Physician salaries in America - are they too high?
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StrangeADT
Banned
And if you cut what you pay them, there's nothing keeping the good ones in your country (or attracting foreign talent). You live in a modern, globalized world. There is a marketplace for talent. Dropping wages doesn't solve anything. You just end up creating a shortage which is typically counteracted by *increasing* wages; either that or a severe shortage of qualified staff manning hospitals, increased wait times for surgeries, and consequently, more unnecessary deaths.
Particle Physicist
between a quark and a baryon
Humans aren't machines. Humans don't present in textbook manners. While some things in medicine are algorithmic, most of it actually is not. If you haven't actually been at beside, seen a patient and actually treated patients in any capacity, you really have no leg to stand on here.
yep...the ceo of my company has a salary of "only" 1 million. He brought in another 15 million in bonuses and other means of compensation.
No. The schooling and job is still extremely stressful and they should be compensated as such.
hockeypuck
Member
So you're generalizing an entire profession to a few simple principles based on your interactions with a handful of pathologists. Fascinating.
Physician group lobbying?
I'm against cutting doctors salaries just cause they are high but the view of doctors in this thread is bordering on Gray's Anatomy. Most doctors aren't doing any life saving in their whole career never mind regularly.
I'm biased from having interacted with some shitty doctors after a really serious accident. I've had an ortho surgeon bitch to me about my health insurance in a pre-op assessment while I'm in an ICU on morphine with open wounds. He then billed $350 for 15 minute check up appointments where he would ask me to raise my arm and then say "range of motion is looking good, keep up the PT". Also had a neurosurgeon of 30 years that couldn't/wouldn't diagnose the cause of my positional dizziness after finding out I didn't need surgery on a fractured C7 vertebra. A physical therapist knew exactly what the issue was but the neurosurgeon, contracted by a hospital to deal with people in accidents, had no idea.
RowdyReverb
Member
As somebody who is about to embark on a 4-year residency (probably followed by another 3-year fellowship) it warms my heart to see people here standing up for doctors. It is such a long road to train for these positions. Its tough to have friends the same age as me in other fields who are already financially stable enough to have a nice car, big house, and a family. Thankfully, my wife works full time and has been gracious enough to support the both of us for the past 4 years.
It's also hard for doctors to stand up for themselves in this regard because it can be very taboo to say that compensation is important to you, because most doctors truly are passionate about their work (you really have to be) and they don't want to insinuate that they are only doing it for the money.
There's also a whole conversation to be had about how to treat the patient, not just their problem.
It's also hard for doctors to stand up for themselves in this regard because it can be very taboo to say that compensation is important to you, because most doctors truly are passionate about their work (you really have to be) and they don't want to insinuate that they are only doing it for the money.
The biggest hurdle with this lies in people skills. While a computer could be fed raw data and come up with a diagnosis and plan, it still has to rely on data gathering techniques. Often patients don't really know what information to provide without some sort of intelligent guidance to the conversation. Sometimes patients are even disingenuous with their answers, or may try to tailor their answers to confirm their self-diagnosis. It really is trickier than a simple input-output problem, and it's the reason why so much physician training occurs in the real world with real patients rather than purely studying from books.
There's also a whole conversation to be had about how to treat the patient, not just their problem.
darkistheway
Member
Sorry, but I disagree. The whole mysticism argument is utter bullshit. I didn't say algorithmic, I said heuristic. And it is amenable to systematic analysis.
Don't be defensive and use ad hominen attacks.
I am generalizing a complicated argument using a mobile phone and posting on a videogame website.
I am not generalizing the entire profession, but actually a very specific part and it is based on more than interactions with a handful of pathologists.
Dr.Guru of Peru
played the long game
The physician lobby pales in comparison to the nursing lobby. Mid levels need backup because they just haven't had the training to accumulate the same amount of knowledge and experience.
All doctors have to go through a residency that involves working for at least a year or two in the acute care setting. I'm sure most have had at least one patient encounter where they helped a sick patient.
