Why Are American Doctors Paid So Damn Much?

[ErikJ]

Why Are American Doctors Paid So Damn Much? —By Kevin Drum| Wed Nov. 20, 2013, Mother Jones

Conservatives have picked up today on a Kaiser Health News piece reporting on doctor complaints that insurers plan to pay them less for Obamacare patients than for other patients:................................................................

Matt Yglesias is unsympathetic. He says American doctors are very well paid and should quit griping: "If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we've squeezed too hard. Until that happens, forget about it."

That's pretty cold. But if you really want to know what's going on, take a gander at the chart below. It's from the OECD, so it includes all of the world's relatively rich countries:



That's damn peculiar, isn't it? If Econ 101 is to be believed, higher pay should produce more doctors. And yet, even though the United States pays doctors far more than any other country on the globe,... we're in the bottom third (of supply_. We have more doctors per capita than poorish countries like Mexico and Poland, but far fewer than Belgium and Britain and Germany—all of which pay doctors considerably less than we do here. So what's going on?

As Matt says, the basic answer is that U.S. doctors operate as a cartel. They artificially limit their own ranks, which drives up their compensation:

What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse-practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and it means opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were thirty years ago. But that's not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.

This is yet another reason not to shed too many tears for doctors. They've basically brought this on themselves. If the market were allowed to produce as many doctors as there's demand for, they'd already be getting paid less. Right now they're enjoying the substantial rents that come from squeezing their own supply, and they've fought like lemmings for decades to keep it that way. You can hardly blame them for that, but there's no reason the rest of us should put up with it. It's time to fight back.

http://www.motherjones.com/kevin-drum/2013/11/why-are-american-doctors-paid-so-damn-much

[treestar]

1. Interesting, thanks!

Debating this in another thread - didn't think about what single payer countries' doctors get paid. Of course it is not equal for them all, some have greater responsibility. But what's the real market value without all the restrictions.

[Recursion]

2. Just like taxicabs in Manhattan: the number of doctors was set years ago

And a cartel prevents more people from moving in.

[former9thward]

3. Why are American actors paid so damn much?

Why are American athletes paid so damn much?

[Jamaal510]

9. I've seen that

question posted on Yahoo Answers a few times, and most people replied saying that it is because there is a demand for it, and that millions of people watch them.

[former9thward]

117. That is pretty much why doctors are paid what they are paid.

There is a demand for them and millions of people need them.

[truebluegreen]

161. And there would be less demand per capita if there were more doctors.

Which they know very well and is why they have worked, as a group, to limit supply. Which is the point of the OP.

[former9thward]

163. I am in the legal profession and it is the opposite there.

Last edited Thu Nov 28, 2013, 04:07 PM - Edit history (1)

The American Bar Association is constantly certifying new law schools even though there is high unemployment in the legal profession and it is not getting any better. Most lawyers oppose this but the ABA only acts in the interests of big corporate law and big law firms. They don't care about the average lawyer.

[truebluegreen]

165. I know that is true.

There is a sweet spot where supply meets demand, where the cost of becoming a doctor or lawyer is balanced with the wages those professions can demand. Lawyers are on the wrong side of that equation in the legal profession while patients are on the wrong side of the medical.

[rock]

20. For a simple reason

Those are Star Systems. Just picking one arbitrary example, Bruce Willis is paid 24 million plus for movies because his they (generally) make many times that amount. It's his draw not his talent or looks.

[Vox Moi]

24. An athlete has stats. An actor has box-office draw

These entertainers have simple meteoric that justify their salaries (for the folks who write the checks, anyway).
It is almost impossible to get meaningful metrics on the performance of a doctor.

[treestar]

106. At least supply and demand works there

The numbers are not limited; anyone can try out or audition.

A lot of people could be competent doctors, but they are kept out of medical school.

[white_wolf]

150. That may be better than the alternative.

I understand your complaint and I'm not sure I don't agree, but I do think there should be some limits on medical school admissions. If not then the medical profession will end up in the same place as the legal profession. There will be too many doctors and not enough demand.

[YarnAddict]

4. I have no problem with doctors' salaries

When you look at the cost of their education, the number of years involved, the dedication, the responsibility, I think they are worth every penny. Plus their expenses, such as malpractice insurance, etc. makes it necessary to pay them well.

[onyourleft]

6. Nor do I.

Just another hit piece on physicians.

[YarnAddict]

11. I lost my primary care physician

a couple of years ago. She was a young woman with a couple of small kids. She was paid through our local hospital, and she left because she wasn't being paid enough to rase her family, run her practice, and pay her student loans. We are in a small town, and I think this happens to a lot of local docs in small towns.

I also have a specialist, a heart surgeon, at a large impressive clinic. He is a member of "the millionaire's club." And I don't begrudge him a nickel of it!

[tech3149]

84. I wonder how Cuba manages to train so many

and send them around the world, especially to poor and devastated communities to provide effective health care. It might not be sophisticated but it sure seems to be effective.
Does any one ever think about how institutions like the AMA or state medical boards might influence how many people are trained or licensed to practice.

Given the current practice, without evaluating how it came to be, I think most would agree that the licensed physician has little to do with evaluating and diagnosing a patients condition.
Most of the information and judgment is from NP's and PA's.
I've spent too many years looking over the shoulders of "health care professionals" in the US while trying to do my job.
To me the professionals were mostly nurses, PA's, and NP's. There were those physicians that were not only skilled but spooky good but they were few and far between.
I've said for the last 3 or 4 decades the best way to stay healthy is to stay away from doctors.

[TroglodyteScholar]

92. I don't see cuba on the list in the OP

I looked twice. Am I just missing it?

[ErikJ]

22. Concerning the ACA

from article: "Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. But many primary care doctors say they barely have time to take care of the patients they have now."

We dont have nearly enough primary care physicians for any national health care program to cover all people, because the pay for specialists is so so much higher. If we had more doctors getting trained there would be more specialists and more primary care physicians evening out the pay discrepancy.

[onyourleft]

64. I agree...

...that we need more individuals being trained in medicine; however, this is not a new problem. It started many years ago and still is not being adequately addressed.

[HappyMe]

8. I agree.

[Drunken Irishman]

10. Pretty much...

[Carolina]

36. Exactly!

Medical education is costly and ranges upwards of $200,000. That means loans for many/most students on top of whatever college expenses they incurred. Then it takes years: 4 years college, 4 years medical school and a minimum of 3 years postgraduate training (residency), though some fields require more: 4 years for OB/GYN, 5 years for general surgery, 6+ years for neurosurgery, etc.
Then factor in malpractice insurance, practice overhead...

Unlike the health insurance CEOs -- next to whom doctors' incomes pale -- MDs earn every penny

[enlightenment]

38. The cost of their education is a big part of the problem

The median debt for a med school graduate in the US is $170,000.

In the UK it averages slightly less than £25,000 - (approx. $40,000).

In Germany, about €3000 - (a little over $4000)

This is worth a look: http://www.amsa.org/AMSA/Homepage/Publications/TheNewPhysician/2009/1209IntlTraining.aspx

[treestar]

109. Very interesting how single payer advocates

which involves most of us, think in terms of how to pay them their fees, rather than how to get the market to lower their fees. Socializing that cost might be a good legislative effort. If you are smart enough to go to medical school, the government could subsidize that.

[enlightenment]

115. I certainly think so.

If health care is a public good, then shouldn't the entire process - including educating those who provide it - also be considered a public good?

[thecrow]

118. Plus the cost of Malpractice Insurance

My doctor told me IN THE 80s that her biggest expense was malpractice insurance.

[penultimate]

46. I was talking to someone who was a veterinarian yesterday, and that sparked me to look up

how much schooling they have and their average salary. I was shocked to see their programs are usually harder to get into than an MD program (more competitive) and they spend 8 years in school, but their average starting salary is like $40k - $60k/yr and most don't ever go over $100k/yr.

[mainer]

94. Veterinary school is notoriously hard to get into

and you're right, they hardly make enough to justify the schooling. The reason so many people still apply (mostly women) is simply a deep and abiding love for animals and for the work.

However, it does tell you why it's so hard to find large-animal vets. That is not where the money is.

[Hoyt]

53. Most docs could have their loans forgiven if they were willing to practice in rural or inner city

area for a few years, but few do.

