The Medical Cartel: Why are MD Salaries So High?

By Jun 24, 2009, 2:47 PM Author's Blog  

Greg Mankiw features the chart below on physicians’ salaries in the U.S. vs. various European countries and Canada, showing that MDs in the U.S. make about $200,000, which is between 2 and 5 times as much as doctors make in other countries. How do we explain the significantly higher physician salaries in the U.S.?

The Medical Cartel: Why are MD Salaries So High?

One explanation is the restriction on the number of medical schools, and the subsequent restriction on the number of medical students, and ultimately the number of physicians. Consider the difference between law schools and medical schools.

In 1963, there were only 135 law schools in the U.S. (data here), and now there are 200, which is almost a 50% increase over the last 45 years in the number of U.S. law schools. Unfortunately, we’ve witnessed exactly the opposite trend in the number of medical schools. There are 130 medical schools in the U.S. (data here), which is 22% fewer than the number of medical schools 100 years ago (166 medical schools, source), even though the U.S. population has increased by 300%. Consider also that the number of medical students in the U.S. has remained constant at 67,000 for at least the period between 1994 and 2005, according to this report, and perhaps much longer.

The charts below tell an interesting story (data here):

The number of applicants to medical school keeps going up, by more than 21% between 2003 (34,786) and 2008 (42,231), despite the fact that the number of students admitted has gone up by only about 9% (from 16,538 to 18,036) over that period.

The Medical Cartel: Why are MD Salaries So High?

Because of the 21% increase in applicants since 2003 for only 9% more openings available in U.S. medical schools, the number of medical school applicants per available opening in medical schools increased from 2.1 in 2003 to 2.34 in 2008 (see chart below).

The Medical Cartel: Why are MD Salaries So High?

Because of the significant increase in applicants for a much smaller increase in available openings in medical school, the percent of medical school applicants accepted has decreased from 47.5% in 2003 to 42% in 2007, before increasing to 42.7% in 2008 (see chart below).

The Medical Cartel: Why are MD Salaries So High?

Bottom Line: One reason we might have a “health care crisis” due to rising medical costs, and the world’s highest physician salaries is that we turn away 57.3% of the applicants to medical schools. What we have is a form of a “medical cartel,: which significantly restricts the supply of physicians, and thereby gives its members monopoly power to charge above-market prices for their services.

In his classic book Capitalism and Freedom, Milton Friedman describes the American Medical Association (AMA) as the “strongest trade union in the United States” and documents the ways in which the AMA vigorously restricts competition. The Council on Medical Education and Hospitals of the AMA approves both medical schools and hospitals. By restricting the number of approved medical schools and the number of applicants to those schools, the AMA limits the supply of physicians. In the same way that OPEC was able to quadruple the price of oil in the 1970s by restricting output, the AMA has increased their fees by restricting the supply of physicians.

If we had 130 law schools (instead of 200) and 200 medical schools in the U.S. (instead of 130), it would probably go a long way to solving our “health care crisis.” More MDs at much lower salaries along with fewer lawyers and lawsuits would be a good thing, wouldn’t it? Can’t breaking up the medical cartel, training more physicians, and lowering MD salaries be part of the discussion for health care reform?

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87 Comments

  1. To be clear, the AMA does not limit the number of people who pursue careers in medicine and has no power to do so. The AMA continues to advocate for an increase in the physician workforce, especially in light of our quest for health-care reform that covers all Americans. We need to attract the best and brightest to careers in medicine and help practicing physicians continue to provide high quality patient care. To successfully increase the physician workforce to meet America’s long-term needs, the AMA is calling on Congress to lift the current cap on residency positions, create new incentives to get physicians to underserved areas, and enact permanent Medicare physician payment reform. With the growing U.S. population and aging baby boomers, the physician shortage is one our nation cannot ignore if we want adequate access to health care.

    -American Medical Association

    • AMA Commentator says:

      (Parody). We, the AMA, are lying to the public. We do effectively restrict the number of physicians produced by the methods described in the above article. More med schools and more accepted applicants would mean more doctors, oversupply and less pay for us – c’mon now, we don’t want that. Yes, there are other problems in the healthcare system – but fundamentally, our lobbying of Congress (we are annually one of the top political lobbyists) helps us restrict the supply of doctors. Sorry, if you don’t like it, go to Europe where it may cost $10-20 to see a doctor for a flu virus. Here, in the US, yup, you see us, you’re gonna PAY.. hey, how else can our family docs make 2-5x European doctors, you understand, right?

    • Td says:

      Wow very clever! I almost thought you were the AMA! Moron

      physician salaries are a small factor in the cost of healthcare so this whole thing is pointless, drug prices, expensive medical technology, more imaging, etc is why your healthcare is so expensive. Also we live in an expensive ass country, what do you expect! Higher physicians salaries, compared to what ever country that you can’t even use as a comparison because of demographic differences, are here to make up for expensive and long education that docs must fund as well as high malpractice insurance because

      These docs in other countrys work half the hours and half the pace. And don’t have the problems of our county, immigrants and income disparity. You aren’t just paying for your own healthcare but the ED visit of the homeless guy outside! What you think the government actually makes money and pays for that guy? Everyone needs to get paid

      close this horrible and ignorant article

    • veritas says:

      doctors make so much because the average debt for a graduating medical student is >150k. So starting out as a resident, not a doctor, they only make ~50k/yr minus the cost of living. Then once they do become a doctor, they pay out the ass for insurance (obstetricians pay average 100k)….

      long story short, graduating medical students are overworked and underpaid until they become doctors, at which point some person, who knew the risks, will have a child with a genetic disorder; after the lawyer makes 300-400k and the patient makes 1.1M, we all have one less doctor and one more rich lawyer.

      (I am not a medical student or doctor, nor to I intend on becoming one…just my two cents)

  2. JB says:

    I was told by a doctor that the US government offerred to pay to have solders sent to medical schools during WWII due to the severe shortage of MDs and the AMA refused to to allow the servicemen into the medical schools. If the AMA is serious about increasing the number of doctors, why hasn’t it happened? The AMA is one of the most powerful lobbyists in the US and Congress has nothing to gain by limiting the number of doctors. I have already written my Senator about the need to increase the number of MDs to get the cost of healthcare reduced. Maybe this needs to become a major issue ofthe healthcare debate.

  3. dave says:

    The comment by the AMA above is rubbish. Medical schools are controlled by the LCME. The LCME is dominated and funded by the AMA. The AMA deliberately holds down the numbers of medical graduates to keep their disgusting incomes high.

    • jon says:

      1. Work your ass off at one of the top undergraduate schools in the country for science and engineering to get a B.S. in molecular biology with minors in chemistry and psychology. Work 12 hours a day 7 days a week while everyone else is having fun. Over the summers work full time while interning at a hospital, or holding down a 60 hour a week lab position.

      2. Be one of the 40% of pre-med students who have good enough grades to make it worth the effort to apply to medical school and not get turned down by every medical school you apply to. Getting into medical school is extremely competitive because when it all goes to hell you want a doctor who can think on their feet and in a matter of seconds discern and perform the one thing that can save your life.

      3. After 4 years of attending 40 hours a week of intense classes, plus all the work outside of class, and more lab and hospital internships over the summer graduate medical school with over 150,000 in debt.

      4. Complete 5 years of residency training to become a general surgeon. By the way pay is around 50k at this point, you’re trying to start a life, and have all that debt collecting interest.

      5. After becoming a general surgeon, at the age of 31 if you’re one of the lucky people who got into medical school at 22, average age is 25-26, complete 3 years of fellowship training in neurology at slightly higher pay. About 70-80k while still paying off enormous debt.

      4. Finally complete 2 years of advanced training in neurosurgery to become a fully certified neurosurgen at age 36-40.

      Yeah your a doctor now! Now pay 150K a year in mal practice to the medical malpractice leach(lawyer) so he can sew you for not saving someone who had less than 10% chance of living with surgery and 0 without it. If you want to criticize doctors for the salary they make then try doing all this for yourself and try telling us all with a straight face that you don’t deserve a good salary. Physicians in Europe make less because the education required to become a doctor is less, the debt they carry after medical school is less, the government controls reimbursement and underpays them, and doctors in Europe are simply less competent than the average US doctor. Why else would all the foreign people flock here to go to medical school? The AMA keeps people who lack the mental focus, hard working attitude, and problem solving skills necesarry to learn how to save your life from using up the limited supply of cadavers and funding for medical students. There are only so many doctors available to teach people during residency and they have patients they are responsible to as well.

    • 1oldchemist says:

      We currently import some 20% of the nation’s doctors from other countries, while turning away qualified medical students. Many of these countries are in dire need of qualified medical professionals and subsidize their education.

      Why is the richest nation on earth not education more doctors to help the world’s medical problems, rather than stealing the poorer nations?

      If 20% of the practicing MD’s are from other nations, how can the AMA claim we need to restrict medical schools to get the best and brightest students. Have they checked the medical school from which we are accepting imports?

      Different personalities are motivated by different employment incentives. As testified by many MD’s in this thread dollars were not the main factor in choosing a medical profession. If greed is not a good motivator for a good MD, why don’t we work to provide the proper incentives? I would think reduction of accounting work and threats for loss of employment do to ambulance chasers would be a start.

    • Furry Bear says:

      For those of you who think we are overpaid, why don’t you log off this blog, and get to work. 4 years of college, 4 years of medical school, and 3-7 years of working 100+ hours per week as a resident at roughly $8/hour. Think you can handle it? Why don’t you try that, accumulate that $150,000 debt burden, and then get back to me when you’ve put in the 11-15 years. Until then, get off the Internet. You’re wasting your time when there’s a bonanza to be made being an MD in America.

    • bob says:

      Do I think the AMA limits the number of doctors? The answer’s are in the charts people. While I don’t knock how much the average MD gets paid (it really is a pittance compared to the work you put in), the fact of the matter is that there seems to be a mysterious shortage of MDs. Also, when the author mentioned that doctors in the US get paid 2 to 5 times as much, he wasn’t quoting the salaries in Haiti or China. Heavens, no! British fully NHS-certified general practitioners average at 100k (USD) which is even less in Pounds. This is even less in EU countries. The cost of living is 50% higher in Europe than in the US (which kills the “we live in an expensive country” theory). Another question: does working them to death really equate to better doctors? An acquaintance from high school recently committed suicide after she botched a surgery after being subjected to crazy hours by her residency. Residency itself sounds like one of those ridiculously archaic things old folks say will “build character.”

