MEconomics, Part One: The Personal Side of Physician Compensation

Recently, I've read a few comments from readers on other blogs/sites who feel that doctors make too much money.  Examples:

1. At KevinMD, a reader wrote:

"I was on your web site. As a patient with unsolved rare medical problems and also as one with wrongful diagnoses and surgery, I have no sympathy for most doctors. In the words of a very fine doctor that I now have, 'most doctors are not worth a ----, because their main concern is money and not their patients' health.'

When doctors live in millionaire neighborhoods, you had better believe there is a definite conflict of interest on the patients' part. I have seen more than my share of bitchy doctors who spend less than 5 minutes of quality time learning about their patient. The older I get, the less I am valued as a human being and patient."

2. In the comments on a Forbes article by Tara Weiss, entitled "Reasons Not to be a Doctor," a commenter wrote:

"Doctors make absorbent [sic] amounts of money for the work they actually do. Sure it is intense from a load perspective, however, it's not dangerous by any means, your work environment is very comfortable, and you have loads of job security, mobility and flexibility. So yes you have to sacrifice up front a few years to make 5 times the national wage average. Giving up 5-10 years for a 5x multiple in wage over your working life is a small sacrifice. I find it funny doctors complain about having to sacrifice a few years when you get a much better life than the rest of society out of it. Stop being hypocritical and take a hard look at your life some time. I personally would like to see a better policy put in place that would further protect doctors from lawsuits with the trade off for a ceiling on doctor pay (similar to the systems in the UK and Canada). Nobody deserves to make 5, 10 or 20 times the national average on pay unless they are truly special and add considerable value to mankind. Just because you went to school for 5 extra years hardly justifies that. The rest of the world does not compensate doctors in such a way and neither should we. It's a job and you should earn your money and quit complaining about compensation until you actually earn that additional value through innovation and expertise. You are no expert just out of school and should not be compensated as such."

Oh dear.

I believe the commenters quoted above are operating under a standard set of assumptions about physicians' compensation:

• Doctors make a lot of money
• Doctors have to undergo a long training and work long hours, but the money they make is more than worth it
• Doctors complain about having to see patients, and their concern for getting paid to do so compromises their bedside manner/quality of care 

Now, anyone who actually makes a living as a physician knows these assumptions are usually false, or at least fatally flawed.  I suppose there are some celebrity physicians out there who do live in multi-million dollar houses and drive fantabulous cars, but I don't know any of them personally, and I bet none of you do either.  Yet, despite their flaws, these assumptions persist in the popular image of doctors.  Why?  I don't claim to know, but I like to blame the media for portraying doctors as oversexed, overdressed luxury hogs. Every popular TV show about doctors emphasizes the excitement and glamour of practicing medicine, and excludes the tedium and aggravation of doing so.  (Not that I blame the networks; I don't think a show about a bunch of overweight, baggy-eyed family doctors sitting around in a windowless room, filling out paperwork and talking on the phone would be a huge hit with the viewing public, and I'm pretty damn sure Pepsi wouldn't pay $10 million for a 20-second advertising slot on it either.)

If the media are at fault for portraying a one-sided view of medicine, then so are doctors.  Let's face it, we do spend a lot of time griping about the injustices of diminishing compensation in an era of increasing liability premiums and med school debt, but I don't often see doctors writing about the bottom-line economics of making a living in medicine.

That's what I propose to do in this series of blog posts, affectionately entitled MEconomics.  Over the next few weeks, I plan to outline my past and current financial profile, beginning with my first medical school debt and ending where I stand now, in mid-2008.  At first I was going to be cute and talk about hypothetical scenarios, but then thought better of it.  The truth of the matter is, I don't have anything to hide because I'm not a wealthy person and all of the money I have, I earned in a perfectly legal manner.  If the honest portrayal of one working family doctor can have any leveling effect against the misconceptions about physician earnings and lifestyle that are running amok in the popular culture, then I am happy to volunteer to expose myself.

I plan to post on this topic at least once weekly until I've told my story.  Because there's enough involved in the telling to fill a short novel, I'm going to break it down into digestible chunks so you don't have to read it all at once and--more importantly--I don't have to write it all at once.  Here's a tentative outline of posts:

• Part One: Introduction and Assumptions (this post)
• Part Two: Where it All begins--Med School Debt
• Part Three: Chosen Luxuries, an examination of spending money
• Part Four: The Cost of Living, if you can call it living
• Part Five: the Reality of Retirement--planning for the future
• Part Six: Real-life Income scenarios
• Part Seven: What can we do? Improbable solutions 

The order and contents may change as I work on this series, but that's the rough outline.  I haven't reviewed all my personal data at this point, so you'll be discovering the numbers along with me.  I hope this series will inspire some dialogue about the state of things for real working physicians. Comments, email, and all other participation from others will be welcome.

