6 ms·

Since doctors in other countries sacrifice similar amounts of time to become doctors, what makes US doctors so special? (We all know why)

empath75 6y ago
Because Americans make more money for most equivalent jobs?
- jhwang5 6y ago
  Or there's a systematic inflation of the cost of delivering healthcare?
  - jac241 6y ago
    Everyone loves to compare doctor salaries between the US and the UK, but they fail to compare the salaries for other professional roles. These kinds of jobs often pay the same 1.75-2x premium comparing the two countries. They also fail to compare doctor salaries with other countries like Canada, Switzerland, and Australia which also pay similar absolute amounts to physicians in the US. Doctor salaries are not the driving force of increased healthcare expenses in the US. Per unit of work, they're paid much less than they were in the late 90s. Here's a graph that shows one of the main culprits: https://i1.wp.com/investingdoc.com/wp-content/uploads/2017/08/admin-jobs.jpg?w=1024&ssl=1 https://i1.wp.com/investingdoc.com/wp-content/uploads/2017/0...
    - AlotOfReading 6y ago
      Can you give numbers to those absolute salaries? US PCPs make ~$220k on average. Switzerland seems to be the highest, but the numbers I'm seeing for non-specialists are all less than 200k. Switzerland also has a famously high CoL, so even matching would be reduction compared to say Kansas.
      - jac241 6y ago
        Here are the swiss salaries - https://www.reddit.com/r/medicine/comments/a8t87g/swiss_physician_salaries_switzerland_conducted_an/ https://www.reddit.com/r/medicine/comments/a8t87g/swiss_phys... Most are the same as US. They pay anesthesiologists more, dermatologists less, gastroenterologists more, etc. Most are about the same as here. They also have universal healthcare. Here is a chart for Australia: https://www.businessinsider.com.au/heres-how-much-money-australian-doctors-actually-earn-2014-5 https://www.businessinsider.com.au/heres-how-much-money-aust... Hard to say how much they earn when working private as well. Anecdotes from the medicine subreddit suggest a lot. Canada: https://www.cnbc.com/2018/03/06/canadian-doctor-protest-their-own-pay-raises.html https://www.cnbc.com/2018/03/06/canadian-doctor-protest-thei... Medscape always sets the bar low when comparing US to other countries. I don't know why they do not include these ones. Here's the Medscape report that conveniently leaves these three countries off (wonder why): https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen... I'll try to find more sources for the other countries as I am interested as well. 220k is likely on the low side for PCP here. Offers coming in more around $250-270 range.
craftinator 6y ago
> (We all know why) Do we? Please educate me then. I have a few guesses, the primary ones being artificially limited numbers of doctors, the artificially inflated cost of a medical degree, and the elite status that doctors hold. A runner up guess is that Americans have the delusion that modern medicine has a near perfect solution for every problem, so doctors do not factor in cost when prescribing treatment, even when extreme costs are associated with marginally better outcomes. The funny thing about this is that because of the extremely high cost of modern medicine in practice, prescribing treatments that have the best health outcomes at the present can cause years, decades, or lifetimes of poor health and hardship due to the burdens of debt and stress. If I had to pay $10 grand for some stitches that I could do myself (which is a fairly common amount for say, 30 stitches), that cost would decrease both my life expectancy and my personal happiness.
- jac241 6y ago
  It's easy to point at physicians and say they're artificially limiting the number of physicians created but they are not. Residency spots are funded by Medicare and that is the limiting factor. The hospitals get paid 150k for each resident, pass 55k on to the resident as salary, and keep the rest. Hospitals could choose to pay for their own residency positions, but they don't because then Medicare wouldn't be willing to subsidise the spots anymore. You could suggest we replace the high paid physicians with nurse practitioners or physician assistants but that is ignoring the fact that they are paid in the exact same way (and soon to be amount - executive order signed to equalize Medicare payments b/w midlevels and physicians) as physicians! If an NP or PA sees 25 patients in a day, they will bill for the exact same amount as a physician would. Additionally, the midlevels would order more tests and imaging on average than physicians, driving healthcare costs ever higher. There's a reason hospitals love midlevels so much and are helping to push for their independent practice. Each unnecessary test or CT scan is extra $$$ to the hospital.
lotsofpulp 6y ago
I am not aware of any other country that asks their doctors to spend hundreds of thousands of dollars for their license and are required to work 80+ hour weeks into their early 30s. And someone with the intelligence and drive to become a doctor in the US can easily earn $100k per year for 40 hours per week in their 20s if not more, so the lost income alone is a minimum $500k, on top of hundreds of thousands in debt. It all doesn’t make sense unless you come out making $200+ per hour.
- jhwang5 6y ago
  Ever considered that a lot of people who become doctors aren't just factoring in financial tradeoffs in career decision? Like, the desire to heal people who are sick?
  - lotsofpulp 6y ago
    No, I don't believe "a lot" of people will throw hundreds of thousands of dollars of debt on their back and forego almost all of their time with friends, family, and significant others in their 20s to work grueling 24 hour and overnight shifts in hospitals just to heal people who are sick. It's not just a financial decision, you are sacrificing a good portion of your young life, delaying family planning, etc. There is no reason they need to be run through that gauntlet, other than to restrict supply and make them go through a hazing of sorts. Why can't they have work life balance? Why do they need so many years of schooling when other countries don't? Why are they paid minimum wage (if calculated per hour) during their residency years? Other countries show that none of this is necessary to heal people who are sick.

