This article on physician salaries should be emailed to undergrads planning their future and, perhaps more importantly, to any person with a PhD who insists on calling him or herself “doctor”. It turns out that the average physician in the U.S. makes around $200,000/year after paying malpractice insurance and all other expenses. The clever docs who specialized in radiology earn a median income of $350,000/year after paying their malpractice insurance premium of $12,000/year. So next time the pompous PhD signs an email with “Dr.” ask him “Wow, are you making $200,000+/year? No? Why not?”
Maybe these are the folks who’ve stripped America’s car dealers of all the minivans…
I know just how you feel. I read this survey a week or two ago and was floored by the numbers. It was especially surprising to me because my brother is one of those radiologists. (No, he’s not snapping up all the minivans. He’s more of an SUV person.)
I used to wonder if anyone could actually afford a house in San Diego — median home price $500K — and now I have my answer. It isn’t the programmers.
My sister is an OB/GYN resident doctor. Three attending physicians at her program are dropping obstetrics practice *solely* because of high premiums (the premiunms go up more than 60% as of next year). In some parts of rural PA the nearest obstetrician is so far that women ether have stay home or end up delivering in the car on the way to hospital. You would think this should not happen in USA. But it happens in part because of ridiculous malpractice cases (BTW, the patient only gets only 40 cents on a dollar, the rest goes to pay legal fees). OB/GYN residency programs used to be a very competetive, but now it’s one of the easiest and unpopular ones.
Another thing is do you really want practitioners who literally makes life and death dicisions be underpaid and unhappy about their jobs? There is a very small percentage of people who have enough stamina to go through many years of training and become a doctor in the U.S. so why can’t they be rewarded accordingly? If you want some underpaid bitter doctor to play with your guts you can always fly over to some other country and have it for cheap.
Phil’s point actually highlights how small premiums really are relative to the price that MDs get [over]paid to do their jobs. Blame insurance companies for outrageous premiums: not Doctors.
presidentpicker,
Can you back up the claim that only a “very small percentage” of people are capable of becoming a doctor. I thought it was med schools that had a limited number of openings to keep doctor salaries high (it seems to be working). I don’t know of any med schools short of students.
On average, malpractice insurance comprises 3% of doctor revenue. Some can cite OB/GYN as illustrative of the need for tort reform, but that’s a stretch to pronounce the state of an entire profession for a small minority of doctors. And in states where there are damage caps, malpractice insurance is not any cheaper.
http://www.usatoday.com/news/nation/2003-03-04-malpractice-cover_x.htm
3%! How much of your paycheck goes for health insurance? I’d say for most Americans, it’s a lot more than 3%. My daughter works 2 jobs, has insurance, but it sucks so bad, that she had to pay $1200 out of pocket for a gallbladder operation that did not require overnight stay.
The disappearance of ob-gyns is a sign of health for Americans. If medicine were a science instead of a guild, most women would give birth at home with midwives in attendance. This would lower the costs of health care and improve the outcomes in almost all cases. The malpractice problems of ob-gyns are the result of their own lies. (Sample of 1, except I didn’t sue the bastards, but I wish I had. I would have settled for their medical licenses.)
And yes it is true that very few people who have the stamina (and ability to tolerate 1) abuse and 2) internal contradiction) to put up with 100 hour weeks in pursuit of health.
On that note…
http://www.design.caltech.edu/erik/Misc/Doctors.html
Guys, guys… what makes you think that I was complaining about MDs being overpaid? Every few weeks I write a recommendation to Med School for a former student of mine. These are nice MIT grads and I sincerely hope that they all make at least $1 million every 3-4 years during their working lives. I posted the link not to diss real doctors but to help folks like myself who are called upon to advise the young.
Ray: ob-gyns aren’t disappearing! One of them showed up at my house Sunday night for wine and cheese. Her insurance is paid for by Harvard University, which seems to own most of the things in Boston that aren’t nailed down, including her hospital. Harvard hasn’t complained that the insurance premium put a dent in its $25 billion in assets. Anyway, because smart people are common as dirt in Boston she isn’t paid that much but any time she wants to move to the Midwest she could start earning real dollars.
You can’t blame the insurance companies for the high premiums– they are just covering the risk. Make malpractice a criminal offense without excessive (any?) punitive damages and all will be well.
As for Doctors being overpaid– I can’t say I envy them. Have you ever looked at some of the people sitting in the same waiting room as you!?
“Real” doctors, unless subsidized by scholarships, have significantly higher education, internship, and residency debts to amortize than the Ph.D. who can generally slide into a lucrative post-doc or teaching fellowship appointment upon graduation. Surely, high starting salaries are justified. Furthermore, I can think of a couple of cases where lawsuits could/should be based on disinformation created by “professor” doctors. When I was employed by an academic community, we referred to the “professor” doctors as PHuddyDuddies. We had no problem with the legitimate professors.
The minivans are here in South Jersey, parked outside all our McMansions.