Comments

[ddx:dx]

I remember the first time I had to sign for a Med School loan. Fear, nausea, drops of sweat and stomach knots. I remember the kind secretary at the Financial Aid office reaching across the desk and patting my hand in an excellent display of compassion. "Don't worry." she consoled. She knew. I didn't.
I had no idea what doctors made as income(1982). I had no docs in my family. It was the employment recruitment ads in the back of my complementary NEJM that gave me my first hint. Wow! $100K! I had grown up on a teachers salary of Depression era parents and debt was shameful and dangerous.
I believe the medical profession has the same behavioral symptomotology about money as the alcoholic about his /her drink. We speak in generalities. We deny the real numbers or that we have a real problem. So, Theresa, real honest numbers from you would be welcome. But they would be a sign that YOU have a healthy attitude about money. They may reflect some healthy choices on YOUR part. I still believe the profession is sick.

[Theresa]

Hi Brainboxer,

Good points. I agree with the idea that medicine is a desirable career from the standpoint of earning potential/prestige/being recession-proof. What I'm trying to disabuse in the MEconomics series is the idea that physicians are filthy rich and primarily motivated by money--neither of which I think is true.

Thanks for stopping by again.

[Brainboxer]

What I'm pointing out is, you, like many other medical students & graduates'd not been "outside" the health industry per se. Your views & expectations are somewhat colored by what you think is "normal" for general employment. They are not - if you think medical doctors are having it tough - it's due to economy & I can assure you it's generally "tougher" for others. Understand that medical doctors occupy a vaunted position that allows freedom to practice wherever they choose & to earn a relatively good living - somewhat recession-proof - I'm sure you already know that from some of your posts. Recession & economic strife are the foremost personal tragedies responsible for wrecked marriages & broken homes.

It's understandable to be griping about the relative remuneration & opportunity decline "compared to the past" in medicine, but hey, in my previous field, long-term employment & a stable career ladder used to be a given too, until outsourcing, offshoring & what not, came about and put me on the streets or on friends' couches several times after my midcareer doldrum.

Now that I'm a medical student, I can tell you that a majority of the average working population would sell their 1st born to enjoy the professional, societal & economic privileges afforded to the medical profession.

Always think of it this way - if you're having it tough now, be assured that most of your patients're having it tougher. Disavow yourself from the cynical notion of "boo-hoo, I left potentially 'million-dollar' careers at Wall Street/(insert non-medical field here) for Medicine". Medicine has always been among the top 10 best SALARIED occupations & continues to be. Furthermore, most businesses're set to fail especially given today's economic climate - it's a 'no brainer'. It's also hubris to suggest that it only takes "acumen" or "capability" to succeed in an open industry when in fact, there's an all-time high in the number of repossessions & insolvencies for many Wall-Street/business types of late. Read Forbes.

Just my $0.02.

[Theresa]

Hi Brainboxer,

I was a research assistant in psychiatry for about six years before I went to med school. I had a pretty good idea about how hard doctors worked and I had the impression they made a moderately comfortable living. However, at one time, the balance between earning potential and the cost of medical training was more favorable than it is now, which is what I have discovered over the last four years since I've been a "real" doctor.

As for my parents, neither of them encouraged me to be a doctor. My mother was frankly appalled when I announced my decision. Her advice to me was to invest in some fixer-upper properties and find reliable tenants--this was excellent advice before the current credit crisis, btw. Later, she suggested I become a plumber.

I agree that a person can make a comfortable living as a physician but not the high-flying salaries of yesteryear.

[Brainboxer]

Hi Theresa,
How long have you worked in another field before medical school?

As one of East Asian descent myself, I know that Asian cultures and most parents are pragmatic to a fault. If doctors did not make a comfortable living, they wouldn't be as forcefully "encouraging" to their children to pursue a medical career. Prestige is but a side-effect, really.

That said, the suggestion that earning potential of a medical career, is not a large consideration for medical aspirants, is fatally flawed. As you already know, just don't expect to hear that during interviews.

The truth is, doctors the world over, even in many 3rd world nations, are among the highest paid in society. They are at the top of the pecking order in the professional field.

[Doc]

This is just another example of perpetuation of class warfare.
May I add a couple of assumptions to the list:
Doctors have considerable control over their income and can easily request to make as much as they want.
Doctors cant make as much in other countries.

Frankly, though, if you are going to attempt to sway those of this extreme mentality, I wish you well. These are socialists.

[Theresa]

I knew it! I knew I should have been a florist! :-)

[Peggikaye]

The surgeon who did my thymectomy lives in one of the most extravegant houses in town.

The source of income isn't his surgery practice ...
..
..
..
it's his wife's floral business
I'm serious!