8 ms·

Average physician salary in France: $154,000[1] Average physician salary in the US: $352,000[2] That’s a big chunk of the difference. Simply changing who pay

• deleted 3y ago
  [deleted]
• aldarisbm 3y ago
  do you understand why they get paid that much in the US...?
  • alephnerd 3y ago
    School is expensive, there's more money to go around, and the opportunity cost is much higher.
  • Jensson 3y ago
    USA has too few so it pushes wages up. That is what happens when you don't have a free market, lots of people who want to become doctors aren't allowed to creating artificially high wages. Physicians per 1000 people: Germany: 4.25 France: 3.27 USA: 2.61
    • Grustaf 3y ago
      Why aren’t they allowed to become doctors?
      • sct202 3y ago
        Lack of residencies which are funded by the government. Medicial schools in the US try to get as many students placed into residency as possible so they control admissions to match residency slots, because if you don't have a residency you cannot become a doctor and med school costs $200k-$500k so it's life wrecking if a student doesn't match. The side effect is that we have a lot of pseudo-doctors who have roles that overlap in capabilities with doctors like Physicians Assistants and Nurse Practitioners to fill in the gap.
      • addicted 3y ago
        The “allowed” terminology indicates they’re gonna suggest AMA licensing, etc. never mind that every country has those, and probably more restrictive versions. One of the major reasons the U.S. has low physicians numbers is because med school is just so expensive. You either have to pay a ridiculous amount of money upfront, but more importantly, need to figure out how to pay for your existence for nearly your entire 20s where you’re studying and not earning, or you need to take massive student loans. That’s just too much of a ln upfront burden or risk for large chunks of the population to take.
        • arethuza 3y ago
          "because med school is just so expensive" Doesn't the US also require that people study medicine as a second degree? That can't help with the costs... e.g. Here in the UK you can go straight from high school to study medicine at university.
        • Jensson 3y ago
          > AMA licensing, etc. never mind that every country has those, and probably more restrictive versions. How can they be more restrictive when they are licensing way more doctors? USA is at the bottom of the developed world in number of physicians per capita but also pay the most. The only plausible way that can be true is if USA is the most restrictive in the developed world, like requiring way more years of schooling than necessary or limiting residency spots or limiting how many schools are allowed to educate doctors or making it hard for immigrants to become doctors etc. Japan has less doctors, but they are also among the healthiest in the world so maybe they don't require as many for that reason. But USA is at the other end of the healthiness spectrum so you can't use that explanation there.
      • thereddaikon 3y ago
        Medical school is very expensive.
        • Grustaf 3y ago
          Sure, but I reacted to the idea that some people were not “allowed”.
          • thereddaikon 3y ago
            High cost creates a barrier to entry. And it can often be an intentional one. See luxury goods as an example. Almost all luxury items are sold at insane profit margins and cost nowhere near that much to make. But the high price is the differentiator itself. Is a Gucci branded article of clothing that much better? No of course not. The value is indirectly signally to others you have the money to afford gucci. Poors not allowed. Other things can have their access limited by price in similar ways. Raising the price is a very effective way of keeping the poors out. Its not always intentional. But many times it can be.
• alephnerd 3y ago
  Factor in cost of employee as well. The cost of employee is around an additional 22% of Salary in France but around an additional 140% in the US [1] (401k, SSA, Health Insurance, etc), which brings the total spend much higher in the US. [0] - https://www.internago.com/how-much-does-it-cost-to-employ-people-in-france https://www.internago.com/how-much-does-it-cost-to-employ-pe... [1] - https://www.sba.gov/blog/how-much-does-employee-cost-you https://www.sba.gov/blog/how-much-does-employee-cost-you
  • ivanhoe 3y ago
    The page that you've linked for France says: "Total cost for the employer: 4970 EUR (142 % of gross salary)", so it's a lot more than what you say... Those 22% you mention is extra cost for employees, on top of the gross salary (in Croatia that's called gross1, while the actual total amount for employees is called gross2)
• mfer 3y ago
  Chronic illness rates in the US are far higher than in France, too. In the US 40% of adults report suffering from 2 or more chronic conditions.
