In the American health care system I think we really on doctors too much. There are planty of services where a Physicians assistant or a Nurse practitioner would be fine. Often its pricey overkill to be seen by a doctor. You don't need a district manager to do a shift supervisor's job.
Physician salaries in America - are they too high?
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Dr.Guru of Peru
played the long game
The average physician probably sees 20-40 patients a day. Do you really think we're making $12 million a year?
An overall problem of billing on quantity and not quality of care
Work in a hospital for a day, then see if you keep that attitude.
SuperBowser
Member
It's nice to see the majority of people are supportive 
Sometimes doesn't feel that way. My own opinion: Doctors are paid on the higher side in USA to the rest of the world. However, they work extremely hard comparatively to other Western countries and I doubt reducing doctor salaries will address any of the issues proposed. Doctor salaries are a small fraction of healthcare costs.
Just no. Patients are more than tests and numbers. If you don't understand that, you will kill people. Seeing a patient as a whole, clinical history, applying experience and processing vast amounts of information is what a doctor does. It's not easy to decide what is relevant and not relevant to a case and doctors ultimately take responsibility for these decisions.
Aside from that, it's not easy to analyse all available data for a patient. Do you have any experience? It's kind of laughable you think it is easy to interpret ECGs with a few facts and numbers. We are not even close to a stage where computers could begin assessing and treating a patient on its own.
Sometimes doesn't feel that way. My own opinion: Doctors are paid on the higher side in USA to the rest of the world. However, they work extremely hard comparatively to other Western countries and I doubt reducing doctor salaries will address any of the issues proposed. Doctor salaries are a small fraction of healthcare costs.Just no. Patients are more than tests and numbers. If you don't understand that, you will kill people. Seeing a patient as a whole, clinical history, applying experience and processing vast amounts of information is what a doctor does. It's not easy to decide what is relevant and not relevant to a case and doctors ultimately take responsibility for these decisions.
Aside from that, it's not easy to analyse all available data for a patient. Do you have any experience? It's kind of laughable you think it is easy to interpret ECGs with a few facts and numbers. We are not even close to a stage where computers could begin assessing and treating a patient on its own.
IAmtheFMan
Member
I will make a decision to treat a hyperacute stroke with extremely powerful medication that has a 3-4% chance of bleed(or sending the patient for an acute interventional procedure) based entirely off of my examination. Sure, I will get a CT to rule out any bleed beforehand but that helps me diddly squat when it's negative in terms of making this decision as it is in 90% of cases. I do this routinely. We have a stroke protocol in place to make sure the patient is triaged as soon as possible but the most critical part of the exam (I.e the actual physical examination) has absolutely no substitute.
ReplacementPelican
Member
If I'm being entirely honest, as I can't speak for qol, I don't really know of a Doctor who cites 'money' as their main reason for doing so (admittedly I only know half a dozen or so).
That's fair, similar situation over here.
But Europeans who take this debt in loans are still significantly lower than graduates in the US.
velociraptor
Junior Member
The vast majority of medical diagnoses (>80%) are made through history and examination, not diagnostic workup.
ShooterMcGavin
Member
Nope - in some cases, they deserve even more.
Which attitude is that?
soundscream
Member
I have read a few posts about physicians doing nothing more than relying on labs and images with possible automated diagnoses - which, as already discussed immensely, is ridiculous and an indication of a bad doctor rather than the standard of care. I may be biased as I work in academic medicine, but the patients I see are complicated cases that often require multidisciplinary teams for care, where lab tests aren't always that helpful. Lab tests for many disciplines may help guide management, but will rarely tell you exactly what to do, it is up to the physician to interpret those results. I can't tell you how many times we have had to correct the automated analysis on ECGs - if we just relied on those, then many patients would undergo further unnecessary testing and possible treatment causing more harm. Much of medical decisions in at least sub-specialties requires a great deal of experience and reasoning, not just a dependence on memorization.
In addition, I conduct research alongside my clinical duties.
However, as I work in academic medicine and in a pediatric sub-specialty, I get paid considerably less than my adult counterparts, especially those in private practice.
One thing that should probably be discussed is the difference in salary between private practice physicians and those in academics.
In addition, I conduct research alongside my clinical duties.
However, as I work in academic medicine and in a pediatric sub-specialty, I get paid considerably less than my adult counterparts, especially those in private practice.
