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I am disappointed to learn that GPs/PCPs average under $200k/year. 12 years of school, extremely difficult subject matter [chemistry/biology/anatomy] beyond the ken of many, horrendous hours while interning, dealing with multiple patients of all stripes, financial pressures of running a practice ......and so on and so forth.
Frankly, I don't begrudge the docs their money. There may be abuses in the higher-paid specialties - i.e., unnecessary surgeries, etc.
But, having spent 26 years working in a law firm where the 25/26 y/o kid out of law school (only 7-8 yrs of school, not 12) started at $180k/yr., the average partner earned $250,000-$500,000 - and the senior partners in the millions - and none of whom were dealing with instantaneous life and death matters - seems to me - all things considered - many, many docs are underpaid.
jmho
Last edited by Ariadne22; 11-20-2015 at 11:34 PM..
Most people use the 10% figure because (as noted in your article) roughly half of physician fees go to paying overhead such as their employees. But even if it's 20%, if you cut physican fees in half, you have only reduced total healthcare spending by 10%. What about the other 90%?
Short-sighted appraisals like this love to over simplify things. How much does it cost for a judge to pay for his education? How much do doctors in other countries you reference pay for their education? It's easy for people with an agenda to look at what is going IN to physicans' pockets, but they conveniently ignore what is going OUT of their pockets. The price of entry in both time and money for US doctors is not addressed in your summary. Feel free to get back to us when you got all your stuff together.
1. Whether physicians actually pocket 10% or 20% of the amount paid in physician fees is irrelevant in terms of this analysis. The question was: What percentage of total health expenditures are physician fees? Answer: 20%, or one fifth of all health care expenditures. Do physicians have overhead? Of course, they do. Is running an office expensive? Yes, it is. Could we save money in the health care system by enacting certain reforms that reduce or limit physician fees? Absolutely. That's the point. We have to look everywhere and not treat any area of healthcare as though it was sacrosanct. No one here is saying we ought to stop paying physicians.
2. Law school graduates graduate with less debt than medical students do. However, college debt everywhere is increasing. The average physician graduates with a median debt of about $170,000.
If you review the information I presented on average physician salaries, virtually every salary is in the $200,000 to $400,000 range for every medical specialty. My point would be that $170,000 in debt is a lot of money, but it is a completely manageable debt for someone earning $200,000 to $400,000 per year--even when their living expenses are taken into account. I currently am paying off a mortgage that has a balance of about $130,000. Its a relatively easy thing for me to do in a low interest rate environment on far less of an income, or salary than the average physician earns.
Actually, the salary and debt data got the curious side of me thinking. I wonder if it would be an economic bargain for our country to agree to pay off all medical school debt if the average physician would agree to reduce his salary by $50,000 per year? I think we would save far more in the long run with that kind of a model. My guess is that physicians wouldn't hear of it. They'd do the math and conclude that it made more sense over the long run to simply pay off their student debt. This demonstrates that the issue is a sort of "straw man" that is often erected to justify salaries that exceed what the normal forces of the market would generate.
3. You talk about "what is going out of physician's pockets". The salaries described in the article I have quoted are net salaries. They are not gross salaries. They wouldn't include student loan repayments, but they would include what a physician receives after all office, overhead, and insurance expenses.
4. The stress and rigor of a physician's education is certainly worthy of comment. I calculate this would include four years undergraduate education, four years of medical school, and a residency lasting somewhere between three and five years. Family physicians and most primary care doctors do a three year residency. I believe neurosurgeons and perhaps cardiac surgeons might do a five year residency. However, the problem is that many other professions are similarly demanding and not nearly as lucrative. My sister, the college professor, would be happy to tell you all about that. I know scientific researchers, people who have pursued intensive graduate programs in education, and a few super engineers that can compare their training with medical doctors in terms of years and complexity. None of them earn between $200,000 and $400,000 a year.
5. Finally, I'm not big on anecdotes, but I have physicians in my family and I've seen too much waste, too much extravagance, to be mislead into the idea that they aren't overpaid on some level. I know physicians who own their own islands or 5,000 acre ranches. The biggest complaint I hear from most is not about income its about difficulties "avoiding taxes". I have a family doctor who lives next door to me and I cannot say he seems at all extravagant. However, it may be because he chose to have six children.
In short, my comparison between physicians and a sitting district court judge is a highly relevant one. Loan repayments on a $150,000 loan should not exceed $10,000 a year. After a physician earning $200,000 pays this, he will have $190,000 left. This is still a third more than a district court judge will be earning. in my state.
