Friday, January 13, 2006

The Meme of Overpaid Doctors

We recently posted about the increasing despair felt by academic physicians.

Those of us in who are in the primary care or generalist fields, e.g., general internal medicine, general pediatrics, and family medicine, seem to be particularly despairing. We feel ever-increasing economic pressure, and see our students endure more pressure when they go into practice. Yearly efforts to freeze or cut physicians' reimbursement fall especially hard on physicians whose reimbursement is already relatively low, and whose costs uncontrollably increase.

But this economic pressure occurs in a health care system whose overall spending continues to increase rapidly. This year, according to the New York Times, health care spending grew at the "moderate" yearly rate of 7.9%, while total health care costs in the US approached $2 trillion.

Why do we feel so economically threatened while more and more money flows into the rest of the health care system? I wonder whether at the root of this contrast is the persistent meme of greedy, over-paid doctors who are responsible for ever-rising health care costs. We don't feel like we are greedy, or over-paid, but yet are held responsible for controlling costs.

Are we greedy and over-paid? To get some idea, I compared the yearly and hourly pay of academic generalists to some other types of educators, using the data about physicians' work hours found in the recent survey in Academic Medicine.

My first assumption was that academics make no more than physicians in practice. Thus data from the most recent 2004 MGMA survey (see link here) should apply to them. It showed that family practitioners' median compensation was $156,011, pediatricians, $161,188, and internists (which includes sub-specialists), $168,551. The survey in Academic Medicine reported that academic physicians worked an average of 61.1 hours a week. Assuming (conservatively) that physicians work an average of 46 weeks a year, I computed average yearly pay and hourly pay were: Family Physicians- $156,011, $55.51; Internists- 168,551; 59.97; Pediatricians- 161,188; 57.35.

My first tried to compare these figures with those pertaining to college professsors. The American Association of University Professors (AAUP) survey showed that faculty at institutions that granted doctoral degrees had average salaries from $60,567 for an assistant professor to $104,411 for a full professor. However, at well known top-tier institutions, salaries were considerably higher. For example, average professor's salaries were $127,135 at Georgetown, $136,326 at Northwestern, $145,550 at Yale, and $163,162 at Harvard. However, I have not been able to find reliable data on university faculty work hours. But in any event, yearly salaries for primary care faculty are not tremendously higher than those for other university faculty, and it is possible that the medical faculty work longer hours.

My second comparison group was public school teachers, chosen because their hours are well-defined by contracts. I was able to use salary figures from the budget for the town in which I live, Barrington, RI. Salaries for teachers range from $45,000 to $77,999. The median is between $65,000 and $69,000. The school year is 180 days, and the defined work day is less than seven hours.

So to compare yearly and hourly pay received by academic generalists and public school teachers: Family Physicians- average yearly pay $156,011, average hourly pay $55.51; Internists - 168,551, 59.97; Pediatricians- 161,188, 57.35; Public School Teacher (Low)- 45,000, 35.71; Public School Teacher (Median) - 66,500, 52.78; Public School Teacher (High)- 77,999, 61.90.

Thus, although public school teachers make considerably less than academic generalist physicians (and practicing generalist physicians) per year, their hourly pay is comparable, and in some cases, higher. No wonder we don't feel overpaid and greedy. It is time to vanquish the meme that overpaid, greedy physicians are mainly responsible for the high cost of health care.

But that meme has served as a fine way to distract the public from the mismanagement and corruption by the leaders of health care organizations that we have documented on Health Care Renewal.


Anonymous said...

Your teacher example is flawed for a couple of reasons.

1. 180 days is the number of days the CHILDREN must be taught. It does not include the in-service days, the month before school starts when most teachers have to report, the week or so after, etc.

2. No teacher works on merely a 7 hour day. There may be 7 student periods in a day, but the teachers also have bus duty, lunch duty, etc. And that doesn't include any extra curriculars they may work on. What's more, even assuming they have a free hour, 1 hour during the day is rarely sufficient to keep up with work.

