine physicians to spend 3 years doing a fellowship only to make less money on the other end. On top of that, these physicians are missing out on an attending's salary during those 3 years of fellowship.
    • sfashset 9y ago
      Fact check: False. That figure is comparing the total number of applicants to the match with (first year) residency spots. But the total number of applicants to the match is not the same things as students accepted to (U.S.) medical schools. Foreign medical grads are dying to get trained in the States. If you read on in your link, you'll see that "[t]he PGY-1 match rate for U.S. seniors was 94.3 percent", while the match rate for non-U.S. medical school graduates is slightly above 50%. Again from your link: "This year, 35,969 active applicants vied for 28,849 first-year and 2,908 second-year (including physician (R)) residency positions. U.S. allopathic medical school senior students comprised 18,539 of the active applicants, 352 more than in 2016. " US medical school graduates have no problems matching, the ~5% who don't usually do so because of their match application strategy, and have the opportunity to scramble at unfilled positions (of which there are ~1300).
• dijit 9y ago
  I'm a big fan of the NHS in the UK and I live in Sweden now which also has national healthcare services that are heavily subsidised. There are some things that allow the system to be cheaper- for sure. As one hospital buying cotton balls might be more expensive per cotton ball than if you decide as a country to produce or procure millions of them at a time. But RE salaries; Is it the USA who pays too much? or is it those other countries which pay too little? The NHS in the UK and the Vardcentralen in Sweden are both having intense crisis' at the moment due to funding and are overstretched to say the least. In Sweden in particular Doctors are more keen to be contractors and hire themselves out to hospitals and offices, mostly due to the fact that Vardcentralen has limits for how much it will pay permanent staff Doctors. And since that's so ubiquitous the Vardcentralen cannot avoid paying these contracting rates, else it would not have Doctors for people. So, are they greedy? or are they just getting what they should really get? Eitherway we end up paying the Doctors the full amount out of tax money-
  • nyreed 9y ago
    >In Sweden in particular Doctors are more keen to be contractors and hire themselves out to hospitals and offices, mostly due to the fact that Vardcentralen has limits for how much it will pay permanent staff Doctors. This is much the same in the UK. Hospitals struggle to fill rota gaps, so offer locum shifts at sometimes 2-3x the normal rate to fill gaps at short notice. However staffing is so tight now, one can sustain a workweek solely on locum shifts. Most doctors at junior level have taken notice, and many (more then half afaik) defer entering specialty training after their first two years to spend a year (or three!) solely filling these shifts. At the cost of job progression and workplace continuity, you're getting paid way more for the same work, but with way more shift flexibility and less CPD paperwork. Sounds pretty good to me! Are docs greedy? Hard to say. If locum wages are what fills rota gaps, is that the market dictating the true price of medical labour? The feeling among a lot of my friends is that if regular and locum wages met in the middle, it might help things. Can't really account for that flexibility of what is essentially taskrabbit for doctors though.
• hristov 9y ago
  There should definitely be more med school slots and more residency slots in the US. The idea of nurses prescribing pills is very bad though. The shortage of doctors is a problem, but we should not kid ourselves -- the biggest problem in America's health care is out of control drug costs. Even with the shortage there has not been a massive inflation of doctors' salaries. In fact all of my doctor friends are constantly complaining about how they are paid less than the previous generation. But there has been a massive inflation of drug costs.
  • albertgoeswoof 9y ago
    Why are nurses unable to prescribe? Nurse practitioners (mid-senior nurses) have been able to prescribe a limited set of drugs in the UK for quite some time now, quite successfully.
    • RandallBrown 9y ago
      Nurse practitioners can prescribe in the US as well.
      • mljoe 9y ago
        This right. In fact CVS MinuteClinics are usually manned by nurse practitioners. They can do many things typically associated with internal/family medicine.
    • Lendal 9y ago
      And it takes years of education and training to become a nurse. Why do people think that nurses shouldn't be able to prescribe medications? Is it because of the gender they're traditionally associated with?
      • jeffreyrogers 9y ago
        No. And no one made that claim.
• rtx 9y ago
  Personally I believe that the good doctors are underpaid for the skill and training they have.
  • albertgoeswoof 9y ago
    Are they really that super skilled? If medical school was free and had unlimited places, do you think we would have the same number of doctors that pass the bar?
    • nullspace 9y ago
      Honestly, while cost is a real factor, I don't think the number of doctors that pass the bar would increase by as much as you think. The amount of knowledge, skills, experience in that practicing physicians possess dwarves what people in many other specialized professions have. I doubt most people would have the grit and patience that it takes to cross that bar. (Disclosure/source: my partner is a physician, I am a software engineer). That said, (only) one of the reasons for compensating physicians more is the time and money they put into their education. At least 2x - 3x more than other professions. Reduce this time / money commitment, you will be able to reduce the salaries.
  • nxsynonym 9y ago
    Not too mention the personal sacrifices they have to make to maintain a career (long hours, odd schedules, being on call, the stress of having someones life in your hands, etc). Not to mention one mistake could cost you your entire career and all that training/money invested into education would be thrown away. And someones life is in the balance. Pay them more by taking the money out of the hands of big pharma and insurance.
  • wolco 9y ago
    But is the average doctor worth more in the US vs another country? 700 worth of taxes better?
• jondubois 9y ago
  I do think that there might be too much regulation in medicine. It seems strange that someone should study for 20 years to learn how to perform the same operation on a specific human organ... Most doctors tend to specialize anyway so why should a heart surgeon spend so much time learning about other organs which they're never going to sink their scalpels into? Doctors are extremely well rounded these days, maybe they don't need to be. There are plenty of very good software engineers who never went to university, could it be the same for doctors; if we allowed it?
  • tryingagainbro 9y ago
    Most doctors tend to specialize anyway so why should a heart surgeon spend so much time learning about other organs which they're never going to sink their scalpels into? Because everything is linked?
    • jondubois 9y ago
      That makes sense and it's the same as software engineering. That's why you have a product manager/generalist to coordinate the different domain experts. Most surgeries these days require a team of doctors already so doctors are already capable of working together with divergent skillets... Maybe there is no harm if these skillets diverged just a little bit more. Maybe if there was more focus on communication skills as part of training, it would be better.
  • protonfish 9y ago
    I don't think "less" and "more" should ever be used when discussing rules, regulations, and laws. Only "better" and "worse". As for "specializing" in a type of medicine, this is naive. The human body is not separated into discrete modules; every part is extremely interconnected to many others. Doctors must understand general medicine because treatment can effect all body systems.
    • jondubois 9y ago
      Maybe you do need at least one person who understands everything to oversee treatment but does the person who actually does the 12 hours of precision meat-cutting need to be that person? I don't know, it's just a thought. Master jewelers can do very fine work and handle lots of variation in the materials they work with but they don't need to know anything about the chemistry of gold in order to actually make the jewelry... They just need to know the right techniques and potential issues that can arise.
