I have often heard people (not on oldpremeds!) complain bitterly about the dip in compensation for medical doctors. However, the Bureau of Labor Statistics shows that NINE of the top 10 best-paid jobs in the United States require an MD or a DDS. As one would guess, income accrues to risk, with the specialties most likely to be sued, like surgeons, anesthesiologists, and obstetricians, earning the highest wages. Nonetheless, even physicians in general and family practice are STILL the sixth-best paid profession in this country.
Whenever we feel sorry for ourselves, I think it’s a good idea to remember The Rest, for example, the LOWEST paid jobs in America: food preparation, cafeteria attendants, counter attendants, hosts and hostesses and dishwashers, all of whom earn roughly a tenth the salary of a doctor. To this, I would add health care aides, like the women who are taking care of my grandmother in her nursing home in Fairfax County, Virginia, doing the work that most Americans disdain, for extremely low wages. Without these people’s efforts, the American healthcare system would instantly collapse.
COURSE I’m not a doctor yet, for a long time! But it’s good to remember just where you came from and how lucky you are: all in all I’d rather be the guy earning $100,000 and owing $200 grand, than the guy earning seven dollars an hour “debt-free”.
Matt
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all in all I’d rather be the guy earning $100,000 and owing $200 grand, than the guy earning seven dollars an hour “debt-free”.
Matt
That’s EXACTLY it!
Great post, Matt! I feel the same way. I think a lot of physicians feel that other “lucrative” professions that have less schooling and training have it so much easier. I sat down with one of these doctors and explained to them what it was really like to be a lawyer…that most lawyers don’t make over $100k and those that do are consistently looking at resident-type hours indefinitely, and those hours are spent poring over dense, tedius contractual language and legalese. And the truth is that, you really can’t compare, but in life nothing is for free.
In any event, I’m always a little taken aback when people tell me that there is no money in medicine. I know I will never be a millionaire and I know that there are many years in which I will feel like I am poor, but in the end of it all, I don’t understand how $100-200k a year qualifies for year. Sure, you owe a lot, but who said, you have to pay it back in one year…you have 30 years at about 3%. In any event, great points and great post.
Hi everyone–great posts. I just wanted to add don’t forget about rewards doctors get on the human side of things. It’s not monetary, but for many people it’s what matters the most. What other professions allow you to get back so much from helping people and at the same time make such incredible money?
My wife is an attorney and she has chosen to work in the area of poverty law. She is executive director of the largest legal service provider for low-income residents in our county and works between 60 and 80 hours a week and she still makes less than my sister who works for an accounting firm with a two-year degree.
They say you don’t go into teaching for the money. Imagine how great it would be if all doctors could say the same thing for their choice of profession? 
Of course it’s not apples to apples, but just a little food for thought. (Oh, such a very, very bad pun. 
)
Matt,
Excellent post, and I would like to add, as much as I hear the griping (from my OWN docs, who seem to think its okay to air this to their patients), it seems to be from older docs who scored during the 70s and early 80s before all the new regs. Money has never been the issue for me, if I make enough to pay the loans and live okay, I’ll be fine.
Kathy
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I just wanted to add don’t forget about rewards doctors get on the human side of things. It’s not monetary, but for many people it’s what matters the most. What other professions allow you to get back so much from helping people and at the same time make such incredible money?
Well put. In just eleven days I have already had some terrific rewards. Most amazingly, the family of one patient sent me flowers!!! I was astounded - I had spent some time with them explaining what was going on, including giving my radio phone (in-house use) number to my patient so his daughter could call me directly, but honestly I was just enjoying caring for him and explaining his treatment plan to him and his relatives. The flowers were UNbelievable - made my day, week, maybe more! One friend told me, “You’ll have to remember that when you’re having a bad week!” That is for sure.
Mary
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I have often heard people (not on oldpremeds!) complain bitterly about the dip in compensation for medical doctors. However, the Bureau of Labor Statistics shows that NINE of the top 10 best-paid jobs in the United States require an MD or a DDS. As one would guess, income accrues to risk, with the specialties most likely to be sued, like surgeons, anesthesiologists, and obstetricians, earning the highest wages. Nonetheless, even physicians in general and family practice are STILL the sixth-best paid profession in this country.
Whenever we feel sorry for ourselves, I think it’s a good idea to remember The Rest, for example, the LOWEST paid jobs in America: food preparation, cafeteria attendants, counter attendants, hosts and hostesses and dishwashers, all of whom earn roughly a tenth the salary of a doctor. To this, I would add health care aides, like the women who are taking care of my grandmother in her nursing home in Fairfax County, Virginia, doing the work that most Americans disdain, for extremely low wages. Without these people’s efforts, the American healthcare system would instantly collapse.
COURSE I’m not a doctor yet, for a long time! But it’s good to remember just where you came from and how lucky you are: all in all I’d rather be the guy earning $100,000 and owing $200 grand, than the guy earning seven dollars an hour “debt-free”.
Matt
Hi there,
I rather resent the “Feeling sorry for ourselves” when I see the malpractice insurance rates for a General Surgeon climb from $40,000 to $120,000 in one year in Wyoming. I also droves of good general surgeons leaving some states like Ohio, West Virginia and Pennsylvania because of the astronomical malpractice rates. It may be cool to earn $200K+ a year but you have to pay your office staff, office expenses (malpractice included) and pay off your loans. After that, you ARE that guy making $7.00 an hour with plenty of debt. Couple that with a 100-hour week and I FULLY understand the frustration of many physicians. You can totally love this profession but not be able to practice what you have trained long and hard to be able to do.