  4. Rachel says:

    The AMA’s opposition to nurse practitioners may also be a factor.
    Didn’t they come out against NP-clinics recently?
    And yet it is acknowledged that the inconvenient hours
    and locations of the average doctor’s office do contribute
    to the overuse of ERs. So NP-clinics are helpful. But
    the AMA doesn’t like any competition, it seems.

    Thanks for the bar-graphs.

  5. Can says:

    agreed….we have a cartel here, is Obama aware?

  6. jd says:

    more training, competition, debt, and arguably more work than other professions-why should they deserve more money?

    You can’t just pop up med schools like some of these store front law schools, much more is involved in training physicians and the education is regulated so you have a well trained physician population

    more med schools and larger class sizes have been increased recently, so efforts have been made, but without increased residency spots its pointless, which takes government $, so encourage the government to increase residency spots rather than spend their time helping their lawyer buddies

    • s johnson says:

      why has the number of medical students remained constant? Don't you think 300 percent increased in population should be reflected with inn 300 percent greater number of qualified applicants.

      And, Isn't the 'more work' the direct consequence of cartel?

  7. Bronson says:

    It is actually a little of both. The AMA, through sponsored entities does limit both the number of med schools and the number of accepted applicants. It is also true that Congress effectively limits the number of residents since Medicare pays for the bulk of resident expenses in Direct Graduate Medical Expenses DGME).

    If AMA representatives want to blame Congress though, I’d like to see them also support getting government out of the medical field entirely and restoring free markets. When you let the bear get its nose in your door, it is going to come all the way in and eat you. It seems most every Association plays this game of trying to get the most money through government and then expecting they can control the strings that will be attached.

    Both Congress and the AMA should let the free market work. The clearest article I’ve seen on this is Milton Friedman’s article here:
    http://www.hoover.org/publications/digest/3459466.html

    Yes, there are not enough doctors. Yes the cost of medical education is tremendous. Yes, there is not enough competition between insurance companies in most states. Yes, there is too much “lawsuit abuse.” Yes, the doctor -patient relationship is broken.

    All of this can be traced back to government involvement either directly (regulation/legislation) or indirectly (distortions through subsidies or the tax code.)

    The answer is not more government, but less. If we continue down this path, there will not be a need for more residents or more schools, as government will dictate all terms of the profession and the “brightest” will look elsewhere for a career.

  8. Norris Hall says:

    For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

    “It didn’t happen,” says Harvard University medical professor David Blumenthal, author of a New England Journal of Medicinearticle on the doctor supply. “Physicians aren’t driving taxis. In fact, we’re all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers.”

    http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

  9. JR says:

    Dave,

    What do suggest the physician’s income should be? How do you determine their salary is “disgusting”? I can make the same argument for lawyers/electricians/plumbers and definitely pro-athletes.
    With your reasoning, why don’t we force the NBA and NFL to have 5x more teams. This would create more accessibility and hopefully, lower costs.
    I have an idea. Why don’t we allow high-school graduates who want to “help people” take a 2month correspondence class. If you pass with a 2.0, you can be a doctor. This would surely lower costs since the start-up costs for physicians would be minimal.
    I am not really advocating this approach, but the time and costs to become a physician is astronomical. Also, during this time, income is lost while many of physicians’ friends are out in the “real world” making very good money. I should know, I am a physician who owns an old car (and will keep if for awhile) while many of my friends are doing better than I ever will.
    I was one of the top students in high school and college. If you want to keep competent people interested in medicine, you have to shorten the training/costs or keep salaries relatively high. That is the real world we live in. Any denying this is naive.

    • Gordy says:

      Nobody put a gun to your head to become a Doctor, Doctor. If you wanted to make more money quicker, that option was open to you. You should have done more research into how long it was going to take you to become a country club member who plays golf more than practices medicine. Cry me a river.

  10. Ravi Sundaar says:

    I completely understand that the doctors have to be well paid and they need to be compensated for the ordeal they go through in the medical schools and the debt they incur going through it.

    Here is my argument against the current system however. You ask any doctor – they are over worked. There just are not enough doctors and to cater to the demand, they overwork. But, just like I don’t want a sleepless truck driver, pilot – I don’t want a sleepless surgeon either. Why not let the market demand determine the number of doctors we need, just like any other profession – or at least have a formula that measures up with the population growth? We’ll have enough doctors, well rested and maybe in the rural areas as well.

    It is well established that the AMA indirectly, in subtle ways, controls the number of doctors in this country, using various tools in its arsenal. It is quite appalling how they always throw the free market principles in everyone’s face except when it comes their own union members.

    These days I feel that if monetary reward is the primary approach to attract good candidates to a profession, it would hurt the profession in the long run; people in it will look for ways to enhance their income at any cost. That is obvious in the wall street. Not sure what the right number should be – why not let the market determine that rather than the AMA? Besides, there are enough contols (board exams etc) in place to ensure that the not-so-good doctors are weeded out.

    Regardless, with the cost of the healthcare going up, everyone that is sharing the pie has to give up some including the doctors, insurance companies and maybe even the patients…

    • doc dude says:

      hell yes Ravi. the process of becoming a physician is borderline insane. the amount of personal sacrifice is huge. brutal hours, no sleep. i mean literally like no sleep. work for 24 hours then try to catch 45 minutes when suddenly your pager goes off and you need to get your self together and run to the ER to evaluate some very sick patient with a complete small bowel obstruction. the pay isn’t really that great when you consider the amount of work, and the responsibility. i’m all for having more docs around, well-rested and on point. i’d rather there be more training years and less hours per week, so that i could see friends once in a while, and maybe enjoy life outside of the hospital a little bit, without sacrificing breadth of clinical experience. and the medical culture sucks. imagine doing all this work and basically getting treated like dirt by the higher ups, arrogant surgeons and the like. the whole system, and the whole culture, need to be revamped

  11. Td says:

    Again

    no increase in docs, without an increase in residency spots

    Medicaid funds them, which is controlled by the government

    like everything else

    • Ravi Sundaar says:

      You are right!

      The number is residents is controlled by the congress based on the amount of money they allocate towards residents’ payments. Unfortunately, it is the organizations like the AMA that lobby for limiting the funds – that’s why I was careful to say they “indirectly” control the number of doctors.

      Anyone who is against any union, has to wonder why and how this union was so powerful all these years …..

    • Td says:

      The AMA is weak, that’s why so few docs even belong to it

      medicine is competitive for a reason, do you really want your pediatric heart surgeon to be that dumb kid in glass who used to eat glue?

      Docs will gladly leave this country for Australia, France or wherever for a bit of a pay cut. And people with half a brain won’t be entering medicine for 300k in debt and no way of paying it off as well as education till they are 30 and long ass hours.

      Your health is the most important thing to you, why wouldn’t you want to take the best care of it that you can?

    • William says:

      The other option would be to facilitate the immigration of foreign doctors to the US. Currently, they must have a US residency to practice, no matter how experienced they are in their home country. It is simply hubris to take the stance that US medical education is inherently superior to medical education abroad.

    • Td says:

      It would negatively affect the US and the country the doc was leaving. The US because, inherently or whatever, medical education in the US is more thorough, pretty self evident when you look at duration and curriculum. Language and cultural barriers are also a factor. Their country because then all these docs flock to the US for more money and better opportnites leaving their own country in the lurch. We could do this for every job in the US, replace with an immigrant that’ll do it for cheaper, problem solved! Pull your head out of your ass

      And as an aside this is an article on lowering physician salaries in the US and you are really just arguing for increasing international physician salaries.

    • Ravi Sundaar says:

      I think there are any number of ways this can be done:

      1. Remove restrictions on numbers of doctors and instead, specify and enforce standards (to some degree this is already in place). I understand the argument that you don’t want anyone and everyone to become a doctor, but there are enough smart people who can and are willing. And, you test them. Universities would be willing to increase number of medical admissions, because there is money to be made there (look at the MBA offerings). More people will get into the program because of the rewards.

      2. Come up with a way for patients to bargain down prices. This is one of screwed up systems in which as a buyer (patient), I want to pay the maximum (the insurance pays for it after all), because I can get the best doctor/treatment. Or, at least, increase insurance industry competition so that they can bring in lower cost doctors (you need enough of them however).

      3. Just squeeze down the payment rates (needs government intervention) – the salaries are still high enough that people are not going to run away to other professions.

      4. Reduce the debt burden that the doctors complain about by looking at the training that is actually required for doctors. Many other countries are able to produce doctors cheaper. They do ok. One can argue that our doctors are better than docs from elsewhere. But, is that commensurate with the amount of money that’s spent? Do they actually require as many years in school, regardless of the specialty?

      I am sure there are holes in these approaches and there are other better approaches. But, broadly we have to rely on either the free market or mandated cost controls to lower the salaries. Right now, there are no cost controls and no free market since the supply is artificially controlled.

      Regardless, the wastage and amount of money in our healthcare system is so much that no one even cares about the doctors’ salaries. Rightly so. And that’s how this issue is swept under the rug, I believe.

  12. TW says:

    As a medical student there is one BIG thing I would like to point out here, the “average” salary is listed as ~200K. While that may be, this is certainly not the mode. Most physicians are, in fact, still in primary care (though we do need more) and most of these are making closer to 100-150K. The outliers are the cardiothoracic surgeons pulling in 600K+ or the plastic surgeons making bank. Well guess what, these guys deserve that much for a variety of reasons, market forces being one. There is a reason that big-shots from other countries come here for complex procedures.