  • pocketarc 3y ago
    > In the US 40% of adults report suffering from 2 or more chronic conditions. Holy cow, really? Is this a case of over-diagnosing things, or are virtually half of Americans legitimately struggling with multiple health issues?
    • TuringNYC 3y ago
      >> Holy cow, really? Is this a case of over-diagnosing things, or are virtually half of Americans legitimately struggling with multiple health issues? There isnt much incentive in the US to prevent disease, doctors make their money from visits fees, procedures, etc. Not saying they purposefully make people sick, but I think there is some Darwinism in a system like this -- a hospital system that keeps people healthy would wither and go bankrupt because hospital systems dont get paid to keep people healhty, they make most of their money when people get very ill.
    • mfer 3y ago
      Over 1/3 of US adults have cholesterol levels that cause them to use or qualify for a statin. High cholesterol which leads to cardiovascular disease (leading cause of death in the US). what usually causes this also causes a bunch of other chronic issues. So, yeah. Life expectancy rates in the US were going down before COVID. Chronic illness. The numbers aren’t looking good. Unless you’re trying to make money on healthcare. Healthcare income goes up when health goes down. Capitalism.
      • 2devnull 3y ago
        High cholesterol can be genetic. The US cannot change its genetic profile, which includes a lot of big boned individuals.
• TuringNYC 3y ago
  1. Average physician salary in the US: $352,000[2] I have many friends who are doctors. There is the salary they make, and then there are all the extras. Some have used their salary to buy the equipment in their office, and charge thru for equipment usage (added money on top of salary.) Some have used their salary to buy the building used for their medical practice, and charge thru the facility fee (added money on top of salary.) I agree both are "investments" but it is a non-traditional investment where you have a huge edge and a ready customer.
  • pxmpxm 3y ago
    Large, rich country + Baumol effect. https://en.wikipedia.org/wiki/Baumol_effect https://en.wikipedia.org/wiki/Baumol_effect Politicians pushing single payer or similar such state owned entity are just looking for power and influence.
    • Krutonium 3y ago
      Or, alternatively, they're looking to save money while improving service?
      • pxmpxm 3y ago
        Given that the source of payment is unrelated to the cost of the service or quality of service, the answer is probably elsewhere? Also I don't think you can come up an example where transitioning from private to state operated enterprise has improved the quality of service. Tragedy of the commons/OPM etc.
• closewith 3y ago
  > Simply changing who pays for your healthcare won’t close that gap. I mean, it absolutely will.
  • ejb999 3y ago
    please explain why it would? The government essential funds colleges educations (through loan guarantees and grants etc) for tens of millions of students - has that driven down the cost of college? or did it have the opposite affect?
    • troupo 3y ago
      You could look at why this worked in most of Europe.
    • closewith 3y ago
      > please explain why it would? Well, look at all the other countries where universal healthcare has been implemented. > The government essential funds colleges educations (through loan guarantees and grants etc) for tens of millions of students - has that driven down the cost of college? Look at all the countries with free university. Yes, the cost is lower. > or did it have the opposite affect? Fixed fees and a single payer obviously would have that effect, like everywhere else it's been tried.
      • thereddaikon 3y ago
        >Well, look at all the other countries where universal healthcare has been implemented. Oversimplification. Most countries that have universal healthcare do many other things in addition that you aren't accounting for. The US healthcare system is not the same as Europe's but its not single payer. >Look at all the countries with free university. Yes, the cost is lower. See the above. >Fixed fees and a single payer obviously would have that effect, like everywhere else it's been tried. So now you're starting to get the idea. It's not just single payer. Never was.
        • 3y ago
• lotsofpulp 3y ago
  And yet all my doctor friends and family would advise their kids to not become a doctor.
  • sct202 3y ago
    I suspect some of that is due to 4 years of med school (at a cost of $200k-$500k) followed by 3-7 years of low paying residencies, when you could alternatively go into tech or consulting and have years of high income during the same period of time.