• haaen 9y ago
  I'm aware that that many of doctors' high salaries are due to the government creating artficial shortages and I support less government regulation in order to make helathcare better and more affordable. That having said, I don't think high doctors' salaries are the most important societal problem in healthcare. Years and years of studying, long working hours, great responsibilities, saving lives and healing patients: doctors are welcome to their high salaries.
  • conanbatt 9y ago
    I read once that doctor salaries account for 30% of the cost of healthcare. Its significant.
    • lazerpants 9y ago
      Nope. 8%. Source: https://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ https://www.jacksonhealthcare.com/media-room/news/md-salarie...
      • conanbatt 9y ago
        Thanks! Had that wrong, or remembered it incorrectly. NYT says 10% in another article. Its still considerable. Have to take into account that a 5% reduction in price can lead to a much higher increase of consumption than 5%, particularly on things like healthcare in the us that have clear excess demand.
        • fjsolwmv 9y ago
          How is it possible for 5% decrease in price to cause ore than 100/95 consumption, if medical care is already a top priority for spending?
          • conanbatt 9y ago
            Because there are people that do not get healthcare today because it is above their affordability. If net income for a large amount of people is 100 U$S, and healthcare service costs 101U$S, the jump from 101 to 96 would surge in demand. Medical services have low elasticity but there are millions of people in america not getting medical service.
• oxymoran 9y ago
  It blows my mind that people can’t see this is as one of the glaring issues with out healthcare system. In addition to the outrageous costs of higher education and the litageous nature of our judicial system, it’s pretty obvious why healthcare costs so much. We can talk about insurance and Medicare until we are blue in the face, but those are just symptoms of a system that was broken from the start.
• eric_b 9y ago
  It's too bad this is the case. My experience with the medical professionals in my area isn't particularly positive. Many of them just look up symptoms on some kind of medical Google and regurgitate what the screen says. I had RSI in my wrists for years. I had several different diagnoses, and none of the treatments worked. Finally I found Dr. Sarno's book and my RSI has been gone since then. I guess my point is - we pay these people a lot, and they aren't even particularly competent at what they do. I'm sure the Mayo Clinic specialists are, but those folks are making more like 500k a year. To be competent.
  • priam 9y ago
    Reminds me of how software engineers just regurgitate what stack overflow says.
    • alexanderstears 9y ago
      However, few mediocre software engineers make 200k/yr. Most mediocre doctors do make >200k/yr.
      • priam 9y ago
        Software engineers aren't $200k+ in debt at 32 either. If you are an average salaried software engineer, you can accumulate more wealth than a doctor if you invest at recommended rates. The break even point is somewhere around 60-65 years of age.
        • s0rce 9y ago
          Really, I'm curious care to share your calculations? What salaries are you using? What about cost of living?
        • user5994461 9y ago
          A doctor can work in any city in the world, an engineers can work in less than 10 cities.
• deleted 9y ago
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• wpietri 9y ago
  For those interested in the broader picture, I recommend Aaron Carroll's series "What makes the US health care system so expensive": https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/ https://theincidentaleconomist.com/wordpress/what-makes-the-... Physician salaries are a part of the problem, but by his numbers they are a pretty small part (as shown in his pie chart at the bottom): https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-conclusion/ https://theincidentaleconomist.com/wordpress/what-makes-the-...
  • bootsz 9y ago
    > Much of what we choose to spend money on is stuff that we as Americans seem to value. Much of that value, unfortunately, isn’t all it’s cracked up to be. This speaks volumes, far beyond just the healthcare system too.
  • matrix 9y ago
    Thanks for this. It's a far more informative read than the original article.
• csulmone 9y ago
  I don't think it is fair to compare physician salaries from countries where education is heavily subsidized by the government. Are new doctors in the UK or the rest of the EU starting their careers $200k+ in debt?
  • doctorslol123 9y ago
    So American taxpayers should fund the absurd cost of medical school instead? Genius
    • csulmone 9y ago
      Either that or you will have even fewer doctors with much higher salaries. How would a doctor be able to afford any sort of life working 80hours a week to barely pay back loans accumulated over a decade of education. Supply/Demand
      • conanbatt 9y ago
        Lets get some of that cheap foreign government subsidies and allow foreign doctors into the US. What a win!
      • doctorslol123 9y ago
        I have doctors in my family. They would be sad to know the truth, just like you. There's nothing special about American doctors... the education, the quality. It's just another classic example of the fat needing to get cut. And there's a juicy chunk of fat to cut here
    • toomuchtodo 9y ago
      American taxpayers should fund medical schooling that is ruthlessly efficient, transparent, and operated with no profit motive.
  • mljoe 9y ago
    Part of this is because medical professors make a salary that is at least twice (and usually higher) what the next highest paid professor at a university makes. You fix the salary program across the board, and medical school will become cheaper as well.
• Quarrelsome 9y ago
  I sorta figure if you spend around about a DECADE of your life training in a profession then that profession should give you that sort of salary. The amount of education doctors have to do compared to the other routes to getting $200k p.a. makes me much more sympathetic to this outcome than say investment banking.
  • conanbatt 9y ago
    Thankfully, it is not up to the individuals to gauge what the value of other peoples labor is. Any decision that strays from what people want to pay is going to be either more expensive than it should, or lead to supply shortage. In this case, both are happening.
• ryandrake 9y ago
  Software practitioners could learn a lot career-wise from our counterparts over in medicine. Here's a profession with salaries more consistently high and more commensurate with the value they provide, where they're not as worried about global competition, and where ageism is not a factor. They have strong professional organizations who not only set competence standards and control labor supply. They lobby the government to mitigate competition and legislate who-can-do-what, with results very friendly to M.Ds. This is in stark contrast to the free-for-all race-to-the-bottom that characterizes tech labor. I'm not sure what an "AMA for software developers" would look like or do, but I'm pretty convinced a strong organization would be overall beneficial.
  • hackinthebochs 9y ago
    This will never happen as long as we continue to have a broad distrust of academics and fetishize the hacker with no formal training. We don't value ourselves as a profession and so we reflexively reject the idea of forming a professional organization. There's also the fact that a significant portion of software developers have no or sub-par formal training and are insecure about their ability to pass any rigorous standardized testing, and so there's some measure of self-preservation involved in rejecting a formal licensing body.
    • psyc 9y ago
      I’ve been repeatedly denied by gatekeepers disinclined to let me inside They say stay at the perimeter. Keep to the outer limits. They’re the ultimate limiters. Competitors can’t get in it. If we can’t even begin, they keep taking the win. We stay thin like we’ve been. They keep raking it in. Good luck plucking a chicken or an egg from nothing. Success flows to success, and so far I hear no clucking. I’ve jumped through enough hoops in my lifetime. More exclusion? No thank you. If we take cues from anyone, let it be tradespeople, e.g. apprenticeships.
    • user5994461 9y ago
      Your description is only true for web startups. Try to have a look in the defense or finance industry.
• krishanath 9y ago
  One problem not covered by this story: it takes too many years to acquire a medical degree. In India, you can go to medical college right after graduating from high school. It only takes 5 years in the medical school to become a doctor. By age 22 you are a doctor. Compare that to the US: you have to get degree from a 4-year college before going to medical school. This is wasteful, unnecessary, and increases the cost of medical education, which in turn increases cost of medical care.