    Also, just opening up more schools isn’t the answer. If you want to see someone less qualified, go see a nurse practitioner. They are very abundant (for good reason, it’s just a 4 year nursing degree followed by 1-2 years of graduate classes). Do you know what it takes to get into the off-shore schools? Basically you have to have a pulse and some cash. Plus we have new D.O. schools opening up, so don’t forget that, that makes the count more like 160 medical schools. Yes, D.O.’s are pretty much identical to M.D.’s, albeit with the OMM garbage thrown in.

    • TW says:

      Oh, and P.S. It is a well known fact that most physicians are not part of the AMA. The majority of their membership is medical students, and most of us join because for 50$ they give you a pretty nice dissection kit. So keep that in mind. Doctors are decent people for the most part.

    • Ravi Sundaar says:

      I think most people will agree that doctors need to be well paid for what they endure and also the nature of the work. I also believe that most doctors are nicer than average because those are the kind of people the profession attracts; otherwise, they would have gone to the wall street.

      The issue is not whether doctors’ salaries should be high but why it is high. This discussion was primarily about whether the market should determine the salaries or whether the number of doctors produced should have been commensurate with the population. Either of these approaches would have been fair. What’s not fair is the controls that have been in place to keep the salaries high.

      It’s true that the AMA suffers decline in its membership. It is true that the AMA has reversed its position on the number of primary care doctors recently. However, these are fairly recent transformations and will take years for the effects of these changes to propagate.

      To deny the influence that the AMA has had in our politics is ignoring the facts, although I am glad that their influence has decreased. I would be equally glad when the influence that the pharma and insurance industry lobbies decrease as well.

      Nevertheless, the problems in our healthcare industry are so huge that doctors salaries won’t make much of a dent. There are much bigger fish out there.

      Ravi.

  13. Rick says:

    Twenty years ago I worked like a dog in college
    and mustered a 3.2 grade point average. I applied
    to 50 medical schools in the U.S. and Canada and
    they told me I was “ineligible.” A student must
    have a 3.8 GPA or higher or he or she is “ineligible.” It was horrible. I went to medical school in Mexico and was down there for 10 years through some wild & wooly adventures (the Americans I knew down there were horrible while the Mexicans were mostly decent people).
    The requirements to be eligible for U.S. and
    Canadian medical schools are beyond the mental
    abilities of 90% of all pre-medical students-
    hard-studying pre-med students who muster GPA’s
    beteeen 2.0 and 3.7 have no chance at all.

  14. Jordan says:

    An important aspect to remember is the great cost to train a medical doctor. While medical students often complain about the extreme amount of debt that is acquired over medical school the state and private donors both are also contributing to the cost of training each student. While a shorter of doctors is a real problem the problem. Increasing the number of medical students would be expensive and may not help at all. The real problem in the United States is that too many medical students are going into tertiary care. We have way more dermatologist that we need, but not enough primary care doctors. Increasing students may give us more primary care doctors, but it will also give us more tertiary care doctors. I would argue that the increasing tuition costs associated with allowing more medial students into each schools will only make the imbalance worse as students are more likely to enter tertiary care, which is better paid, with more debt. The real problem is too many tertiary care doctors, not that there are too few doctors.

  15. The number of new physicians coming out of our nation’s medical schools has been flat at an average of around 15,800 since 1981, which is almost 30 years of historical data. To meet demand, the supply of physicians must be increased, or at least considered by economists. More at:

    http://wjmc.blogspot.com/2010/04/training-new-physicians-in-us.html

    Thanks for the opportunity to comment…

  16. Frank says:

    Doctor’s salaries should be determined by free market. Unfortunately, in our capitalist system, we make an exception in the medical industry and allow the AMA to limit the supply of doctors to artificially inflate doctor’s salaries.

    The problem is that there is a major conflict of interest. Memebers of the AMA are doctors. Once you become a doctor, it is in your interest to have less doctors to compete with for your salary to be higher.

    Doctors have the AMA.
    Lawyers have the BAR association.
    Auto workers have their unions.

    What ever happened to true competition?

  17. Garrett says:

    The typical US Medical School graduate finishes medical school at age 28 with >$250000 of debt. This debt will accumulate over the next few years of low pay, long hour residency programs.

    At age 30-35, halfway through life, US physicians have sacrificed their youth and taken on $300,000 in debt. Should this be rewarded in some fashion?

    Physician supply is not the whole story. Canadian medical schools have only a 25% acceptance rate, much lower than American schools. Their tuition is greatly subsidized, however, as are the tuitions for most of the nations on the graph.

    The story also make zero mention of the issue of specialists. The US has the capability to train more specialists, these physicians are paid more. You are comparing specialists to primary care physicians in the graph.

    Perhaps Mr. Perry is jealous that ignorant that distill incorrect information from a few facts don’t get paid.

  18. Anon says:

    Rick is completely incorrect. I attend medical school, and I did not have a 3.8 GPA. Schools do not deem anyone "ineligible" based solely on their GPA. Admission is based on a compilation of factors, which include GPA, MCAT scores, volunteer and EC experience, etc., and it is done on a school-by-school basis and a case-by-case basis. One factor alone does not make one "ineligible."

    Garrett is completely right. After medical school, I will have invested over $300,000 and 9 years of my life training to be a doctor. If you start decreasing the pay for physicians, which decreases the amount of compensation not only for time without pay invested (that could have been spent earning money in another field) but also compensation to pay back those loans which have likely doubled by the time you are able to pay them, it will only make the problems of physician shortage worse. Who wants to enter a field where you cannot be compensated for your hard work and investment? If that happens, you will lose the best and brightest medical students and end up with less capable and fewer doctors, and everyone suffers.

    What about complaining about nurse practitioners and nurse anesthetists, who basically have a master's degree yet make more or the amount as many doctors? Talk about artificially high salaries.

    • Pronto says:

      Teachers in Chicagoland make an average of $150/hr in total compensation. They only need a B.S. degree. If I were someone who went to medical school and sacraficed so much to be an M.D. and then saw what these teachers make, I’d feel pretty cheated! Of course the teachers here don’t feel cheated- they point to how much professional athletes make… It’s funny how people reconcile things :)

  19. Richard says:

    The author correctly points out the fundamental absence of free market forces in the US to
    determine the number of US doctors and corresponding salaries. Market forces must come to bear on this
    problem, and eventually overwhelm the medical cartel's lobby that has leeched the US public maintaining
    excessive fees contributing to unsustainable health costs. This abuse
    of free markets is a dangerous handicap to the health of the US economy.

    Of course doctors will cry foul. They want to hold onto their absurd salaries, and they perpetuate the myth
    that medicine is for the 'best and brightest,' and therefore opening more positions will lead to weaker doctors. This is tired propaganda. Most doctors simply repeat the same
    decision tree within their sub-specialty following known look-up procedures: "if this lab result, then administer this drug.'
    This is not rocket science. A person with average scientific ability, given the dedication and training, can easily have the capacity to be a fine doctor, and thus the potential supply of fine doctors is enormous.

    When the free market decides what a doctor earns, it will be significantly less, and more in line with the corresponding salaries of the rest of the industrialized world.

    • erik says:

      Decision trees? Really? Richard, you do have a choice. Feel free to get all of your medical care from a nurse practitioner working out of a cookbook. Good luck.

    • Scott says:

      In the interest of responsible disclosure: I’m currently a medical student at one of the US allopathic schools.

      Hahahah Richard, those comments are hilarious. Please, by all means, next time the child of you or someone you know has a fever and a rash and starts coughing, forget going to the doctor. Just look up their symptoms on Wikipedia or WebMD! Or if you’re not of “average scientific ability,” just find someone who is! Such laughable comments could only be made by someone who clearly lacks even the slightest clue about what it takes to diagnose a patient with only a vague constellation of symptoms.

      If “average scientific ability” is all it takes, why then is the MCAT such a show-stopping hurdle for so many people? Why is organic chemistry such a weed-out class? Orgo is MUCH more of a “flow-chart” driven process than medicine is, yet it is possibly the single greatest hurdle that cuts down on the number of pre-meds. And to get into orgo, a student has to satisfactorily pass general chemistry, thereby demonstrating at least “average scientific ability.”

      As has been said, one of the greatest drivers of costs are things like unnecessary tests and imaging. If we followed your cookbook method of medical delivery, even more of those tests would be necessary to diagnose a particular type of infection. We’re taught over and over in medical school by older physicians that the vast majority of illnesses can be effectively diagnosed with a properly conducted history. Things like MRI and CT are not indicated anywhere near as much as they’re used. And they’re extremely expensive. Next time you go to the doctor and have one of these tests done, look at how much goes to the physician, and how much goes to the facility providing the imaging. You’ll be shocked at the disparity. Patients unreasonably DEMAND these things, which cost several thousand dollars, even when they’re not indicated medically. Then they get mad when healthcare is expensive. Unfortunately, too many doctors just allow the expensive procedure or write the prescription because it’s easier than trying to educate the patient as to why it’s not needed. Some do worse – some own the radiology facilities they refer patients to, which is a clear conflict of interest. The CBO estimates that as much as half of the growth in healthcare spending in recent decades is due to technology. (http://en.wikipedia.org/wiki/Health_care_in_the_United_States)

      Patients don’t fit into flowcharts, and to be perfectly blunt, that’s an asinine assumption that belies your understanding of science and medicine.

      It’s been said a few times in the discussion thus far, albeit not emphasized, but all of those who think it’s easy to just open up more schools need to realize that the tuition a student is charged does not even completely cover what a school must spend to educate that medical student. Every single medical student trained by a US medical school is a loss for the school. It’s not just a simple “open the doors and let ‘em in!” process.

      People have said that we just need more doctors, which would reduce the overall burden on the system. People don’t want doctors who’ve worked long hours. I don’t either. And studies have shown that people who’ve been up for many hours make more mistakes. It’s also common sense. But at the same time, the greatest number of medical mistakes arise out of problems during patient handoffs. Every time a patient is passed from one healthcare provider to another, there are chances for things to fall through the cracks that lead to negative outcomes. It’s something else that we need to find a long-term solution to. But in the interim, statistically you’re often better off with a doctor that’s been on for the past eighteen hours rather than being handed off three times during that time period.