Judith Nudelman said...

Recently, I was contacted by a locums group that offered me "top dollar": 55$/hour. When I told a neighbor, she was horrified as she pays her son's math tutor more. I pay my plumber, mechanic and computer repair person more. Additonally, to pursue the teacher analogy, what about call? Do teachers accept calls at all hours, without reimbursement? Are they willing to be sleep deprived for years, despite all the knowledge of the negative health effects of sleep deprivation and the cognitive deficits present when woken from sleep. The pay for primary care physicians vs. the responsibilities is a travesty, and the public still generally believes that physicians are grossly overpaid and at the root of the out of control health care costs.

CyRobby said...

I think this post is a total travesty!
The fact that physicians feel entitled to six figure salaries is the reason why the American Health Care system is so screwed up!

InformaticsMD said...


In fact, medicine is one field where good practitioners (the majority) actually earn the money they make. Review the training and time required to practice medicine.

I could similary argue that people in information technology - with that technology's high rates of failure ( ) - should never make more than $35,000 per year.

But I won't, because it is an absurd position, as is your post about "six figure salaries."

Wallace Sampson said...

Briefly, in the 1950s as residents, we figured the lifetime wages of the local bottled water deliveryman to the lifetime salaries of us physicians - both starting at two years out of high school.
The teamster won handily.


Anonymous said...

This is a very complicated issue that CyRobby cannot understand. If CyRobby came to me with acute appendicitis, or after having been hit by a car, I would ask him/her how much his/her life was worth. It's just too hard to put a price on it ... but I am sure that he/she would want the doctor well reinbursed. After all, the doctor was present during an emergency, probably in the middle of the night. The doctor also probably saved his/her life. In addition, the doctor went to college, medical school, and residency incurring debt and making very little money, giving up his/her youth in order to care for CyRobby. Is it still such a travesty to ask for fair reimbursement?

Anonymous said...

Is it reasonable to compare a GP to a Harvard professor? I think not. It might be more logcial to compare a cardiologist to a Harvard professor, but that would indicate that the cardiologists ARE overpaid.

Anonymous said...

Ah CyRobby,

You must be another self-entitled middle class failure who doesn't understand anything about people who work hard.

Doctors work very hard and until you get a job that requires a similar level of demand. Shut up. Take a lifestyle hit and pay your health insurance like you do on that car of yours that guess what, lot of other people in the world don't have. You live in abundance and then demand more when you contribute nothing more. Learn your place in society. Earn your bread. Stop picking away bits of others.

Teachers for example work pretty hard during the year and also have summer jobs usually. Only after many years and becoming "senior," do they make a decent amount. They lay the foundation of the future and guess what, people like you want to pay them less so you can get a big screen TV that you probably don't deserve. I hope the middle class in America has to challenge workers from China and Indian and get big hits on their wages. Artificial inflation of wages in US for middle class.

Anonymous said...

I certainly agree with the point made by the last post, but maybe a little too hard on the uninformed.

People aren't entitled wages. In fact, supply and demand would inflate physician salaries because people would empty their pockets to stay alive. Yes, competition between physicians would drive costs down for the consumer, but overall, there would still be situations that would be all demand.

I find it funny that people who received BS or BA in worthless degrees in business asking for salaries higher than 40K. Really, what did you learn? How to talk BS with each other at meetings and order out? Or having conversations at the cooler? This is why MOST of you don't earn big money. Your job frankly doesn't require brains and you can be easily substituted.

Anonymous said...

Doctors are greedy overpaid thieves. They use their monopoly to steal off other citizens.

Anonymous said...

