That basically exists in the form of Nurse Practitioners which is 2 years of nursing school + 2 years of graduate school. Job still requires M.D. supervision but they can still handle a lot of day to day stuff, write prescriptions, etc. and of course the median salary is significantly lower than a Dr. with an M.D... There are also physician assistants.
Physician salaries in America - are they too high?
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That basically exists in the form of Nurse Practitioners which is 2 years of nursing school + 2 years of graduate school. Job still requires M.D. supervision but they can still handle a lot of day to day stuff, write prescriptions, etc. and of course the median salary is significantly lower than a Dr. with an M.D... There are also physician assistants.
UnemployedVillain
Member
This was my first concern. Med schools are expensive as FUCK and are partially so, or justify it (it's a chicken and egg problem), because physicians make as much as they do. If they were potentially taking 30%-40% hits, with med school tuitions remaining the same, I could see that causing major issues.
What's more (and someone correct me if I'm wrong on the med school side) is that while grad students are at least being paid a minimal stipend when in school and often don't pay for their programs since it's funded by their departments and grants, med school students are paying out of pocket AND require so stipend at all
How is that a good thing?
I think the poster didn't mean that only certain types of people can become doctors, but that only the most qualified and hardworking people become doctors.
Of course, privilege and perceived talent often intersect. There's a reason why most physicians come from more privileged ethnic backgrounds.
Imbarkus
As Sartre noted in his contemplation on Hell in No Exit, the true horror is other members.
Not sure where I heard this but I did once hear that surgeon's spend half of their income on malpractice insurance.
If there's anyone to be targeted for a reduction here, it remains the suits at the insurance companies, who own the game from both ends.
If there's anyone to be targeted for a reduction here, it remains the suits at the insurance companies, who own the game from both ends.
Aztechnology
Member
The reason there's a shortage of doctors isn't because of the time orequired hard work. It's the upfront cost and more importantly the lack of med schools, especially affordable ones. In Washington for instance until recently only the University of Washington was allowed to have a med school even though Washington State University and a university in Tacoma both wanted to establish med schools. Because of state funding most schools fight tooth and nail to be the only med school in the state.
If there were more medical schools, they would be more affordable and doctors would have much more competition for work and so would make less.
If there were more medical schools, they would be more affordable and doctors would have much more competition for work and so would make less.
entremet
Member
There's also only so many medical schools seats in the US. It's risk mitigation. You can't have too many dropouts as that costs the schools so using GPA and test scores is one of the shortcuts to assessing serious candidates.
I'm comfortable having qualified doctors. If that mean they can make high salaries then so be it.
Living in Canada, I don't have any crazy medical bills that it seems those living in the US have and I think doctors have a similar salary range here.
Fragamemnon
Member
those salaries, if anything, seem a bit low given the massive opportunity cost you have to eat due to schooling. There's a LOT of lost wages+incurred debt that you have to just eat if you go the doctor path.
device, admin, and pharma is where america gets bent over the barrel.
device, admin, and pharma is where america gets bent over the barrel.
Not only is the compensation right for GP, but I believe that similar compensation should be received by policemen, policewomen, teachers & firefighters. People who are capable of changing a persons life and putting their health on the line. Obviously in such a case I wouldn't be against there being a lot more training for all these positions so only the most qualified actually work in these fields.
I think becoming a Doctor should be because you want to help people. Not because you want make lots of money. I think they should be compensated well for what they do, however we could use some better checks and balances of medical expenditures.
You can be a rockstar Dr. and still care about the patient.
To jump on the train, I LOVE my NP (followed her to another practice for gods sake). Doubt I would ever go see a Doctor unless I need to.
You can be a rockstar Dr. and still care about the patient.
To jump on the train, I LOVE my NP (followed her to another practice for gods sake). Doubt I would ever go see a Doctor unless I need to.
As a doctor myself in the US, I feel I can accurately weigh in on this.
It takes a long time to become a doctor. 4 years undergraduate, 4 years med school then at least 2 years residency which can go up to 6-7 years depending on the field. On top of that it's fairly difficult to get into med schools which look at your schools, MCATs, SATs, GPAs etc. Then you have to consider the cost of attendance, getting good scores on Steps, having good interviews for residencies, getting good grades in medical school and the stress that it all takes. Some don't even get a job after getting out of medical school.
So arguably when someone finally becomes a physician/surgeon they have earned that wage. Now the issue is that there aren't enough medical stress cools and more importantly not enough residency seats. It's not just US students trying to become a doctor here but people from around the world. People from all over come to US to become a doctor because it pays the most here (for the most part). That greatly inflates the competition when you have people from India scoring 260s on their Step scores!