      Comparing law school to medical school is just plain silly. If you crank out bad lawyers, what’s the worst that happens? People lose some money paying said lawyer, they don’t achieve their desired outcome, wind up in prison when they didn’t deserve it. Which is a terrible outcome, mind you. I agree that it’s far better to let ten guilty people go free than wrongly incarcerate one innocent. But a single bad doctor could result in the loss of many lives, and a serious reduction in the quality of many more. The quality controls are vastly different. Physicians have to pass many more verification processes before they’re granted autonomy in practice. This isn’t arbitrary, but it’s designed to ensure that patients are protected while doctors in training learn everything they need to learn.

      The number of allopathic residency slots is controlled by the amount government pays to hospitals. Those slots unfilled by US allopathic grads are currently are filled by US osteopathic graduates or foreign medical graduates (FMGs). Even if we could increase US allopathic enrollment, as this article suggests, it would be moot as the end result would be merely fewer osteopathic and FMGs filling the same number of spots. Can the number of spots be increased? I don’t know. It’s not a simple matter of just accepting more people – residency programs will have to determine if they have the capacity to train more people than they currently do. Training more residents requires more attendings to oversee them, and thus more costs. It’s a lot more complicated than just “let more of them in!”

      The graphs in the article that track medical school applications over the years 2003-2008 are disingenuous at best, and evidence of poor research methodology at worst. Medical school applications are cyclic, and the increase suggested to be such a problem in this article is just the latest iteration of the cycle. It’s not news. Heck, numbers that demonstrate these cycles are available on the very link provided by the author, so I assume they were intentionally left out because they contradicted the point he attempted to make. Get the real data here:

      http://aamc.org/data/facts/charts1982to2010.pdf

      Also, the author was not clear that these numbers only reflect allopathic schools. No mention or consideration is made that osteopathic schools have been increasing in number and enrollment.

      “Average physician salary” is a meaningless, misleading metric. Primary care docs make very little compared to some specialties. Cosmetic plastic surgeons and (mostly) cosmetic dermatologists are included in there, but many of them don’t take insurance and only accept direct payment from patients. Do they make a lot of money? Sure. But they offer a service that people are willing to pay out of pocket, and they aren’t contributing to healthcare costs as we typically think of them.

      The numbers also need to be considered in the context of physician expenditures. Surgeons and ob/gyns are included in the “average” as well. But in some places, malpractice for an ob/gyn can reach nearly $300k. Per year. That’s a HUGE amount to take out. We have a drastic gap in this country between reimbursement of different specialties. Some of it reflects greatly increased training time (residency for internal medicine is three years, for neurosurgery it can be as long as eight years) and increased malpractice costs. Unfortunately, some of the differences are arbitrary. There’s definitely room for improvement here.

      Do we need reform? Sure. But as has been said, physician salaries cannot be considered in a vacuum. And what’s wrong with the person who will save someone’s life being compensated decently for it?

    • MSme says:

      “Things like MRI and CT are not indicated anywhere near as much as they’re used.”

      This quote hits the nail on the head. I spent the first two years of medical school having to justify, in detail (and sometimes in vain), why I thought a certain test should be ordered. Some of our assignments were graded partially on the cost of those tests – the higher the charges to the patient, the lower your score. You had to perform a focused and appropriate exam and order only those tests that were necessary and justifiable.

      Now that I have moved from the classroom to the clinic, those teachings, it turns out, were only done ‘in theory’. I am appalled at how many patients are sent for CTs that they absolutely don’t need. In fact, I’ve been reminded, by my fellow students, to tone it down a little bit because I spent most of the day asking the attendings if the patients really needed those tests. On more than one occasion someone has said ‘the patient had a CT of the head’ and I uncontrollably spat out ‘which showed what? that he had one?’ I’ve also referred to d-dimers as ‘d-dumbers’ and have a reputation in my current rotation for being very vocal (and very opposed) to giving every patient GI prophylaxis and daily boluses of heparin to prevent DVTs.

      The fact remains that so many of these things are exactly as you put it: not indicated nearly as much as they are used. I think I’m going to seize from frustration and anger the next time I hear one of my friends/classmates say ‘yo, CYA buddy’. Not this guy. Beneficence first, foremost and always. My hope is that at some point in my career we will return to a time when physicians are also poets, philosophers and priests.

    • Michael Clark says:

      Of course MRI’s are used too much, because insurance pays for it — someone else pays for it. And patients visit the doctor too often, because if the patient’s mind they are covered, it’s almost free.

      Want to change that? Offer cash kickbacks at the end of the year to workers who do not use insurance. Stay healthy, stay away from your doctor: get cash back.

      It’s a fixed game now, between all levels of healthcare providers, as long as benefits are part of the guaranteed pay packet in most businesses — insurance companies fix prices and pass the cost on to workers. Why have workers not had salary increases for several decades: because salary increases go straight into insurance companies’ pockets in the form of ‘mandated”cost of living’ insurance coverage.

      If workers don’t go to the doctor, they get their salary raise back. Watch how fast this changes everything!

  20. Neil says:

    My Wife has graduated medical school and still has not been able to get into residency training because they restrict the number of residents too. I know many doctors who are not working for this reason.

    • Michael Clark says:

      This is insane. We should flood the market with qualified doctors. Of course, the AMA wants to maintain the exclusivity of the professions, for the money and the status.

  21. Norman says:

    I find this article very amusing. In my country, physician salaries are many times lower than that of many jobs, and yet skyrocketing healthcare costs are still a problem. Perhaps people are just jealous that American doctors earn one of the highest salaries, but we need to stop trying to denigrate a profession on the selfish example of one country.

    Perhaps we’re being too reactionary about the idea that we have to restrict entry into medical school to the very best and brightest, such that we have to turn away nearly half of all applicants (three-quarters in my country), which may seem so very inegalitarian, or maybe I’m just jealous that US physicians are one of the best-paid in the world, but at the end of the day, I’d rather it this way. I want to be assured that the person who is in charge of my life and that of the fellow in the opposite bed is competent for the job. The person who says that a doctor only needs ‘average scientific ability’ obviously has no idea what in the world they are talking about. Training to make decisions on other people’s lives is nothing like your community high school.

    Stop spouting this rubbish about complete liberalisation as the magical panacea to all problems. Think about it, how much of the world shows as much fervent zeal to this vague notion of a ‘free market’ as do Americans? And look at how much better they are faring. Even Europe is headed out of this financial crisis faster than the US.

  22. erik says:

    the author seems to lack a fundamental knowledge of how physicians are reimbursed in the US. For medicare patients, CMS sets the rates for certain services that is not at all based on supply and demand. A physician cannot charge more than what CMS says that service is worth. Private insurers base their reimbursement rates on medicare rates and their may be a copay.
    The only way to bring supply and demand economics into the equation is to eliminate third party payors (e.g. lasik, cosmetic surgery,concierge)
    The AMA is essentially useless and only represents 18% of physicians and steadily declining. There main purpose is to make money off of the CPT codes. They definitely arent holding back the number of physicians in the US.

  23. Brian says:

    I’m in medical school, and my cousin is an accountant. Together we crunched some numbers (fairly conservatively, assuming that I’d only be able to invest money in hand now at a 5% rate of gain, assuming a salary well above the average MD salary (b/c of specialty preference), assuming that in my career as a non-MD I would not reach above middling success, and also using tuition at a low-cost (in-state) medical school).

    Given my education level at which I entered medical school (B.S. in Biochemistry and B.S. in Biophysics) the amount of money I would make in a lifetime by immediately seeking employment vs attending medical school, completing residency, etc, once you consider inflation and interest, differs by 2x. So, by investing 7-11 years of my life into more education (and it truly is an investment requiring sacrifice, I am not able to have a normal life with the amount of time I spend in class (40+ hours/week) plus studying (additional 40+ hours/week), and it only gets worse until you become a practicing MD) I end up making twice the amount of money. Keep in mind, this is b/c as a physician there will be less time that I am actually making money, and I could have been making interest or investing in things 7-11 years sooner by not entering medical school. According to the accountant’s calculations, it will take at least 22 years before I end up making more money going the MD route as compared to seeking a laboratory job right now. So even though the “average salary” is at least 4x as much for the MD over the industry researcher salary for someone with 2 B.S.’s, over the career the MD only makes 2x as much money, after having invested all that is needed into becoming an MD. The other consideration is that for an MD in the field I considered, an average work week consists of 58 hours. That’s a pretty high average, and compared to the salary of a researching working 40-50 hours a week average, precludes some significant aspects of life.

    I think that cutting physician salaries is perfectly reasonable. But in doing so it would be necessary that medical school fees be considerably reduced, if not made almost free, and that students should be salaried on day 1 of school. It actually would be preferable like this in the long run, I could save up and buy a house in a few years, rather than living entirely on loans that are accumulating interest, and having to wait 7-11 years to invest in a home or any other big aspects of life.

    Although many readers probably wouldn’t believe this, the salary actually didn’t have a role in my decision to attend medical school. It was the significance of my daily work that was more important to me. Also, it is my impression that the selection criteria is moving more and more towards favoring people who have demonstrated (not just claimed) this kind of motivation, as opposed to people who get great GPAs and MCATs. So, if in the course of health care reform doctor salaries are decreased, I wouldn’t be terribly disappointed, especially if it meant I could have a 40 hour work week and spend more time with my family.

  24. Brian says:

    Also, I forgot to make this part of my initial post. I am confused by the claim that the number of doctors coming out of medical school has not changed. Mainly because there are more and more DO schools opening each year. Or was this count only including MDs? In which case it is not valid, as a practicing DO is the equivalent of a practicing MD in what they can and cannot do.

  25. Whitey says:

    Here in Vegas there was an article that dentists are really hurting in this economy. We have a surplus of them, and they are competing heavily for business which has become thin. I can get x-rays and a cleaning for $60. Normally $250. The free market is a good thing.

    Don’t get me wrong. I’m glad that you make great money as a Doctor. When I hear wealthy Americans bitching about a 3% rise in their taxrate, that would give most Americans access to affordable healthcare it chaps my ass a bit. It chaps me even more when the healers in our society think about their personal pocketbook instead of the human cost to good working Americans who are denied treatment or suffer due the inability of being able to afford it. Doctors, at the very least should understand the dynamic that keeps their salaries high and keep an appreciation for it.