PhD faculty work at least as hard as MDs teaching, writing grants and conducting research. They take longer to complete their degrees and train for many years as a post-Doc and land their first jobs in their mid 30s. Only a small percentage of PhDs even reach the competitive faculty jobs and their salaries are earned by constantly competing with their peers in a publish or perish world (~10 % of applicants are funded) and it takes another 10 years and a less that 25% success rate to become a full Professor earning 104,411. Contrast this with 4 years of formal medical school training, which includes stress management courses and 3-5 years of internship to land a job that instantly pays over 150,000 to the average person who can pass the boards and become an FP. Then one forgets the specialist who gets paid ~$750 for a simple injection taking 1-2 min and a total compensation of over a million dollars. Clearly the lack of continued competition among established physicians to provide the best service at competitive prices is a problem. Perhaps the best way is to compensate physicians and institutions by peer-reviewed grants like NIH-funded scientists, which includes an honest comparison of their work load, number and desperation of the patients, success rate, severity of problems among the patients saved, waiting time to gain appointments, patient satisfaction, morbidity, judgement, errors, unique skills, etc. This should also allow continuous training and elimination of ridiculous paperwork for compensation and specialized licenses for every little procedure. Another false comparison is that the Professors being compared in top Medical Schools include physicians who get paid a lot more than their equally hard working PhD counterparts even when the PhD is more competitive at securing grants, which brings up the average salary.

Anonymous said...

I am a teacher.
Yes doctors get paid more.
Yes I'd like to get paid more.
When my dad had to get quadruple by-pass surgery I was glad that doctor was there getting paid what he did.
My biggest concern over paychecks is with people like professional sports players who make millions of dollars for playing hockey or some other sport.
Can that money not be used elsewhere for better things or for providing better pay checks to people who really deserve it?
But that's just my opinion.

Anonymous said...

To the person above me who is a teacher, I agree with you, a person who plays hockey gets paid millions of dollars for hitting a puck around with a stick, they make no service to the community and usually have poor education. Mean while someone like a doctor who goes to school for 13 years after highschool including residency gets paid a fair amount of money, but on top of that they need to build a certain amount of credits each year from conferences (which cost around 4000$ each depending on which one though). Not only that but the amount of money they have to pay for licences, insurence and such is pretty high too not to mention the risks. And in Canada being taxed 42% on income tax isnt too friendly from the government either. I think they're paid quite fairly. What I find is also rediculous is people who get PhD's can't find jobs, mainly what they either do is write a book or being a professor (if the position even opens) meanwhile a kid streight out of highschool can go work in the Alberta Oil Fields driving trucks around for 8 hours for $25+ per hour. I'm sorry but if it continues like that there would be no point of even going for engineering in university, might as well go work at some of the real overpaid jobs. Thats just my two cents

Anonymous said...

I love all the people on here talking down to anyone making less than 50,000, as if they have no right to grip about the skyrocketing cost of healthcare in this country.
Just to give you a "real World" example of what's actually going on here...I recently received a "bill/statement from my insurance company, stating that a certain health professional (GP) I saw was charging them $275.00 for a 1 hour visit. These doctors charge as high as they can because they know they'll receive some or most of what they ask for.

Find a way to open up the healthcare business to competition and we might get somewhere. It will never happen because the "Non-Profit" hspitals & doctors will empty their pockets hiring lobbyists to shoot it down.

But make sure you be-little those who make less than know, the ones who are "replaceable". You @*$&%^#@ Creep.

Anonymous said...

Finally, an interesting discussion thread on this. I find it interesting the "research" that started this post...comparing GP's to Harvard Professors, and mis-calculating a teacher's "hourly" salary...a complete joke. I see a lot of this--overpaid god-complex-ridden physicians that think they know everything. I work in Information Technology, you know, one of the "easy" jobs that a know-it-all above bashed on. My wife is a teacher.

First of all, my wife is a *good* teacher that works well over 60 hours a week. She also spends at least two weeks during summer, with no extra pay, researching and updating her school materials. Perhaps the "hourly" calculations should properly reflect this. They won't though...again, because they are done by people who think they know everything.

As I mentioned, I work in IT. I always *love* the argument from physicians that they are "on call." Welcome to the real world. Any position that required 24x7x365 support including IT, Utilities, and even some service industries, requires people to be "on call." Physicians are not special in this regard, they are just well known.

