I’d like to just first point out that the medical professionals I’ve interacted with have never once complained about their pay. They consider it their good fortune to be able to have such a meaningful, positive influence on people’s lives while being adequately compensated for it. As we will see, there are apparently people who don’t quite share this view. This post is for them.
I happened across a quick blog piece entitled “Why doctors complain: A history of physician income.” In it, the author Richard Patterson gives a quick overview of how in the 1960’s, with Medicare being new and employer-provided insurance offering lots of coverage, doctors were making money hand over fist. In the 1980’s, Blue Cross was paying 150% more for a gallbladder surgery than in 2000 (without even adjusting for inflation). And now, while doctors still do very well financially, “they are now lagging rather than leading their college classmates who chose finance, business, and other pursuits.” Thus, Patterson concludes, it is understandable that doctors complain about their salaries today.
With that out of the way, while he answers why doctors complain, he neatly sidesteps the entire issue of whether doctors have any room to complain. He does note that many doctors incur six figure debts just from their years of education—and I think that is a fair concern—but overall doctors seem to be well-off and complaints should and do fall on deaf ears.
I don’t doubt for a minute that the vast majority of doctors do a great job and are very worthy of both our admiration and the ample compensation they currently receive. If I didn’t think so, I wouldn’t choose to study medicine with the intent of being a doctor someday myself. But I will say to you what I have been saying for a while to anyone who will listen. Medicine is fundamentally a service profession. If you’re going into medicine with dreams of being rich, you’ve missed the point.
This is the reason why institutions such as the Mayo Clinic pay their attending physicians a salary instead of a per-case fee. The emphasis is on providing a greater quality of care rather than increasing quantity in an assembly line fashion. In fact, Mayo reiterated this sentiment in their open letter to Congress, asserting that “pay for value is the only tactic that will ‘bend the cost curve’ in U.S. health spending.” For years, doctors knew that if they wanting to increase their income, they had to take on more cases. Since when did that become a recipe for good care? The focus needs to be shifted squarely back on the patient, providing appropriately targeted treatment that saves resources and offers better outcomes.
Still, it is natural to equate pay with how valued a service is: isn’t that why a star athlete making $5 million/year holds out for a $10 million/year contract? If that’s the case, it is understandable that doctors feel less valued as the cost per procedure goes down. But in some cases, doctors’ lamentations just make no sense.
Recently, physician-blogger “Birdstrike, MD” wrote a post in response to an earlier blog comment by a “Johnathan Blaze.” While I believe Blaze’s comments where wholly off the mark, I find Birdstrike’s counterargument thinly supported at best, and a reflection of the same old whining at worst. The reason for this is the examples he chose. Birdstrike correctly assumes we should value an entire life over a hip or a finger or a cosmetic breast augmentation. No argument here. He then goes on to point out that two life-saving procedures—emergency intubation and cardioversion/defibrillation—pay him $112 and $131, respectively. This is in comparison to a hip replacement that pays the doctor $1,505.
Oh, woe is he.
Birdstrike conveniently ignores the actual skill and work involved in each of these procedures. An intubation (albeit not in an emergent setting) is something that could be done by a medical student under proper supervision. Defibrillation? They have AEDs in department stores. Let me know when they’re doing hip replacements in the checkout aisle.
The sad thing is, he would otherwise have a point. It’s clear to me that Birdstrike’s angle isn’t so much that he ought to be paid more, but rather that he should be respected more (at least relative to the disrespect he got from the blog commenter). But it would seem that those doctors who are complaining about pay have somehow confounded the two. Esteem and salary don’t necessarily equate. If they did, Ke$ha wouldn’t be rolling in the big bucks while teachers get the short end of the stick.
Instead, doctors shouldn’t really be concerning themselves with any of this at all. The Hippocratic oath invokes a sense of duty toward the patient. That is the crux of what it means to be a doctor. Let’s not lose sight of that and turn medicine into a measuring contest of who makes what.