    1. I say go ahead and give the Doctors what they want: Tort reform so they can practice good medicine without the overwhelming worry of frivolous lawsuits.

    2. Get rid of insurance companies. Create a Not-for-profit system so that the 20-30% which is strictly for making wealthy businessmen wealthier is not a cost to the Doctor or the Patient.

    3. Allow Doctors to compete in the free market like everyone else. Why should so many worthy students never achieve their dream of being an MD. (As Obamacare was approaching law, the Republican party suggested interstate insurance coverage (as well as the Not-For-Profit idea). Competition between ins. companies would lower healthcare costs. I’m suggesting cutting out the middleman and letting Doctors compete for patients). Good Doctors will thrive, and shitty Doctors will starve. I realize medicine is not perfect and therefore results vary based on many many factors. But keep in mind that MD is one of the few professions who are paid regardless of the result. Why shouldn’t they be held to the same standard as every other profession?

  26. Breakondoctors says:

    It is very absurd that a doctor (MD or Surgeon ) is getting to much of cream. Government should act on this and in my opinion free market will be the best option. Let the market decide what should be the salary of a doctor. In other places like Europe and Asia, medial is very cheap and comparably of good quality too. If there is any limit on the schools or no. of medical students, it must be removed to make the free market play. Till now, Medical condition was good in this country because of high income of population but with downturn of economy, there are people who need medical service cheap and government should think about them too.

  27. Engineer James says:

    Seems clear to me that the government should sponsor the creation of new medical schools and increase the pay of med school professors.

    Additionally, med school should be part of the undergraduate degree or replacement (like in India?).

    Both recommendations above should increase the volume of graduates. Additionally, increasing the number of med school professors and schools should (in theory) also advance medical research faster.

  28. chad davis says:

    I am a doctor in the USA and I would say what I earn is ridiculously high for what I do. I earn about 520-550 k/yr and after paying everyone I get to keep about 250k/year. It works out to about 21k/month for about 50 hours per week of work.

    I think I work very hard but it’s all relative. When you compare it with the construction workers I see outside my office everyday they have it much harder, at least physically.

    I do feel it’s more than I need but so far I haven’t offered to give any back. lol.

    I guess what I am trying to say is that I would do the same job for around 100k/yr if that was the going rate and still feel good about it. Anything less and I would probably not think the extra hassle of medical school ,residency, debt, etc was worth it.After all 100K/yr jobs don’t grow on trees unless you work for the govt( snicker)

  29. John says:

    Maybe MD salaries are high because it’s one of the hardest jobs on the planet with the worst hours and a decade of training that you have to go several hundred thousand dollars in debt just to go through? And all the meanwhile the public views you in a negative light and wants to take your pay at the same time you’re treating them, despite already deciding their base pay through medicare?

    Maybe they’re not high enough.

  30. GaryP says:

    If you complain about a physician’s salary (Richard, Dave, etc.), how much do you get paid for what you do and what do you do for a living? I assume you have no valid points to defend your pay because if a physician’s pay is inflated, your pay is likely far more.

    People who don’t see the hard work put in by the “rich” are just simply haters told by the Democrats that they deserve everything for doing nothing. Somehow the kid eating glue or can barely add should be an equal to the brightest because “it’s not fair.”

    And Chad Davis is a troll. You don’t sound like a physician who sounds like he put in the time to become who he is now. Any physician who does not defend his/her salary in such a time is absurd. When the public thinks pro players and celebrities deserve millions by supporting their careers through tickets, merchandise, etc. but crap and moan about paying for necessary services such as education and care (police, firefighters, etc.), they deserve a stick up their own due to their poor priorities. This is how this country will fall because losers will continue to think that they deserve the same as the motivated. And guess what, the losers (75% plus of this country) make way more than hardworking people in other countries. So shut up.

  31. JustAnotherMD says:

    I’ve read through this LONG and exhausting debate…

    I finished medical school recently and am now training to be an independently practicing physician (i.e. a resident). I started out with a $36,000-ish salary (i.e. I got about $2200/month after taxes and all), $140,000 in medical school debt, and was living at home so that I could pay about $1000/month to prevent my loan from becoming $200,000 (which it would if I decided to defer and pay it when I’m done with my training).

    When my family needed some official paperwork from an attorney – just a short visit (appx. 15mins), a phonecall (appx. 2mins), and a letter typed by his secretary and signed by him was over $500! He began working at an attorney at age 25. If he screwed up, how much could he be sued for?

    When there was a leaking faucet that I couldn’t fix in the house, the plumber charged $65 just to come and take a look at it. It took him just about 35mins to fix it and he charged a total of $130. He has a highschool degree and began working when he was 18. If he messed up, causes more damage, how much do you think I could have sued him for?

    I will be around 32 years old when I finally start making the “big bucks” that many people on this site are screaming bloody murder about!

    I went to a conference recently and learned that when a cancer patient visits an oncologist for chemotherapy and a scan to monitor progress (ordered at an appropriate time as stated in researched and validated guidelines), the cost of that day’s visit is about $30,000. The physician payment of that is only $250! The chemotherapy cost is about $17,000. The scan costs about $9000. And the rest is the cost of administering the chemotherapy, nursing costs, facility costs, etc. The cost of drugs and scans is MUCH MUCH higher in this country to offset the “loss” in income by the manufacturing companies when they offer the same drugs/scanners in other countries. Simple fact – medications in Canada cost one-third to one-fourth what they cost here. THAT fact by itself is a reason for the high cost of healthcare.

    When a surgeon in a hospital performs a cholecystectomy (gallbladder removal), the patient is billed $2800, but the physician’s pay is only $800 of that amount. And that’s BEFORE he has to pay the malpractice insurance for that procedure. If he makes a mistake and there’s a complication, and he gets sued… he pays a LOT more. Don’t get me wrong, if it was an obviously preventable mistake (wrong surgery, wrong site, wrong patient, etc.) he deserves to be sued and face the consequences from a medical board.

    An OB/GYN gets paid about $1400 for the entire 9 months worth of office visits, labs, ultrasounds, and time with a pregnant woman if she is on Medicaid. And he can be sued for a potential pre-natal or delivery-complication for up to 18years after the child is born (i.e. when the kid’s 18yrs old)… And anyone who’s been pregnant or been the expectant father know how many OB/GYN visits there are in those 9 months. And if the mother wasn’t taking her pre-natal vitamins, decided to drink alcohol, do any kind of drugs, etc., she may still sue the doctor for problems with the child. Even if the case is dismissed by a judge, the lawyer fees, emotional turmoil of a lawsuit, lost wages during the preliminary lawyer visits and hearings, and the stigma of being a “doctor who was sued” is NEVER compensated by ANYONE!

    When you make $300,000 as an OG/GYN, but pay $150,000 in malpractice insurance, you’re left with $150,000/year. That’s a good income. But those OB/GYNs work a LOT.

    Pharmaceutical Reps used to wine’n’dine doctors, which they can’t do any more. I’m all for stopping that stuff. It’s unnecessary and unethical. But, lobby groups still wine’n’dine other high-paid professionals.

    I don’t understand why there isn’t such a STRONG uproar about lawyer fees. I spend about 30-60mins a week on the phone with patients I’ve seen in the hospital, and more time on the phone with other physicians coordinating a patient’s care. Why can a lawyer bill for all that “air time” and a physician can’t? I’ve filled out a TON of insurance paperwork for my patients. But there’s no extra charge for that… HOWEVER, when a lawyer writes a letter for you, there’s a bill for that?

    I won’t say that there aren’t corrupt physicians – there are. I know one personally and he makes me cringe whenever I see him. I often wish all sorts of ill-will toward him when I see the poor care he provides his patients when they end up needing to be admitted to the hospital for a preventable situation.

    I think it’s funny that in this country people are mandated to pay for water (you all get a monthly water bill), which is considered to be a necessity for life… but aren’t mandated to have health insurance. They’re required to have car insurance, but not required to have health insurance. And are willing to smoke 1, 2, 3 packs of cigarettes a day, drink a 6-pk of beer a day, and eat fast-food 2-3 meals a day… but won’t divert any of that money to paying for healthcare (or even a healthier lifestyle)…

  32. Tom says:

    The MDs defending their high pay don’t realize that there are many professions that also require many years of education and yet lead to a fraction of the pay that MDs receive. A typically PhD has a college degree, 7 years of graduate work and many also have posdoctotal training. Starting salaries are under 100k and don’t increase much afterwards (maybe 50 percent over 20 years). Of course, everyone that studies for over a decade deserves a great salary. But in reality, pay is determined by market demand. The reason why doctors make much more in the US is not because they trained longer, owe more money or a better than those in other countries. It is simply because our system has a number of incentives, such as tax deductions for insurance, restriction in the number of MDs, and the fact that Medicare reimbursement rates increased for decades with little control. Our system is a perverse combination of private and public incentives that has resulted in growing medical costs for decades and now may bankrupt the country.

  33. Jim says:

    Stop being jealous people.

    Everyone in the US who wants to be a doctor can apply to medical school. If you want to help people and make great money while you are at it, APPLY TO MEDICAL SCHOOL. No one is stopping you. You set out the path of your life. All we have is a bunch of whiners. If you want to complain about obscene salaries, talk about professional athletes.

  34. Jake says:

    Remember that residents (although they work hard are paid 50k/yr). Most docs I know are actually not the cream of the crop. They are usually not engineers, and where there undergraduate degree is from is irrelevant. It is just GPA/MCAT.

    That’s why it bugs me when the AMA or MD advocates crow on about attracting the best and brightest. Guys, as an MIT engineer and regretful wannabe doc, I know too many engineering colleagues who couldn’t even apply to MD because of a low GPA, while third-tier, non-engineers, who have a higher GPA get the nod.

    Should I do it over again. I would have gone to an easy school, picked some fruitcake major, and applied to medical school.

