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I found this infographic interesting for several reasons.
The information puts the high US physician salary touted by the mainstream media and political policy makers in perspective with other countries when time spent providing care is considered.
However, the data presented in this infographic also address the important issue of training debt that currently averages about $300,000 for US physicians (We should note that the 2013 Association of American Medical Colleges report on medical student debt mentions only the "median" debt of medical students: $170,000 - a much more palatable way to spin the truth in favor of our educators.)
So while Congress grapples with the SGR "fix" that is never enforced anyway, there are much bigger issues to consider in regard to physician compensation going forward as the US struggles with its growing doctor shortage.
-Wes
Is there any evidence that declining compensation has anything to do with any physician shortage?
ReplyDeleteIs there any evidence that debt levels (which is a real problem all students regardless of field) is deterring future doctors? Are students flocking to state schools and leaving the more expensive private schools without applicants?
I'll be the first to admit that the anecdotal narrative makes sense. I just don't see any data to support it.
There are still many more young people who want to begin medical training than spots to accommodate them.
$300,000 / year? No Doctor. Nice try though.
ReplyDeleteAnony 06:01pm -
ReplyDeleteCorrection made - should be $300,000, not $300,000 /year.
Thanks -
Bogus numbers. Those are the hours that overseas doctors work in state clinics/hospitals. They then work in private clinics to subsidize their salaries. In the end, they make just as much if not more than their American counterparts.
ReplyDeleteHow is the hourly salary calculated? I know of NO doctor making less than $34/hr.
ReplyDeleteI found this article and the comments very accurate:
ReplyDelete1.The average MD is not compensated as well as the average plumber.
2. Scandinavian and Australian/ NZ MD's do work significantly greater hours in private and doing locums to supplement their income.
3. Average debt of 300K must mean Porsches, European vacations and very nice accommodation as some of these approached >400K.
4.By going "Lean" and hiring and training the right people and eliminating the MD as the "rate-limiting step" in the patient getting better, we were able to markedly improve access and quality while also improving productivity (300-500%) and eliminating headaches. The last 5 years of my practice I was able to work like a Swedish MD and really enjoy practice again.
MD's need to change the model or else become plumbers
Oh my! You mean to tell me that these poor doctors are forced to work fifty six hours a week and only get thirteen days of paid vacation? After ALL that they are forced to drive their luxury cars to their huge homes in the nicest neighborhoods? How awful! Maybe we all should surrender a larger share of our income to improve their pitiful lot....
ReplyDeletePlease...
Dr. Fisher,
ReplyDeleteThank you for discussing the important topic of medical student education debt.
Your post seems to suggest the recent AAMC report on debt and cost of medical school included only median debt data to make the totals more “palatable.” The AAMC annually publishes a Debt Fact Card which includes both mean and median debt totals for all medical students: https://www.aamc.org/download/152968/data/debtfactcard.pdf.
The 2013 version shows that for all indebted medical school graduates, the mean/average education debt was $169,901 while the median was $175,000. In 2013, seven percent of graduates reported education debt of $300,000 or more.
For further information on this topic, you may be interested in the AAMC report you cite (https://www.aamc.org/download/328322/data/statedebtreport.pdf) that analyzes debt and cost of medical school and includes interesting evidence on the minor role of debt in specialty choice while highlighting a variety of repayment scenarios that allow physicians to manage current levels of education debt repayment.
The Department of Education has a number of “income-driven” repayment plans that link the monthly loan payment to the borrower’s income, regardless of debt level, and these plans could be quite useful to physicians repaying education debt. See http://studentaid.ed.gov/About/announcements/income-driven for more information.
Finally, you may be interested in the Jan. 2013 article in the journal Academic Medicine (http://journals.lww.com/academicmedicine/Fulltext/2013/01000/Can_Medical_Students_Afford_to_Choose_Primary.15.aspx) which takes a detailed look at the household finances of a primary care physician repaying education debt and concludes that “A primary care career remains financially viable for medical school graduates with median levels of education debt.”
Sincerely,
Jay Youngclaus
AAMC
$35/hr and 56 hr/week puts the 'average' internist salary at $102k. Really? That's hard to believe. It also picks a relatively low paying specialty as a basis for comparison.
ReplyDeleteHmm, here's a Kaiser report that puts internist salaries at $165k in 2012 (http://capsules.kaiserhealthnews.org/index.php/2012/04/few-doctors-consider-themselves-rich-survey-says/).
Jim L -
ReplyDeleteGo to PayCheckCity.com and enter that $165,000 salary to any state you like (California is my favorite) and see what the weekly take-home pay is after federal, state, FICA, SS withholdings are made, then do the math.
I think the answer will surprise you.
2 ways to keep docs working longer.
ReplyDelete(1) pay them enough that they prefer work over leisure.
(2) loan them enough that they can't afford to quit.
Pre-meds are still busting down doors to line up for deal #2
Why? Because a mountain of debt that results in a guaranteed ticket to the upper middle class still beats the alternatives these days.
As another exercise in real world incentives - how many docs do you know who began training in the US and left to work in other countries? The reverse?
Last time I checked, there were interest rates attached to student loans, so any valid discussion of the subject would most productively be undertaken considering the amortized cost of repaying the loan, NOT the median or mean principle borrowed. It would also be useful to give data on the number of defaults on such loans... I have found that medical students are more prone to satisfy hedonistic desires than to be practical about how much they borrow instead of dealing with basic needs for their education. Nonetheless, such current practices only add to the number of new/future doctors who will have no choice but to accept whatever fees Uncle Sam mandates, and trust me, they're not going to be inclined to work any more hours than their employment contract specifies...
ReplyDelete