One thing that should probably be discussed is the difference in salary between private practice physicians and those in academics.
darkistheway
Member
This is a scenario where (based on what you are presenting) I would agree that expertise/experience/knowledge is not easily replaced. The subtleties of presentation may be far beyond any algorithm.
I am less knowledgeable about stroke diagnosis compared to renal or cardiac disease, which are two of the main patient populations I see data on.
I will be the first to argue that the same thought processes hold true of nearly any acute patient population . An aggregate of lab data won't necessarily tell you if a patient requires initiation of dialysis or cvvhd . Elevated troponin and an abnormal EKG don't necessarily inform you of whether or not the patient needs an emergent Cath or medical management. The more data that you are presented with, the more important it is for someone with a holistic view of the patient and the experience and medical knowledge to provide oversight and incorporate said data appropriately and sometimes SELECTIVELY into their ultimate diagnosis and treatment.
Remember, sometimes the lab data is incorrect. Sometimes you have artifacts which change the interpretation completely. Sometimes you have known or unknown medication on board which skew results. All can lead to a sentinel event if a knowledgable physician is not managing the patient care.
direct_quote
Member
This is where machine learning algorithms come into play. In fact machine learning algorithms would pick up on all the subtleties and make links that a doctor might not even think of.
darkistheway
Member
I agree. As I mentioned before, the utilization of the data needs to be performed by some process (currently physicians) where treatment decisions are made. My argument is that much of the data gathering, and many of the initial decisions in differential diagnosis can be performed without doctors.
I have to take issue with the idea that lab data can be incorrect. This would be extremely rare. We are at a stage where the technology for most tests is extremely reliable, where error rates are less than 0.5%.
And even at those error rates, mistakes are often caught by the technologist because they don't fit the clinical picture. So they wouldn't impact patient care at all.
That said, I understand what you saying.
Absolutely.
SuperBowser
Member
This sounds like dangerous clinical practice. You can't make management decisions for a patient without meeting and assessing them. There's more to a test than simply being "accurate". You need to account for risks, false negatives, false positives, sensitivity, reliability and relevance to management. My granddad died due to an unecessary CT scan with contrast; he developed kidney failure as an adverse reaction. Retrospectively, there was never a need for the test because it wouldn't have changed his management anyway.
There are things computers simply cannot do yet:
Is the patient giving an accurate and reliable history? Have you consider other diagnoses? Is anxiety a factor? Are they taking their medications as prescribed? What were the findings of the examination? What investigations are safe and appropriate for this patient? Is the proposed procedure/treatment/management plan appropriate for the patient? What are the risks of treatment for this patient? Are the side effects and potential adverse effects safe for this patient? Is the patient agreeable with the plan? Does the patient understand the plan? Does the patient need time to consider their options? Does the patient trust you?
Maybe in 100 years when a computer can speak to a patient, examine them and collect all the data relevant to a situation.
If it's gonna be anything like webMD, every patient will have cancer.
Physicians and surgeons should continue to be payed well, and I was encouraged to see that under one example of Universal Healthcare, the UK's NHS, they are indeed well rewarded, as highlighted in Michael Moore's excellent movie Sicko, which Bernie mentioned in his recent TYT interview, which contrasts the American private insurance based system, with the public "free at point of delivery" systems, in France, and the United Kingdom.
Here's the segment where Michael interviews a doctor (General Practitioner) from London, which you might find quite an eye opener (e.g. lives in a million dollar home, has a sweet ride etc): https://www.youtube.com/watch?v=GOZmvaFfjtk.
As a previous long term resident of the UK, Sicko might give you the false impression that the NHS is all "milk and honey", which it isn't (e.g. its budget is by no means infinite, so it has to sometimes make hard decisions on which new drugs it makes available), but that doesn't mean we we shouldn't even try to emulate the best, from healthcare systems around the World, and make affordable, quality care, available to all Americans.
Here's the segment where Michael interviews a doctor (General Practitioner) from London, which you might find quite an eye opener (e.g. lives in a million dollar home, has a sweet ride etc): https://www.youtube.com/watch?v=GOZmvaFfjtk.
As a previous long term resident of the UK, Sicko might give you the false impression that the NHS is all "milk and honey", which it isn't (e.g. its budget is by no means infinite, so it has to sometimes make hard decisions on which new drugs it makes available), but that doesn't mean we we shouldn't even try to emulate the best, from healthcare systems around the World, and make affordable, quality care, available to all Americans.