Particle Physicist
between a quark and a baryon
Mysticism? Haha, who said anything about mysticism. You are in a lab. What exactly do you do in that lab? Do you look at every disease process that physicians treat or are you basing this off a very limited view of some diseases that physicians treat. You still seem to think that patients come in with direct chief complaints, easily identifiable signs and symptoms that seem to fall into prepackaged disease processes. If you are the guy relying on the EKG machine read to tell you what the EKG shows, you will be missing some major things and you will be diagnosis some things that aren't there.
You can't Monday morning quarter back when reviewing patient care and think that the treatments and the decisions physicians make are easy or simply heuristics that can be plugged into a computer program. If you have been in a position where you have cared for a patient in any capacity you would understand that. But you are in a lab where you never actually interact with patients.
boiled goose
good with gravy
They work SUPER hard. Ceos are overpayed. Not doctors.
I do think med school is too expensive and inaccessible.
I do think med school is too expensive and inaccessible.
LordOfChaos
Member
If you spend 15 years training for a job that saves lives, missing out on usually their entire 20s and some early 30s of investing, come out with huge debts, and going through a decade and a half part of which is not getting paid and part of which is not getting paid much....Hey, take the damn money, you earned it.
Can definitely think of other people who should take the pay cut first...Don't want to discourage good people from getting into medicine.
Can definitely think of other people who should take the pay cut first...Don't want to discourage good people from getting into medicine.
User 479360
Banned
I honestly thought it'd be higher.
In some ways, there's no price you can put on what these people do. They save lives. I know my life would be hellish if it wasn't for doctors, after what my family has been put through.
These people work hard, most of them are great and very dedicated, and they do great work. They also have to study like crazy, amass student debt, etc. I'm fine with it, and would be fine with it if it was higher.
I'm jealous, but that's my fault for sucking at life.
In some ways, there's no price you can put on what these people do. They save lives. I know my life would be hellish if it wasn't for doctors, after what my family has been put through.
These people work hard, most of them are great and very dedicated, and they do great work. They also have to study like crazy, amass student debt, etc. I'm fine with it, and would be fine with it if it was higher.
I'm jealous, but that's my fault for sucking at life.
The problem is that you're exposed to a very small subset of what doctors actually do. Also, there's all kinds of doctors - there's specialists in their respective fields. Maybe what you are exposed to seems easy for you because you're seeing common trends, but you're severely underestimating the depth and difficulty of the profession.
I can understand an issue with the arrogance - a lot kids doing their residency can be pretty cocky. But most of them phase out of that.
Your argument falls apart due to the simple fact that medicine is not a simple 1:1 correlation between symptoms and diagnosis or between diagnosis and treatment. Common and not so common conditions can each present in a variety of different ways (and more importantly, in new ways over time), and it sometimes takes subtle signs to differentiate a patient having a benign condition versus a life-threatening condition. Acquiring the knowledge base is one thing, but actually applying it in a clinical or hospital setting to determine a proper diagnosis and treatment is an entirely different matter that's dependent on multiple variables (such as the patient's body language or the ability to elicit pertinent information from the patient based on the situation, among other things) that "automation" simply cannot account for. If you don't have any prior experience when it comes to seeing patients at the bedside (like in your case), then your opinion of the "difficulty" of applying that knowledge base is honestly deficient from the onset.
Dr.Guru of Peru
played the long game
Much of what we do in medicine is already aided by systematic analysis. We use clinical decision making tools to guide our decisions and give us confidence when we do make these decisions, but they exist to enhance clinical decision making - not replace it.
To begin with, someone has to not just gather the data but also decide which data to gather. This is especially true in primary care and the ER setting, where patients dont come in with lab values and images attached to them (and in the primary care setting, not even basic vital signs). These also happen to be the two most common patient care settings.
