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Doctor Salaries, A Problem Overseas Too

In a previous post (Physician Salaries on the Decline) I wrote about declining physician salaries and how that is bad for healthcare.

I recently found a post from a medical student in the U.K. The system is kind of different there. He talks about the salary a newly graduated doctor would make out of medical school. Here in the States, I’ve found some residency brochures that advertise paying their residents somewhere between $45,000 and $50,000 USD.

Anyways, the post talks about how the financial benefits of a career in medicine might not be enough to entice the “cream of the crop” into medicine. And, the author points out, wouldn’t you want the best and the brightest to be the ones taking care of you when you’re sick?

From the post:

Where would you want the brightest people in the country to work? Would you have them making you money as stockbrokers; defending you in court as lawyers; writing your next headline as journalists; or would you have them saving lives as doctors? Most people would rank their health as one of the most important aspects of their lives, but is medicine financially attractive enough to entice the cream of the crop? I am not sure. In financial terms medicine might not be the best choice for the bright young future of tomorrow.

The post is at sBMJ – Viewpoint: Deterred by the doctor’s salary?

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Physician Salaries on the Decline

Related Posts: Doctor Salaries, A Problem Overseas Too

Sources: American Medical Association, American Medical Student Association, Center for Studying Health System Change, New York Times

Last year (2006) a story published in the New York Times reported something troubling. Physician salaries are on the decline.

the average physician’s net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

Some people do not think that this decline is a problem at all. Even with the decline, physicians are still making a decent salary. They aren’t going hungry. Maybe they have to forego a brand new S-class, but doctors don’t live off of welfare. And with the ever-increasing costs of healthcare, physician salaries just don’t seem as important.

It is very important. This country is headed towards a severe physician shortage. New medical schools are opening up and existing schools are expanding their freshman class sizes in response. Producing more physicians each year is not enough. Physician salaries must increase as well.

The shortage we are expected to go through is in the primary care segment. As it is, the current state of healthcare encourages doctors to enter high-paying specialties. New graduates are not flocking to Pediatrics, Internal Medicine, and Family Practice. Take a survey of any freshman medical class in the country. Many will share their desire to go into radiology, surgery, orthopedics, plastics, or dermatology.

Why? Frankly, for most, it’s because that is where the money is. Those specialties are the quickest way to get out of the enormous debt incurred during medical training. According to the American Medical Student Association (AMSA), the median debt for students at a public medical school is over $119,000 while those that go to a private medical school will carry a median debt of nearly $150,000. On top of debt, physicians make approximately $48,000 during their years during residency — which lasts at least 3 years. It could take up to 8 years for a thoracic surgeon to complete his/her training.

The stereotype of a lawyer is someone whose focus is on the number of billable hours. On the other hand, the stereotype of a doctor is one of compassion for a patient. While stereotypes can be dangerous, it is possible that in some ways they may give us a glimmer of reality.

The kind of people that go into medicine are usually people who truly care about the health of their patients. It is not a career chosen solely based on financial reasons. Today’s medical students are aware of the huge costs of training and the low reimbursements from insurance, medicare, and medicaid.

But there are many people who would make excellent doctors. They have all the right qualities but choose to go into other fields. They are discouraged from pursuing a medical career by working doctors tired of rising costs of malpractice insurance, declining salaries, bureaucratic hassles, and long workweeks. A career in medicine just does not seem “worth” the time and effort (see AMA Response to declining physician salaries).

Declining physician salaries are a big problem. It’s a big problem for the medical community and a big problem for the patient. If they continue to fall more and more prospective medical students will decide not to go into medicine because it is not “worth” it. Medical school graduates will continue to avoid primary care for higher paying specialties. And doctors will continue to order diagnostic procedures that bring in more revenue.

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Reforming the U.S. Healthcare System

Related Posts: Physician Salaries on the Decline

This quarter I’m taking a course called “Medicine and Ethics.” The class is taught by Dr. X. (name withheld). There are a number of topics that was scheduled to be discussed and each topic was presented by a group of 3 or 4 students. I ended up in a group of four. Our topic, as you can probably guess by the title of this post was “Reforming the American Medical System.”  

I wanted no part of this topic. I felt that the American Healthcare System is a mess but there’s not much we can do about it. I really wanted to be in the group that would present on physicians and war. But as Dr. X went down the list and waited for volunteers for each topic, it became clear that Reforming the U.S. Healthcare was not the popular one. No hands jumped up at the opportunity to tackle this problem… So I reluctantly raised my hand and said I’d join the group.

I had already heard that the United States spends more money than any other industrialized nation on healthcare. I had heard people complain that the Healthcare system in America is broken. But these were only things I heard. I, personally, had never had any problems accessing healthcare. And so when I actually looked at the stats, well, it was a bit surprising.

Some of the things I discovered in my casual research:

  • The United States is the only industrialized nation that does not have a form of Universal Healthcare.
  • The United States spends at least 40% more per capita than any other industrialized nation on healthcare.
  • The United States spends more than 3 times more per capita than Canada on Health Administration costs alone.
  • Almost 47 million Americans (approx. 16%) are without healthcare insurance.
  • Eight out of 10 uninsured Americans come from working families.

Those are some incredible numbers. And while only about 16% of Americans are uninsured, the majority of Americans with insurance are only one major medical emergency away from bankruptcy. Many are well-aware of how much is available to them under their health insurance policy. And, while it may be enough for your routine physical check-up or the occasional prescription medication, it is nowhere near enough to cover $40,000 that might be billed for cancer treatment.

Why is it that every other industrialized nation can provide healthcare to their citizens at a far lower cost than what Americans spend? Its a shame that the country that won the race to the moon cannot figure out how to ensure that every citizen has access to basic healthcare.

In my mind, there are two major roadblocks preventing the United States from transitioning to a Universal Healthcare system.

  1. Doctors
  2. Big Business

Physicians are afraid of the idea of Universal Healthcare and a single payer system. Why? Because they fear losing control. I believe that many physicians are afraid that a single payer system would negatively affect physician salaries. While it may be possible for the government to force down physician salaries in a single payer system, it is not in the best interest of the government or the nation to do so. If there was not financial benefit to being a physician, most countries would have a huge shortage of physicians. But, under the universal systems in other industrialized nations, physicians do make a decent, comfortable living.

The bloated health care system of the United States benefits big business more than any other party involved. It benefits big business more than physicians. But most concerning, it benefits big business more than the patient. As health insurance premiums continue to rise, insurance companies continue to pull in a profit while more and more Americans find out that can no longer afford coverage.

Greed drives the industry. The sole purpose of a corporation is not to look out for the interests of its customers and ensure customer satisfaction. The goal of a corporation is to make money for its shareholders.

And that is the problem with privatized healthcare. If a corporation begins to lose money, its shareholders get antsy. But when healthcare is federally funded, the government can take a loss for the good of its citizens.

Reforming the healthcare system will probably mean that the big corporations in the healthcare system won’t be making as much money. But America needs to decide, as a whole and through our leaders in congress, that the health of a nation is more important than the pocketbooks of corporations. Hopefully, we decide soon.


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