That honestly doesn't even make sense.
I should clarify. Lab errors I speak of are not just on the assay level. Context is vital in many situations that are completely outside of your realm of interaction. That said, even accurate results may be dependent on the interpretation of the particular technologist on duty (especially in the realm of microbiology and cell differentials!)
But the errors I speak of go well beyond what the lab reports. For example. A random cortisol drawn on a patient at the wrong time of day can lead to over or under treatment of a life threatening issue, even if the reported value is completely accurate to the lab's best ability. If that value is reported out of context, without detailed understanding of patient demographics (Icu vs ward), nutritional status, medication status, etc, the interpretation of the data is subject to massive error. This is completely invisible to the lab as a whole. I've seen firsthand what happens when completely accurate lab results are misinterpreted because they were drawn at the wrong time or under the wrong circumstances, and presented as a data point within the patient's chart. Things like unnecessary invasive testing, removal of a healthy adrenal gland, needless pain and suffering on the patients part.
The work you do is invaluable, but it is part of a much larger picture that needs careful eyes on by a multidisciplinary team of trained professionals. Taking that decision making out of a physicians hands, at any level, introduced needless risks because that context is not always evident in a patient's chart. I definitely see machine learning as having a key role in the future of our profession, but as an adjunct, NOT a replacement for clinical interpretation.
Cut doctor salary by 30 percent? You're going to have to cut PA/NP/RN/Tech/Pharm pay by 30 percent. Some of these people are making a lot less than 100k. How many nurses do you think are going to work for 50k? How many techs are going to work for 35k?
You want highly trained, educated, professionally licensed, hard working people who undergo reams of paperwork and oversight into their decision making to work for less than they can make in retail or sales with much less heart ache and stress? These are people who have multiple legitimate degrees requiring years of excellence in some of the most rigorous scientific academic curriculums with strict professional licensing tests and requirements.
Come on.
Liferebooted
Banned
Hell no, start paying doctors less and they WILL care less. You will suffer in the end.
The underlined needs to be emphasized more. Everything that goes on for the patient isn't done by a single person - there's usually tons of other people involved (in the serious cases). Eventually the physician looks at all the data that's been gathered and uses it to support his/her decision. And even then there may be something the physician doesn't feel comfortable with and requests a re-test or second opinions from colleagues.
Those are often not easy decisions to make.
Professional athlete is pretty much the only profession where the amount someone earns is actually demonstrable, and in many cases it's too low, so no.
as a Resident? HELL NO. NOT EVEN CLOSE TO ENOUGH. I also know how much work attendings do and sometimes, it really is not enough. We're at work >8-12 hours a day, including weekends. 4 days off a month (which includes weekends). overnight calls, unruly and angry patients who demand everything but don't want to work with you, having to deal with insurance or the lack thereof and that is just scratching the surface. I of course am speaking about the Internal Medicine Field and all it's associated specialties...Surgery isn't any better I am sure.
So paid too high? get out of here with that BS.
So paid too high? get out of here with that BS.
To be fair, most doctors leave that part for the RNs and LPNs lol
this is untrue. First hand experience.
darkistheway
Member
I agree with everything you said.
Your example of the cortisol is exactly what I am talking about. Right now, the number goes onto the chart with minimal context. It relies on the physician to interpret it in the entire clinical context. And that is error-prone. There is a great deal of data that needs to be parsed. As you stated, misinterpretation can lead to inappropriate outcomes.
I don't think I have done a good enough job in articulating what I envision.
The cortisol value should be reported with interpretive comments that are algorithmically generated from other data elements (time of collection, medications, vitals etc) that provide a more detailed assessment of the value.
Other testing can be initiated on the basis of these sort of algorithms. It is not intended to replace the clinician but rather ensure more valuable information is provided.
The non-chartable contexts that you are talking about are outside my scope of knowledge. And I apologize if I give the impression that I am discounting them. My area of expertise is lab testing and subsequently, disease states amenable to lab diagnosis.
Your example of cell differentials is another interesting one. Advances in imaging software and flow cell analysis are beginning to impact how we look at a slide. It used to take a lot of expertise to tease out the subtleties but these advances are starting to dramatically reduce the amount of time and resources needed to provide the clinician with an accurate diagnosis. Further, the specificity of the testing guides treatment with greater detail than ever before.