Malpractice insurance is about 5% of practice overhead.

Almost any businessman would invest $200,000 in loans to walk out of school and make a minimum of $125K - $175K or more per year for 25 to 30 years.

Nowadays the residencies and training are not nearly as taxing, and most no longer start a private practice, they take a salary and work pretty reasonable hours with others sharing call.

They also spend a lot of money on lobbing/PACs to protect their turf from nurses, optometrists, foreign trained MDs, etc. -- limiting supply to preserve their salaries.

With that said, getting puked on, looking up folk's rear ends, watching people die, etc., ain't a lot of fun.

[Initech]

61. My brother is a doctor.

And this article is really making my blood boil. One of the biggest myths about medical school is that you make the 6 figure+ salary right out of medical school. You don't. You're a resident and you're stuck with the shit jobs around the hospital, like in Scrubs. You also make the resident salary of about $40,000 - $50,000. You don't make the salaries until you pass the boards and that's a good five years after you graduate. The author of this article does not know what he is talking about. What I do have a problem with is the ridiculous salaries of health care company CEOs. They don't deserve it, and don't attack the low level employee. Attack the ones at the top of the food chain who are raking in all the profits for themselves.

[ErikJ]

66. All of those are to reduce the number of doctors for the greedy AMA.

The tuition should be free or greatly subsidized. The residencies should be increased and meet fair working conditions like all other jobs.

The AMA is the gatekeeper to keep their pay astronomically higher especially the specialists. All the students want to be specialists now because they make so much more leaving few GP's to do the groundwork. This will make the ACA almost impossible to maintain if something isnt done.

One good idea is to give students free tuition if they agree to work for 5 years or more in a rural town as a GP.

[truebluegreen]

162. I do. I've had too many doctors, particularly specialists,

who can't reason their way out of a paper bag and don't look at the big picture. I am in favor of a system that promotes more primary care and a closer relationship with a GP.

Edited to add: lowering the cost of education or forgiving the debt in exchange for work in small towns is desperately needed too.

[Vox Moi]

5. Because they are 'The Entitled'

I never met a doctor who did not complain about the crushing burden of student loans.
A highly-paid doctor I worked for, an MD/MBA from Harvard, complained to me about his student loan payments.
I asked him why he was complaining to me about a capital investment he made that seemed to be paying off pretty well.
He was very insulted.

[YarnAddict]

15. I probably would have been insulted too n/t

[Vox Moi]

17. Curious … why would you be insulted?

He was making huge money and resented the fact that he had to pay for his education.
If you complained that you had only made 200% on an investment and i asked why you were complaining ….

[YarnAddict]

18. Everyone complains about their student loans

Do you make similar comments when teacher friends grouse about their student loan payments--which are probably significantly less than the doctor's?

[Vox Moi]

21. I never met a teacher who was making $180k or more

… and complained about the $10k per year in loan payments.
Great margin.

[YarnAddict]

23. So what?

In either case it isn't your business to be passing judgment, or deciding if they have a right to bitch about their payments.

[Vox Moi]

26. Exactly! So what?

Why was he asking me to commiserate with him and insulted when I didn't?
I'm, not obligated to suffer for his success … just because he's a doctor.

[yeoman6987]

76. What on Earth

Wow. You are something else. Quite the attitude. I say doctors should be paid double or even triple. Saving lives is a huge stress on a doctor and they don't have a 9-5 job like you. They could be in surgery for 24 hour stretches.

[Initech]

65. Then you haven't met doctors.

You know how much debt most doctors are in? My brother is in debt in the $250K+ range and starting salary you don't make that. You get the shit jobs with the shit hours, the shit patients, and the shit pay, just like on Scrubs. You have to be a resident for four years and once you pass the board examinations then you become a licensed medical professional and make the big money.

[Chathamization]

72. Lowest paid: "With a base pay offer of $189,000 a year, on average, family practitioners,

pediatricians, and psychiatrists are offered the lowest pay of all physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2012 Review of Physician Recruiting Incentives."

Here.

Not saying that Doctors have no problems, but when the lowest paid group in a profession makes $189,000 a year on average, we shouldn't really be trying to protect their salaries.

[Initech]

81. That's exactly what the Heritage Foundation and the Koch roaches wants you to think.

Doctors are paid too much. Teachers are paid too much. Lawyers are paid too much. You know who really is paid too much? The CEO. No other profession comes close. We should be protecting our salaries from them. And if you think any profession is paid too much, you couldn't be more wrong.

[Chathamization]

85. If you have actual data, feel free to show it. The average public school teachers salary is $56,069

so it's a bit disingenuous to lump them in with a profession that gets paid several times that amount.

It's quite simple. We have a shortage of doctors. Our doctors are paid more than other countries, our healthcare costs are too high, and the AMA is a cartel that has a history of trying to protect profits at the expense of health. Anyone who looks at this and thinks the biggest concern should be protecting the large salaries of doctors does not have their priorities straight, in my opinion.

I agree that CEO's are paid too much - how does that make the problems with our health system disappear? Or in a thread about medicine, are you just throwing that out there as a distraction?

[Initech]

89. No. It's not a distraction.

I'm tired of the media saying that X profession is paid way too much. This type of thinking is dangerous. What makes our health care costs so high is the ridiculous pursuit of incredible profits. Does the CEO of United Healthcare really need a $106 million annual salary? And then we have to go blame the doctors for our health care costs?

[nadinbrzezinski]

139. And pharma

I just paid in Mexico, for a month worth of Metmorfin extended release rounding up, $20. The same exact drug in the US runs me $40.00 for a deductible, and the real cost if $750.00 a month. If I did not have insurance I would be dead by now.

It is a profit motive but people are too lazy to even look at the chart in the OP which goes against the perceived idea that doctors make too much. Average training for a specialist is 15 years, average debt is $750,000. Yes, we could lower salaries, if we decided to make medical education the same cost as oh the National University in Mexico City (one of the top programs in North America). When a doctor graduates they ideally owe nothing. If they owe anything is to family who helped pay for the labs. In other words, it is symbolic. Of course, some people here, doctors make too much you know, would not mind if doctors in the US were paid like their counterparts in Mexico, as we at times joke in the public system they make enough to buy gum. In the private system they can make quite a bit more (which is the reason the average is so high, as most doctors do not make that much in the States either, but a few in the private medical system do, and that is a few.)

As is, hospitals are starting to cut into doctor pay (which the person you are arguing with does not know, since the NYT is not publishing this, I know this first hand from my brother WHO IS an MD), because insurance companies are cutting into how much they pay the hospital he works at. For the record, since you know medicine you will understand this, that is a quaternary referral center, that receives patients from all over the world. It is one of the top medical centers in the United States, where doctors work on salary, not private practice.

[hfojvt]

149. and the CEO salary costs about $1.5 for each customer

yet there are 700,000 doctors in their network.

"Our family of companies delivers innovative products and services to approximately 70 million Americans. UnitedHealthcare's nationwide network includes 739,034 physicians and health care professionals, 80,000 dentists and 5,620 hospitals. Our pharmaceutical management programs provide more affordable access to drugs for 13 million people."

http://www.uhc.com/about_us.htm

If they pay each doctor $50,000, then that total cost is $35 billion. 35 billion is much much greater than $106 million.

Actually their revenues were $112 billion, gross profits $9 billion, net profits $5.5 billion and dividends paid $800 million. Their stock pays a mere 1.5% rate on dividends. When expenses are $106 billion, the CEO salary would appear to be a mere 0.1% of the cost.

Not that I do not agree that $106 million or even 1.06 million is absurdly high for anybody's salary.

[nadinbrzezinski]

138. Try reading that chart again

for god sakes I know Canadian docs who make more than American docs.

[mnhtnbb]

157. Hubby is a psychiatrist in practice for almost 40 years. He's never made $189,000.

or even close to it.

My family practice doc (Chapel Hill, NC) was making so little he quit practice a couple years ago and went
to work for one of the big pharma companies in the Research Triangle.

Be careful about these averages.

[woo me with science]

7. The problem is the corporate owners, not the doctors.

The goal is *always* to suck profits to the corporate owners, the One Percent, even though they are never the ones who actually provide the services.