What I've noticed in discussion of health care costs is that many people are reluctant to go after what I will call "sacred cows". Physician income is a sacred cow of sorts. I'm not silly enough to think physicians will work for free or for vastly reduced salaries. I do think there is room for containing these salaries and particularly increases. Tackling the whole issue of health care costs is going to be unpleasant and it is going to require more aggressiveness and stamina than most people seem willing to muster. Further, I don't accept the condescension in your post which seems to suggest that ordinary people--like me---have no clue what we are talking about when we talk about high physician salaries as being a problem in containing medical costs. We simply have to find ways to economize in health care. The alternative is unaffordable insurance (or physician fees) no matter what scheme is put in place.
Last edited by markg91359; 11-21-2015 at 08:32 AM..
I am disappointed to learn that GPs/PCPs average under $200k/year. 12 years of school, extremely difficult subject matter [chemistry/biology/anatomy] beyond the ken of many, horrendous hours while interning, dealing with multiple patients of all stripes, financial pressures of running a practice ......and so on and so forth.
Frankly, I don't begrudge the docs their money. There may be abuses in the higher-paid specialties - i.e., unnecessary surgeries, etc.
But, having spent 26 years working in a law firm where the 25/26 y/o kid out of law school (only 7-8 yrs of school, not 12) started at $180k/yr., the average partner earned $250,000-$500,000 - and the senior partners in the millions - and none of whom were dealing with instantaneous life and death matters - seems to me - all things considered - many, many docs are underpaid.
jmho
Well, Ariadne, the lawyers you worked for were unusual. The average salary for an attorney in my state is around $85,000 a year. After thirty years in practice, I typically earn about $110K to $140K per year depending on circumstances. A few partners in big Salt Lake City firms might earn that, but they are far from typical. They represent the highest paid part of the legal profession. What we are seeing here is that average salary for all doctors ranges from between 200K to 400K per year.
Police officers and EMTs deal routinely with "instantaneous, life and death matters". Yet, no one would dream of paying them $200K a year to do it.
I have said before that I do think based on what other highly educated professions earn that I believe medical doctors are overpaid (more so with specialist physicians than PCPs). Its a function of supplying an essential service. No competition because of strict licensing requirements. Finally, the role of third party payers, or insurance is a huge factor in driving these costs up.
In reading these posts, I guess I'm in a sort of bitter mood. I was just informed by an orthopedic surgeon that he couldn't write a medical report for a client of mine without advance payment of $1,000.00. This is for something that will likely take a maximum of one hour of his time.
Mark aren't you forgetting an important distinction between judges and docs? Most docs currently are self employed and receive no benefits; judges are employees and receive health insurance, vacation pay, pension etc. Those bennies are worth a pretty penny and should be factored into your equation.
BTW How much will you bill your client for YOUR time spent trying to contact the surgeon? I am sure you are getting reimbursed for your time, why shouldn't the doctor? What amount do you find to be equitable?
Law costs are also insulated from competition. I am sure many people would rather pay a paralegal directly for services than pay lawyer fees for a job that gets done by a paralegal in the office anyway.
Well, Ariadne, the lawyers you worked for were unusual. The average salary for an attorney in my state is around $85,000 a year. After thirty years in practice, I typically earn about $110K to $140K per year depending on circumstances. A few partners in big Salt Lake City firms might earn that, but they are far from typical. They represent the highest paid part of the legal profession. What we are seeing here is that average salary for all doctors ranges from between 200K to 400K per year.
Police officers and EMTs deal routinely with "instantaneous, life and death matters". Yet, no one would dream of paying them $200K a year to do it.
I have said before that I do think based on what other highly educated professions earn that I believe medical doctors are overpaid (more so with specialist physicians than PCPs). Its a function of supplying an essential service. No competition because of strict licensing requirements. Finally, the role of third party payers, or insurance is a huge factor in driving these costs up.
In reading these posts, I guess I'm in a sort of bitter mood. I was just informed by an orthopedic surgeon that he couldn't write a medical report for a client of mine without advance payment of $1,000.00. This is for something that will likely take a maximum of one hour of his time.
Sorry, but don't tell me they aren't overpaid.
Police officers and EMTs did not invest 11+ years of their lives training for their occupation. In fact, I know a lot of Police Officers and EMTs who never attended college.