The technology and systematic approach greatly improve outcomes for patients.
I'm mostly being facetious, but it is true somewhat. I've seen a lot of docs that want to spend as little time as possible and just leave the instructions to the nurses so they have to deal with the patient hahaha
It's actually kind of funny - you can tell when the doc is totally rushing and wants to nope the eff out of there asap.
Yoda
Member
So there is a bit of nuance here. Most Physicians are small business owners, when you add in account that their "salary" is in the same pool which directly influences their ability to conduct business, they A) can have variable income year-to-year B) ANY business owner has to spend non-trivial amount of time on routine maintenance of their business and C) Their business normally is started w/debt and they surely have student loan debt from their post-grad education. Most doctors don't make big bucks the second they get out of school (when you factor in the opportunity cost) and more and more senior doctors are waiting to retire, thus putting downward pressure on mobility in the field (this is actually present in all professional fields).
Now, doctors do have the AMA, which lobbies to kill any expansion of residency programs each year. The way they do this is a bit shady, as they frame it as "Congress working against them" when Congress refuses to tie medicare insurance payouts to something akin to CPI, inflation, or a mix of economic variables. The flip side is that residency programs remain at a fixed rate in terms of headcount, thus straining the supply of in-demand labor (doctors). If this weren't the case, there'd be more doctors -> lower salaries via standard supply and demand.
Long term I think doctors in the U.S. are in for a rough ride, the Affordable Health Care Act did NOT begin reversing the trend of our inflated healthcare costs. The U.S. Govt. is bankrupt from a debt perspective and medicare/medicaid account for 60% of the healthcare industry. To put it in simple terms medicare/medicaid are going to payout less money in some fashion in the near-mid future => less money going to doctors (and lower benefits for patients). The current system is not sustainable, and the American middle class has gotten weaker year by year, so I don't foresee doctors being able to forsake medicare and charge for services instead, the money simple doesn't exist.
Now, doctors do have the AMA, which lobbies to kill any expansion of residency programs each year. The way they do this is a bit shady, as they frame it as "Congress working against them" when Congress refuses to tie medicare insurance payouts to something akin to CPI, inflation, or a mix of economic variables. The flip side is that residency programs remain at a fixed rate in terms of headcount, thus straining the supply of in-demand labor (doctors). If this weren't the case, there'd be more doctors -> lower salaries via standard supply and demand.
Long term I think doctors in the U.S. are in for a rough ride, the Affordable Health Care Act did NOT begin reversing the trend of our inflated healthcare costs. The U.S. Govt. is bankrupt from a debt perspective and medicare/medicaid account for 60% of the healthcare industry. To put it in simple terms medicare/medicaid are going to payout less money in some fashion in the near-mid future => less money going to doctors (and lower benefits for patients). The current system is not sustainable, and the American middle class has gotten weaker year by year, so I don't foresee doctors being able to forsake medicare and charge for services instead, the money simple doesn't exist.
God Dayumm
Banned
I agree with the people that say doctors should not be paid less but others should be paid more. I would like the minimum salary to be a living wage and that probably means that salaries will increase across the board, even doctors, and I'm fine with that.
This kind of thinking is so fallacious
I don't think doctors will care any less, because if you're just interested in making money, there are far better careers for people to go into that don't carry the same liability or emotional turmoil. It's not a profession people should go into because they have dollar signs in their eyes. the intangibles should be the greater draw.
The truth is, though, if you pay doctors less, you will see fewer and fewer people becoming doctors.
Clockwork5
Member
Those seem reasonable, to be honest.
Particle Physicist
between a quark and a baryon
Does every elevated troponin mean the person needs to go to the catch lab? The answer is not necessarily. Risk stratification based on the TIMI score or the HEART score is only one small component. An elevated BNP doesn't mean the patient is having an acute exacerbation of their heart failure.
Hyperkalemia is also not the only indication for emergent dialysis in a ESRD patient. The other indications are based on clinical diagnosis.
You are also only seeing a subset of all presentations that physicians see and are extrapolating your limited and flawed view to everything a physician does.
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damn, already covered by m0dus!
Haha, you have every physician on this board replying to you :/
Can't believe I overstayed 3 hours in the ED yesterday night with no overtime pay when a computer could have done all this for me!! How Foolish!