    • ryathal 3y ago
      The cost of school is fairly minor in the reason's not to become a doctor. It's the massive increase in administration overhead that has reduced a doctor's time spent treating patients and practicing medicine significantly. EMR systems are slow compared to paper/dictation from a doctor's perspective, they also produce extremely verbose reports, so more time is spent sifting through records to find the useful bits. Doctor's need to perform X task that is often irrelevant to qualify for increased reimbursement from Medicare. Doctors have to justify why they prescribed X medication with prior auths and appeals just to get a patient the help they need. The additional scrutiny on opioid medications forces people to come in more often even if they've been compliant and successfully managed for years. Doctors that serve the neediest patient populations get rewarded with the most expensive malpractice insurance, because poor people are far more litigious than average, and often get paid less as Medicaid has some of the lowest reimbursement levels.
• davikr 3y ago
  Consider most physicians are hundreds of thousands of dollars down in education debt and have been training in healthcare settings for almost a whole decade, and that significant time has been invested in a previous undergraduate course and to pass the MCAT. I think they are paid accordingly for their investment, and only 8% of that healthcare spending [1] accounts for physician personnel salary. What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are. A CT or MRI (which are admittedly expensive machines) scan shouldn't cost >$1000, and it probably doesn't anywhere else in the planet. [1]: https://www.npr.org/sections/money/2019/03/12/702500408/are-doctors-overpaid https://www.npr.org/sections/money/2019/03/12/702500408/are-... > Baker estimates that the salaries of the roughly one million doctors in the U.S. account for about eight percent of total healthcare spending.
  • MichaelZuo 3y ago
    > Well, physicians have to be paid accordingly for their time and financial investment. Consider most are hundreds of thousands down in education debt and have been in training for almost a decade > What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are. If you understand the former, then why is the latter baffling? The cost of any tests includes labour...
    • kergonath 3y ago
      But even very expensive labour does not explain the costs of the US system.
      • MichaelZuo 3y ago
        Why not? It seems to explain a large part of the difference.
  • iteria 3y ago
    Unfortunately, it's a matter of where you get it done. Getting literally anything done at a hospital is highway robbery. That said, i get two MRIs a year at not a hospital and it's a couple hundred dollars, not a a couple thousand. It's not cheap, but it's a about 1K expense twice a year, which you can budget for. I feel like this is the crux of the US's issue. We have medical care deserts and for many people the hospital is the only way to get something taken care of. This is where the US is different from many other wealthy nations. We really don't get economies of scale at all. We have cities, but a lot of our major cities juet have nothing like the population of other nation's major cities.
• neuronic 3y ago
  That is not even remotely account for the insanity of the US healthcare system. Multiple orders of magnitude away from being relevant at all. US healthcare spending 2023 [1]: $4.7 trillion, 16.6% of GDP, $12555 per capita France healthcare spending 2023 [2]: €0,34 trillion, 12% of GDP, $6630 per capita How many physicians can you hire or pay better with an additional $4.x TRILLION? [1] https://www.oecd.org/unitedstates/health-at-a-glance-United-States-EN.pdf https://www.oecd.org/unitedstates/health-at-a-glance-United-... [2] https://fr.statista.com/outlook/co/health-indicators/health-financing/france https://fr.statista.com/outlook/co/health-indicators/health-...
  • AnimalMuppet 3y ago
    > How many physicians can you hire or pay better with an additional $4.x TRILLION? That line forgets the size of the populations. US population is 333 million; France is 65 million. How many more physicians can you hire with an additional $6000 per capita? That is a relevant question.
• vkazanov 3y ago
  Software people have the same difference with Europe, if not worse. And it's ok. Both numbers are a very, very decent pay in respective countries.
  • Xenoamorphous 3y ago
    And lawyers. You hear about how elite lawyers are in the US but not in Europe, or in my country at least.
• cycrutchfield 3y ago
  1 million active physicians in the US. At $352k/ year that is only $352 billion in physician compensation, or less than 10% of total healthcare spending. > That’s a big chunk of the difference. The math disagrees with you.
  • MichaelZuo 3y ago
    You have to add in nurses, techs, administrative staff, etc... It could easily be 40% to 50% of total spending, so the parents point seems valid.
    • cycrutchfield 3y ago
      What does that have to do with physician salaries?
      • MichaelZuo 3y ago
        The differential compared to France for most other jobs in the healthcare sector is similar to the differential for physician salaries?