I also love the comments above labeling the business world as "easy." Any person I know earning more than 100k/year in business worked their tail off to get where they are...significantly longer than the 7 year post-college track of most know, the one that "earns" them a 150k plus a year job? Cry me a river about long hours and long nights. The "trust fund babies" and lucrative jobs that are simply passed down from a father to child are few and far between. Most people work extremely hard to get where they are. Get a clue.

I also would like to speak to the comments above about how much you would pay to save your life. One of the arguments above supports lucrative physician compensation, eluding to the common "can't put a price on health and life" argument. However, I would also argue that a physician seems to have no problem at all putting a "price" on it...e.g. $750/hour. Bad argument to start kind sir. If you are in it to help people, you wouldn't have any issue working for $100k/year or less. You're in it for the money...come to terms with your own motivations and stop kidding yourelf.

Also, make sure you take a look at the "lovely" AMA solution to providing healthcare for know, the one that's one TV? Take note that there is no mention of reducing any costs associated with physician compensation...even by a little bit. If you look under the "healthcare costs" section, you'll find this goal:

"reduce nonclinical health system costs that do not contribute to patient care"

Interesting don't you think? "Reduce nonclinical...costs..." So reduce everyone's charges and overhead but those that conveniently are closely associated with physician compensation. A bit arrogant don't you think?

Being one of those "clueless" businessmen, I can keep track of numbers...thank god I learned to count (sarcasm...). Take Orthopaedic surgeons...average salary is approximately $400k/year on the low end. WHAT POSSIBLE ARGUMENT CAN YOU MAKE FOR THIS TYPE OF COMPENSATION! Most Orthopaedic surgeons I know over the age of 40 work 3-4 days a week, and ROTATE call every few weeks. They attend up to 3 conferences a year for a week at a time! Where does this fall in the silly original hourly pay calculations?

Sorry to rant a bit here, but this whole "doctors make more because of initial effort, intelligence, and ongoing sacrifice" is a joke.

Anonymous said...

Setting aside compensation, let us just examine quality and cost. The US has the costliest medical care and the worst clinical outcome for patients on hemodialysis. No one can determine the cost of anything. Imagine, if you went to a mechanic and no one knew the cost till the repair was complete and Lucca Brazzi was sent after you for collection. Thank goodness, you can throw the car out and replace it, but with your little kid, you are held to a ransom. The taxpayer-based system should be like public schools-free- but a parallel free enterprise should flourish for those who want to pay for more or simply pay more for the mental satisfaction of getting what you pay for. The public system should be competent and accountable and the private system-competitive. There are different levels of quality for everything. Why should healthcare be uniformly incompetent and protected by legal shields and jargon? The best should make much more than they now and the average must compete for patients by providing coupons.

Anonymous said...

Specialist Doctors have median incomes after taxes of well over a million dollars. They are monopolistic and greedy and deliberately keep the training numbers down to create shortages and increase their own incomes.

Anonymous said...

And of the lowly nurse...who cares.

I watch the doctors and I can tell you exactly who deserves what. I know who to call when an emergency is going down, and who NOT to call. The nurses are hit with the same problems. The smart ones get the major tragedies and the lesser ones get a slide.

But we make the same money for doing more work with more responsibility. Those of us that take on the task are only paid back in the knowledge that we really helped out in a bad situation. The MD's and nurses who, by virtue of their lesser abilities back off from the emergencies, will still announce and take full credit. The MD's have their consults and the nurses have their superiors.

Oh, but healthcare stinks. I've lost two of my best critical care pulmonologists to "the numbers game." They're not going to get so invasive anymore, not going to help out so much anymore, as the pay and the stress don't support their endeavors.

And as for me...I'm royally screwed. When a patient crashes, I don't have any backup...just too young nurses with little experience. But they're cost effective.

David said...

Salaries should be flat for all.Medical Locum Work

Anonymous said...