We'll I suppose at least we can then blame adverse outcomes on the Computer and not have to worry about being sued for malpractice
It seems a bit high, yeah. I think you could pay the chief doctor salary at a Swedish hospital with just the average US salary and still have money left for breakfast.
Then again, the Swedish doctor didn't pay for his education, so... still, i figure the US doctors are a bit overpaid. But that seems to be a general trend with US salaries - the high end jobs have too high salaries while the low end jobs have much too low salaries.
Then again, the Swedish doctor didn't pay for his education, so... still, i figure the US doctors are a bit overpaid. But that seems to be a general trend with US salaries - the high end jobs have too high salaries while the low end jobs have much too low salaries.
How do the relative salaries of physians in America compare to other first world countries. My understanding is that it is higher by quite a bit in America, but I could be misremembering.
I think doctor should be paid well, but not sure if they should be paid a lot more than other professionals like engineers, scientists, lawyers, etc.
I think doctor should be paid well, but not sure if they should be paid a lot more than other professionals like engineers, scientists, lawyers, etc.
If you're not sure of the extent of the work and risk / personal liability encompassed by the profession, is it really comparable to lump it in with the rest?
And it's interesting that you throw 'scientists' in there. You should remember that, at heart, all physicians are trained as scientists. We are taught in our respective training programs and fellowships to approach every problem, every new development, be it clinical or academic, with an eye for study design, underlying biases, potential outcomes, and ethics. Some physicians (oncologists, microbiologists) examine blood smears of their patients in the lab personally. Others submit papers, and contribute their time to clinical studies that may have far reaching implications for the science of medicine as a whole.
Unfortunately not every physician applies those principles with the same passion or skill, but this is true of any of the professions you mentioned.
hockeypuck
Member
I think the AMA representation/lobbying thing is overblown. There has been a continual decrease in membership spanning decades. Only 15% of U.S. physicians these days actually consider themselves members of the AMA. Contrast that to the 1950s, when membership levels were 75%. Physicians are way more likely to just join their states' medical associations and/or their specialties' associations. Interests are more local and specialized, thus less overarching.
I would also argue that increasing residency spots might have less of an impact than you think. In the 2015 match, internal medicine, family medicine, pediatrics, and psychiatry, among others, all had unmatched spots. Only 49% of internal medicine interns graduated from a U.S. medical school. Family medicine, a more sorrowful 44%. The rest were taken by up by foreign medical graduates. These FMGs, the majority of them coming from countries will much lower living costs, came here to pick up the undesirables. And even then there were still spots available.
I mention those fields because the incentivization for going into primary care needs to increase to have the bigger effect, not increasing the training spots. The best training spots in the country (and thus the best areas to make the best doctors) already have residents packed to the gills. If an already-developed residency program needs more residents, it will happen.
I'm not sure how replacing ~50% of all primary care doctors working in the U.S., those who came from poorer countries, with American graduates is going to decrease the overall doctor pay. I also believe an ethical argument can be made of how the U.S. is poaching doctors from poorer countries.
I'd agree that many doctors stay in the field due to their genuine passion in delivering healthcare.
But I keep seeing people say there's better careers for money and that's simply not true. For what other trajectory can you see a guarantee of a 6-figure salary at the age of 30 except Silicon Valley path (which is its own brand of crazy).
The big, big allure of medicine is its #1 prestige #2 stability of career and #3 great salary.
Putyouinmyoven
Member
Not sure, but they suck in the UK, we're getting a pay cut imposed on us by a monopoly employer yaaaaay
Some people go into it that just are interested in the money, or start out wanting to do it, but are just interested in the money ten, fifteen years later.
Agreed that it shouldn't be there for the people with dollars signs in their eyes, but it happens. I've met a fair few doctors that cared more about the money than their patients, and the care they offered suffered as a result.
And yes, these days, you pay doctors less, you'll see fewer doctors.
I don't mind doctors being paid more. I work in the healthcare industry and enemy #1 has to be hospitals. The amount that they (over)charge for various services and fees should be criminal. The reason healthcare costs are as high as they are isn't because a doctor makes almost $200k a year. It's because the shitty hospital he works at does whatever it can to charge patients as much as possible and insurances companies end up raising their rates as a result. Unless we have a law that mandates standard fees for all services in every hospital, costs will keep going up for everyone (except for the hospital).
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