  • dugmartin 9y ago
    You don't always have to have an undergrad. A good friend's Dad earned an MD/PhD from the University of Chicago without an undergrad. This was in the 1960s though and he entered after doing a stint in the Peace Corps.
    • sjg007 9y ago
      This is less likely now since competition is so high so undergrad courses/GPA is a filter, but it does speak about how an undergrad degree is strictly orthogonal to the job. You could probably get away with it today based on the MCAT as proof of pre-qualification maybe...
  • potatote 9y ago
    Same in my country (somewhere in SE Asia) too. I went to med school there for 2 years. It takes a total of 5 years there and doctors who are trained there eventually leave the country to practice in UK, US, etc. I have a few friends who graduated in my country and are making big bucks; all of them came to the US as IMGs (international medical graduates) and did well in USMLE exams to get into residency programs and hospitals eventually. That's why I don't think the 4 additional years of undergrad education (implicitly) required in the US is necessary. It only adds more debt to the would-be doctors.
• vbezhenar 9y ago
  In Russia most of doctors getting very low salary, less than MacDonalds employee. It doesn't work very well, talented people moving to other professions.
• deleted 9y ago
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• thatonechad 9y ago
  The marxists are out in full shill on this one. It's all about equality right? Ignore the fact that doctors in America are the best in the world, and spend years to become that. They see the bottom line and are more concerned if billy at McDonald's is making $15 per hour.
  • donquichotte 9y ago
    > doctors in America are the best in the world citation needed
    • eeZah7Ux 9y ago
      It's just plain wrong.
  • ptaipale 9y ago
    I don't see marxists here, some socialist tendencies yes. American doctors are good but "best in the world" is a very difficult claim to substantiate. One thing is certain: they aren't provided the best price-performance ratio, but one of the worse ones. It's not just doctors of course, it's the whole system. It looks like my country (Finland) shines in that price-performance ratio, according to the link provided above: https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-conclusion/ https://theincidentaleconomist.com/wordpress/what-makes-the-... Though even here, we're not without problems, e.g. in access to care in non-life-threatening situations.
  • sctb 9y ago
    You've been posting many comments that violate the guidelines lately. We need you to stop, read them, and then post accordingly. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
• mavhc 9y ago
  1. Someone's paying for those mansions Doctors live in. 2. Someone's paying the people selling drugs to doctors, advertising on tv etc 3. Someone's paying to run the insurance business According to my uk taxes I'm paying £800/year for the NHS
  • sjg007 9y ago
    And that's cheap! With employer health insurance I pay $4k in premiums.
    • vonmoltke 9y ago
      How much coverage do you have? My coverage is only for myself, but I would pay a bit less than $4k in premiums if I paid for 100% of my insurance.
• qaq 9y ago
  OK considering the time it takes for someone to start making that amount of $ in medical field to be honest we in IT should really be the last to complain.
• acconrad 9y ago
  All of my close friends are doctors and the toll that school and residency does on the body and mind is honestly shocking. I'd want to open up the residency and med school programs for nothing else but to not force our young doctors into 24 hour shifts. They're treating these young doctors like it's Hell Week in a fraternity, and the main excuse you'll get from the AMA is because that's what they (the older doctors) did so all of this fanfare is a right of passage towards full membership (attending physician) which unlocks all of these riches to justify sacrificing your youth for. To me, that's a much better narrative to support increasing the number of doctors than "they get paid too much." Instead, this article reads like a con artist who is using slight-of-hand to distract you from the watch he's taking from your pocket. The trick is the doctor's salaries, but the real stealing is happening from the health insurance companies. The article mentions how many billions of dollars this "problem" impacts the Federal budget. "Billions" - it's a large number in absolute terms, but relative to the problems with our inflated military budget ($850B), it's a pittance. What I'm trying to get at is this feels like the kind of thing a propaganda outlet would do to give you a false enemy to hate. Even if the premise is grounded in truth (that US doctors are paid twice as much as everywhere else), it just feels like the wrong villain.
  • jseliger 9y ago
    All of my close friends are doctors and the toll that school and residency does on the body and mind is honestly shocking Absolutely true: http://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school http://jakeseliger.com/2012/10/20/why-you-should-become-a-nu...
  • giarc 9y ago
    I work in healthcare and know, and went to school with many doctors. I hear this "long hours" compliant all the time. The problem is, they all seem to assume it's someone else's problem to fix. If physicians and med students want to get rid of the 24 hour shifts during residency, well they have to make that happen internally. They drive that decision, not the patients.
  • 0xB31B1B 9y ago
• chimeracoder 9y ago
  A big point people often forget when comparing doctors' s salaries to other fields: physicians are expected to cover a large number of their own work-related costs, like continuing education, insurance, or even medical equipment and (sometimes) overhead like office space. Because physicians almost always pay AMT, these work-related expenses are not tax-deductible. $250,000 sounds like a lot, but it's really not once you take into account how much of that goes towards insurance, licensing fees, equipment, supplies, and all your normal business expenses. (The article linked says that this is "even after malpractice insurance and other expenses", but that's clearly not what the underlying source data represents.)
  • hkmurakami 9y ago
    Are these cost categories true even for non private practice folks who are employed under a larger organization?
    • chimeracoder 9y ago
      > Are these cost categories true even for non private practice folks who are employed under a larger organization? Yes - depending on the employing org, they may not have to pay for some things office space (though many employers won't even cover that). But the bulk of their expenses - insurance, continuing education, and licensing - are not covered, and are paid for out-of-pocket by post-tax money.
  • mljoe 9y ago
    Their gross pay is way higher then $250,000. Actually $250,000 is the net salary after all expenses, and that's about right for not particularly enterprising doctors (ie. internal medicine, no surgery).
    • chimeracoder 9y ago
      > Actually $250,000 is the net salary after all expenses It's not. The article says that, but it's flat out wrong - even the source that the article links contradicts this claim. > For employed physicians, patient-care compensation includes salary, bonus, and profit-sharing contributions. For partners, this includes earnings after taxes and deductible business expenses but before income tax. The author of the article clearly doesn't know that "deductible business expenses" covers only a tiny fraction of the business expenses that physicians are expected to pay - most are not deductible.
• beisner 9y ago
  Before making a judgement on whether doctors are overpaid or not, I’d kinda like to see an analysis on the value doctors provide. For instance, how much does an average doctor’s treatment affect the economic productivity of all her patients in aggregate? If patients would produce substantially less without treatment, and she sees many patients, a high salary is much more justifiable. If you’re not keen on analyzing things strictly in terms of GDP, how much does an individual doctor influence quality of life, happiness, lifespan, etc? Again, an outsized effect warrants an outsized compensation. Of course, value is quite difficult to assess - especially added value versus alternatives (I.e. online self-diagnosis) - but it’d be interesting to see.