Even with so many people trying to enter, there are no where enough slots for them. And there is always a shortage of doctors in the country. It's all very tightly regulated by lobbyists. Keep number of seats low, increase prestige of being a doctor, keep wages high.
There's a bigger problem here than just doctors making too much money in the states. If they didn't make as much money then there would be far less incentive to go into the profession. Why would I become a doctor who gets payed 90K a year when I can become a civil engineer after 5 years vs 10 years of medical schooling/training? Why would I enter a field with more competition, hurdles and stress to make just slightly more money? Sure some people like just working with and helping people but you can also become a nurse, health technician, research scientist, PA etc.
Wages for doctors in US are probably still too high (especially for someone like a Radiologist/Family physician versus a trauma surgeon) but the overall up front cost is also way too high (and I am not talking about just financial cost here but time which is the biggest resource). If they greatly lower the initial cost of becoming a doctor.. then sure they can reduce wages.
It takes a long time to become a doctor. 4 years undergraduate, 4 years med school then at least 2 years residency which can go up to 6-7 years depending on the field. On top of that it's fairly difficult to get into med schools which look at your schools, MCATs, SATs, GPAs etc. Then you have to consider the cost of attendance, getting good scores on Steps, having good interviews for residencies, getting good grades in medical school and the stress that it all takes. Some don't even get a job after getting out of medical school.
So arguably when someone finally becomes a physician/surgeon they have earned that wage. Now the issue is that there aren't enough medical stress cools and more importantly not enough residency seats. It's not just US students trying to become a doctor here but people from around the world. People from all over come to US to become a doctor because it pays the most here (for the most part). That greatly inflates the competition when you have people from India scoring 260s on their Step scores!
Even with so many people trying to enter, there are no where enough slots for them. And there is always a shortage of doctors in the country. It's all very tightly regulated by lobbyists. Keep number of seats low, increase prestige of being a doctor, keep wages high.
There's a bigger problem here than just doctors making too much money in the states. If they didn't make as much money then there would be far less incentive to go into the profession. Why would I become a doctor who gets payed 90K a year when I can become a civil engineer after 5 years vs 10 years of medical schooling/training? Why would I enter a field with more competition, hurdles and stress to make just slightly more money? Sure some people like just working with and helping people but you can also become a nurse, health technician, research scientist, PA etc.
Wages for doctors in US are probably still too high (especially for someone like a Radiologist/Family physician versus a trauma surgeon) but the overall up front cost is also way too high (and I am not talking about just financial cost here but time which is the biggest resource). If they greatly lower the initial cost of becoming a doctor.. then sure they can reduce wages.
The Albatross
Member
I'm not comfortable with the idea of anybody putting a cap on what somebody can earn. Increased taxes for high earners, sure, but in a private industry, I don't think it's reasonable to say that somebody is only allowed to make X amount of money in a year because some schools are government subsidized, or some insurance is government subsidized.
$100,000/year is comfortable, but puts a doctor who has some 10-15 years of training, higher education, and (essentially) interning at about the same range as a mid-level software developer. I think the result could be a drain in talent if we put artificial caps on what somebody earned.
I'd prefer for it to happen that Doctor X earning $350,000/year competed with Doctor Y earning $250,000/year, and that in turn allowed patients to choose whether they want expensive Doctor X or slightly less expensive Doctor Y. You might see more patients opting to go for a less expensive doctor and then Doctor X would have to lower his costs. This, of course, isn't how the health care industry works at all though so along with tort reform and the high cost of medical school, it's all an unrealistic pipe dream.
Dathbomb said:
Yep, this is exactly how I feel about it. An incentive to becoming a doctor and going through extensive schooling is that, at the end of that, you're generally going to be one of the highest paid non-executives in the country. My sister is a physician and she just started earning a salary commensurate with her education level in her mid-30s, where as for the last 15 years, she's essentially been in school, residency, or something similar in perpetuity. If physician salaries had some artificial cap at $100,000, then there would be very little financial incentive for somebody to go through that, and instead, go into a tech field where you can get up to that $100,000 range within a couple years, and generally do so with just a bachelor's degree.
The time and stress cost would remain unchanged, however. Even if medical school training were completely free, one would still be looking at 4 rigorous years of medical school, followed by 3-7 years of residency training depending on the field they would want to go into.
If you bring physician salaries down into the $100,000 range, does the time/stress investment make it worth it, even if it's something you're interested in doing? Would potentially great doctors be turned away from the field if that extra financial incentive wasn't there to push them through almost a decade of additional training after college?