Skilled and educated employees of all types have learned this. Doctors will, too.

The One Percent hope to turn doctors into technicians, so that they can be paid the same shit wages as the rest of us.

[Vox Moi]

14. That is very true and something to resist.

but it is also true that the culture of medicine is elitist.
We benefit from the use of technicians and well-trained specialists for certain medical procedures and services. There are many functions that don't need a doctor that are reserved for doctors.
That trend is coming right along.

BTW: American doctors, on average, have higher salaries than in other countries.

[hfojvt]

50. but if a doctor is making $380,000 a year

then THEY are part of the legendary 1%.

[Initech]

82. No. Bullshit.

That's more Heritage Foundation / Koch / Romney line of thinking. That if you make a certain percentage of income that oh you must be rich. Not all doctors make that kind of money and most don't until they're well out of residency and have passed the medical board exams.

[hfojvt]

86. uh, no, it is a matter of statistics

If you make more money than 99% of Americans, then, by definition you are in the 1%.

I know that some people want to define rich as being the same thing as "super duper rich" but I will never agree with those people. I will always find it ridiculous for people who make more money than 90% of the country to insist "I am NOT rich".

I think that type of thinking actually benefits the Romneys and the Koch billionaires.

[woo me with science]

100. No, it is a matter of your deliberately missing the point of the argument.

The problem is not that some people "make more money than 99 percent of Americans." The problem is that a predatory group makes money FROM the 99 percent of Americans...from THEIR labor.

Doctors study hard, work hard, and provide a critical service. You are playing word games here. The "One Percent" is a handy shorthand term, but the real problem is a particular vulturous segment of the One Percent: the corporate Owner Class, that sucks profit from the labor of others.

Your whole argument here is a distraction from the real problem. The familiar propaganda tactic of the predator One Percent is ALWAYS to get workers fighting among ourselves and demanding lower pay for other groups that also work for a living.

The problem is not that any group of legitimate workers needs to be paid less. The problem is that we have a predator-owner-corporate class that sucks the profits from all of us, from OUR labor, when they, themselves, contribute nothing.

[hfojvt]

116. that becomes even more ridiculous then

Now, it is not "the 1%" it is what "the 0.5%"?

As I have said before, even the 1% does not get all of the pie, nor even a vast majority of the pie.

See, I worry myself about the people at the bottom, the ones who are getting squeezed, getting trampled, getting left behind in the rat race. Well, it is not just some tiny "predator class" that does the trampling, that does the squeezing.

The bottom 50% gets a very small, and shrinking piece of the economic pie, not because some tiny sliver at the top is taking it all. Nope. It is the ENTIRE top 50% that is taking the rest of the pie and leaving only a tiny sliver for the bottom 50% and even less for the bottom 25%.

I have done these calculations before. The average income of the bottom 50% of taxpayers is (or was in 2007) - $15,287. That group probably includes a lot of teenagers who file taxes.

The average income of the next 40% is $61,890. The average income of the next 5% is $165,389.

Now, let's take away ALL the income of the "top 1%" even though that group includes a lot of workers (does a CEO count? After all, he/she does a job. And so does a pro football player. And so does Rush Limbaugh and Bill O'Reilly. Are they NOT part of that predator class, because they work for a living?) Anyway take away all their income and give it to the bottom 50%.

How much does each of them get? About $28,000. Which I am sure would have them jumping for joy. But notice that it would only raise their average income up to $43,000. Well short of the $61,890 that the top half averages. To say nothing of the $165,389 that the 90-95th percentile averages.

And to say nothing of the $227,956 that the 95th to 99th percentile averages.

Oh, and sure those people provide services. Important services. But who pays for those services? A whole lot of people who don't make as much money. The big slice of the pie going to those in the top 10% simply DOES come out of our pocket.

But what the heck. Why should I begrudge the pound of flesh they take out of my hide? Why not give them two or three pounds just for the heck of it? Just in the name of solidarity, let the poor worker gladly give more to the rich worker. After all, we are all equal.

Some are just more equal than others.

[woo me with science]

119. Avoid the MAIN IDEA. Bypass the central point I made.

Pretend that the main point about the corporate ownership class was never made, even though it was simply and clearly stated.

Repeat yourself. Obfuscate. Quibble over numbers that have nothing to do with my main, central point.

And most of all, continue pushing the cynical corporate strategy of divide and conquer. Anything to keep those who DO work attacking one another instead of focusing on the REAL problem, which is the looting of America by the corporate, parasitic, ownership class.

I rest my case. Bye.

[hfojvt]

136. I think I said, your main idea does NOT make any sense

"looting of America"?

Corporate profits are a mere 11% of GDP. Income of the top 1% is only 22% of national income. The next 49% of it gets 65% of it.

Leaving only 13% (or less) for the bottom 50%.

Am I supposed to pretend that 22% is bigger than 65%? Am I supposed to pretend that a $280,000 a year worker is just as poor, just as non-rich as a $28,000 a year worker or as a $7.25 an hour temp?

[nadinbrzezinski]

140. I can literally count those in one hand, serious

Most MDs in the US do not make that much in their dreams.

[hfojvt]

143. depends on the specialty

I think the internets told me that radiologists might AVERAGE $400,000 a year. Probably there are more than 5 in the US who make that much.

[nadinbrzezinski]

148. And radiology is one specialty

That is getting outsourced to other countries.

[gollygee]

12. I don't have a problem with doctors making a good salary

I have a problem with insurance companies making insanely obscene profits. That's where the money is being pilfered. Look to CEOs of large corporations, not to doctors.

[hunter]

13. The insurance and big hospital corporation executives thank you for your concern...

Geez.

The right wing is screwing over doctors now just like they've screwed over all the other altruistic professions.

Immigrant doctors are just another flavor of job outsourcing. The U.S.A. is in essence outsourcing medical education and importing doctors who will tolerate increasingly bad working conditions. The days of the upper-middle-class suburban General Practitioner playing golf on Wednesdays are long gone.

What next Mother Jones? Maybe all those people living in poverty are not really poor because they have cell phones and televisions...



If anyone thinks primary care physicians are over-payed, it's probably because they themselves are underpaid by the extremely wealthy "MBA" parasites who are stealing everything in this world they can for no better reason than they are greedy pricks like Mitt Romney.

[Mojorabbit]

80. + a gazillion. nt

[Xithras]

16. The average medical student in the U.S. graduates with $205,000 of debt.

And that's before they buy a car, or a house, or a single boat or golf course membership.

America is the only country in the world that places that kind of debt burden on new doctors.

If a young doctor wants to live a normal middle class lifestyle...with house payments, a couple of car payments, retirement savings, and college funds for his/her future kids, they need to make a 6 figure salary right out of the gate.

To reinforce the point in the OP, building more medical schools would also introduce price competition, lowering the cost of a medical degree and reducing the income that young doctors would REQUIRE in order to get started.

[Vox Moi]

19. Well, if you make $150k you can pay it back easily.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0

Medical school, in our patchwork system, is an expensive investment that pays off.

If a guy buys a house for $250k and sells it for $1,000,000 do we cry over his investment?

[Xithras]

31. Sure, if you want to forgo that middle class lifestyle.

We're not talking low interest loans here. My daughter will be facing loan payments of over $2700 a month when she graduates. That immediately means that she will NOT be able to serve any low income areas or take on any "low-return" clients.

You also have to remember that the average person doesn't even get into medical school until they're 24-25 years old, which means that the typical student won't graduate until they're 29 or so. Tack on the year of residency, and now you're 30 before you can even START paying them off. And remember that your loans have been racking up interest this entire time, so the total has been increasing every year you're not in a practice. If it takes you 30 years to pay off that medical school debt at 7.5% interest, you're going to be out around a half-million dollars. If you go with a more aggressive payoff route like my daughter is, you can get it paid off in 10 years...but she'll still be FORTY before she's got that loan paid off.

Of course, normal people don't want to wait until they're 40 to buy a house, or start a family, or start their retirement funds. The median home price in the SF Bay Area, near where she grew up and where much of our family already lives, is over $500,000. So, if she buys a perfectly average home in a perfectly average neighborhood at 30 years old like any perfectly average person would, she's now nearly three-quarters of a million dollars in debt.