There is no greater contribution to the health of society than the collection of garbage and thus the elimination of disease-causing refuse from the streets. Therefore, according to medical doctors' criteria for compensation ("you can't put a price on health"), it is the garbage collectors who should get paid the most in society, i.e. more than any medical doctor.

The typical clinical medical doctor has far less education in science than a physics or chemistry major at the undergraduate level, or even a serious biology major, and couldn't pass an exam in any of those subjects at even the high school level if his or her life depended on it. And as for mathematics, where logic and reason are paramount? Most medical doctors never got beyond freshman calculus, which is only the beginning of that subject at the university level.

A clinical medical doctor is merely a technician, using the tools of science developed by pharmacologists, biochemists and engineers. They are almost always struggling students in undergraduate science and math courses. Then they go to medical school where they focus on practical training, i.e. technicians' work. As technicians, clinical medical doctors deserve corresponding pay, such as that of an automobile mechanic. The procedures that they carry out and the drugs that they administer are from "cook books", all worked out by others. There is nothing in any of it that amounts to the slightest degree of scientific analysis at any level -- just a little bit of common sense, that's all. Even the science taught in junior high school is beyond what is required to look in the PDR and read, "for patients between this age and that, administer 20 mg per day of drug x". And to top it off, the statistical studies that doctors reference are incomprehensible to them, with most doctors figuring that a 5% false positive rate in the outcome of a certain test means that the test is 95% accurate, when in fact it may be far less, e.g., 2% if the frequency of the disease is 1 in 1,000. But this involves high school probability, which is totally beyond a clinical medical doctor.

Even the MDs in research understand far less than the PhD'd counterparts with whom they work. (MD = technician. PhD = scientist.)

Students should go from high school straight to medical school, skipping undergrad completely, like they do in most other countries in the world. They only need technical training, not education. Of course, the government should pay for medical school on their behalf, so that they aren't burdened with large student load payments, given the much lower salary that they should be paid, as in other countries.

And "no", you don't want your surgeon paid a lot of money, because if he is, then his motivations are corrupt.

The American medical system is so corrupt with respect to the systems in any other country that if one thinks otherwise, then America is right and the whole world is wrong -- very unlikely scenario. The situation is nothing other that what has existed for thousands of years in various societies throughout history: hegemony, with the ones in power defending their absurd, oppressive practices to the nth degree and the "common folk" duped into going along. But like the astrologists of long ago, the merchants of spices and more recently, the magnates of the industrial revolution, clinical medical doctors are mainly extortionists. The rest of the world got wise to this decades ago. But hey, since Americans continue to ignore the situation and do little about it, perhaps they deserve to be abused?

Roy M. Poses MD said...

Its amazing that this post still attracts comments, and that many of the commentators seem not to want to address the specifics of what I wrote.

I wrote about generalists, also often called primary care physicians, not procedural specialists.

If in 2010, anyone who wants to argue that primary care doctors are overpaid, go for it.

Also to the last Anonymous,
You might want to catch up with what we have written on this blog since 2006 and then think if you want to try to defend your assertion that doctors, including presumably primary care doctors, have hegemony over health care.

pjacob said...
This comment has been removed by the author.
pjacob said...