Isn't this what would occur if the federal government is the only entity providing reimbursement payments to physicians? It would effectively be a monopsony - physician's would only have one entity offering money for their services, and if that entity cuts payments to save money, and because it bought (and nationalized) all the competition, what would prevent them from setting specific caps for physician services?
Good stuff right here
Wife is doing nurse anesthesia and it's 6 1/2 years total for her including undergrad and grad school. Hard part about it they usually don't accept you into grad school without a couple years ICU experience so she'll be graduating when she's 28 but again pay is very good but does require some form of supervision (depends on the state)
This plus teachers.
Yes, that's where the cost goes. Pharma in particular.
victreeb3l
Member
I feel like doctors should be paid more.
Or... Make considerably more than that as a mid-level practitioner (PA or NP), have only 2 years of training, and incur a fraction of the malpractice and education cost.
At this point, It's a no-brainer. I have no idea why people are killing themselves in medical school when other options exist, particularly those in which they would be essentially doing the same thing.
Some people have a passion for it - it's not about the money.
Zaraki_Kenpachi
Member
Why are we so concerned about wages of doctors? Really not understand how that prevents single payer.
CEO salaries are determined by market forces and shareholder votes at major corporations. If you don't like it, fire the board.
CEOs are also extremely productive members of society. Many CEOs are more productive than doctors could dream of being in terms of the impact of their decisions, both first order and indirectly. You could even translate that into lives saved if you want to get clever.
Say you are the CEO of a bridge company. By making smart decisions, you are able to win a contract to build a bridge across a river. By being good at his job, this ceo has:
1. Employed the work force, giving them the ability to use their effort in coordination to build a bridge. This is called entrepreneurial leadership and is the skill a CEOs brings. This is potentially thousands of jobs, which means billions of dollars flowing through the economy. These people can now pay for healthcare, raise kids, feed themselves, etc.
2. Compensated shareholders, so now people can retire, pay for education, and do all the fun things that investing can do. This also increases the size of the business, so now they can build more bridges.
3. By building this bridge, the CEO and his companyhas now saved commuters say 30 minutes on their daily commute. Multiply this by commuters times days times years and his company has done the equivalent of saving thousands of lives. He also allows for consumers to get products more quickly, ambulances to reach sick people, etc.
He isn't singlehandedly responsible for this of course. It's a network of people bringing skills and capital to the table. He does however play among the largest roles in making it happen. How much is that worth? How much is it worth over the CEOs who couldn't make it happen? I'd pay that ceo a lot of money, more than a doctor by far.
The salaries? No, not at all; I think they deserve every bit of it for the work they do.
Now...hospitals charging $20 for a goddamn aspirin? Yeah, that shit needs to go away.
Goddamn right. You get your crappy teachers (as I'm sure there are some crappy physicians who get lazy), but in general, they are passionate about what they do, and are paid far too little for it.
Now...hospitals charging $20 for a goddamn aspirin? Yeah, that shit needs to go away.
Goddamn right. You get your crappy teachers (as I'm sure there are some crappy physicians who get lazy), but in general, they are passionate about what they do, and are paid far too little for it.
You misunderstand my point. I even pointed out other jobs in the healthcare field.
Mid-level practitioners (PAs and NPs), essentially, have the same responsibilities and in the case of an NP can practice independently.
So to reiterate, I was pointing out that the reasons for going the route of becoming an MD today make even less sense. First, it's obscenely competitive to get into a program, and then even more so to get a good residency and field. As DahBomb pointed out, there simply aren't enough residency programs. So basically you're subjecting yourself to years of torture in undergrad, years of torture in medical school, and then 2-7 grueling years in residency if you even get into one.
Meanwhile, as a PA- 2 years of post-undergrad education, then you're out in the workforce. Not nearly as hard to get accepted, and there is freedom to move into any field once you're accredited.
My point was simply this- If you're interested in just helping people in medicine, there are more sensible ways to go about it at this point, and that the arguments for becoming an MD are becoming fewer and fewer.
They also spend a decade in college along with a crazy amount of hoops to jump through before they can practice medicine on their own and still work crazy hours. If you wanted to make distinctions, then I'm sure some get paid a bit too much for what they actually do, but saving lives and dealing with death and gore on a daily basis probably deserves a bit of pay on top of having to pay off your student loans from medical school.
Many in this thread feel that the administrators and CEOs should be the ones who have their salaries slashed, not physicians.
And the general thought is that a single payer system would result in a precipitous drop in the salaries of physicians, bringing them down closer to $100,000, which is where they are in the UK under such a system.
If this were to occur, the effects could be substantial on the healthcare industry as a whole.