Yes, doctors make a lot of money, but in a lot of the country they HAVE TO just to live the same kind of lifestyle that others do on a smaller salary.

It's entirely true that she'll end up making a LOT of money over the course of her lifetime, but most doctors don't actually become financially well off until they get into their 50's and 60's, when the debt finally clears. Your typical doctor in his/her 30's and 40's doesn't really live a posh lifestyle. They have far too much debt to do that.

[Carolina]

45. Actually

no, you don't pay it off as easily as your post would suggest.

Grossing 150K is one thing, but what is the net and what is the continued debt after taxes, malpractice insurance, living costs, etc? And bear in mind many medical students/young doctors incurred college debt as well. According to the AMA and the Association of American Medical Colleges (AAMC), student debt has now reached a point where the debt/income balance is negatively skewed, meaning the debt has begun to outpace the projected income.

Many young MDs will not reap the full reward of their educational investment (their time, youth, personal sacrifice as well as money) until their late 40s, early 50s, even 60. And please don't compare a real estate investment with medical education... it is simply not the same. Plus since 2008, real estate flips are not as lucrative as your putative example.

[melm00se]

52. Here is an article where an MD breaks down his costs

http://money.cnn.com/2010/03/04/news/economy/medicare_doctor_costs/

He spends about $60,000 a month on "fixed costs" to run his practice. "That's more or less my breakeven point," he said. "If I spend more, I'm in the red for the month."

Business costs include rent, payroll, utilities, medical and office supplies. Because he maintains electronic health records for his patients, Schreiber also pays for equipment maintenance and other management services associated with patient billing.

so that equals approximately $720K per year in costs vs:

Those costs go against the $800,000 or so in revenue, which includes about $100,000 in income, he said his practice collects in a given year.

[Carolina]

56. Look at his age and malpractice insurance

He's an older guy, probably my generation. His medical education debts (if there were any because it was a lot cheaper 37 years ago when I, and likely he, attended med school) aren't even considered because they probably no longer exist; and his malpractice as a generalist is only 7K.

Younger MDs have formidable education debt, plus essential fields like OB-GYN and surgery have malpractice costs in the 5 figures alone. Also, don't forget federal, state and local taxes which this MD wisely didn't air in the public domain!

Finally, one MD's story is not necessarily representative

[KamaAina]

28. California just opened one

at UC-Riverside.

http://en.wikipedia.org/wiki/University_of_California,_Riverside

Preliminary accreditation of the UCR School of Medicine was granted in October 2012 and the first class was enrolled in August 2013. It is the first new research-based public medical school in 40 years.

[Xithras]

34. Yep, I know.

My daughter is currently attending UC Davis and is looking at med schools. While UC Davis has a med school of its own, they have an odd informal policy that denies applications to most applicants who come from their undergraduate schools (you CAN get in, but it's very tough). She's hoping that the new school at UCR will improve her chances when she starts applying, because she really wants to stay in California.

[Carolina]

39. More medical schools are NOT inducing price competition.

The projected shortage of MDs is the driving force behind more medical schools, not tuition/education expenses. The US population has grown but not the overall number of physicians. As my cohort of baby boomer MDs retires, there is a need for even more replacements; but the whole spectrum of physician education has to be met and our short-sighted, quick answer society is not addressing that.

More medical schools require more postgraduate hospital training positions (residencies); and right now, that's a looming problem. Residency training is a must for qualified and licensed MDs. Medical school without residency training is virtually meaningless; you don't want what is basically a 4th year medical student performing your coronary artery bypass procedure!

Carolina, MD (x 33 years)

[treestar]

107. A thought - go to a foreign medical school

And then qualify here. It might be cheaper.

[AZ Progressive]

25. You have to blame the Greedy Higher Education System and the high costs of doing business

The Higher Education System in this country is just ridiculously expensive, and those expenses trickle down to the expensiveness of professionals.

The costs of doing business IMO are also expensive. People who know little about business may be surprised at just how expensive it is to run a business.

[Vox Moi]

32. That's getting to the heart of the problem ...

If a medical degree is worth that much to a graduate then the schools can bump up the tuition and get away with it.
It's a cost-benefit analysis.
And that's the trouble with a for-profit medical system. Medical care becomes a commodity and subject to the same cold calculations a broker would apply to a barrel of oil.

[Chathamization]

74. Yep, professional schools in general are seen as cash cows

They can charge exorbitant amounts because people are willing to pay, people are willing to pay because they think they'll make a lot of money, they think they'll make a lot of money because our current system is screwed up. My answer would be cheap public professional schools.

[maxsolomon]

27. It took my Stepson 3 years to get into Med School.

He was completely qualified the 1st time he applied and didn't get an interview. High GPA from a great University, high MCAT scores, working as a published research scientist, father is a surgeon, etc ad nauseum.

There simply aren't enough spots for qualified candidates, nationwide.

And the tuition! His choices were Pitt at 60k/year, and UWashington at 30k/year. He took the "bargain".

[lostincalifornia]

30. and most doctors after graduating are are residency, etc, are at least 200k in debt to boot

[lostincalifornia]

29. A lot of doctors are in major debt when they get out of medical schools. Clinic an d hospital

Administrators make entirely too much, just like CEOs of insurance companies

8 dollar aspirins and the 200 dollars for a 10 minute visit with your doctor is mostly a result of the administrators.

[MicaelS]

33. Because doctors come out of school in debt.

Up to their eyeballs. The new eye doctor at the office I have been going to for years, said she just got out of school, and she owes $360,000 just for her education loans. Plus malpractice insurance.

[Hoyt]

54. Let's see, she invests $360K to get salary over $200K per year for 30 years -- not a bad investment.

Malpractice insurance is not nearly as much as they want you to think.

Now there is a lot of pressure on their fees. 30 years ago, they'd get over $2000 ($4000 in today's dollars) per eye for cataract surgery. Now it's more like $850, so they have to pump em through to get rich.

[Lex]

58. EXACTLY.

Don't feel sorry for them for education debt. They get it paid off way more quickly than most.

[frazzled]

35. They are the highest paid in the world

Two articles that discuss high salaries for doctors in the US:

http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0

[mainer]

105. Probably so are our plumbers, pipefitters, and actors

US incomes are highest here for many professions.

[MH1]

37. That's stunningly misguided and simplistic coming from Kevin Drum

He thinks all "doctors" are the same?

Where is his evidence that "the United States pays doctors far more than any other country on the globe"? I don't actually doubt the truth of the statistic - IF you are talking about ALL medical professions. The US has the lion's share of the gilded specialist positions and probably also service most of the world's wealthiest of the 1% for their expensive procedures. The inclusion of those components sharply skews the result.

Meanwhile, I am close to someone who runs a sole practice as a primary care doctor, and it is very tough. He gets paid barely ok after he and his wife navigate the labyrinth of horseshit that is our system for actually paying doctors; but NOT great and oh by the way, is essentially on call almost 24 hours.

And, some primary care doctors ARE quitting, because the pay sucks for the long hours and the stress that you have to accept. If, like my relative, you can't stand the way clinics operate and want to operate a sole practice - or also like him, you want to offer care in an underserved, difficult area - you can just give up on any idea of "wealth" as most of us think of it. Remember this is someone who goes to 8+ years of college and graduates with massive student loan debt.

I think Kevin Drum has his head firmly up his posterior on this one and I am very sorry that he is spreading this manure. Maybe he should have gone to med school and tried it himself, if the pay is so great.

[B2G]

47. +1000 nt

[mainer]

98. I quit medicine for those reasons

No, the stress wasn't worth the "big paycheck" I got. Which turned out not to be enough to send our kids to college. We couldn't even qualify for a home loan in our mid-30s.

I left for a non-medical profession and am so much happier.

[Capt. Obvious]

40. Doctor's Pay Is Too Damn High Party

[ErikJ]

43. Or "The Medical Bills are Too Damn High Party."

I would join that party. A good part of it is the doctors pay. We need a lot more doctors to let the market economy take care of it ,,but the AMA is the gatekeeper.

[BlueCheese]

41. Why are mediocre political bloggers paid so damn much?

Nothing against the OP, who I thank for sharing this post. I'm referring to people like Yglesias and Drum, who as far as I can tell have very little expert knowledge in this area but don't mind shouting from their soapboxes.