Secondly, you're also neglecting that we just don't have the data to automate much of what physicians do, let alone validate it. Basic clinical decision making rules take years to make it to practice, and they often only answer very specific questions (I.e. can I rule out X in this patient for the next Y days). It would take far longer to supplement (or replace) an entire speciality.
I'm not saying there is no future to "automation". In fact, I think its the only way clinicians can keep up with the ever increasing complexity of medical care. It'll help keep our workloads manageable and help us make better patient care decisions. But if history is anything to go by, barring the development of an A.I. out of a science fiction novel, it won't cut costs
darkistheway
Member
Your second point is an interesting one. The gathering of patient data for the purposes of diagnosis and treatment is very important, obviously.
In my hospital group, Emerg uses triage nurses for most patient admits. They can initiate certain testing on the basis of information gathered from the patient. By the time, the doctor sees them (ie. a couple hours later) there is a lot of factual data available.
This is an effort to streamline patient care without increasing the cost by adding more ERPs to the pool.
Another area where things get interesting is using lab analysis and highly specific and sensitive testing that greatly narrows down the investigation with minimal testing.
I don't mean to downplay the role of the physician but rather I feel like given some of the more modern tools we have available, the role of a physician may become less vital to patient care.
Of course, none of what I am saying takes into account that people really like having a doctor involved in their care. It totally makes sense, in that respect.
This point should be emphasized, too. Medical insurance is very expensive.
hockeypuck
Member
I think it's fair for me to criticize you personally since you're making these arguments not based on any empirical evidence but on your own anecdotal interactions that are predominantly based on pathologists, the one profession who do not regularly come in contact with live patients.
Since you're basing your arguments on anecdotes, I'll counter with my own. Critical care medicine has the highest quality, most reproducible, empirical, objective, observational, blah blah blah data points applicable to direct patient care out of all the medical fields. The patient's bedside is littered with numbers. Dozens of protocols are already in place, more than any other specialty. And yet we deviate from them all the time, because not every patient fits the protocol perfectly.
You underestimate the variability of presentation of illness and overestimate technology's ability to quantify it.
Pretty crappy excuse. What did NeoGAF do to you?
Well, you're generalizing the one part that makes doctors, doctors. The ability to introduce new medical knowledge and knowing how to argue for change requires additional learning. A doctorate, but more importantly, a residency and the following lifetime of training. The learning never stops. From what I can surmise you have not interacted with at least a neonatologist, a radiologist, or a medical oncologist in their normal work environments. If you have interacted with them like I have, for example, managing a 26 week gestation premature baby on an oscillating ventilator, reading a MRI, or discussing which chemotherapeutic regimen is best for a certain Stage III cancer, respectively, then I guarantee you wouldn't have made those arguments that look foolish in my eyes.
I basically think the same thing. But I've just had plenty of inept doctors over the years. Some people are worth paying a lot of money, but a lot of doctors are just people who spent a lot of time in school. You don't really have much choice which you get as a patient.
darkistheway
Member
I would argue that most don't, actually. From both personal and professional experience.
The difference from what I am talking about and what you are talking about is actually night and day. Acquiring the data and utilizing it are two separate entities. By all means, go to the bedside and study the body language but at the end of the day, the diagnosis is determined by concrete data - imaging, lab, ECG etc. None of which is hard to understand or analyze.
For instance, if a patient presents with fatigue, bruising and bone pain, when do you start treatment?
What information gathered at bedside is more important than what I will tell you?
You are correct in your second point. What I am talking about ( in the most general sense) would take years of research to even begin to implement.
Particle Physicist
between a quark and a baryon
Something seems off here. I've never heard of an emergency department that uses nurses to triage patient admits. They may triag patients into the ED, but they are admitting patients at triage? Seems crazy to me. They are already deciding who needs medical care versus surgical care. ICU versus step-down versus telemetry versus general floor versus observation unit, etc at triage?