This issue "doctors are overpaid" gets to people's passions for some reason. A few things I disagree.
1- "No price for a life": this is nonsense, doctors do not save lives, institutions with support, technology, infrastructure employ doctors to participate in life-saving activities. A Neurosurgeon in the jungle can do little to save lives with his expertise. We do these activities as a community, from the people manufacturing the technologies to the nurses and surgeons.
Personifying the act of life-saving is small minded and glorifies the individual doctor in a pop-culture fashion, symptomatic of a population obsessed with TV shows about medicine. If you want to believe doctors deserve a lot of money because life has no price, please become a kidnapper instead. It is a much more direct way of applying this rationale. This is a fallacy and does not relate to the economics of the matter.
2- Doctors earn what the market allows them to earn. Specialists work with high technology and are in scarce supply in a monopolistic market: of course they are going to be highly paid. Other countries with private medicine have the same pattern. An interesting case is Brazil where there are both Private and Public options. In the Public sector there is little difference in income between the neurosurgeon and the GP, whilst the private sector, in the high end, follows the American pattern with the most expensive doctors serving the richest sectors of society. Lets open the market and let doctors compete.
3- the comparison between Harvard Professors and MDs is ludicrous. Professors in competitive fields are by definition unique, and if the contingent that pursues medicine had pursued academia, they would find the horrors of a "there is only one professor" reality. There is incredible arrogance in trying to compare an average MD to someone on the top of a scientific field. Most highly skilled and equally trained scientists end up in inferior schools, research jobs or simply wise up and move to wall street. A Harvard or MIT Professor is an international authority in a complex field and earns a fair wage for it, inferior to any average specialist in medicine. I question whether a plastic surgeon's wage is fair. But if the market allows it, then it is fair.
4- Finally, the issue of hard work. If you think doctors have it hard, after having been pampered by parents and attended top institutions to have one of the best and most respected careers, try a few years living on survival wages cutting sugar cane in the third world to make clean ethanol for our new age environmental world: they work much harder and earn much less, so, please, stop whining. We all work hard, but anyone familiar with MDs know they share a lot of personality traits: they want a lot of money, they enjoy the status and have large egos. This is not true for all of them, but it is a pattern.
5- Ignoring all actual forces (economics) and descending the level of analysis, doctors should be paid more and more. Their wages are a fraction of the health care process and if ensuring quality means paying them a lot, lets pay them a lot, they love money and are in medicine for this very reason. Forget humanism, compassion: money is the matter. This will not change. GPs should be paid more so their egos aren't hurt compared to specialists. When you see a doctor, give her/him all you have in your wallet and thank him for existing.

Roy M. Poses MD said...


1. Occasionally a doctor using minimal technology can save a life. For example, sometimes simply treating pneumonia with an antibiotic can be life-saving. A neurosurgeon with some minimal instruments might be able to drain a subdural hematoma even in a field hospital with minimal technology. The fancy technology (requiring complex support mechanisms) is often not as life-saving as pop culture advertises.

2. Doctors' payments are mainly fixed by the government. See this post and follow the links:

It is hard to imagine a true free market in health care, given the uncertainties, assymetric knowledge, and difficulties faced by people who are facing a major illness making decisions in a cool and collected way. See this post:

3. Are you really serious that college professors are unique but physicians are just widget makers? In any case, see the comparison with public school teachers' hourly rates.

4 and 5. I submit that doctors' training is harder, more stressful, and relatively less well paid than that of any professionals (but not comparable to military officers). I also submit that some doctors actually do believe in putting patients first, although unfortunately, not all of them do.

pjacob said...

I would like to maintain a few ideas though, but without the nasty attitude.

1- Arguing for financial rewards to the activity of "saving a life" appeals to emotion and does not address the problems faced by doctors and patients that concern the MDs paycheck. Saving lives is a collective effort in something we call health care. I am always wary of MDs who cling excessively to the heroic ideal, and I love meeting a doctor who thinks he belongs to his community instead. Call me socialist, but I think we all work in society. Someone manufactures, distributes and markets the antibiotics, the logistics of our society is mind boggling, if it brings happiness to MDs to believe they are somehow superior, sure, go for it. My point is that equating the financial reward to the life-saving concept will not get us anywhere, it is philosophically arguable, and bring interesting questions of how much each life is worth. However, I agree that a bonus for working at the tip of health care is fair, given the levels of cortisol the job entails.