Yes, the AMA operates like a guild at times, and I wouldn't object to increasing the number of doctors.

Having said that, the idea that doctors' pay is a major problem with our health care system is absurd. The amount of money and training they put in to practice is huge. Anyone who becomes a doctor for the money has got to be crazy-- there are so many simpler ways of striking it rich (investment banking).

[ErikJ]

48. Most countries pay for their doctors education.

and educate a lot more of them. Yet we still spend twice as much per capita on health care than those other countries.

[treestar]

111. This ^^^^^ and even as single payer advocates we don't think in those terms

Even with that system, we'd all be taxed to pay the high fees.

[procon]

42. And the arcane training methods practiced in American medical schools.

Even in the best schools, outdated traditions and the tiresome rationale that "we've always done it this way", often trump modern methods and high-tech training systems.

It's an old world, feudal system of power ruled by clannish empire building prima donnas who condoned, coddled, and even encouraged because their fame adds to the school's prestige and status. Its a big money biz that translates into higher fees for students who hope to benefit by attending a renown school and increased revenue for the school.

MDs jealously guard their fiefdoms and turf battles have deliberately slowed progress to prevent changes in how basic medical care is delivered. Other countries are expanding and enhancing quality healthcare services by using highly skilled ancillary medical professionals as first layer providers adjunct to physicians who's skills are better utilized to manage more complex and challenging medical problems.

[B Calm]

44. Just a doctor appointment now days costs over $100.00! Wouldn't

it be nice to make that kind of EASY money every 10 minutes!

[Carolina]

49. Easy money?! It isn't going into

the doctor's pockets. Think overhead for all that insurance paperwork. Think malpractice insurance because of ambulance chasing lawyers. Think practice costs: building, equipment, staff, etc....

Thank the lawyers and businessmen for this quagmire.

http://www.ilhealthagents.com/blog/tag/health-insurance-company-ceo-salaries-2011/

Carolina, MD

[madrchsod]

51. doctors have always been paid more than any another profession

they probably well into the future.

[taught_me_patience]

55. EVERYTHING for a doctor is delayed

The live in a world where:

they don't start a 401k until 30yo
they cannot buy a house until 32yo (need two years of income verification before qualifying for a loan)
typically have kids in the mid thirties

There are also huge debts and large risks involved:
student loans = $100 to $200k
practice startup money = $150k

Shouldn't additional training (meaning a delay in every financial decision in life and playing "catch up" for decades), big debts, and high risk be rewarded with more financial gain?

[Carolina]

60. Thank you, taught__ me __ patience

Unlike our bought and paid for Congress whose members are paid nice 6 figure salaries with assorted benefits including health care, and unlike some CEOs who literally lie, cheat and steal... MDs spend years acquiring the knowledge and technical skills to do what they do. And as you so aptly pointed out, everything is delayed because of the 11 years (minimum) post high school education and training that has become more costly than ever.

I wish those in this thread and elsewhere who think it's so easy and so undeserved would take those factors into consideration when they experience a life altering or threatening event (MVA, GSW, MI, CA, etc.) that requires the diagnostic skills and surgical expertise that literally took years to learn and master so that that an MD can act quickly and appropriately to any given crisis.

The education doesn't stop and the responsibility is tremendous. It is not like flipping real estate or merging businesses.

[treestar]

108. There's always a risk with investment

That's why it seems strange people have to take out loans in order to be educated for something they can not be sure there is a market for.

The problem here seems to be high costs of education and artificial limits on the number of people who can do it.

Maybe future legislation could ameliorate the costs of the education and make the standards more reasonable so more people can be doctors. The focus should be on the patients, not on making sure the doctors get a reward any more out of balance with the free market than any other type of person's efforts.

[Igel]

57. Med school admissions increased throughout the '00s.

Med school graduates increased throughout the '00s.

Number of new doctors entering field per year stayed pretty constant.

The problem is that people assume "med school graduation" = "becoming doctor."

What training slots stayed constant during that time?

Residencies. They can only train so many per year. Oddly, that number is lower than the number of med school graduates so it's the bottleneck.

And for that, you get to blame a governmental decision to not increase the number of residencies--horribly expensive--because there was going to be a glut of doctors. Hospitals could, of course, add residency slots themselves, but so many already have razor thin operating margins (which the ACA is unlikely to help, as it tries to reduce costs by paying less) that they probably can't easily afford it.

So instead, we're going to vastly increase demand while holding supply constant. In 2010 the first decision should have been to increase the number of residencies.

The other problem along the way was restricting payments to GPs. Which caused more people to head for specialties. (In that horrible fit of selfishness that some people, but certainly nobody here, have called "trying to get higher pay" and "trying to get better working conditions.&quot The solution to that seems to be restricting payments to GPs.

[Initech]

59. No. Absolutely no. Doctors deserve every cent they make.

I'll get flamed for this but flame away. My brother is an emergency medicine doctor, he's on call 24 hours a day, 7 days a week and he performs tons of life saving surgeries in a week. This article is fucking bullshit.

Medical school is insanely tough and competitive, even just to get your foot in the door. And once you're in you study 20+ hours a day. And then when you graduate, you're saddled with incredible debt, often reaching the $250K mark.

This article is not only fucking bullshit, this author is pointing the wrong finger at the wrong people. You know why our health care costs are so high? It's the fucking CEOs. It's not doctors. The doctors deserve their pay. The fucking CEOs don't. This article is pissing me off to no end.

[Carolina]

62. Thank you

for your understanding, Initech.

The article is definitely directing the blame on the wrong people. The health insurance CEOs are the villains in the whole health care costs quagmire.

Hats off to your brother. His is truly a stressful field and he deserves compensation for his expertise and surgical skill(s). I left OB-GYN for the quieter field of Pathology (which has it stresses, too). But I am thankful for those clinicians like your brother whose work none of us could live without and yet who have to take so much flak from those who simply want to point fingers at "rich doctors."

Carolina, MD

[Initech]

63. Yeah exactly. CEO of United Health made $106 million.

That is obscene. Saying a doctor's salary is responsible for rising health care costs is like blaming the mechanic's salary on rising transportation costs. Especially since YOU DO NOT KNOW WHAT THEY DO!!! This article is blind ignorance to the point where I really want to write a rebuttal. And the comments section in that article is equally disgusting.

[Carolina]

67. And United Health is but one of the villains

Check out this link which includes a graphic of all of those CEO bastards' incomes:

http://www.ilhealthagents.com/blog/tag/health-insurance-company-ceo-salaries-2011/

BTW, I couldn't bear to read much of the comments section of the article... have to watch my blood pressure!
I simply chalk it up to ignorance. America, the dumb and deluded.

[BlueCheese]

68. They don't study for 20 hours a day.

The ones I knew stopped at 16 or so.

[duffyduff]

69. Matt hits it on the head. Limit the supply, create the demand, which in turn causes

the income to go way, way up.

Fear of losing the gravy train was the biggest reason the AMA has been against national health insurance or single-payer.

[Butterbean]

70. I'm with Initech on this one, crap like this really irritates me.

I'm a nurse, and my doctors work their asses off (most of them). When they're residents, they work for peanuts and for ridiculous amounts of time with little or no sleep and no breaks. The acuity of patients in this country is increasing, and the general public still expects doctors to work miracles and "fix" everything, reality be damned. Don't pooh-pooh malpractice insurance rates, either, those are ridiculous as well because our society is so freaking litigious. Even in nursing school, it is hammered into us from day one to "chart for a jury." Every minute of every day at my job, I think about the legal ramifications of everything I do, and what would happen if the particular case I'm dealing with went to court. How do you think doctors feel? Want to reduce medical costs? Try tort reform. Doctors often over-treat because of fear of lawsuits. I hear that first hand from them all the time. Yes, there are absolutely legit malpractice cases, duh, but the bullshit lawsuits are out of control in this country. The phrase "ambulance chaser" isn't in our lexicon for nothing.

They bust their asses, and they go through YEARS of intense schooling to do it, and they should damned well be compensated for it. FFS. The shit I have seen go down for the past 16 years at the bedside....trust me, doctors earn their damned living. I wouldn't want their job for anything, and hats off to them for doing it.