  • hn_throwaway_99 9y ago
    But the main argument is that US health outcomes, with their much higher costs, are not better than the outcomes in other developed countries with much cheaper costs, and there are lots of studies to back that up. Seems like you can skip all the analysis you are asking for, at least as long as salaries in the US are much higher than elsewhere without commensurate improvement in health outcomes.
    • beisner 9y ago
      I think comparing salaries across the world isn't really a good way to measure whether a provider is "overpaid" or not. If you're just looking at contribution to well-being and human happiness, that way of looking at things might be valid, but even if well-being/happiness outcomes in different healthcare markets are equal, productivity outcomes might be quite different. Americans work longer hours than in the countries outlined in the article, resulting in significantly higher annual productivity per capita compared to other countries. From a labor economics perspective, doctors in the US therefore might (again, depending on real metrics that I'd like to see) contribute more in absolute terms to GDP than doctors in other countries. Additionally, it might be the case that, relative to their productivity, doctors in other countries might be significantly underpaid. This sort of distortion happens in many other industries. Software, for instance, is notorious for this. Internationally, people might look at US software engineering salaries and balk at how high they are compared to the rest of the world, and might make the judgment that US software engineers are underpaid. But if you look at the profit per employee at leading tech companies, that figure dwarfs engineer salaries (e.g. Facebook's profit per employee is north of $400,000/year, Google's is similar). So, relative to value delivered, many software engineers in the US are actually underpaid. This implies that software engineers abroad are significantly underpaid, as they often work for the same multinationals doing the same sort of work. At the end of the day, salaries are determined by all kinds of factors, including competition, regulation, value generated, etc. I think that real value added is the only way to determine if a position is overpaid, and comparing to other systems doesn't really help us evaluate that.
• MBCook 9y ago
  This featured pretty promenantly in the most renecent episode of the Freakonomics podcast: http://freakonomics.com/podcast/nurses-to-the-rescue/ http://freakonomics.com/podcast/nurses-to-the-rescue/
• wdn 9y ago
  The issue here is we don't directly pay for the services. It is handle by 3rd parties, AKA health insurance companies. Health insurance company is not true insurer. They pay for everything. I meant, do you call your car insurer to pay for oil change? Since health insurance companies merely handle the payment and get a cut for this services, they have the incentive for the cost to go up. High cost equals to higher profits. Insurance company should be insure on highly unlikely illness, such as cancers.
  • criddell 9y ago
    > Insurance company should be insure on highly unlikely illness, such as cancers. I get what you are trying to say, but I think it's worth looking a little bit deeper. It's possible that it could be more cost effective to also cover some preventative care.
• nilkn 9y ago
  Most other wealthy countries subsidize the cost of medical education to some extent. This article didn't touch on the possibility that the extra $100 billion the US spends on doctor salaries is just being spent on education subsidies in other countries. Many professions in the US are paid more than their counterparts elsewhere. Software development is a good example, where the salaries I see in the US are often twice as high as what I see in Europe. But Americans have basically no rights as employees, very little time off, no access to universal healthcare, no access to high quality public transportation, etc.
• bkovacev 9y ago
  Going against the popular opinion. Sure, but when the salaries are too low like they are in Southeastern Europe doctors don't want to schedule surgeries($500+), do a proper look-up ($50-100) or even bother to check on you or when an inadequate doctor/nurse/practitioner checks on you or does a procedure and screws up what happens? Nothing. Tough luck pal. Healthcare is public, you're required to pay for it and it's deducted from your salary. What do you get in return? Two nights ago I brought my girlfriend's sister to the ER, her appendix was inflamed, she couldn't walk, talk or move due to pain and was left waiting for an hour. They did blood work and gave her an IV and sent her home, told her "we cured you" after another blood work was completed and her leukocytes dropped a bit. No ultrasound, ct or anything advanced, they haven't even properly checked her stomach. Her leukocytes were >19000. I was later told by a friend that I need to give a 50 to the nurse to push her through the line and another 100 to the doctor. Great world we live in. Don't get me wrong, but I think you should not fix something that is not completely broken. Your doctors still do their work and don't expect money, expensive gifts, bottles of whiskey and roasted pigs like they do in my home country. In my country number of doctors you're allowed to have in a Clinic/ER/Urgent Care is proportional to the number of people living in the region. There is 1.3 gynecologist on a region of 10,000 people. Is that normal? My grandmother has to schedule a month and a half in advance to get her prescription medication and check ups are every two-three months. Not sure how it is in the States now, but in my 10 year tenure there and 10 times I was in the hospital, I never waited for more than 10-15 minutes after my scheduled time.
  • test6554 9y ago
    That's why it's going to take automation to finally drive disruption in health care.
  • jacobrobbins 9y ago
    bkovacev out of curiosity what country do you live in? Because i have friends who have had much better experiences in Estonia.
    • bkovacev 9y ago
      Jacob - I'm living in Serbia. This has happened to us in Novi Sad couple of nights ago. I should have maybe added Southeastern Europe. I'll fix that. Estonia is light years ahead of my home country! :)
• test6554 9y ago
  If you want to reduce doctor salaries, then you need to reduce the exclusivity of their skillset. You need to reduce their working hours, their student loans, and you need to automate the detection of issues/mistakes. Their hours need to be limited to sane levels. Medical schools need to get cheaper. Robots, IoT health and fitness devices, and nurses need to take over more functions that Doctors perform.
• qaq 9y ago
  And now let's look at the size of US drug market and it's 4.6x the size of estimated salaries from the article. Almost looks like article was sponsored by Big Pharma
• IanDrake 9y ago
  I’ve been expecting this type of discussion for a long time. It’s part of the march toward socialism. We are now starting the price fixing phase of the march. Now that enough of the nation’s healthcare bills are being paid by tax payers, it will be popular to blame overpaid doctors. Forget all the government involvement that got us to this point and just blame the free market. Things like this make me sad for our future.
• jamiesonbecker 9y ago
  Correlation is not causation, but this basic principle is sometimes lost on political journalists.
• shams93 9y ago
  As an engineer my salary is frozen in 1998, technical salaries have been effectively frozen so long that my salary thinks Biggie and Tupac are still the big thing. It doesn't matter how rare the technical skills there's a hard ceiling on income coupled with high cost of living and you work 100 hours a week but still have to go hungry on some days. Salaries are frozen in time for the benefit of the thin layer of people who own other people for a living.
• taurussai 9y ago
  So lets just say the savings as described in the article by not paying doctors as much would be $100billion (cut doctors salaries by half). Spending on US Healthcare was in 2015-16 was $3.2 trillion. Assuming there are no side effects in the market (such as number of students entering medical school would decrease etc) the $100 billion in savings is 3.1% which is a very small figure.
• killjoywashere 9y ago
  Paul Starr's The Social Transformation of American Medicine is the standard text on these issues.