        • cycrutchfield 3y ago
          That’s not what OP was saying. They were saying that physician salaries are a big part of the difference, which they are not.
          • MichaelZuo 3y ago
            10% is a big chunk. Are you confused as to the meaning of 'big chunk'? It by no means implies a majority or even close to a majority. If you are confused about my previous comment, I added the 40% to 50% example to demonstrate the likely overall contribution of salaries to costs.
            • CyberDildonics 3y ago
• tuyiown 3y ago
  They're that. There is also the massive inefficiency of of having non-universal system, due to administrative operational complexity cost and marketing spending. France is one of the less efficient in europe due to having a dual system, the universal part is very efficient (5% of budget spend on operational costs), the other part, operated by competing organisms, loses up to 20% of their budget on marketing, plus the general operating cost of having a multi tier for insurance coverage.
• ivanhoe 3y ago
  Also there's a big difference in the quality of pretty much everything, from the chairs in the waiting rooms, to the medical technology and equipment used. In US everything looks a lot more newer and fancier - at least from the patient's point of view, but I think doctors would agree too. Also US doctors are far more willing to order extra searches and tests, while in many EU countries doctors have limits on how many lab tests or medication they can prescribe monthly, which affects the quality of service that patients receive. And still the medical system is in huge problems in many EU countries, e.g. in Croatia where I live the quality of service has been really devastated in the last 3-4 years, there's a lack of everything including the medical staff - doctors've been emigrating to countries with better salaries (Germany and yes, US). So, just keep in mind with these types of news, it might be more economical system overall when you look just the numbers, but it's not like everything is working great in EU either...
  • LeafItAlone 3y ago
    > In US everything looks a lot more newer and fancier - at least from the patient's point of view Are you in a city, perhaps? That is not universally true across the US, in my experience.
• Irishsteve 3y ago
  It’s not quite as apples to apples comparison. To employee someone in different EU countries the organization pay an extra 20-30% on top of the gross salary. And if we wanted to be more accurate we could factor in statutory time off. You also factor in a percentage of their salary incase you need to exit them (maybe doesn’t apply to doctors). I’d assume the states is still ahead but not as drastic as the shared numbers
• macNchz 3y ago
  So physician pay is a complex topic related to cost of education and artificially restricted supply, but pay itself is not as big a driver of healthcare costs as people imagine it to be. Estimates I’ve seen put it at around 10% of healthcare spending in the US. Interestingly, this research in 2011 found its estimate (8.5% in this case) to be comparatively low among western countries with universal healthcare systems: https://app.texmed.org/tma.archive.search/5078428591114721616.html https://app.texmed.org/tma.archive.search/507842859111472161...
  • jdietrich 3y ago
    The US also spends frankly absurd amounts on drugs and devices. In my country, generic drugs are the norm and you essentially need special permission to be prescribed most drugs that are still on patent. I see a lot of Americans grumbling about their high out-of-pocket costs for drugs, but a lot of the drugs they're paying for simply wouldn't be routinely prescribed in my country on cost grounds. I think it's basically a fantasy to imagine that the US could have affordable healthcare if only the system was reformed. Rationing of various kinds is the norm in single-payer systems, because everyone wants the insanely expensive new drug when it's their health and someone else is paying; I don't think that America can do much to control their healthcare spending if they aren't willing to engage in a serious conversation about what they don't want to pay for. Even Medicare covers tons of stuff that I wouldn't get from my universal single-payer system.
• api 3y ago
  France has either free or heavily subsidized college for doctors and a large social safety net. I bet if you counted those things total comp would be a lot closer.
• r00fus 3y ago
  Let's not leave Big Pharma out of this. They charge the US 2.5x compared to countries with universal healthcare [1]. Why? Because Medicare and other large population sizes here are prevented from negotiating drug prices. We also need to consider hospital, ER and ambulance costs. In this case, having a single universal plan can greatly reduce those costs. https://www.pgpf.org/blog/2022/11/how-much-does-the-united-states-spend-on-prescription-drugs-compared-to-other-countries#:~:text=According%20to%20a%202021%20study,Switzerland%20and%20the%20United%20Kingdom https://www.pgpf.org/blog/2022/11/how-much-does-the-united-s...).