[Carolina]

99. Thank you , Butterbean!

I left OB-GYN for Pathology precisely because of the awful litigious nature of OB in particular. MDs are responsible for the outcome, yet they don't control all the parameters of a pregnancy. It's absurd... Tort reform needs to be a part of any health care reform but sadly the lawyers make the policy.

Few outside medicine understand the burden and responsibility, not to mention the years of study and training which never stops. My clinician colleagues deserve every penny they earn. And hats off to nurses... oh how I depended on their experience and expertise when I was a younger doctor in a clinical field! Thanks

Carolina, MD (for >33 years)

[Trillo]

71. Here's a recent example of the doctor oligopoly at work, limiting supply.

Gynecologists Run Afoul of Panel When Patient Is Male
By DENISE GRADY
Published: November 22, 2013

About two months ago, Dr. Elizabeth Stier was shocked to learn that she would lose a vital credential, board certification as a gynecologist, unless she gave up an important part of her medical practice and her research: taking care of men at high risk for anal cancer.
...
http://www.nytimes.com/2013/11/23/health/gynecologists-run-afoul-of-panel-when-patient-is-male.html

[Trillo]

103. Authored by Dr. Dean Baker, macroeconomist

A trade policy that quite deliberately puts factory workers in direct competition with low-paid workers in the developing world, while protecting doctors and other highly paid professionals, would be expected to redistribute income from the former to the latter.

http://www.opednews.com/articles/Technology-didn-t-kill-mid-by-Dean-Baker-Inequality_Jobs_Middle-Class_Unemployment-131126-220.html

[mainer]

73. Average UK primary care doctor earns about $160,000

but he has no loans, no malpractice worries, and probably works decent hours.

I bet a lot of US primary care docs would love that kind of life.

[ErikJ]

75. American GP's less than that I think

that's why so many are going into specialist medicine where ethe BIG bucks are. The govt could easily subsidize GP's education to balance it all out but I doubt they will.

[Hoyt]

77. Nowadays, a lot of family docs do not do hospital work, limiting a lot of oncall issues.

I think that is fine, although some patients complain. Bigger group practices limit oncall requirements too.

[treestar]

112. why no malpractice worries?

I'd like any professional to have at least some worry, so they will not be encouraged to be careless.

[mainer]

114. Because in UK, doctors aren't financially liable for malpractice

NHS Indemnity
It is general practice in cases of clinical negligence that National Health Service Trusts and Health Authorities are the bodies that are sued, rather than individual clinicians.[2] Under this practice, NHS Trusts and Health Authorities are vicariously liable for the negligent acts and omissions of their employees – including doctors, nurses, and clinicians. This liability arises from the duty of care that the NHS Trusts owe to their patients.[3] This application of vicarious liability has resulted in a government policy[4] known as NHS indemnification, which arises when an employee of the NHS[5] in the course of their work, is responsible for a negligent act or omission (commonly referred to as “clinical negligence”)[6] that results in harm to an NHS patient or volunteer.[7]

The NHS has provided guidance stating that when it is vicariously liable for the negligent healthcare professional it should “accept full financial liability where negligent harm has occurred, and not seek to recover costs from the healthcare professional involved.”


http://www.loc.gov/law/help/medical-malpractice-liability/uk.php

[treestar]

159. So the doctors don't have to buy insurance?

That would seem to follow. Yet something should happen if they are negligent. It's the patient that doesn't have to worry about the cost and it would seem may not have to sue anyone - though vicariously liable suggests they do and they still have to prove negligence.

[flyingfysh]

78. there is a very simple reason

Doctors accumulate huge debts while in medical school, they have to be able to repay the loans somehow. If medical education were free, they could charge much less.
Also they have to carry malpractice insurance. Being died, even if they have come nothing wrong, it's always extremely expensive. So insurance costs thousands a month.

[Hoyt]

87. You'd be surprised how little malpractice insurance is for most docs.

Many folks in their 50s/60s pay as much for health insurance, even under Obamacare.

Loans are often forgiven if doc will serve in rural or inner city for a few years. Would you borrow $200, 000 to earn $200, 000 a year for 30 years?

[pangaia]

79. Not to disagree with anything in the OP,

but my understanding is that it is not so much a problem of not enough medical schools and pre-med and med students , but not enough residencies at hospitals.
I could be wrong about that.

[Lydia Leftcoast]

83. An acquaintance of mine lived in Israel for a few years and said that

Israel makes a point of training a lot of doctors and tuition at medical schools is free. The doctors therefore do not feel entitled to a high income. They're not poor, but they aren't particularly rich, either.

[slipslidingaway]

88. They do take on a substantial amount of debt at a young age ...

and while we are on the subject ... who pays the salaries of resident doctors in the US?

Where exactly does that money come from?

Who is limiting the positions that are offered to resident docs in the US?

[slipslidingaway]

90. And the majority of physicians were in favor of a national health care system...

funded by tax dollars, but our Dem politicians were too beholding to corporate interests and could not even advance the issue when it was the most important issue for most citizens.

Very sad, what a wasted opportunity for the Dems

[solarhydrocan]

93. being arrested by Baucus made it difficult to advance the issue

Uploaded on May 5, 2009

On May 5, 2009, eight activists were arrested at a health care hearing of the Senate Finance Committee, in the Dirksen Office Building, Room 106.

As soon as the Committee Chair, Sen. Max Baucus (D-MT), opened the proceedings, the activists began in turns to stand and to make comments, like: "Why isnt a single payer at the table?" They were immediately "escorted" out of the room by the Capitol Hill police and placed under arrest.

Dr. Margaret Flowers, one of the eight arrested, added in the press release: "Health insurance administrators are practicing medicine without a license. The result is the suffering and death of thousands of patients for the sake of private profit. The private insurance industry has a solid grip on patients, providers and legislators. It is time to stand up and declare that health care is a human right."

The activists are supporting HR 676 and S 703. For background and any updates, see: http://www.healthcare-now.org and
http://singlepayeraction.org and http://md.pnhp.org

[mainer]

95. Certainly a majority of young physicians would

Those who just want to practice medicine would probably welcome the simplicity of a national health care system. As it is now, you need to pay an extra layer of administrative workers to deal with insurance companies.

[treestar]

113. Is there any evidence for that?

[Chuuku Davis]

147. I don't think so

I know of three

Just another doc here

[fujiyama]

91. I'm not so concerned about the pay of doctors

I'm more concerned about douchebag CEOs of major banks and investment bankers that crash the world economy and then get a bailout.

At least doctors use their education for good and try to better others lives.

[mainer]

96. Drastically dropping doctors' pay would result in a number of changes

-- With less incentive to put in the long years of study to become an MD, the system would require the influx of para-medical personnel to take over the work, such as P.A.'s and N.P's. For simple things like blood pressure checks, diabetes monitoring, well-baby checks, this would probably be fine. But as soon as something gets complicated, and they have to send it to the M.D., do you think that doctor is going to want to be paid the same per-patient rate as the N.P. when the MD's patients are far more complex and take a lot more time? Absolutely not.

-- We'll need to open up medical school admission to a wider range of students. (In Europe, just about anyone with decent grades can get into medical school, where the winnowing-out process takes place, so they have a high drop-out and fail rate. In the US, the winnowing-out process takes place at the time of admission (based on grades and MCATs) and you have a very small drop-out rate.)

--States and universities have to bear the cost of setting up new medical schools. Just for Anatomy class alone, you need specialized equipment (morgue tables, dissection tools, highly-skilled faculty, refrigeration units, facilities to handle biohazards, etc.) and very few universities or state budgets are prepared to spend that kind of money right now. Add to that expensive clinical faculty, lab equipment, etc. A large part of the hold-up in producing more doctors is the sheer cost of starting new medical schools.

-- We need more residency positions opening up to accommodate all those graduates.

-- We need to protect doctors from malpractice costs. Doctors cannot work for less on behalf of the government, plus still be liable for millions of dollars in damages. And who is going to cover NPs and P.A.s? Will they have to have their own malpractice insurance? What will malpractice attorneys say about all this?