    PS: My life sucks now, as I design those scanners for rad oncs. who pull in 300-400k while I struggle to make 100k. I struggle with deadlines, issues with job security, while those docs press some buttons on my machines. Bottom line: if anyone has a right to whine its engineers, especially those who design medical technology (imagine medicine in the early 1900′s).

  35. td says:

    well you sound unbiased.

    Such a cry baby, you didnt get to be a doc so now you complain and downgrade those who are

    You have no idea how much more demanding medical schools is than any undergrad degree, and throw residency on top. It never ends as well cause drugs and technology change, as well as new diseases and understanding of old

    They do a hell of alot more than press buttons on a machine

  36. td says:

    any engineer who really wanted could go take some classes part time to boost his gpa, I had to as I was an engineering major as are many in medical school. So its your own lack of effort/shortcomings

  37. Jake says:

    I have a M.Eng from MIT and a PhD from UCLA, not just an undergrad degree. I’m saying my ugrad engineering GPA (3.1) is much more rigorous than a 3.7 from some fruitcake school. Im not disputing that once you are “in” medical school its not rigorous.

    You do know that its not “docs” that deal with changing drugs and technology…its mostly PhD’s who are lower paid than doctors.

    The bottom line: Doctor’s in other developed countries are compensated far less, but is their “technology or drugs” different from that in the USA? No its not…US doctor’s salaries are higher because there are fewer doctors, caused by a limitation of supply.

  38. td says:

    You are really cherry picking the argument. Physicians dont determine or have anything to do with emgineering compensation, thats you being shorted by your company. In other countries the governments invest in their technologies and here wall street runs it.

    First off Phds are not the only ones developing drugs and technology, many MDs and MD/Phds as well

    Second off the drugs/technology are the reason for the rise in healthcare, not docs. So you can read all these articles you want, written by people with these private interests in mind. I cant find the most recent, but physician salaries were quoted by the ny times as declining 7% from 1995 to 2003. I’m sure more since then.

    Yea everyone makes alot less in those countries and the only reason medical tech/drugs do not cost more is the government collectively bargains to get at a lower price and we end up subsidizing the companies profits

    The developers of drugs/tech are the ones that make the real money in healthcare and have
    driven up the costs, some are amazing some drugs show little improved efficacy

    If you genius MIT Phds think you should be paid more maybe instead of whining on an internet board and insisting that a profession be paid less, you should demand more money from the company that pockets the profits from your innovation or passes off to shareholders. I dont see what physicians have to do with that. Only a chickenshit blames someone else when they cant fix their own problem

    I think their should be more doctors, I dont give a crap or am trying to get more “business” but the only area that limits their supply is residency spots and thats the federal governments area. The AMA has nothing to do with suppply of residency spots, they arent even a real union and its only members are med students most practicing docs know that.

    And the LCME has greatly improved the number of medical school spots as well as building more schools so it will be less of an issue and an antisocial baby like yourself can get in next time

    Also note with decreased salary, increased overhead, debt increases of 100% in a few years, the opportunity cost of delaying entry into the workforce, physicians are not overpaid pigs you make out. They definately used to make more but no will argue its very different and has been for a long time. They were never the reason behind healthcare costs and sure their are some assholes like any other profession who are greedy, but dont generalize. They are still a very hardworking and caring group of professionals.

  39. td says:

    Turning physicians into 50k a year government employees will not stop the rise of healthcare costs because it was never the driving force and you can be sure you will be getting substandard care as the debt load will preclude many more qualified people from pursuing.

    We have a very different and complex patient population in the USA, you cant compare it to germany or canada. We have a large percentage of foreign born patients and this makes medicine here uniquely complex and difficult with each population having different disease incidence and culture, as well as higher violence rates and drug abuse that makes healthcare demands

    bring those 50k german docs over here and pay them the same and theyd last a week

  40. td says:

    Since you are such a brilliant MIT grad you should also be able to understand some basic math and economics

    You struggling to make 6 figures is not the same as a doc out of residency with 250k making 160-180k.

    You graduated with zero debt as a Phd, so break out a calculator, and see what kind of take home pay each has when the average interest rate is 7% and they are taxed at a higher rate. Then why dont you divide that by the number of hours each makes. See how long till it takes the physicians life net income to be more than the engineers, if it even does.

    This article insults everyones intelligence when you dont consider hours per week worked for that income and debt load. In those other countries physicians graduate debt free and work less per week, its not much different and after considering for those you should know something about medicine, genetics, epidemiology, disease and the USAs particularly difficult mix

  41. td says:

    http://www.er-doctor.com/doctor_income.html

    here lifetime earnings vs ups driver example

    and if you want to talk about docs who make a higher income you have to consider the 35% overhead a practice has and their higher tax rate

    this outdated too so debt is much worse in just the past 3 years. my tuition has gone up 34% since then and using universities own audited statements its been going to subsidize hospital/healthcare for others and research money for Phds and some research with private interest connections

    I cant read another one of these BS articles that are so deceptive and insult the reader so much that they cant do a normalized comparison

  42. td says:

    And I think innovative professions like yours should be paid more, and would have no problem with them being paid more than MDs

    But our salary has nothing to do with yours, its the companies/CEOs that profit off your innovation and I dont know what you expect to change by insulting MDs and the difficulty of medical education.

    welcome to the real word where your education and intelligence arent the basis of compensation but business and the ability to screw others, who are the drive behind innovation, out of money is

  43. td says:

    And if youd like to make MDs salaries as little as other countries all you need to do is follow their method
    -shorten their training, they consolidate undergrad/grad so 8 years becomes 6
    -pay for education like them because theyd be bankrupt immediately after starting work
    -pay them more during residency like they do relative to ours
    -have mds work fewer hours like they so and see fewer patients in the same hour as they do
    -change the US population into a homogenous group as theirs are, making diagnosis and treatment far easier because of genetic and cultural factors
    -reduce homocide/suicide/assault because that is a heavier burden on healthcare here to treat
    -expect less medical innovation (not drugs/technology) as our mds through clinical research produce more studies on better surgical procedures such as organ transplantation and others that are beyond my knowledge base, clinical outcomes for different lines of treatment in every specialty. And although engineers may make innovative technology/drugs on their own they do not have the clinical training or knowledge to implement or study their efficacy after development. So their demand will go down and you will see salaries drop further.

    And you will inarguably see a less qualified MDs practicing because like anyone amd anywhere a hardworking and intelligent person will seek a job that compensates them more adequately for such a long and difficult training process. It has nothing to do with being greedy but why would anyone spend an extra 5 years if you consolidate, or 7 here minimum, post undergrad to work more and get paid slightly more than other career options. It has nothing to do with money as your motivation, proper compensation and caring about peoples health arent mutually exclusive. Everyone has a mixture of motivations when they make any choice, you are not going to find 1 million saints in the US to do the job and beyond that just because someone is a saint doesnt mean they will make a better healthcare practicioner. They need to be able to have the aptitude, study skills, and dedication. I’m no smarter than most but I know how to absorb the amount of information needed.

    You want to control healthcare costs you need to cut the middle men that profit an drive up costs, government, insurance and businesses

    For every dollar you pay in insurance, self reported non-profit insurance companies report only 77 cents goes to healthcare costs, for profit with shareholders report 83 cents

    the rest goes to administration of company, salaries, and profit for the for profit ones. If you a public healthcare system it would be the same figure, less of your tax money that paid for it would go towards your healthcare and more towards all the money the government can steal, spend on jobs for their friends to run

    you only need insurance for something you dont anticipate happening and you cant afford, like wrecking your car or a tornado tearing off your roof

    you know you are going to spend money on doctor visits or meds this year so you should have a high deductible plan, cheaper, pay the rest yourself because you get less for what you pay through insurance

    Look up what the few practices that can survive on a cash only basis charge. Its barely anything cause they dont have the same overhead with billing and payment delay with insurance/medicare

    and if you need surgery at some point your high deductible kicks in at 5k you spend a year you arent paying for anything the standard person cant afford, theres differejt deductible levels

    mds dont have the power to drive up healthcare costs, they arent even allowed to have a real union like other professions because it would be a monopoly and is illegal. the AMA isnt like a real union like nurses or teachers. its illegal for mds to go on strike or collectively bargain for what they charge. medicare/insurance dictactes what they pay for each visit/treatment.

    Only insurance companies, government, businesses have the time to put out biased press to blame MDs for the cost of healthcare and say they are being paid too much

    do your own research, dont read articles like these like a sheep

  44. td says:

    additional factors unique to USA that such a direct comparision is unwarranted:
    -poverty level-its a comorbid condition or risk factor for every many if not most diseases, physical and mental. Treatment for a person with any condition will be more difficult and take longer because either because of insurance/co-pay they do not get the primary physician care to diagnose early so it gets serious and not till its acute do they get to the ER where everyone gets care. At this point symptoms and the progression of illness will be more difficult and a heavier burden on the healthcare system. And the government won fix with a public healthcare system because as anyone who has been on medicaid and other programs know theres too hoops to jump through or with all the overhead and little reimbursment a physician will lose money for every visit, but many still do keep a certain percentage of medicaid patients but cant take anymore or their practice would go bankrupt

    These countries do not have the same issues

    -drug/substance abuse-as with poverty its a comorbid condition or risk factor for almost every disease and has similar net effect as poverty. It is also a disease itself.

    These countries do not have the same level of abuse

    -MDs in other countries dont have the same overhead and malpractice insurance cost

    -The malpractice issue drives up costs because MDs have to provide treatment and time above and beyond what is needed and these other countries do because if they dont and for some unrelated reason a person gets ill or disease progresses a weak argument can be made by lawyers and the MD will be sued for a large sum. They needed to be 100% sure we need to be 110% not cause we need it but because it needs to be documented that an MRI or whatever was done so they will not have their cost of malpractice insurance double. Huge reason for healthcare costs

    -We are a consumer culture and it effects healthcare. A person has insurance to cover so many dont care about cost so they will overutilize. Like Id rather just have unlimited internet/netflix or whatever then pay each time. This burdens the time of the healthcare professionals and when a system is stressed and overutilized it costs more to run. A person isnt doing anything wrong, and Im no better but every little cold or time you have some mild symptom you dont need to see a doctor or need a drug. Not saying people shouldnt go or generalizing but it is an issue and stems from our culture and system of healthcare. If it was a public all you can use system this would be worse, but I believe everyone should have access to healthcare but that is an issue with thd government, through or taxes, taking care of the poor and theyve had medicare/charity care for years and have done an awful job of it. Cut out the middle men. Get rid of the hoops for the poor and the overhead cost for docs who get paid almost nothing to see the patient by giving a tax credit. But that will never happen. There are lots of easy solutions but it involves less government control which they dont like

    So if you are going to make a fair comparison and think MDs should be paid less you should consider these factors.