So they are ordering basic labs and/or troponins for chest pain and/or lactic acids for possibly sepsis based on vitals. That is a subset of patients and only gives you a small piece of the puzzle. When your door to doc time is a couple of hours, like at your place, it can definitely facilitate things but you are conflating things here, majorly. Obtaining labs based on some criteria is not comparative to the full role of a physician, which is to identify and treat disease processes. For instance, an elevated lactate doesn't mean the patient is septic.
Dr.Guru of Peru
played the long game
This is actually standard of care and has been for some time (though I think you're incorrectly using the word "admit"). While it makes the job easier for physicians, it has not done anything to reduce the cost of or need for physicians. The efficiency of an ER is mostly dictated by bed space in the hospital and (to a lesser extent) open exam rooms, all of which are directly tied to funding for nursing staff. Very rarely do you run into a situation where there aren't enough physicians around to see all the patients. By having nurses order the labs beforehand, you mitigate the impact of lab turnaround time on ED waiting lists. Everyone still has to be seen by an ER physician, just as before.
Particle Physicist
between a quark and a baryon
A thousand times nope. There are plenty of disease processes that are clinical diagnosis and are not based on any labs or imaging. Also, if you think labs, imaging and EKG are easy to learn to read, you havent had to do any of it. There are so many nuances to reading imaging and ECGs you have no idea. Hell, I even gave you an example where labs can be misleading as well.
hockeypuck
Member
This is the poorest argument you've made in this thread. I'll let others take a shot at it first.
Edit: dammit Particle Physicist
Absolutely not, and once again, your lack of any prior experience seeing patients is continuing to hurt your already faulty argument. Numerous conditions can be diagnosed clinically during the H&P without the need of any imaging or labs or ECGs.
How many images and ECG's have you interpreted, by the way?
What experience do you have that allows to make the assumption that that data is not hard to understand or analyze?
Dr.Guru of Peru
played the long game
This is completely false. I would argue that the vast majority of decisions in medicine are made without imaging, labs, or ECGs. Other times, the concrete data mislead you because we simply don't have many perfect tests in medicine. I'll give you an example: I had a lady in septic shock last night. We resuscitated her. Her follow up lactate was 9. I didn't believe it - she looked like a million bucks. And there was no other explanation. So I reduced her fluids and repeated it. It came back at 1.5. Probably a lab error, I don't know. But if I had gone by the "concrete data", I would have put her into heart failure.
Again, you have a skewed view of how medicine is practised. You work in a medical lab, but to physicians the lab is simply one component of the total clinical picture.
For your example, it would depend on the story and the context. There's a good chance I'd send that patient home without any treatment, or I might do a full work up. It all depends on the clinical picture.
Also, I should point out that residency dedicated to reading images is 5 years long. It may be a bit harder than you think.
makingmusic476
Member
I think salaries are too high, but have to be high given how deep in debt people end up after medical school.
Working on higher education costs would help bring down salaries. As it is, people who decide to go to medical school do so knowing they won't make decent money for a decade or more after they graduate because of how much they have to pay back.
Working on higher education costs would help bring down salaries. As it is, people who decide to go to medical school do so knowing they won't make decent money for a decade or more after they graduate because of how much they have to pay back.
darkistheway
Member
Yeah, sorry, I misused 'admit,' I just meant triage really.
It is just an example of a situation where diagnosis begins using algorithms(very basic ones) to increase efficiency. Not really meant as an argument against doctors.
Damn those ECG .... It's such a skill
SilentSoldier
Member
Most of us going into medical school go into it not because we want to make a lot of money. Lord knows there are a much better professions to get into if that were the case. I like how the narrative seems to be that physician salaries are what's driving health costs up when in reality its like, what 10-15% of the total amount that is spent on health care?
I would probably be more for lowering physician salaries if the cost of medical education wasn't so damn high. Even with my scholarships and non loan based aid I'm still looking at a significant amount of debt. I'm just glad I didn't have that much in undergraduate debt to add on to it.
Now excuse me as I have to go study more for my step 1 exam in a week. Light at the end of the tunnel, or possible cave in? Who knows.