• jprafael 9y ago
  Disclaimer: I'm not a doctor nor do I work in the US. My prespective is as a software engineer who contacts daily with doctors. In order to get into med school you must sure that your high school grades are on the top 5%. You must ensure that the hospital(s) you work in are able to function 24/7. This means you don't really control your vacations, you must work nightshifts and you will work on special holidays. You don't get to clock out when your shift ends. You are medicaly responsible for your patitients until someone else takes over. If the patient starts having problems just before the end of your shift, you have to handle it. Its frequent to only actually leave the hospital 2h after. Your work doesn't end when you come home either. You are supposed to study for exams, to refresh your knowledge over the diseases you are currently working on. You need to build your curriculum by publishing research papers and attending expensive conferences. Your hospital rarelly pays for this. You either lobby with pharmaceuticals in exchange for favours or pay out of your pocket. In order to get a specialization you have to go through 4-6 years of training/evaluation. That is, if you can get into one in the first place. Due to the limited amount of positions available, doctors have to compete against each other. Only the top 2% will get to the prestigious/high paying positions such as neurology or plastic surgury. The pressure is huge. People will die or live depending on your decisions. You'll make 10s of those every day. People will still die everyday regardless of what you do. Its not cost/health effective to try every procedure on all patitents. You will have to come home to your family knowing that you could have saved someone but you decided not to. You will be the one informing their relatives. They might sue you or the hospital over malpractice. The hospital has insurance for this but its there to cover the hospital, not its workers. You are expetected to have your own insurance if you work in high risk zones (e.g. ER). Being a doctor is a high risk profession. There are plenty of infectious diseases just lying arround. You never know what the next patient might have. You have to be wary of criminals trying to steal drugs, criminals comming in to finish of someone, patients with mental issues trying to hit you. Not to mention people that have received bad news or have simply been waiting for too long, wanting to take some frustration out on the next person they see. The 200k average is most likelly misleading. Where I live doctor salaries are very skewed. Most high profile doctors also have management positions and can make 10x than regular doctors. Sure they get more money at the end of the month, but for what its worth, I wouldn't trade my salary/responsabilities/perks over theirs.
• darawk 9y ago
  Totally agree with this article. All excellent points. I think these sorts of improvements to a free market medical system need to be fully explored before we turn to socialized medicine. I'm not opposed to socialized medicine if it's necessary, but I think all else equal, market-based systems are better. If we truly can't make a market based system work, then i'm all for it. But I think there are a lot of ways to improve competition and drive down costs without making that leap. Just to pile on a few other things: - In order to open a new hospital in the US, you need to demonstrate 'need' for it. Who certifies that there is a need? A panel of the other hospitals in the area. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need - A large percentage of the things people go to the doctor for right now could be handled by a nurse, or someone substantially less qualified. You don't need to see an MD to get diagnosed with a cold. Making it easier for people with lower tiers of qualifications to provide basic types of care, and even write prescriptions for simple issues would dramatically increase access and reduce costs. There has been some movement in this direction, but not nearly enough. - Breaking the doctor-pharma company relationship. This is a tricky one, and i'm not sure how to go about doing it in a way that doesn't overly trample either entity's rights. However, there is an enormous problem in the US of drugs being prescribed to patients without regard for cost. Often there are many nearly equivalent pharmaceuticals to address a given problem, but doctors will prescribe the latest and greatest one, because they are incentivized to do so by the pharmaceutical companies. Since that drug is still under patent, it costs substantially more than many 'nearly as good' alternatives. Patients don't have the information or education to know this usually, and so they just follow their doctor's recommendation.
• carewolf 9y ago
  The problem are not doctors salaries, it is everybody elses. Double the salary of everybody else, to where it would have been if they hadn't been fooled into dropping unions.
  • conanbatt 9y ago
    Oh my. That's not how it works. Thats not how any of it works. There are less people getting health services than there would be if it weren't a constraint field. Also, the total amount of money paid to doctors would be much higher if more doctors would join: it just would be a lower average. The doctor community makes less money by contraining supply the same way a bagel shop makes less money if it doesnt satisfy its demand. This is absolutely basic microeconomics.
• jhas78asd 9y ago
  The article failed to mention the high cost of medical school, high interest rates for loans, and being phased out of interest deductions from earnings (which are capped quite low IMO to being with). My wife attended a Big 10 university medical school, costing around 50K/year, graduating with around 200K of debt, added to her 50K of undergrad debt, deferred through most of training, making 50-60K as a resident and fellow, looking at a 2000+/month expense for P&I on those loans. We've re-financed it, but the rates are still quite high relative to car loans, home mortgage etc., so of course this reality of essentially carrying a second mortgage of debt, was a factor in her choosing to go into a specialty, with additional training (fellowship), and moving to a lower cost, higher demand (higher wage) area. We pay 15K+ INTEREST annually on those loans and we are phased out from deducting any of that. If undergrad was less expensive, or free as it is in other countries, if med school was less expensive, doctors could enjoy the same quality of life with less salary.
  • s0rce 9y ago
    Isn't the important statistic when break even with someone who makes less but started saving earlier with less debt (say only college debt). I haven't run the numbers but 250k in debt doesn't seem so bad if you make 300k after you finish at 32, compared to making $100-150k with 50k debt starting at 22. You could also compare the opposite, if you have 250k at 19 is it a good investment to go to medical school or take a less lucrative job and just invest the 250k in index funds, I'm guessing medical school still comes out on top, maybe after 20 years.
    • potatote 9y ago
      I agree with your point. I never understood why making >150K starting at the age of 32 with a debt of about ~300K is an insurmountable burden. I have a close friend who fits the above profile. She actually makes about ~200K/year (after tax and everything, she nets about 100K); her work hours are nothing unusual--~9-10hours. With this rate, she can comfortably pay off her debt in ~10 years top.
      • fjsolwmv 9y ago
• chriskanan 9y ago
  I feel like doctors should at least be paid as well as programmers. My wife is a physician with $500k in debt and she completes residency next summer. That took 4 years of undergrad, 1 year to burnish her credentials, 4 years of medical school, and 6 years of residency. Her job offers are all under $200k for pediatric neurology. With that enormous amount of training, debt, and responsibility, I feel like she should be making a lot more than your average AI programmer. In other countries the education process is much shorter. For example, in Columbia, I'm told, you skip undergrad altogether to be a physician. Some other nations make training free, which encourages more general practitioners. Can anyone explain why Medicare subsidizes residency slots? Moreover, why do they need to be subsidized? Residents earn about $40-60k per year and work 80 hour weeks.... If you think PhD students are slave labor, talk to residents.
  • wonderous 9y ago
    Comment to me reads as a rant with a mix of false claims and requests for someone else to do the leg work. For example, the average salary for a Pediatric Neurologist [1] within the US is higher than the average programmer salary [2]. [1] https://www.glassdoor.com/Salaries/pediatric-neurologist-salary-SRCH_KO0,21.htm https://www.glassdoor.com/Salaries/pediatric-neurologist-sal... [2] https://www.glassdoor.com/Salaries/programmer-salary-SRCH_KO0,10.htm https://www.glassdoor.com/Salaries/programmer-salary-SRCH_KO...