-- There will eventually be a two-tier care system. There'll be "Walmart" care for most people, where you can only see an NP or PA (unless you have a complex problem.) But the wealthier patient can go to a private-pay M.D. and use concierge care. In fact, most highly trained M.D.s will probably opt for concierge or fee-for-service care, because it will simply be more lucrative. There's something of this now in the UK, where patients who opt for additional premiums can go to private doctors.

[mainer]

97. Medical school enrollment figures -- up 30%

First-year medical school enrollment in 2017-2018 is projected to reach 21,434—a 30 percent increase from 2002–2003. The 30 percent increase matches exactly the 2015 target recommended by the AAMC in 2006. Of the projected growth from 2002–2017, 62 percent will be at the 125 medical schools that were accredited as of 2002. New schools since 2002 will provide 31 percent of the growth, and the balance (7 percent) is expected to come from schools that are currently in LCME applicant-school standing.

Survey results show that the adequacy of clinical training opportunities for students may pose a challenge for medical schools. Seventy-eight percent of respondents expressed concern about the number of clinical training sites for students, 82 percent about the supply of qualified primary care preceptors, and 67 percent about the supply of qualified specialty preceptors.

Medical schools also reported concern about enrollment growth outpacing growth in graduate medical education (GME). Thirty-three percent of schools reported this as a “major concern” in their state and 42 percent as a “major concern” at the national level. However, only 14 percent of schools reported “major concern” about their incoming students’ ability to find residency positions of their choice after medical school.

Seventy-six percent of schools said they had either established or recently implemented at least one initiative to increase student interest in primary care specialties. These efforts included changes in curriculum, extracurricular opportunities, expanded faculty resources and training, and changes in admissions criteria.

Full report from the AAMC here -- and their efforts to increase #doctors. The problem is cost, #preceptors, and post-graduate training.


https://members.aamc.org/eweb/upload/12-237%20EnrollmSurvey2013.pdf

[The Velveteen Ocelot]

101. Fought like lemmings?

Lemmings don't fight; they just jump off the cliff. An odd choice of metaphor - I'd have picked wolverines or Tasmanian devils.

[MindMover]

102. Read the history of the AMA and you will understand why Dr's get paid so much ...

[mainer]

120. You do know that only 15% of doctors belong to AMA?

It represents a very small minority of doctors in the country.

[MindMover]

123. Whatever dude, read about its goals ... to promote and further physicians incomes ............

"The American Medical Association (AMA), founded in 1847 and incorporated in 1897,[3] is the largest association of physicians—both MDs and DOs—and medical students in the United States.[4]"

"The AMA sponsors the Specialty Society Relative Value Scale Update Committee which is an influential group of 29 physicians, mostly specialists, who help determine the value of different physician's labor in Medicare prices."


http://en.wikipedia.org/wiki/American_Medical_Association

[mainer]

126. Just like any trade union -- only this one represents a fraction of doctors

It isn't the all-powerful organization you think it is.

[ErikJ]

144. They spend $13 MILLION a year lobbying congress

http://www.opensecrets.org/lobby/include/IMG_client_year_comp.php?id=D000000068&type=c

[hunter]

166. Pharmaceutical corporation money...

The AMA is essentially owned by big industry now, bought in the same manner National Public Radio was bought by the Koch Bros., the natural gas industry, etc..

The AMA sends out letters begging doctors to join, often with steeply discounted membership rates (even free for new doctors) which go right into the trash with the rest of the doctor's junk mail.

They've become little more than a marketing agency for the pharmaceutical industry and they send out their Journal for free to doctors who are not members.

Big multi-page advertisements for expensive medicines, many medicines that work no better than "four dollar" generics, are all that's keeping the AMA afloat.

I always picture the typical AMA member as an older male doctor who likes to flirt with the pharmacy reps and is not always up-to-date in his practice.

I'd actually go out of my way to avoid a doctor who was an AMA member.

[Marrah_G]

104. I have no issue with what Doctors make

They have long years of study, a very difficult job, high college loans, high insurance and they provide a vital service to our society.

I'm saving my anger at the leaches who suck millions out of our society and provide nothing beneficial in return.

[n2doc]

110. It comes down to medical schools limiting the number of students

It is very hard to get into a US medical school. I've known doctors who had good (b-to high b) averages, who couldn't get in, even though some went on to get a masters with an A average. They went overseas, got their degree, and came back. They had no problem passing their exams here and setting up practices.

I do think people don't appreciate just how hard most doctors work. We see the plastic surgeons and other specialists living the high life. But the ones you interact with when you are sick, they work incredible hours, to exhaustion. Maybe if we had a better supply situation the average workload would be less, and they would have a more normal life.

[Carolina]

122. Please see Mainer's

thoughtful and correct post above.

Increasing enrollment requires: professors, clinical sites for 3rd and 4th year undergraduate medical clerkships and funding for postgraduate medical training (residencies).

And just a little note about plastic surgery. It is much more than breast augmentations and rhinoplasty. It takes years of training and technical skill. When I was a 1st year resident (we were called interns then), a woman came to the ER who had been badly slashed about the face by her boyfriend. The general surgery resident and I knew we needed help or she would be left with awful, disfiguring scars, so we called the plastics guy on call. To this day (31 years later), I marvel at his work. With masterful efficacy and skill, he put that woman's back together. When I happened to see her several weeks later in the surgery clinic, I couldn't believe how wonderfully she'd healed and beautiful she looked. Plastics often involves reconstruction and in many such cases, it is absolutely artful. Those so skilled deserve what you refer to as the "high life."

[n2doc]

124. They receive no more difficult or extensive training than do ER doctors

Yet make millions. Sorry, I live around them. I also live around many other docs as well. The plastic Surgeons are the most venal, greedy SOB's I know. Well, maybe the Pharma salespeople are worse. At least Neurosurgeons and heart docs save lives.

We once were willing to fund science and vastly increase the number of scientists, to help 'win' the cold war. Why not win the war on disease the same way?

[mainer]

125. You are so, so wrong about ER docs = plastic surgeons.

You think an ER doc can do just as good a job as a plastic surgeon?

I've worked in the ER, and the first thing an ER doc does when there's facial trauma to a young person -- especially a woman -- is call for a plastic surgery consult. Because he knows he doesn't have the skills or the experience to suture a potentially disfiguring wound, for which he'll surely get sued. If it's some older guy who doesn't care about a scar, then he'll get the standard suture job that most of us learned to do in medical school. But anything more delicate than that calls for a plastics doc.

Plastic surgery isn't just stitching things together like a seamstress. It requires knowing precisely how the skin will heal, and whether edges will buckle or if keloids will form. No, skin isn't just pulled together in a straight line; sometimes it means making new zig-zag incisions with a scalpel.

Same goes for other specialties. Let's say gastroenterologist. Maybe a regular doc could get a colonoscope up the sigmoid, maneuver it up and around the transverse colon, and even reach all the way to the ascending colon, but does he know enough to recognize that abnormal patch? Recognizing cancers in situ takes years and years of hands-on experience, not just "technique" learned in medical school.

[Carolina]

146. Hey mainer

Have enjoyed your posts,but no matter what you (and I) write, some opinions cannot be changed, people just don't understand. I pointed out the same thing about plastic surgeons from my own experience during residency, but it meant nothing.

[nadinbrzezinski]

167. Wrong.

I will give you a very concrete example. I had an open lip when I was in EMS, and it was the Plastic Surgeon who fixed that. It is barely noticeable. My mom fell, and needed her head closed up, her scar is large, uggly and easy to feel. The difference in this is quite simple. I had a plastic surgeon do the work, she had an on call ER physician.

Those who want rhynoplastic surgery to "look better" benefit that doctor in the practice necessary for when a patient comes in to the Trauma Unit with a Lefort Two fracture that needs extensive repairs.

[TBF]

121. Cuba is a great case study on this -

they have arguably the best doctors in the world.

Here is a great article from Monthly Review on this subject -

http://monthlyreview.org/2012/09/01/cuba-the-new-global-medicine

[MADem]

127. Organized crime, basically--it's an extortion racket.

Plus, they limit supply to keep demand high, and they don't let people with less training take care of "easy" shit.

[mainer]

128. So doctors should only take care of the "hard" shit

spending more time per patient, on more complex problems...

and get paid less for it?