  45. td says:

    http://www.medscape.com/viewarticle/411372

    you overestimate engineers role in medical innovation and underestimate physicians role, not just in implementation but in innovation as well.

    you can see from this list of the most important contributions to medicine, MDs original innovation far outweighs any other professional background. Besides the fact they are integral in the implementation of all of these innovations

    obviously other fields have made crucial contributions, but you seriously overestimate the role of emgineers. They have made great ones like the CT scan, but if you research the rest of the list including the original step in using MRI as a medical device MDs have made far more and research pharmacologists more then engineers. I assumed your point of view as well but maybe you should research your stance before elevating your profession and demeaning others

  46. Ben says:

    By way of analogy- if the farming industry had been able to influence Congress the same way (in the name of food safety), then today, food could only be grown, prepared and sold by a limited number of accredited business, with the input of a limited number of accredited workers). Supply thus restricted would lead to the US having the highest food prices and the highest wages for food workers in the world.

    Prices for medical products and services in the US are now the highest in the world and have spiked to levels which are not sustainable in relation to GDP or the average paycheck. As a result, some US citizen have little or no access to care, while others are forced into bankruptcy and the competitiveness of the entire US economy suffers.

    The economic evidence indisputable. The AMA is only part of the problem. The US medical care industry consists of several uncompetitive markets each with its own cartel.

    The solution is simple. If Congress could end legislated restrictions sponsored by the cartels (by way of accreditation of medical care workers, hospitals etc) and move towards legislation to regulate a private medical care market (regulation of price transparency, standards for safety and access) then market forces would, over time, take care of the problem (especially in this sector with the huge and untapped potential for productively gains through technology).

    At this stage, it might take a decade for supply to catch-up with demand, but pricing would become competitive.

    Unfortunately, we have already seen how the cartels block every attempt at reform. If nothing changes in the coming decade, this monopoly will continue to be the largest single contributor for the economic downfall of the US in the mid-term.

    • tj says:

      so remove standards for educating and training healthcare workers? serious?

      it would last one day

      not to mention the door in leaves open for fraud/scams besides the obvious health risks for everyone

      there is no such thing as free market in the US, why do you think lobbyists exist? the supply side with the deepest pockets can sway any notion of “free market ” to their favor.

      and their is no untapped gains in the technology or pharm sectors

      anyone is still free to develop and patent something

  47. Becky says:

    I see two reasons doctors make more in the U.S. than in other countries: 1) much more extensive education- in the United States, students complete four years of college, with the required pre-med requisites (bachelor’s degree) and then complete four years of medical school, followed by additional years for an internship and residency, whereas in other countries (at least in Latin America, the region I specialize in), doctors graduate college as physicians, rather than getting a bachelor’s degree first. 2) salaries tend to be lower in other countries, across all occupations.

    Personally, I’m glad that the doctors make a decent salary- look at what happens with teachers- important jobs that get paid poorly and often result in poor quality of teaching. If doctors don’t make as much money, the smartest people in the country will go into other fields instead, and we’ll be left with less intelligent people in charge of our health! If we want high quality healthcare, we have to attract high quality talent with high salaries.

    • Clocky says:

      Some people argue that there’s diversity in the US making MD jobs harder, let me tell you something, I go to the doctor and they never classify me as “different” even though I’m asian.

      For example a high population of asian are lactose intolerance, my doc never even considered that when checking me up… let just say that I’m blessed to never have huge issue with my health, but i’ve had plenty of sour experience when i go to the doctor for minor stuff.

  48. Dr says:

    Most doctors couldn’t get into wall street jobs… Speaking as a current student at a top school, premedical students are as a rule the midlevel students

  49. tj says:

    different ethnicities have different genetic predispositions for diseases, cancer, diabetes, congenital, etc

    some have different cultures which effects include things like diet

    particularly recent immigrants of which the US has a much larger amount of then any of these other countries. different epidemiology. its like practicing medicine in several countries in one day. I have nothing against immigration and love our country for its diversity but it requires a wider knowledge base to practice from, most physicians enjoy it but it requires more time and expenditures for them in school and afterwards

    as well as culture competency which is a necessary requirement for physicians in order to elicit a proper history like asking about other remedies used outside of traditional western medicine. These can interact with some treatments

    socioeconomic diversity is more broad here and effects every aspect of medicine

    we are a very violent country and those obvious implications

    we have barriers to routine healthcare that are caused not by lack of insurance because insurance sucks money out of the healthcare sector and uses it as profit for shareholders

    malpractice drives up costs as well as the need to practice “protective medicine” when tests and orders are made not to diagnose but to prevent frivilous lawsuits

    pharmaceutical companies develop treatments aimed at making them the largest and the most long term profit, the bottom line, not the most effective treatment and prevention strategy

    physician salary adjust for hours worked, malpractice, tuition burden is the proper metric

    look at who publishes these articles for the real source of costs and bias

    physician salary has zero to do with increased healthcare costs and when adjusted for inflation has been declining while the same time tuition and malpractice has doubled or tripled

    these statistics are deliberately misleading

    do your own research before you lay blame to a group that does not deserve it and is being sleighted just as much as anyone because of our government and groups with real power to inflate costs-large companies, pharmaceutical and insurance as well as lawyers and the judicial system which most politicians hold alliances to

  50. Bill Murphy says:

    The salary of Doctors should not be compare with the lawyers’s, and while we are at it to actors or CEO.
    Lawyers that can bring or save millions of $.Often the first consultation is free and they only get paid on results as a % of what they bring.
    Actors can make the success of a movie and bring in millions.
    As for CEO the make decision that bring up considerable revenues to a company.
    Doctors are providing a very important service to the community and sometimes they save life.
    For doing so they should receive a unsubstantial compensation.
    This compensation however should not be artificially controlled by the AMA who restrict the number of schools available and the number of doctors. They make sure that supply is always lower than demand, keeping the doctors fees above market price.
    It is totally artificial. Lawyers do not try to limit law schools or law students. There compensation is not regulated by supply and demand, but by there expertise alone and the importance of cases they are working on.
    An example of over pricing and abusing fees : When I go to my dermatologist for sun induced keratosis, my doctor tells me that it is not covered by insurance because it is a cosmetic intervention. Just to burn a couple lesion he charges me $350 for just 5 minutes of work.He then charge my insurance for $ 170 and when I ask why after receiving the statement the answer is : this was just for the office visit. ( So just to walk in $ 170 and for 5 minutes of “expert”burning of a couple lesion that a nurse could have performed: $350).

    It is true that involved in the all procedure was the diagnosis. The lesion could have been malignant. I understand that part, but do you think it’s worst $350 + 170 = $ 520 for a 5 minutes consultation.
    Don’t you think that $170 would have been sufficient ( again only for 5 minutes of work).

    another problem the AMA restriction on the number of doctors is a lack of competition not only of the fees but of the service itself.
    In America, service is very important and well developed in many industries : 24 hrs banking,banks open on Saturdays, services at car dealership open late, grocery stores open all night etc…

    Only in medicine is the absence of service that only a lack of competition could bring.
    Most American have to take a day off or at least an afternoon off to go to a doctor’s appointment. It is virtually impossible to make an appointment after 4PM.
    In France for example, you can make doctors appointments up until 7H30 PM and saturday doctors work until 1PM generally.
    In small towns, doctors are on call one night a month. It means that they are available to patient all night that day.
    If you have a mildly sick child at 10pm you do not have to go to the ER. You just have to call SOS MEDECIN and a young doctor (usually resident) would come to you with first doses of antibioics or other medications.
    The victims of this lack of competition are the consumers.
    I am tired to hear that most doctors are left with an average of $151 000 debt for medical school. They choose to study medicine, but they should not expect the consumers to pay for it by charging unfair and way above market price fees that exist nowhere else in the world.

    What happen to the love or passion of helping others ? This should be the main motivation to become a doctors, not money.
    Should doctors make a good living ? Definitely yes, they deserve it .
    But should they organize a cartel style organisation to keep competition low and inconvenient service to customers ?
    Definitely not!

    • Anirban says:

      Usually the lawyers, I knew in medical malpractice, used to charge as a percentage of the life time earning and the pain & suffering awards. If one doctor, policeman, firefighter saves your life, are you eager to pay him a percentage of that. Won’t that be fair? He is literally enabling you to enjoy the rest of your life. Just imagine how much money your doctor saved you had your oral lesion turned malignant. No lawyer can save you that. Of course, someone else got it, had your doctor screwed up.

      Don’t Lawyers go the profession for love of giving people “justice”? Don’t Football players go for it for representing their country or state whatever, and make us “proud”. I think the logic is tenable to any other profession or service you can name. What prompted you to join your profession.. I wonder. Should or shouldn’t money become the secondary motivation everywhere. We know money matters everywhere.

      If you are tired to hear the argument of medical debt and really think those young stupid fellows who joined it knowingly can be brushed aside. I can guarantee you students are getting smarter. The future medical applicants don’t look too great and it is no solace if junk fills up the void.

      I can forego all actors and NBA players. Anyway I need those Doctors and a good quality one and may be a lawyer or two. I want them to be paid “substantially”. Can’t buy champagne with beer money, as simple as that.

  51. tj says:

    The AMA doesnt restrict anything.