3- Yes, I am really serious about college professors and MDs. But I meant Harvard, MIT, Princeton Professors, not your average professor. The blog post made an argument for comparing average MDs to top scholars, international references in important fields, I find it absurd: if you are going to argue for better pay for MDs because of intellectual merit, and compare their intellectual merit to that of, say, a world renowned mathematician at Princeton, earning one tenth of what average cardio-thoracic surgeons earn, we can determine wages are not distributed according to intellectual prowess. I do find it arrogant to compare the average MD, to someone at the international summit of different fields: it belittles other fields. The comparison would be fair if we could compare a Harvard Professor in string theory to his equivalent in the world of Nephrology. My point is that MDs are not super stars for being MDs so lets compare where comparisons are due. Any MD can make a lot more than a physics genius, so I think MDs are quite well paid in the USA.

4,5- The training is tough but it isn't tougher than what other people go through in this planet. Maybe compared to the peers in suburbia the work is hard, but life is difficult and whenever I see a doctor saying he works too hard, it is not about him working hard, it's about him working harder than everyone else. Again, try a two year internship in mining or sugar cane cutting. In this planet that we share, MDs, PhDs, CEOs are a staggering minority, but we happen to think a lot more about ourselves and our needs, the people who matter. I agree though, you guys are overworked.

This brings me to my most serious concern about the lives of MDs: EXHAUSTION. I lost someone important to me, who was a 3rd year resident in Head and Neck Surgery, to a traffic accident caused by sleeping behind the wheel. She worked too much, sometimes 100h/week. Why isn't there a class awareness among doctors? Why don't they organize the work hours? Are Doctors really more productive working so much? I honestly doubt it. It seems like an endless competition, it is part of the culture to see who is toughest. But judging from her colleagues (whose personalities are the source of my disdain to the field) it seems to be about the individual MD, not about the collective, the patient, nothing. Maybe I only met young ambitious doctors.

I believe GPs should be paid more (and interestingly, the nicest colleagues she had were pursuing clinical fields), overworked doctors should work less, and if good health care means paying them well or a lot I am for it.
However I disagree with a lot of the ideas I hear from MDs (as you can tell). And I do think most MDs went to for 2 reasons: Status and Money.

sorry to be so mean, but it's the thoughts from the other side of the doctor's office table.

Roy M. Poses MD said...

PJacob - thanks for your thoughtful comments.

If you want to communicate with me directly, try rposes at firmfound dot org.

It is hard to determine when you were discussing the original 2006 blog post and when you were discussing the various comments.

Please note that my original comparison was between academic physicians, that is, medical school faculty, and other academics. It was not between practicing physicians and Harvard professors.

1. You are right that it takes considerably complicated infrastructure to "deliver" contemporary health care. But I do believe that infrastructure and technology have been over-emphasized, and the importance of trained health professionals, including but not restricted to physicians, has been under-emphasized.

3. Again, my original comparison was of medical school faculty and general university faculty, and then public school teachers. I am confident that primary care faculty make less per hour than university faculty. So the comparison might be a professor of internal medicine (in general internal medicine) and a professor of English at the same university.

4,5 - I would invite you to observe the life of a typical medical student, and then a typical intern or resident. I still would assert that the hours are longer, the stress is higher, the consequences of bad decisions are worse, and the conditions are more difficult for them than for a typical graduate student, or professional student in another field. The problem is not just physical labor (although there is that, too.)

That being said, I agree that the hours are too long, and that fatigue and sleep deprivation are a real problem, one that physicians have not adequately addressed. But remember that interns and residents are a source of relatively cheap labor to hospitals that have gotten used to spending money on other things, like executive salaries.

Thanks again for your thoughtful comments.

pjacob said...

I think I agree with you on all counts, and I think I misunderstood the Professor analogy. Again, I disclose my negative bias towards dealing with MDs, both as a researcher in bioengineering and as a patient.

The way I see it, medical school is more labor intensive than any other graduate program. And PhDs are paid, even if overworked and tackling challenging problems, PhDs have more freedom to express themselves. Medical students enter a pasteurization program.