  • Cd00d 9y ago
    I don't understand the reasoning that because one opts for expensive training that incurs debt then a high salary is necessary. What other forms of debt behave that way, where the more you take on the more compensated you should be? I did a physics PhD, which took roughly 8 years of graduate training. My stipend was ~$12k per year for 80 hour weeks, and from that I still had to pay student fees. It's possible to graduate debt free in that situation (I did not), but does that imply that my working salary should be less? Or, because I did take on debt, I should get paid more?
  • lancebeet 9y ago
    In Sweden, there's no undergrad degree required for med school, but med school is 5.5 years (followed by 18 months of the Swedish equivalent of residency). Like in the US, most physicians are specialists which requires around 5 more years of training. Their student debt will generally be around 350k SEK once they finish med school which is around 40k USD, but they're paid peanuts compared to physicians in the US (~50k-80k USD per year). That is, unless they work as independent contractor physicians in which case they will make (almost) equivalent amounts before taxes.
• assblaster 9y ago
  1) Physician salaries have been decreasing relative to inflation for the last 30 years. Decrease it further, and opportunity cost will drive smart talented people away from healthcare. 2) Physician education and training are fundamentally different from nursing education. Not just in duration, but also in mindset. Doctors think through medical problems through a physician mindset, and nurses think through nursing problems through a nursing mindset. Simply letting nurses make medical decisions without the proper frame of thinking has been proven to have higher rates of complications and misdiagnosis and physician consultations. 3) The main driver of healthcare costs is not physician salary. More attention needs to be paid to equipment, capital infrastructure, nursing staff, administrators.
• hanklazard 9y ago
  The article fails to mention the debt-load that doctors acquire through their lengthy schooling. I agree that it seems ludicrous to pay (some) doctors the outrageous salaries that they are paid, but most professions don’t require a couple thousand dollars of post-college debt to practice. That may be fine for a specialist surgeon pulling in 600k annually, but it’s quite different for academic primary care docs making more like 120k$ in major metropolitan areas. Disclosure: doctor
• kwhitefoot 9y ago
  You have a similar number of doctors per capita as other comparable countries so it seems unlikely that the mere supply of doctors is the problem, Patients per doctor Norway: 320, US: 390, UK: 440. (http://bigthink.com/strange-maps/185-the-patients-per-doctor-map-of-the-world http://bigthink.com/strange-maps/185-the-patients-per-doctor...).
• dustinmoris 9y ago
  This article is total bollocks. Doctors are not overpaid in the US, the ones in Europe are massively underpaid and overworked because they are funded by tax payers.
• arikrak 9y ago
  > Doctors and other highly paid professionals stand out in this respect. Our autoworkers and retail clerks do not in general earn more than their counterparts in other wealthy countries. You need to compare doctor pay with pay on other skilled careers like software engineers and lawyers. A software engineer earns considerably more in the US than in Europe.
• aabajian 9y ago
  I'm a surgical intern right now, it's not fun. I'll be doing radiology next year, and very much looking forward to it. I'm biased, but I don't agree with the premise of the article; Doctors should be among the highest earners in any country, it's the price you pay to ensure the brightest students are attracted to medicine despite the long training. I do agree with the following: A second route would be to end the requirement that foreign doctors complete a U.S. residency program in order to practice medicine in the United States. This means setting up arrangements through which qualified foreign doctors could be licensed to practice in the United States after completing an equivalent residency program in another country. The admission of many more doctors would put downward pressure on the pay of doctors in the United States, as insurers would have a new pool of physicians to add to their networks who will accept somewhat lower compensation. I've met many foreign-graduates who have already completed residency. In makes ZERO sense to have these individuals repeat a residency in the U.S. They have already undergone 12+ years of training, actively treat patients in their home countries, and there's a need for physicians in the U.S. This is very much cartel-esque of the AMA. I know it would result in lower salaries, but this would (hopefully) translate into lower-cost medical school in the U.S. This is a situation that may benefit from tech solution. There are already certain states allowing foreign medical graduates to practice in the U.S. If you're looking for a "startup pain point", let me present you with the two sided market: 1. There were ~7,500 international medical graduates who applied to residency in the U.S. (http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-IMGs-2016.pdf http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outc...) Presumably, these are individuals who want to practice in the U.S., but must undergo a U.S. residency. I don't know how many of them have already completed a residency in their home country, but let's conservatively say 25% or ~1,800. 2. The AAMC is estimating a physician shortage of 30,000 by 2030 (https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/ https://news.aamc.org/medical-education/article/new-aamc-res...). Even if all of the foreign train medical graduates were allowed to practice in the U.S. w/o residency, it still wouldn't be enough. Maybe there's a startup opportunity that matches foreign MDs to positions in the U.S. As I mentioned, states like Missouri have already allowed some non-residency-trained physicians to practice (https://www.statnews.com/2017/05/15/missouri-doctor-dearth/ https://www.statnews.com/2017/05/15/missouri-doctor-dearth/). My preference would be to have a foreign doctor who has undergone residency in his or her home country rather than a U.S. grad with no residency.
• sbov 9y ago
  https://www.cdc.gov/nchs/fastats/health-expenditures.htm https://www.cdc.gov/nchs/fastats/health-expenditures.htm The US spent 3.2 trillion on health care in 2015. 100 billion is 3.12%. It doesn't seem like that big of a problem.
• Brakenshire 9y ago
  This is a big reason why the NHS is a lot more affordable, average wage for a GP is still something like £90k, but it's not in the hundreds of thousands. Staff costs are just a really big part of the total cost of providing care. The rest of the benefit is making clear cost:benefit decisions on buying drugs, reducing bureaucracy from the insurance system, the ability to centralize and scale care without so much replication, etc. But doctors salaries are still a big part of it.
• SkyPuncher 9y ago
  My wife is in medical school and we often talk about these types of issues. I think this article is a bit misleading in suggesting that the limitation of spots in residency programs are intentionally and disingenuously imposed. The reality is training doctors is very, very hard and there simply enough resources to do it properly. This is not an issue with medicine alone. We're seeing similar trends in the tech industry where developer salaries are sky-rocketing because there is a lack of highly qualified talent. Even with a slew of "bootcamps", "code universities", and a general influx to the industry the tech industry still doesn't have enough highly qualified individuals. The medical industry is facing a similar issue, but everything has even higher standards because medicine involves human life. The medical industry is trying to keep up (my state has opened 3 new medical schools in the past 5 or so years), but it takes a very, very long time for organizations to find the proper resources and build a proper program. I believe my wife's school was in works for 10 to 15 years before opening its doors 4 years ago. Opening more spots requires finding qualified doctors who not only understand the subject well, but can actually teach it. This severely limits the sample size. On top of that, these programs also require doctors who are willing to put up with medical students and residents on a daily basis. Could you imagine if you were paired with the new development intern every day of your working life? You'd go crazy. ---- I do think something needs to be changed, but I don't think medical schools and residencies are really the place to make an impactful change. I see a lot of value in doctors becoming "supervisors" and managing a team of nurse practitioners or physician assistants. Then again, we're seeing similar training issues in both of those fields.