    The LCME accredits US medical school spots but has increased that number to meet residency spots in recent years

    number of medical schools isnt the kink in the pipeline shortage of docs.

    number of US grads will meet or exceed number of residency spots in 2014. which just means none to few foreign mds in residency spots.

    the LCME controls numbers of US grads and has been very good at increasing that number.

    the real kink is the # of residency spots, which is necessary, though how long residency is in years for certain spots could he streamlined, but in senior residency years the resident functions like a junior attending often. That basically means the hospital gets a doc for just 45k a yr instead of the normal rate.

    residency spots are funded through medicare and thats the real kink. Each resident makes a hospital more than it costs to fund their training through medicare. Hospitals need to start contribuing and privately funded residency spots are the only feasible solution for doctor shortage

    AMA is not a cartel or even a union and has no real power. just a puppet for press and propaganda like this to shoot down docs who arent the real leak or cause of increased medical spending.

    cut all doctor salaries in half and we will still be at this juncture in US

    if a visit is paid by insurance the cost to consumer is insurance company overhead+insurance company profit+doctors cost

    non profit insurance companies just have increased overhead like if the government ran it

    like anything paid through insurance, what u pay in premiums costs more than the premium

    like why never filing a car insurance claim means youll pay less in premium a year

    you only need insurance for the unforseen or catastrophic or what exceeds your income

    paying for regular doctor visits and other medical services you can expect to spend in a year will just cost the US more than paying a doc directly. Paying this way cuts out insurance overhead/profit and the docs cost of hirining a medical biller and having to wait to get paid for a service through insurance

    same way its cheaper for me to have minimum insurance just for major accidents and pay out of pocket for minor fender benders or car problems which i can expect to get into.

    insurance is run of the same principals and companies will continue to increase their profits as is their nature no matter what level of healthcare they provide

    put a limit on the margin of profit that can be made on healthcare services and this would all be fixed. allow for reasonable salary for physicians and they will always be their. doctors arent taking billions in healthcare payments from US citizens and linining their pockets or paying out in stock dividends

    absentee profiteers in every aspect lf healthcare is the cause of these problems. the money invested isnt helping our healthcare because it is not invested in ways that improve our health but in healthcare services that provide the most profit like meds for chronic conditions rather than vaccines or cures

  52. bc says:

    Well this is how the system is, and whether or not it changes is anyone’s guess. The only people who are complaining are those who couldn’t get into medical school or realize how unrewarding their jobs are now. I am a medical student now, and I haven’t quite made it to the end yet, but I will say that medicine is one of the most rewarding professions out there. Not only can you make a decent and stable income, but you also earn the gratitude and trust of other people on a daily basis if you do a good job. Which is why the barrier to entry is so high, which I think is a good thing because you don’t want clowns in charge of your health. It’s scary enough thinking about the students at the bottom of my class becoming doctors, because you can’t really tell how good someone’s medical knowledge is in a brief encounter. Most people pick their doctors based on personality anyway.

    I think the salary numbers are quite misleading. Most docs I know are workaholics and their pay per hour wouldn’t look as impressive. Not to mention that you still have to study as a doc which you don’t get paid for. Try cracking open a book after coming home from work. My friends in business hate it when prepping for the GMAT. The day to day is also quite tedious and even some docs I have followed that work at relatively relaxing jobs don’t have time to eat. Most docs have to take call which can mean staying overnight in the hospital or going for a week or more with the chance of someone calling you at 3AM. There are people I know who went to pharmacy or optometry school because they decided that medical school was just not worth it.

    To the engineer from MIT – You should have went to med school after your PhD. It’s a field dominated by MD-PhD’s and medical students with multiple publications. One of the most competitive fields to match into, and to be honest a 3.1 GPA (even from MIT) work ethic would not have cut it. I know, because I have an engineering degree from a top10 undergrad school. It doesn’t matter where you went to undergrad. Medicine is all about repetition and memorization. There are people at my low tier med school who went to no name undergrads who are smarter than me and work like dogs and score in the top percentiles on national board tests. Even then most kids end up in primary care which pays no where close to 300-400k/year.

  53. Don says:

    I have an answer to you Doctors who scream when anybody talks about your pile of money. Germany. If it works over there it can work over here. I know the system over here demands a high salary so I see that as the problem to overcome high health care cost. You all are in General quite Elitist and demand to be wealthy and think you are entitled to be wealthy. I lived be a Medical school and most students are there for the money. Oh please save your arguments for the Lawyers. The reason you go is there are few professions that pay ( save it ). Our Capitalist system has sucked out the middle class like a giant blood sucking squid and we are becoming a 2 class society. Read the 2005 Citigroup report. The giant squid will one day find you they you will cry like the Germans.

  54. Don says:

    I have an answer to you Doctors who scream when anybody talks about your pile of money. Germany. If it works over there it can work over here. I know the system over here demands a high salary so I see that as the problem to overcome high health care cost. You all are in General quite Elitist and demand to be wealthy and think you are entitled to be wealthy. I lived by a Medical school and most students are there for the money. Oh please save your arguments for the Lawyers. The reason you go is there are few professions that pay ( save it ). Our Capitalist system has sucked out the middle class like a giant blood sucking squid and we are becoming a 2 class society. Read the 2005 Citigroup report. The giant squid will one day find you and you will cry like the Germans.
    It works over here because so many players get a piece of the action.

  55. Don says:

    And to the Elitist notion that everybody else are less than able I know of One GP who only had to know Algebra. I looked at his Block classes and It did not look difficult. I think it’s interesting but not a profession I would want. I can tell you a few stories of a Diagnostic isolation based on BS guesses rather than any data. Rather than refer me to somebody who actually knows what they are doing they give it a crap shot and bill me.

  56. Thomas Westin says:

    The very nature of a physician all most has to be one that can find personal reward in the observance of healing, and not in the pay scale. To take the time to go through the incredible amount of study and deal with the every day unpleasantness requires more then money. What the MD has to deal with takes people who answer a much higher calling then that of greed.

  57. soul says:

    I am an immigrant moved here from one of the poorest country where medical school is only 5 years aornd internship is a year long. My US MD doctors would not test to see if I have a germ or ulcer. I had Any stomach pain would be classified as IBS or GED.I had to suggest the doctor about H pylori after suffering years from three MDs and one Gastro. Doctors are bribed to prescribe the most expensive medicine even if generic version works better. Sleepless nights for doctors are designed to make them robots who crave money, not good doctors. Despite having the best talent and most resources US medical system is the worst. Reason? AMA.Despite medical malpractice laws, dentists would root canal when not needed(there is stat for that). Capatism is not making your women whores who earn money but became a robot. Our doctors have become lap-dancers who pays 5 min lip service to take your money. Specialists are more caring and effective even if they charge more.

  58. Bob says:

    Some of these posts have touched on what I think is the most important driver for health care costs … paying with other people’s money.

    There are 3 players in health care: Doctors, Patients, and Insurance Providers.

    The Doctors have no incentive to reduce costs.

    The Patients (most of whom are covered by some form of insurance) also have no incentive reduce costs.

    So the only player left of the 3 who *might* have an interest in reducing costs would be the insurance providers. But since the insurance providers just pass their costs along, and since there’s more profit to be made from bigger bills (a greater percentage “cut”), then even the insurance providers don’t really have an incentive to reduce costs. So there’s no one in the loop who’s really trying to drive costs down.

    I believe the solution has been hinted at several times. A free market system can only control costs when the people getting the services are the people paying for those services. Without insurance (private or government), there would be no “deep pockets” to pick (by anyone), and the costs would have to be what “regular” people could afford to pay. The quality of our health care might go down, but we wouldn’t be bankrupting ourselves to the point where we can’t sustain the “great” system that we have anyway.

  59. evan l says:

    Those who cry out for lower physician salaries: you are out of your minds. I am a medical student who is accruing debt at a rate of over $70,000 per year to be at a top ten medical institution. That means I’ll have well over $300,000 in debt after interest. Why did I decide to go to a top ten institution? Because I want to be the best professional and doctor I can be; I want to serve my community. I want to cure the people I can and improve quality of life for those I can’t. We as doctors and future doctors are PRIMARILY here for our communities.

    We make a LOT of sacrifices to our lives to do it: total education is about 8-14 years of medical school through residency/fellowship training; total debt is in the quarter million range; and the hours are INSANE (avg of 50-65 hours/week across the board when you’re ESTABLISHED). Further, it’s the most singly competitive field to get into (as it should be)…meaning the doctors in the US are some of the best and brightest (who else would you want as your primary health advocate?).

    Why, in our capitalist society, would you want to discourage incentive for becoming a doctor? Or lower the quality of candidate by decreasing this incentive? These are people who are certainly smart enough to be entrepreneurs, consultants in industry, or on Wall St…and our economy somehow sustains those peoples’ incomes. Hell, we pay professional athletes and entertainers salaries in the millions… if you want to bemoan high incomes, I don’t really think there’s any reason to point to doctors.

    Further, if we DID make this a straight up supply and demand market for healthcare, there are plenty of docs who would just make MORE… People want the BEST when it comes to their healthcare, even if they can’t afford it. Moving to that system would just create immense disparity in the quality of care given to the wealthy vs. the disadvantaged. Straight up, decreasing incentives to become a doctor (especially given the sacrifices training already takes), will result in crappier health care, and who wins there?

  60. Dias Brito says:

    They make good money because they have too. The stupid system is very expensive. The patients sue too much. From the 200 grand, 30% goes only to the malpractice insurance.
    Health system in US is sick

  61. Richard Harrington says:

    It is not just that physician training and compensation is insane. The whole health care system is insane. In fact, it isn’t even a system. It’s a collection of independent actors loosely tied together by insurance contracts.

    There is essentially no coordination of care. Very little consultation between specialists and primary care physicians. No wonder there is such duplication of testing, MRIs and dangerous CT scans. No wonder a small percentage of patients with chronic conditions constitute a disproportionate number of hospital admissions and expensive procedures.

    In a more rational system, the primary care physician would be the focal point for diagnosis and coordination of care. The specialists would be in service to the primary care physician responsible for the overall management of the patient. In such a system, there would be centralization of medical records providing for a full appreciation of the overall history of the patient rather than the fragmented approach today. Unfortunately, today the primary physician is the least payed, most overworked and relegated to perfunctory medical care. That needs to change.

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