SugarDaddy
Member
Nah, fix the hyper inflated cost of pharmaceuticals, and then revisit whether or not medical professionals require a pay cut.
Can confirm...my wife is an NP. FAR less in student loans, no 16 hour days, and less chance of accidentally killing someone. We're not going to live in a mansion with a couple of Porsches, but there is still a pretty good quality of life that comes with that degree. If you're going to become an MD, it really has to be worth it to do so these days.
Heh, super-salt on my part, but I think if you're rich, you have a much better chance of cracking the med school game by loading up on them delicious extracurriculars.
Workin' dat minimum wage job ain't so sexy.
ReplacementPelican
Member
But Swedish graduates also had free tuition so don't have the levels of debt as an American graduate.
30yearsofhurt
Member
Seriously?
You don't think professions dealing with peoples health should faces higher levels of scrutiny than lowly qualified professions such as used car salesmen or real estate agents?
Well, how is their QoL? Because I don't see why peeps would subject themselves to a med career when there's a cushy tech/finance job with same salary but less hours 'n stress.
Do you like having intelligent, responsible, hard working people who care about helping people stay healthy and ALIVE? People who are, in fact, proven to be among the most intelligent, responsible, educated people around?
If you don't care about that, cut physician salaries to less than 100k and relax the requirements to become a physician. Maybe eventually we can get rid of all qualified health care workers and go full on idiocracy.
Physician salaries have actually decreased in terms of real dollars from the 70s when there was a lack of regulation on pricing. With the ACA, compensation has taken yet another hit. Some physicians are getting pennies on the dollar from the government for the services they render to medicare patients. They are literally losing money on some patients, yet they continue to provide care because that's what they're trained to do, naturally inclined to do, required to do by their strict professional oaths.
Physician salaries account for just 8% of spending on healthcare. Meanwhile, administration costs account for 25% of healthcare expenditure and that number is increasing. Administrative costs in the US are up to twice as much as other countries, with no improvement in health care outcomes.
http://www.commonwealthfund.org/pub...rature/2014/sep/hospital-administrative-costs
I would argue that the parts of healthcare that need to be looked at right now are...
Palliative care for end of life patients - Too many end-of-life patients cycle in and out of hospitals repeatedly, incurring expensive bills for what is basically palliative (comfort) care because there are lacking palliative care resources in communities (nursing homes).
Mental health care resources - Too many patients are inappropriately utilizing expensive resources (emergency rooms) for mental health related issues because, again, there is a lack of resources in communities to serve their health care needs.
Pharmaceutical negotiations - Refer to any of the numerous resources that show how much the US is gouged on pharmaceuticals compared to other developed countries.
Administrative costs - Refer to the linked article showing how inflated US health care administrative costs are.
That gets balanced out with shitty house prices in Nordics. All our debt gets unloaded into property. It's like people have a chronic condition to pay off something for 30 years.
sweden is a large country with a small population, so we don't have many universities. If you want to study something like medicine you'll pretty much have to move. Rent and living expenses are crazy expensive here, and there are very few part time jobs available so almost every student end up with a loan of 40-75k(usd) anyway. I don't know a single person who studied and didn't take at least 30k in loans.
I worked with a Dane. He used to joke that you could never really own your own house. He said a few very rich people did but most people would never pay it off. It was part of the reason he moved to the US.
Dr.Guru of Peru
played the long game
PAs need to be supervised by MDs. At the time of graduation, they are essentially medical students who are getting paid. Your autonomy is minimal unless you have years of experience and are self motivated.
Most NPs also need physician back up. When I was a resident, I would constantly get bedside consults from NPs. There would be NPs who had been in practice for years, and they would be running things by me - a first year resident. They just don't have the depth and volume of training to equal MDs. You also don't have the career options that physicians do. You can overcome some of this by being motivated, but there's only so much you can do with self teaching. You will always have that ceiling, If you can get satisfaction with that, great. Many wouldn't.
Lolwut? Becoming a medical professional should be one of the hardest things out there. Only the brightest and most dedicated people should be doctors. Not the average person - that's why we have liberal arts majors.
As someone who's potentially interested in moving to north america after i've finished my medical education, i'd say keep 'em high for a while still.
But joking aside, I don't give a fuck about the salaries, honestly. If all you care about is money there are plenty of other careers and fields that offer way more bang for your buck in that regard. I simply can't imagine me doing anything else, i'd do it if it paid minimum wage no questions asked.
But joking aside, I don't give a fuck about the salaries, honestly. If all you care about is money there are plenty of other careers and fields that offer way more bang for your buck in that regard. I simply can't imagine me doing anything else, i'd do it if it paid minimum wage no questions asked.
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