  • fjsolwmv 9y ago
    Programmers are making a fortune because they are critical to generating massively superlinear business profits, and the market is winner-take-all competitive My doctorcan't generate superlinear profits for curing me better than your doctor cures you.
    • SkyPuncher 9y ago
      I'm a programmer so I see both sides. The reality is both programmers and doctors have a highly technical skill. A high school can build an "app", but they likely don't have the depth of knowledge to build it properly and reliably. The same goes with medicine. A nurse, WebMD, or other resource might get you the correct answer, but that's not really the name of the game. Medicine is about both getting things right and not getting things wrong. It's easy to teach the first, it's very hard to get the second.
• wife_is_md 9y ago
  Until I met my MD wife, I would have agreed with most of the points in this article. Doctors in the US are certainly well compensated relative to Doctors in other countries. Also, the story of physician credentialing as a means of restricting labor supply appeals to my economic rationale. However, there are some weaknesses with this argument. To start with, physician compensation makes up just 8% of total healthcare costs in the US: https://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ https://www.jacksonhealthcare.com/media-room/news/md-salarie... So, if they were somehow cut in half, that would net a savings of just 4%. That assumes there wouldn't be a corresponding drop in quality as a result of loss of physicians from the occupation. Keep in mind that this is an occupation whose supply is so tight that one of the primary ways being discussed to increase supply is by lowering the credentialing requirements for primary care by having Nurse Practitioners and Physician Assistants provide primary care, unsupervised by a Physician. I think that's really the rub in terms of talk of lowering physician pay. The barriers to entry in the field (in the US) are so high that if physician pay were significantly reduced without a corresponding reduction in the barriers to entry, it would disincentivize our smartest, and hardest working people from becoming physicians. Which would lead to a significant decrease in the quality of healthcare in the US. In the case of my wife, she is both smarter and harder working than I am. She spent her 20's and early 30's working 60+ hour weeks doing work that is very taxing mentally and emotionally. She went through four years of undergrad and four years of medical school. She exited medical school at 26 with a significant amount of student debt (though less than many, and at a lower interest rate due to smart decisions on her part) that started capitalizing immediately. She then spent four years in a residency program, making $50,000 a year, and then another four years in two different fellowship programs also making $50,000. When she finally got to a point where she started making a Physician's level of compensation, she was almost 35 years old with $240k in student loan debt and a small amount of savings and retirement built up. She could have dropped or failed out at any time and, if she had, she would have taken on the full cost of the student loan debt without the ability to repay it. This level of debt represents a significant personal risk for physicians that shouldn't be discounted. If you were to compare our financial situations independently, as a software developer, I'm in a better position financially. I've had the opportunity to invest my earnings in my 20's and 30's and haven't had to forfeit so much of my later earnings to debt. As a result of this financial head start, even though she makes more than twice what I make, she doesn't have a chance to catch up with me in terms of wealth accumulation until she's in her 40's, assuming she's financially disciplined and doesn't succumb to physician lifestyle inflation. If she had instead aimed to become Nurse Practitioner or Physician Assistant, she would have been looking at a low to mid 100k job in her mid-20's with maybe 40k in debt. This would have been a much lower risk in terms of debt, it's much less work to go into one of these fields, and I would argue it may be a better move financially because of the ability to put her money to work earlier from an investment standpoint. So, if the carrot of higher compensation later down the road is eliminated, I think we will see less quality people entering the field. Physicians are some of the smartest and hardest working people in the US. They'll be able to weigh the cost benefits and will choose alternative fields that have better financial renumeration or lower risk. If the student loan burden were reduced for physicians, you might be able to get away with lower pay without disincentivizing becoming a physician. But I don't see the government providing more assistance to cover the cost of medical school. If we really wanted to cut down costs for healthcare in the US, the first place to look is administrative costs. We pay more than twice what other countries pay in administrative costs as well. And administrative costs make up a greater percentage of the total money spent on healthcare. Administration costs are mostly waste in that the reason it exists is to keep the gears turning so people can receive healthcare. One of the reasons administrative costs are so much higher is b/c of the complexity of the private insurance system in the US. As others have noted, some of the administrative burden would be simplified by a universal healthcare system. http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs http://www.commonwealthfund.org/publications/in-the-literatu...
• rcpt 9y ago
  My wife is applying for family medicine residency right now. There are 20 slots for the entire Bay Area. 6 at UCSF, 6 at Kaiser San Jose, and 8 at Stanford. Family medicine isn't neurosurgery or radiology but the artificial limitations on residencies still lead to hyper competition, long hours, and an insane "match day". When graduating med school it doesn't look that much harder to push a bit more for a specialty and get paid twice as much. And now we have too many specialists in the United States. It seems like we could solve this pretty easily by simply increasing the number of residency slots for GPs.
• grandalf 9y ago
  When you start with the premise that a price is too high (or too low) the resulting reasoning is bound to be sloppy and fraught with bias. This article is no exception. It is embarrassing to read this article, because it is full of small, emotionally-potent morsels for those who don't like doctor salaries being high. It's as if the article were read as ASMR but the excitement is instead induced by those potent "the price is bad" morsels. The truth is that not all doctors make even $200K and many struggle for years to pay back their med school loans once they finally are able to earn a salary after years and years of training. But it's only by a slight of hand that we are even focusing on doctor salaries instead of the broader issue of the cost/benefit offered by the healthcare system as a whole. Doctors combine a form of scientific authority with both social and moral authority. They have scarce knowledge, they judge whether or not we deserve workers comp, a paid sick day, a sticker to park in a coveted parking spot, permission to take a pill that takes the pain away, etc. They tell us which of our symptoms we are to blame for vs which we can blame on others, and they offer us hope when our loved ones are at death's door. This makes doctors the closest thing modern, mainstream (secularized) culture has to priests and priestesses. The status held by doctors goes far beyond any financial rewards. We must ask ourselves the difficult question of why we (as a society) need the absolution and authority offered by doctors. Why can't we just (as the article suggests) make pragmatic decisions that would lower the bar for entry into the profession? To do this, we must appreciate that there is a uniquely American view of health that differs from the view held in many other places. Health is something we deserve. Health is understood as something that can be restored or improved through science. Disease is understood in a way that is analogous to "evil forces" that can be successfully eradicated from the body. The social and psychological aspect of disease is minimized, and the physicalization of mental health challenges is nearly completely denied. Death too is treated differently. Death must always have one cause, and the implication is that were it not for that cause life would have gone on much longer. In such a view, it is only through the perfect knowledge and/or perfect technical performance that we can overcome disease and stave off death, so doctors must be close to perfect. This is why the bar is set so high for entry into the profession. Those who are selected into the profession are typically very highly skilled. Medicine is among the most popular career plan for college freshmen, but only a small percentage manage to be admitted into medical school. The rest wash out either because they don't want to work that hard or because they can't make the grades. This pressure on perfect outcomes (and all the fallacies the notion entails) results in expensive malpractice insurance and far too many costly interventions that have little chance of significantly benefitting the patient. A massive amount of lifetime healthcare spending occurs in the last two months of a person's life. The author seemingly blames this on doctor salaries. This is false. The problem is that patients and their families expect the 80 year old with pneumonia to miraculously recover and live to be 100. The fact is, when an 80 year old gets very sick and ends up hospitalized, it's quite likely that a cancer or two might be discovered, as well as all sorts of other impending problems. But the family still thinks of the person as a healthy 80 year old. Most of the cost of our healthcare system comes from this adjustment process during which we flush money on useless tests and interventions, all to help a patient and family adjust to the reality of old age and impending death. Yes, there are some docs who profit from largely elective and arguably wasteful surgeries, but many of those are also the optional "lifestyle" surgeries that the public demands most (arterial stents, plastic surgeries, many cosmetic derm treatments, etc.).