I would probably be more for lowering physician salaries if the cost of medical education wasn't so damn high. Even with my scholarships and non loan based aid I'm still looking at a significant amount of debt. I'm just glad I didn't have that much in undergraduate debt to add on to it.
Now excuse me as I have to go study more for my step 1 exam in a week. Light at the end of the tunnel, or possible cave in? Who knows.
Xenogears, my man.
Lowering the salary of a doctor wouldn't be a terrible idea if the cost of malpractice insurance and cost of education wasn't so astronomical. A misconception a lot of people have is they see too many movies and tv shows - they see the hot young doctor with an entire team at their disposal, often times breaking god knows how many ethics codes and even stepping into illegal territory. The fantasy land of a lot of MD in tv is ridiculous. Not to mention they're always riding the awesome sports cars. So from that people deduce that doctors must be making hand over fist while having a God Complex. This could not be further from the truth for most doctors.
Some doctors do make bank, but the vast majority I'd even go as far as saying are severely underpaid.
TheLaughingStock
Member
Yes, America pays way too much given how it stacks up globally. America could probably use 40,000 more immigrants or so trained to US standards to bring wages of doctors in line over 10 year window.
My guess is your experience was such because your primary interaction was with surgery locum -- but here's the thing, what was your outcome? Did he do his job? Are you healing? Any complications?
I make a concerted effort to ensure all my patients issues are addressed. We are always pressed for time during encounters, but I take longer if need be. I sit in the room. I let the patient talk uninterrupted, unless the story is going nowhere for at least a minute. I provide a large business card with a blank side to write questions. I follow up after my initial visit during the day. I make sure we are providing adequate pain control (without snowing the patient). I take time to frame explanations of diagnosis and provide our plan of care in laymans terms (even draw diagrams and provide education to family as well if need be.). Most of our patients have good outcomes, despite being in the CICU (I tend to all the MI's, cardiac arrests, hypertensive emergencies, etc)
Here's the thing. Our org sends a survey about your physician experience that determines part of your quality and productivity 'bonus' (its actually a chunk of the 'salary' the OP mentioned). If less than 8 surveys are returned in a quarter, or if you score less than 80%, you don't get your bonus. After my story up there, you'd think I'd be good, right?
I haven't seen that bonus ever. Never enough surverys are returned. Sometimes the ones that are returned reflect low scores, less than 70%. It was baffling until we started calling respondents to get feed back: one guy wrote all low scores because he was angry at the size of his bill (he had a cardiac arrest in a parking lot). Another lady gave me low scores because she didn't like the food (diabetic, placed on a controlled carb diet) despite the fact that she has been in the hospital repeatedly on the verge of death because she is non compliant with her outpatient care. Yet scores of others rated their physician interaction as poor because despite all the efforts I put into providing close and meaningful patient care, they were upset that their cardiologist didn't answer all thir questions on the last day of his hospital stay. It was some of the most fickle, trivial stuff I've ever heard. And that's just the surveys. We deal with patients who threaten us if they aren't getting what they want. People who are out of their minds, social services nightmares, psychotic, families that are hostile, or God help us all, someone who watches Dr Oz.
And let's not forget the pall of possible lawsuit always hanging over your head if someone has a bad outcome.
Keep in mind that despite the fact that the compensation sounds like a lot, administration finds ways to deny you of it. More and more of what we receive is based upon perfomance metrics that are not set by people with any medical or clinical experience. Analytics applied to people as if they are all equal or present the same or recover at the same rate. It's frustrating to have that juxtapositioned with things like patient safety and patient satisfaction because in many respects they are not equal entities.
Still, I have enough good interactions that it offsets that part of it. Enough people every once in a while take the time to thank me, or provide meaningful feedback, that keeps it from getting completely morbid. There is also the satisfaction of seeing someone recover who otherwise was in dire straits. I won't complain about my job because I'm glad every day that I have it.
it's funny that people think doctors should be paid more just because of the intensive nature of their training.. that's not how the economy works guys
hospitals are going to pay nurse practitioners half the cost of a physician, get similar outcomes, and increase their patient satisfaction..