Philip: if so many smart people are in Boston, why are they living in Boston? [/cheap shot]
Overwhelming majority of doctors just out of residency have >$100K in debt. (4 years of undergrad, 4 years of medical school and 3-7 years of residency, during which they are unable to pay that debt off). +Interest. Starting salary for an internist, for example, is about $80-120K (depending on the region).
Chris: In San Francisco, most of my friends who are programmers are making at least 100K. And that’s after 4 years of undergraduate education only. And they are the ones buying the houses.
Imagine a situation with 10 doctors, each of which has a 10% chance of being sued for $100 every year for malpractice. On average, there would be one suit a year, so they form a group and pay in $10/year each to cover insurance.
Since they don’t know when or if a doctor will be sued at any given time, they put their money into short term investments, earning, say 5%/year. If they get sued at the end of the payment period, they had the opportunity to earn $5 on their $100. On average, they can earn perhaps $2.50 each year.
Now imagine a company offering this service. They aren’t in the business of providing this service for free, so they charge $11/year for premiums. Not too bad from the doctor’s perspective. The company also invest the premiums in the same investments, and earns on average $2.75 from investments and $10/year on premiums. Since the company might be very big with lots of assets, it might even be able to assume more risk / less liquidity and earn maybe 10% on its investments.
So this insurance company has two sources of income — premiums and investments. One is flat to down. Here’s the pop quiz: How do you show good profits (and just as importantly profit growth) in such a company when the investment markets are generally down / flat ?
Huge malpractice suits may be responsible for some of the premium crises, but there are other factors too.
I agree with you DZ, poor business practices by insurance companies and a desire to return profits to their investors have more to do with high insurance premiums than malpractic suits.
Check out these business practices:
http://www.nzherald.co.nz/business/businessstorydisplay.cfm?storyID=3604249&thesection=business&thesubsection=insurance&thesecondsubsection=general&thetickercode=
Anyhow, I think that it is another common business practice to blame these high premiums on ‘somebody else’… All it takes is the media access to spread a few grandiose stories around, and BAMMO you got middle america repeating the tripe like it is gospel.
Considering that 5% of doctors are responsible for the majority of all medical malpractice claims, wouldn’t a more prudent strategy in combating medical errors involve weeding out bad doctors?
Excuse me, you said you had a doctorate in what? The utter bankruptcy of today’s higher-education institutions has been transferred to the realm of the absurd & morally offensive. “Education’ itself has been the greatest fraud & mumbo-jumbo of the past 100 years: It purports to equip us to live, yet, for the most part, shapes our thinking in a sshadowland type of mentality. (Witness, e.g., the comment attributed attributed to Prof. X re Osama & 9/11, in Phil’s post, supra. PhD. dissertations have become large, more irrelevant, and about as convincing as the defense transcripts from a Michael Jackson defense dossier. Burrowing deeper & deeper into the recondite recesses of some abstruse discipline, PhD candidates — who inhabit a subgroup rife with a distorted sense of self-esteem, bad diets, and crazy mood swings — write papers that are about as lastingly important as the foreward to a Jackie Collins novel. To some extent, of course, we are all poseurs; but is true intelligence a liability these days?
Three quotations are particularly apposite to this discussion:
“The average Ph.D. thesis is nothing but the transference of bones from one graveyard to another.” (J. Frank Dobie)
“The governors of this institution…made the awful discovery that they had enrolled upon their staff a person who was unprovided with the Ph.D degree. The man in question had been satisfied to work at Philosophy for her own sweet (or bittersweet) sake, and had disdained to consider that an academic bauble should be his reward. His appt. had thus been made under a misunderstanding. He was not the proper man; and there was nothing to do but to inform him of the fact….There are obvious ways in which the increasing hold of the Ph.D Octopus upon American life can be kept in check….” (William James; 1903!)
“We need education in the obvious, rather than investigation of the obscure.” (O. W. Holmes)
When did the amount of salary become the indicator of a person’s relevance?
I feel like I’m being targeted as a radiologist. Well I’m still in residency, but in my case that means I’ve been out of medical school for 4 years. I currently make less than $35 a year POSTtax living in Boston as a resident, and this is after college, medical school, and 4 years of post-MD training, with the associated debts of the last 12 years. This is the situation virtually all residents who haven’t completed post-graduate (i.e., residency) training make.
Most doctors work very hard. Some fields work harder than others. Some fields of medicine are “thinking” fields–spend a lot of time thinking about patient’s problems. Some fields of medicine are “doing” fields–not much brain-power needed, but lots of manual dexterity required (surgery?). In most fields you take call, where there is periodic responsibility for taking care of patients with problems in the middle of the nights, weekend, holiday, or evening. Many doctors probably are workaholics, averaging greater than 60-80 hrs/week when you include time reviewing journals, paperwork, and weekend hours. Most doctors have to quietly accept instances when patients verbally abuse them. Most doctors have to tell patients for the first time that they are suffering from a life-threatening illness, or that they’re going to die soon. Most doctors have to frequently deal with patients upset that their appointment started late, even if it’s because the doctor had to spend an extra 30 minutes consoling the patient who was just told she has breast cancer, or because the last patient arrived 15 minutes late. . . Most doctors sacrifice personal and family life because have so many clinical obligations, or because they’ve spent so much time building their career that they don’t know how to develop a good family life.