• inopinatus 9y ago
  This article is founded on bad research. Research that considers only what it costs to have a consult with a doctor. The same research does not consider what it costs that doctor to become and remain a doctor. Those costs are borne much more directly by the physician in the US, whilst in the other countries discussed it is far more diffused into the public tax burden. In other words, the entire article is built on sand.
• yellowapple 9y ago
  I feel like the most obvious explanation here (one which the article doesn't really cover all that well) is that college tuition is disproportionately high in the US. This means doctors (and other professionals) have to be paid more just to be able to pay off student loans.
  • sjg007 9y ago
    Doctors that work at qualified non-profits can get loan forgiveness. Also there are special programs to pay off medical school debts.
• unionjack22 9y ago
  https://www.cdc.gov/nchs/fastats/health-expenditures.htm https://www.cdc.gov/nchs/fastats/health-expenditures.htm The US spent 3.2 trillion on health care in 2015. 100 billion is 3.12%. It doesn't seem like that big of a problem. This article is just capital scapegoating labour as the source of the inefficiency and insane costs that is particular to the American Healthcare system. If you want an honest discussion, look to the heart of the issue, which is the fundamental incompatibility with effective healthcare and America's fetishism of libertarian market dynamics. I mean even in the Swiss healthcare system which maintains private insurance participation, family doctors on average earn CHF 198,000/USD 201,732. This is just a hit piece by big Pharma trying to squeeze dollars out of labour and we in tech who went through 4 years of schooling to collect comfy salaries for a few hours a day of productive work, we in tech who love to bash H1B's and foreign grads for increasing our competition, and we in tech who seldom reckon with real human suffering, fear, and death in our line of work, are absolutely eating it up. I absolutely look forward to the time when the squeeze comes and companies pivot to blaming us as the reason for the high costs of goods or as the limiting factor stopping execs from achieving the revenue gains they promised investors.
  • chiaro 9y ago
    I'm not sure what you intend on accomplishing by noting that doctor's salaries here are still more expensive than one of the most generally expensive western countries in the world. Conspiracy theories about 'big pharma' on something from CEPR helps no one.
    • hudibras 9y ago
      No, no, no, you don't understand. Although our doctor's salaries are much higher than other countries, it's okay because our drug costs, medical supply costs, ambulance costs, hospital administration costs, and insurance company overhead costs are also much higher. Therefore, doctor's salaries just a small percentage of health care costs in the United States. It's basic math, really.
  • vibrio 9y ago
    "hit piece by big Pharma" seems a bit overstated. It has the same lack of nuance that an accusation by drug companies often make against AMA as a cartel in defending drug pricing. There are examples of gross abuses and genuine value on both sides of this--and also in hospital administrators and insurance ( did I leave anyone out?) Side note: My personal experience leads me to think that many specialist physicians are more than fairly compensated, and good nurses are less so for their value.
• d7 9y ago
  Medical education in Europe is free. In the US, it costs hundreds of thousands of dollars, on top of 4+(1-9) additional years of training with grueling hours during the prime of your life. 80% of doctors are burned out. The emotional toll of watching innocent people die, telling their families, and doing your best with variable levels of success is indescribable. Doctors in the US are not overpaid - the pay is the only thing keeping them in the profession. The real money is going to hospital administration (non-profit hospitals with executives paid more than 6 million per year), malpractice insurance which can go up to 30% of a doctor's salary (a single malpractice case can cost $1M to defend, whether you are guilty or not), and most importantly, tests that have to be done, not out of necessity, but because there is a 0,1 chance of a rare condition that can get caught by it, and the doctor can be sued if they miss it.
• purplejacket 9y ago
  Yup. As unionjack22 says, this is just a hit piece. For instance, hospital bureaucrats can make way more than doctors. This from a 2014 NY Times article: "The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor." -- https://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html https://www.nytimes.com/2014/05/18/sunday-review/doctors-sal...
• vasilipupkin 9y ago
  Hmmm, shouldn't you compare doctor salaries not just with doctor salaries in other countries, but also salaries relative to other professions that require similar level of IQ and schooling in the US? 250k doesn't seem that high in that context. A mid level manager in a company can make that much
• cmurf 9y ago
  Some hospitals certainly are making a lot of profit, and quite a few of the most profitable are non-profit hospitals. https://www.bizjournals.com/denver/news/2017/11/15/denver-hospitals-increase-profits-with-some.html https://www.bizjournals.com/denver/news/2017/11/15/denver-ho...
• nemo44x 9y ago
  The next great thing tech can do is to automate and streamline as many procedures that currently require a physical doctor. We will need to lobby Congress to change regulations and possibly even torte reform for automated, computer based health care. I believe it's the best way we can scale health care. We need machines that can do the majority or tests and diagnosis to at least flag things as suspicious and then send the person onto a human doctor for further analysis.
• sodosopa 9y ago
  Isn't politico a fairly conservative news hub now? I don't see paying physicians less as a good thing, do we really want the lost cost physician operating on us?
• msaltz 9y ago
  One thing not mentioned is the cost of medical school (both in time and money) in the US vs. other countries. I’d imagine that a decrease in doctors’ salaries in the US could cause a significant drop in the number of people willing to spend the amount of time and money necessary to become a doctor. If we want to decrease the pay to match other countries, I think we’ll also need to decrease the investment required to become a doctor in order to maintain a reasonable level of supply.
• curun1r 9y ago
  The first step is to actually start spending more money, specifically on grants for med students. One of the reasons we have to pay doctors so much is because they have so many loans to repay. I've been told that between med school and the low pay during residency, a doctor's break even point can be around age 40. If we paid them less, they might not get out of the hole with time left to save for retirement. But if we can keep them from going so far into debt to become a doctor, it'll be more reasonable to pay them less. Other countries have programs to help or even fully subsidize their training...we should have something similar. Because the way it is now, they get bitten by interest twice, on their loans and on their inability to save for retirement during their 20s and 30s.
• deleted 9y ago
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• mar77i 9y ago
  Not-yet-so-famous musicians should be able to hang out at a doctor's office or house for free. I even see room for mutually beneficial symbiosis, as music as something cheerful in and on itself can help enhance medical treatment. But I digress... :)
• pers0n 9y ago
  Medical tourism or maybe get an medical intern, they can do it for sweat equity and stocks