My ex is a PCP. For the 30 years we were married he was "on call" every 3rd night and every 3rd weekend. His annual income was about $140,000. I, on the other hand, attended law school for 3 years, did not have a residency to complete and never had to worry about sharing call with other attorneys. However, my plans necessarily revolved around his on call schedule because someone had to be available for our children.
So, Mark, from one attorney to another, how many holidays, school events and weekend activities were YOUR children unable to have their Dad around because you were working?
Yes, some specialists probably earn "too much" but that is true in all occupations. I haven't met an attorney yet who should be making $200,000 or more, but I have met many physicians, both PCPs and specialists who should be earning at least that much.
*Note: I have no idea why you think it would take a physician one hour to draft a medical report, unless you gave the physician a fill-in-the-blank form. Is he not supposed to review the record first?
a few weeks ago My dad had a retinal tear on a weekend, when no ophthalmologists were available.
It's urgent, but not a true emergency, although it could worsen to a retinal detachment.
In such weekend cases, you go to the ER, and they page the eyedoc on call.
ER was not busy at all. Waiting room was empty on saturday afternoon.
Typical, my dad gets triaged by a nurse who filled out a questionnaire, then called to a room to wait for the ER doc.
They tried to get him into a gown for full workup. I refused them, and reminded them he was only here to find an eye doc because no eye docs work on the weekend.
I didn't want them to do unnecessary tests and labs.
With no signs of stroke, they wanted to do a CT scan on my dad. I refused that too.
Finally, after the ER doc went through the motions of doing a half-assed eye exam (didn't even dilate the pupils), she called the eye doc for the consult.
Received the bill recently, and the ER doc tried to bill $382 for her services. Medicare slashed it to $66.
But the ER bill was incredible.
basically, my dad just sat on the edge of the bed for 15 minutes, and Medicare approved $1000 for it.
I think I know why our healthcare system is bankrupt.
OTOH, about two months ago I went to the ER with what turned out to be an episode of atrial fibrillation. It resolved itself while I was in the ER but they insisted I be admitted overnight on telemetry and see a cardiologist. I was discharged the next day after I saw the cardiologist.
For the ER visit and the overnight observation, and a bunch of lab tests the hospital billed Medicare $10,000. I see Medicare allowed $900 something for all that and paid 80% of it. The other 20% of that amount was paid by our secondary insurance. While I think $10,000 was excessive for that encounter, IMO $900-something is a bit low, I would have thought a reimbursement in the range of $2500-3000 would have been more likely.
I also noted that Medicare reimbursed the hospitalist physician about half of the amount on his submitted bill, and the cardiologist the entire amount on his bill. IMO neither of these bills were excessive.
My son went to an ER about a month ago with sever pain in his abdomen. Most of the time was spent in the waiting room doubled over in pain. When they finally took him, they gave him a scan which revealed he was passing a kidney stone. He then was put in a cubical and told to wait, and that he eventually would pass it.
He never spoke to the doctor except for once when he poked his head in and said "How you doing there. Hang in there, it will pass."
This stint of almost total isolation there for about 3 hours came with a bill of over $14,000. The hospital charge was paid at $4,300, and the doctor who poked his head in the curtain to say "Hang in there" billed over $!,400. Radiology was separate too. I think that was around $2,300. In fact part of the doctor's bill was considered "balance billing" as he charged too much and my son had to pay over $300 of it.
Other than the scan, the hospital did noting for my son other than give him some fluids and pain medication, which the nurses handled. I believe those costs were unreasonable.
That sounds reasonable. You aren't paying for the 15 minutes on the bed. You're paying for the bed being immediately available and the group of doctors being immediately available to take care of any urgent issues that arise. That availability is expensive.
My son went to an ER about a month ago with sever pain in his abdomen. Most of the time was spent in the waiting room doubled over in pain. When they finally took him, they gave him a scan which revealed he was passing a kidney stone. He then was put in a cubical and told to wait, and that he eventually would pass it.
He never spoke to the doctor except for once when he poked his head in and said "How you doing there. Hang in there, it will pass."
This stint of almost total isolation there for about 3 hours came with a bill of over $14,000. The hospital charge was paid at $4,300, and the doctor who poked his head in the curtain to say "Hang in there" billed over $!,400. Radiology was separate too. I think that was around $2,300. In fact part of the doctor's bill was considered "balance billing" as he charged too much and my son had to pay over $300 of it.
Other than the scan, the hospital did noting for my son other than give him some fluids and pain medication, which the nurses handled. I believe those costs were unreasonable.
If all he needed was fluids and a place to lay down, why did you go to an expensive ER?
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