The problem with our system is everyone is trying to fuck over one another.. Hospitals fuck over insurance companies, Insurance companies fuck the patients, and patients fuck themselves on multiple levels
hospitals are going to pay nurse practitioners half the cost of a physician, get similar outcomes, and increase their patient satisfaction..
The problem with our system is everyone is trying to fuck over one another.. Hospitals fuck over insurance companies, Insurance companies fuck the patients, and patients fuck themselves on multiple levels
Aruarian Reflection
Chauffeur de la gdlk
Appreciate the good sentiment towards doctors in this thread. I basically sacrificed a decade of my prime years to train for my career and acknowledgement is nice, especially considering some of the hostile / skeptical patients that we see on occasion.
No they are not
JORMBO
Darkness no more
I do IT work for hospitals. In talking to several physicians over the years I do not believe they are paid too much. They do very hard work and put in a lot of hours. They are also not in a position where they can make mistakes. Throw in all the schooling too.
If anyone needs a cut its all the overpaid layers of useless management.
If anyone needs a cut its all the overpaid layers of useless management.
DudeWithNoName
Member
My oldest son wouldn't be with us today without an extremely talented OB surgeon at Children's St. Paul.
people are tired of doctor's coming in for 30 seconds.. telling them to use the incentive spirometer and then billing them $1,500 few weeks later
it's not the doctor's fault, it's the fucked up system we have in place. It makes doctor's rich, and patients resentful
as to the original question, the market has set physician salary so there is variation from location to location and from one field to another. physician compensation is a small element of medical care cost, and artificially reducing that compensation would likely not help in physician retention, improvement of care, or increases in patient satisfaction. in addition, anecdotally yes it seems many physicians (who are highly motivated and intelligent) would move into other positions, whether administrative roles, non clinical duties, or may leave the profession entirely. what has not been discussed here is the ever increasing complexity of care (medical advances) but also complexity of providing care; now we are measured by metrics for patient satisfaction, metrics for documentation, metrics for resource utilization. these elements have raised the difficulty of clinical medicine considerably. lastly, yes i am paid well for what i do but keep in mind approximately half of my gross income is withheld by the government for social services. additionally, many of my peers volunteer at free medical clinics in the area.
as for the other discussion, always intriguing to hear why non-physicians think other non-physicians can do what we do.
as for the other discussion, always intriguing to hear why non-physicians think other non-physicians can do what we do.
RoninChaos
Member
But doctors' pay is the problem y'all.
The medical field is as crooked towards Doctors as retail is to the folks that sell product and make the CEOs rich. It's ridiculous. Doctors are helping people and CEOs get rich off of it.
I cannot believe people are advocating for a group of people who help take care of us should be paid less. Our values and moral compass as a country are off when we try to always take from the people on the front lines but have no issue with a CEO making 36 million. That guy obviously earned his money but a doctor making 150k a year, who helps people, is making too much. Jesus Christ.
You couldn't pay those dudes enough. They literally save lives. Think of the worst thing that could happen to you. Guess what, dying is worse than that.
We should funnel salaries from the following professions to doctors:
Athletes
Politicians
Youtubers
Hearthstone pro players
Starbucks employees who write down the wrong name
We should funnel salaries from the following professions to doctors:
Athletes
Politicians
Youtubers
Hearthstone pro players
Starbucks employees who write down the wrong name
About that...
A lot of that money doesn't make it to the physician. They see only a portion of it, and believe me, they want to sit there more than 30 seconds to really discuss things with you.
The problem is the system they are under. It's also the fact that while the doctor would love to chat with you, they have 15 other patients waiting for them. Because of the shortage of physicians, they're stretched thin and we still expect them all to perform miracles. They often have to make do with what they have.
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