[MADem]

130. If they spend more time per patient, they'd be less stressed.

They'd reach more considered conclusions. They'd be working LESS hard with a smaller workload.

The paperwork AFTER the patient is what is time consuming.

If you were a business professional, would you want to spend half your day sorting paper clips? That's what doctors do when they are forced to do band aid work that a medic/corpsman can do, followed by paperwork.

They could see fewer patients, do a better job, be less stressed, and pull down a good payday.

Are you defending the status quo? Sure sounds that way. Do correct me if I am mistaking your intent, here.

Do tell....

[mainer]

131. You want to make doctors' lives better?

and force them to ONLY have the complicated patients? THAT is going to stress them even more, dealing with life-threatening problems from morning till night.

Paperwork is indeed an issue, but a lot of that is due to insurance, documentation requirements, and billing hassles. Yes, let's take that off their backs.

But you want the NP handle the easy stuff, and leave the tough stuff to the doc? That is not going to make his life easier.

I was a doctor. I quit because of the stress. So did my spouse. That's two expensive medical educations unused because, let's face it, the life of a doctor is no picnic.

I don't want the status quo. But I certainly don't want your vision of medicine, either.

[MADem]

132. If working to their full ability is too hard for them, they are in the wrong line of work.

See? You quit because of the stress. You couldn't handle it. That was probably a good move on your part and you should be commended for it, as should your spouse. Not everyone is cut out for that line of work.

Now, imagine all the bullshit patients--the ones that took up your time, but not your skills--were eliminated, leaving you with only the ones who could benefit from your full abilities. You have all the time in the world to use your mind and your education to solve their issues.

In my "vision of medicine," a medical school education is affordable, even fully reimbursable in exchange for a period of duty in underserved areas, we travel down the road through the ACA to single payer, profit comes OUT of the picture, doctors make a good living (though they might not have 3 Mercedes and a Maserati in their 4 car garage in their multi - million dollar home), there are plenty of them, so they aren't working 20 hour days, and patients get good, undistracted care from doctors who aren't "too stressed" and "can't handle it."

That day is coming. Cuba has a lot of these "everyday" doctors, who operate clinics for simple things. When we rapproche with Cuba, there will be a large exodus of medical professionals and many of them will come here. Others, from here, will start attending Cuban med schools once they become certified. Maybe some geniuses will have a good look at their model and export elements of it, which has produced one of the healthiest populations in the world relative to their per capita income.

[mainer]

134. And many, many more doctors will quit if all they deal with is train wrecks

because, as much as you think it's great to use one's full abilities, there's also the stress of watching people die. People who die because you couldn't save them. It's not all simple "mental games" we're playing; it's grief and loss. Medicine isn't a game of crossword puzzles, it's the reality that everyone eventually dies, and that you -- the doctor who makes the decisions that peoples' lives hang on -- will be front-line at their deaths.

While the NPs get to skim off the easy every day patients -- and take a big portion of your income.

I don't know many pediatric oncologists who last very long in their professions. They are specialized, caring people. And they quit because they can't handle it anymore.

Yet you want to give them an unending career of the most trying part of being a doctor.

[MADem]

155. You did make the correct decision.

I have a friend who is one of the best thoracic surgeons in the country. If he were stuck putting band-aids on boo-boos in a small town, he'd be stressed to the bone. It's the difficult cases that empower him. He kicks ass, he takes names, he likes it. He loses one, he shakes it off, and he gets back in there and fights on. He changes techniques, he imparts knowledge, he cures people. He's done this in battlefield conditions, and now he does it as a civilian--and he does it well.

The bottom line-- if you're in the job strictly for the income, you're in the wrong line of work. You have to love the challenge or the work is not for you--or anyone who can't approach the job as a battle of wits and skill.

Your comments do point out, though, that doctors often don't get the psychological help that they need to manage stress appropriately. That should be part and parcel of the medical care industry.

And as for the NPs, in a national health scenario, they wouldn't be 'taking a big portion of YOUR income.' They'd be paid appropriately, per their skillset. As MD's would be for theirs.

[Warpy]

129. Easing the educational bottleneck will help, as will easing the enormous cost of medical school

However, don't forget that a specialist generally doesn't enter full practice until his or her mid 30s. That means they've lost at least 15 years of full earning potential. That needs to be compensated. Docs will always be paid more than plumbers, even if they become as common as plumbers.

[mnhtnbb]

133. Actually, there's quite a range in income among MD's in the US.

http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

Family Practice docs and pediatricians don't make nearly as much as some other specialties.

Hubby is a psychiatrist. We've been married 28 years--I do the taxes--and he's never
made as much as the salary that's listed for psychiatrists.

Yes, there are some specialties that make significant bucks--but they often have
lives in their hands.

Do football players? Basketball players? Insurance agents? Businessmen?

Our health care cost problem in this country is not docs' salaries: it's insurance companies.

We should have single payer. That's just my $.02.

[mainer]

135. Yeah, people complain about primary care doctors' "high incomes"

while they cite neurosurgeons' incomes as the standard.

[nadinbrzezinski]

141. And pharma, never forget about big pharma

asking premium prizes for meds that were developed many a times by NIH, aka funded by our taxes.

[mnhtnbb]

156. True. Very true. Also pushing meds with dubious value--like statins--on everyone.

[nadinbrzezinski]

164. I am an ideal candidate for statins

but I am in that percentage of the population that can potentially benefit from their use. Yup, that grand genetic lottery. One reason my brother just passed was a significant event.

[nadinbrzezinski]

137. Matt needs to read that chart again, for starters

and I will leave it at that. But pay is not the highest in the world, not even close.

[kelliekat44]

142. It's almost a closed system in the US. Just look at the Med school system, who is in charge, who

gets in, cost of feeder education, Ivy League schools, Fed grant funding, the interconnections of politics and medical education, business and profit over actual healing purposes...the sometime undue reverence of the medical profession over our own intelligence, ...lots of reasons but mostly because no one is out there to stop them.

[ErikJ]

145. The AMA spends $13 million a year lobbying congress

http://www.opensecrets.org/lobby/include/IMG_client_year_comp.php?id=D000000068&type=c

[upi402]

152. Our entire medical care system is insane

I think Dr's are just a part of it all.

[cherokeeprogressive]

151. BECAUSE THEY'RE FUCKING WORTH IT.

[ErikJ]

154. BS-In Ecuador they make 1/10th as much and even make HOUSECALLS!

American doctors dont need to work 12 hour days making $300 an hour and have 3 Mercedes Benz while Americans are dying.

[DustyJoe]

158. AfriggingMEN

Totally agree. I had the vascular surgeon with decades of experience, sterling track record and yes, cost more than the newer middle eastern newcomer on a visa with a lower rate do my Aortic graft and repair. I firmly feel it was the right decision.

[joshcryer]

153. The entire education system is a sham.

From the bottom to the top. It's all a shame to keep the rich rich and poor poor.

[beachbum bob]

160. first of all doctors are not usually "paid", they earn as part of a LLC or sub-chapter S corporation

few if any doctors are direct W2 wage earners....usually limited to the public sector type jobs and doctors in residency programs.. The real question should be......why are physician charges so high and their income so out of proportion with average working families??


That should be the thread topic of discussions.....

So why are physician charges so high?

1. high cost of a medical degree

2. 2 year indentured servitude that all doctors must go through in doing their "residency"...this sets the stage of the screwing all the future doctor MUST endure 2 yrs for minimum pay and excessive hours and really impacts their attitude greatly

3. healthcare insurance....where people undertake unnecessary procedures and tests and office visits

4. malpractice insurance driving unnecessary procedures and test

5. massive overlapping of goods and services in localities

6. the generally ill health of american citizens impacted by all of the above

7. greed impacted by all of the above

8. inadequate competition>>>>I would like to see government education program expanded to set up government healthcare system where the taxpayer subsidizes the education of the best and brightest and upon graduation, the medical student serves residency in govt sponsored clinics and hospitals and upon passing the board and becoming a doctor, they serve 10 yrs as part of the contract to repay their investment by the american taxpayer. Think what becoming a doctor with no education expense burden would do to effect their psychology!! Back in 40's, 50's, and 60's a great deal of doctors came out of the military via their education program and the fact that they had to serve in the military for "X" number years....as these doctors were great doctors.......