empath75 6y ago

Because Americans make more money for most equivalent jobs?

jhwang5 6y ago
Or there's a systematic inflation of the cost of delivering healthcare?
- jac241 6y ago
  Everyone loves to compare doctor salaries between the US and the UK, but they fail to compare the salaries for other professional roles. These kinds of jobs often pay the same 1.75-2x premium comparing the two countries. They also fail to compare doctor salaries with other countries like Canada, Switzerland, and Australia which also pay similar absolute amounts to physicians in the US. Doctor salaries are not the driving force of increased healthcare expenses in the US. Per unit of work, they're paid much less than they were in the late 90s. Here's a graph that shows one of the main culprits: https://i1.wp.com/investingdoc.com/wp-content/uploads/2017/08/admin-jobs.jpg?w=1024&ssl=1 https://i1.wp.com/investingdoc.com/wp-content/uploads/2017/0...
  - AlotOfReading 6y ago
    Can you give numbers to those absolute salaries? US PCPs make ~$220k on average. Switzerland seems to be the highest, but the numbers I'm seeing for non-specialists are all less than 200k. Switzerland also has a famously high CoL, so even matching would be reduction compared to say Kansas.
    - jac241 6y ago
      Here are the swiss salaries - https://www.reddit.com/r/medicine/comments/a8t87g/swiss_physician_salaries_switzerland_conducted_an/ https://www.reddit.com/r/medicine/comments/a8t87g/swiss_phys... Most are the same as US. They pay anesthesiologists more, dermatologists less, gastroenterologists more, etc. Most are about the same as here. They also have universal healthcare. Here is a chart for Australia: https://www.businessinsider.com.au/heres-how-much-money-australian-doctors-actually-earn-2014-5 https://www.businessinsider.com.au/heres-how-much-money-aust... Hard to say how much they earn when working private as well. Anecdotes from the medicine subreddit suggest a lot. Canada: https://www.cnbc.com/2018/03/06/canadian-doctor-protest-their-own-pay-raises.html https://www.cnbc.com/2018/03/06/canadian-doctor-protest-thei... Medscape always sets the bar low when comparing US to other countries. I don't know why they do not include these ones. Here's the Medscape report that conveniently leaves these three countries off (wonder why): https://www.medscape.com/slideshow/2019-international-compensation-report-6011814 https://www.medscape.com/slideshow/2019-international-compen... I'll try to find more sources for the other countries as I am interested as well. 220k is likely on the low side for PCP here. Offers coming in more around $250-270 range.

craftinator 6y ago

> (We all know why) Do we? Please educate me then. I have a few guesses, the primary ones being artificially limited numbers of doctors, the artificially inflated cost of a medical degree, and the elite status that doctors hold. A runner up guess is that Americans have the delusion that modern medicine has a near perfect solution for every problem, so doctors do not factor in cost when prescribing treatment, even when extreme costs are associated with marginally better outcomes. The funny thing about this is that because of the extremely high cost of modern medicine in practice, prescribing treatments that have the best health outcomes at the present can cause years, decades, or lifetimes of poor health and hardship due to the burdens of debt and stress. If I had to pay $10 grand for some stitches that I could do myself (which is a fairly common amount for say, 30 stitches), that cost would decrease both my life expectancy and my personal happiness.

jac241 6y ago
It's easy to point at physicians and say they're artificially limiting the number of physicians created but they are not. Residency spots are funded by Medicare and that is the limiting factor. The hospitals get paid 150k for each resident, pass 55k on to the resident as salary, and keep the rest. Hospitals could choose to pay for their own residency positions, but they don't because then Medicare wouldn't be willing to subsidise the spots anymore. You could suggest we replace the high paid physicians with nurse practitioners or physician assistants but that is ignoring the fact that they are paid in the exact same way (and soon to be amount - executive order signed to equalize Medicare payments b/w midlevels and physicians) as physicians! If an NP or PA sees 25 patients in a day, they will bill for the exact same amount as a physician would. Additionally, the midlevels would order more tests and imaging on average than physicians, driving healthcare costs ever higher. There's a reason hospitals love midlevels so much and are helping to push for their independent practice. Each unnecessary test or CT scan is extra $$$ to the hospital.

lotsofpulp 6y ago

I am not aware of any other country that asks their doctors to spend hundreds of thousands of dollars for their license and are required to work 80+ hour weeks into their early 30s. And someone with the intelligence and drive to become a doctor in the US can easily earn $100k per year for 40 hours per week in their 20s if not more, so the lost income alone is a minimum $500k, on top of hundreds of thousands in debt. It all doesn’t make sense unless you come out making $200+ per hour.

jhwang5 6y ago
Ever considered that a lot of people who become doctors aren't just factoring in financial tradeoffs in career decision? Like, the desire to heal people who are sick?
- lotsofpulp 6y ago
  No, I don't believe "a lot" of people will throw hundreds of thousands of dollars of debt on their back and forego almost all of their time with friends, family, and significant others in their 20s to work grueling 24 hour and overnight shifts in hospitals just to heal people who are sick. It's not just a financial decision, you are sacrificing a good portion of your young life, delaying family planning, etc. There is no reason they need to be run through that gauntlet, other than to restrict supply and make them go through a hazing of sorts. Why can't they have work life balance? Why do they need so many years of schooling when other countries don't? Why are they paid minimum wage (if calculated per hour) during their residency years? Other countries show that none of this is necessary to heal people who are sick.