I am puzzled by the lack of "labor laws" in medicine. Doctors seem not to respect their own limitations, but from what you say, it seems the source are the employers.
I've read somewhere else (NYT)comparisons between European doctors and American, claiming that Europeans earn less and do the same job. American doctors are quick to claim they work twice the hours, and this is true. What is the source of the longer hours in America? Is it cultural, do all professionals work long hours in America. Would American doctors want better regulated hours? What is wrong with working 48 or 60 hours instead of 80 ?!!?! In that case, I agree completely that the hourly rate should rise: doctors should earn more per hour and work less, so they are better and happier.

Internal medicine: I read someone claiming professions need to be well paid to attract the best and brightest. Does that mean that we, as a society, think that caring for children (pediatricians) does not require the "best and brightest"?
Someone finishing a residency in pediatrics will take 10 years to pay off the school debts, with the current average values.

Roy M. Poses MD said...


I am not sure I entirely understand the history of the tradition of long hours, especially during training. As a medical student in the late 1970s, on the "hard" rotations like surgery, medicine, ob-gyn, etc I often got only a few hours of sleep on nights on call.

Internship was the worst. Every fourth day, I would go into work before 8 AM, and not be done until about 8 PM the next day, having been lucky if I got as much as 4 hours of sleep. By the next morning I (and presumably all my colleagues on similar schedules) were in a complete fog.

I presume the rationale was toughening us up so we could respond to true emergencies. But how much we were learning, and whether we were even competent to make any decisions or handle any cognitively complex tasks after the first 24 hours of a 36 hour shift was dubious.

Although the hours for doctors in training are now somewhat better, they are still longer than those for nearly any other profession in the Western world.

Presumably, once you get used to these hours, working 50-60 hours a week as an "attending" physician seems like a light load. And, as noted above, the pay of primary care doctors working these hours seems pretty good, if you don't compute it per hour.

I didn't mean to somehow downgrade the importance of pediatricians. I think their plight is generally like that of internists.

Anonymous said...

A small note about the physician saving lives on a daily basis by giving antibiotics.

I've known people misdiagnosed, and who died as a result. The physician responsible was not accountable, as it was put under the normal rate of failure of medicine.

When we have all information and cookbooks readily available to make simple diagnoses using simple tools, it would be definitely possible for a non physician to save lives as well. But they aren't allowed to do so without a medical license, as one has to have the physician's little paper if one wants access to the actual drug.

Saying that the physician saved a life in those cases is also an exaggeration.

Roy M. Poses MD said...

Anonymous, you are very late to this particular party, which started in 2006.

Please note that way above, I was only arguing that doctors do occasionally save lives, not that they do so frequently.

On the other hand, I would submit that practicing medicine well in any specialty is difficult and complicated. Anyone who seriously thinks it could be done out of a "cookbook" needs to think again.

Anonymous said...

Only the market can decide if a person if overpaid or not. If he is, then he is replaced by someone with a lower wage.

The problem I have with the medical community, is that the people giving licenses are the people who already have licenses. There's a huge incentive to give as few licenses (or train) as possible.

Imagine if Microsoft gets to decide who has the "license" to make software. There probably wouldn't be many software developers left (except the ones at MS of course).

I feel that this is definitely the case in Canada (I'm a Canadian). Why is it that whilst there's a shortage of doctors, people with medical training from other countries (immigrants) are working menial jobs? Why are they denied the right to practice medicine?

Roy M. Poses MD said...

It is amazing how this post from 2006 continues to generate comments.

Note that at least in the US, health care hardly resembles a free market. See this post:

In the US, physicians pay is largely set by the US Medicare system, directed, however, by a secretive organization run by the AMA and dominated by sub-specialists who do procedures. See posts here:

In Canada, I believe that it is provincial governments that negotiate with physician organizations to set payment rates, again, hardly a free market process, although actually maybe more fair and open than the one in the US.

In the US, doctors are licensed by state boards, although admittedly with a lot of input from other doctors.

I do not have sufficient expertise in the Canadian situation to comment on why so many doctors trained outside of Canada are not practicing.