On the other hands, most young doctors these days know that the age of unqualified high reimbursement is over. Most people these day enter medicine becase they want to take care of friends, family, and other patients. Most doctors love their jobs–they’re not doing it just because it’s a good way to make money. Granted, it’s much easier to sink that much time and effort in training when you know there’s greener grass on the other side. Sleep is easier to sacrifice if there is a perceptable reward.
I happen to love radiology as a field of medicine. It combines my love of technology, imaging (photography), and medicine. I work long days, averaging between 60-100 hours a week. In a given 10-12 hour shift I may read 40 cross-sectional studies, which have an average of 300-500 images a study. Calculate that out–in a day I could easily look at 10,000 images, and that’s without considering the time required to dictate reports, review the typed reports for accuracy, call referring physicians with important results, and provide physician consultations. With all those images, we try not to miss anything, although the sheer volume of work is making it harder and harder to be “perfect.” For better or worse, referring physicians have really taken a liking to “prescribing” radiologic studies too, in hopes that we’ll provide the answers they may not otherwise be able to establish.
I don’t know how much money I’ll make after residency. I have heard figures varying between $100-500 pretax, depending on if you live on a coast (less pay), if you work at a major teaching hospital (less pay) or in private practice, and what type of specialty training (maybe more pay?) you have. But you know–in the end I’d think that I’ve worked for whatever I make.
Phil — Perhaps someday I’ll meet you in the street and say–“Hey, aren’t you Phil Greenspun?”. I’ve driven by the Cambridge College building so many times and sadly thought–that used to be ArsDigita with the cool car in front, and the grand in the lobby. I was inspired by photo.net, and when I’d hear the ad for Elsa Dorfman on NPR, I’d think of the pictures on photo.net; I had a friend who went to ArsDigita University; I once long ago met one of your 6.171 co-authors when he was still a doctoral student in bld 36; and I even found the web-ized land of pi during the mid 90’s (that was _after_ I wrote a speech for competition on mneumonics and used pi as the example). I thought I’d stoke your narcissism 🙂
I commented to this once and it didn’t get posted. So this is a test, only a test. OK, can’t post anonymously, must have valid email. Try this.
Years ago, upon completion of law school in Maryland, a degree called an LLB (Bachelor of Laws) was awarded.
As requirements changed and a 4 year college degree became a prerequsite to admission to law school, the members of the bar were successful in having the degree changed to a JD (Juris Doctor). A lawyer began to advertise himself as Dr. and the bar association objected. the matter was litigated and taken to Maryland’s highest court which agreed with the lawyer. The surname of the successful litigant: Doctor.
It is really interesting that radiologists make a lot of money in US because in
europe the things are entirelly different . Especially in my country that is greece, a radiologist that begins to work as an expert in a private diagnostic center can earn from 700 to 1600 euros per month working for 8 hours!!
Pompous physicians and M.D.’s need to realize that the term “doctor” has, for over a thousand years, referred to an academician who has achieved the highest degree in his or her field, and usually implies that the person uses the knowledge to teach others. However, most physicians lack the “intelligence” to make a logical argument or speak properly let alone understand etymology and semantics. I love when I go to see a physician and they refer to me as “Mr.” and themselves as “Dr.” to increase their own self-esteem. Sawbones have only been using the term for a little over a century and now want to monopolize it. An exorbitant salary for a lot of guesswork and cahoots with pharmaceutical companies does not earn you any respect or a high-jacked title. Face facts–you get the salary for the demand but the time and effort you put into the “profession” in most cases still results in passing people through like cattle, treating them like crap, and ultimately messing them up with medicines they do not need. “Doctors” take a lot of pride in the money they earn and the titles they wear, but for all the advances in medicine today they don’t seem to be making a lot of people’s lives better except for their own.
After stumbling upon, and reading through this thread, I still cannot understand why people would believe PhD should not call themselves Doctor. In my experience physicians pride themselves on their medical knowledge and feel these expertises are the principle for earning the title of Doctor. I have no doubt that this is a fair argument, but I have but one question to ask those physicians who believe this: Who do you think made the discoveries in the fields you studied in med school? The truth of the matter is that the expert knowledge physicians pride themselves on is based on the work of thousands of scientists who came before them, many of which held a PhD. Did an MD discover the X-Ray? Did an MD discover the cell, the structure and replication processes of DNA, the expression of genes, or even the very basics of the concealed workings of genetics? If it is this knowledge that defines a doctor then how can you exclude these physicists, biologists, statistician, physiologists, and many others who so strongly shape the field of medicine?
MDs are certainly not “real” doctors by any historical sense (see Dr. Manfrensenjen comment above). It is the PhDs who are the true doctors; with an MD degree comparable to a master’s degree. Having taught many future MDs, I have found most lack the analytical horsepower to ever achieve a science-based PhD. Most MDs tend to be analytical dumbos.