While not everyone has to do General Surgery or those other “high” risk specialties, they are needed. Very soon, many states are just not going to have surgeons or OB-Gyn physicians. I will not be practicing in a state with such outrageous malpractice premiums and I live every day with the fallout of malpractice in Ohio.
While you are looking at those wonderful salaries, do a little more Internet reading and look at the malpractice premiums that physicians are required to pay. Also, be mindful that ANY physician can be sued not just surgeons or high risk specialties.
If you are looking for “lucrative” professions, you may need to look elsewhere other than medicine, say malpractice attorney. Far from “feeling sorry” for myself, I am pis-d off!
Natalie
I can’t speak for how much malpractice attorneys make, but I can speak for the fact that most attorneys do not make over $100k or millions has some would have you believe. In any event, I think there are a lot of surveys out there that give average physicians salaries and included in that average is malpractice premiums. In any event, there is no doubt that there is a medical malpractice crisis going on in many states and I do think that this will need to be addressed soon. I don’t think that barring medical malpractice claims are the answer, as not all of them are frivolous, but perhaps capping insurance premiums so there is not a windfall to insurance companies. Again, I don’t have the answers. If there are physicians out there, that when all is said and done, make $7 an hour…that is a real problem and I wish those situations would be documented in the press or in legislative sessions, because that really would be absurd.
Currently, in North Carolina a group of physicians are working with a State Congresswoman to pass a bill limiting “pain and suffering” monetary awards to a maximum of $250K. This limit does not affect amount awarded to compensate for loss of income, cost of added medical care due to the medical malpractice. From what I’ve read about the issue, many OB/GYN drs won’t practice in areas where the insurance is astronomical. Thus, patients must sometimes cross state lines to find a doctor!
Torte Reform is not a new issue. Students in business schools often debate it, and the students (who will be responsible for increasing a corporation’s profit)often side with setting caps because then corporations can calculate how much it will cost them to fix a defective product vs. how much they will have to pay out if, say, one in 1,000,000 customers is injured by the product. If the company can afford the payout then, as the theory goes, the product will stay defective (because cost of retooling a plant can be very high). By keeping “the sky as the limit” for pain and suffering, theoretically, businesses can be “scared” into delivering a safe product.
The cynic in me says that this might be a mindset maintained by the business end of medicine (HMOs and hospitals). But I cannot imagine a physician having this view. I’ve never viewed medical care as a “product” but that model exists for some. It’s a model that doesn’t apply/work for medicine. I think that there can be other ways of reducing errors (other than by a “fear” motivation) and other ways to sanction a physician for gross negligence (which does happen sometimes).
Physicians are tracking data on malpractice awards, insurance costs, costs related to providing quality treatment. The most signficant result of all of this is that doctors are limiting where they will practice due to costs (also, as an aside, there is a physician in California who has created a database of private citizens who have sued their doctors and won the lawsuit. People on the list are being denied treatment by doctors who have used the list as a “reference” check. Someone who ended up on the list is now suing the doctor who created it. The doc claims he has a right to publish it because of the Freedom of Information Act. The names are in public records and the doctor argues that he is simply consolidating already available info).
It’s a tough situation. I believe everyone deserves their day in court (after all, this is America) but there has to be another way to prevent the use of lawsuits as a means for ensuring safe medicine or as a means for gaining financial prosperity for those who sue.
anita
Being the “thorough” person I am, I want to correct an error I made in my earlier post: Torte is a dessert. In my post I referred to “torte reform,” and while I would like to change desserts from calorie-containing to non-caloric it’s not what I meant to say in my post.
The word I should have used is TORT.
Below is a quote from the Cornell Legal Information Institute website:
Torts are civil wrongs recognized by law as grounds for a lawsuit. These wrongs result in an injury or harm constituting the basis for a claim by the injured party. While some torts are also crimes punishable with imprisonment, the primary aim of tort law is to provide relief for the damages incurred and deter others from committing the same harms. The injured person may sue for an injunction to prevent the continuation of the tortious conduct or for monetary damages. (http://www.law.cornell.edu/topics/torts.html)
LMAO AnitaGC!
I work in legal and got stuck on the word tortE in your post but the craving for a TORTE that it conjured up blinded me from the definition issue. thx for the laugh. 
I don’t think that the theory behind torts is 100% deterrant, meaning that lawsuits and ensuing damages awards are meant to scare the defendants into reforming their behavior. Although there is some element of that, I think that a lot of tort is based on the idea of compensation to the victim for your loss. I think that there is a very real loss to someone who lost a loved one or will have to care for a loved one due to a complications, or worse, negligence, on the operating table. In America, money is the price we put on things so recovery comes in that form, and it certainly makes sense when it is a breadwinner who dies on the operating table during routine surgery. The standard “complications” line or even a heartfelt apology does not always cover it. I can’t tell you how I would feel in that situation, but I can certainly understand why someone in that position might want a little more than that. Being someone who wants to go into the medical profession, I like to think that more often than not, these types of accidents or medical mistakes are a result of human error and highly complex systems, and NOT negligence or bad doctors, although I’m sure some do exist. There needs to be a way that families and victims could be compensated for losses or life-changing injuries as a result of medical mistakes, human error, and negligence, and YET, an understanding that medical mistakes and human error are inherent in the system so that physicians, who do not repeatedly commit gross negligence, can continue to practice medicine.
I don’t think the problem is necessarily lawyers who represent victims of medical mistakes. And I don’t think the problems are the doctors who make the medical mistakes. Of course, there will be extremes - the frivolous medical malpractice claim and the grossly negligent physician. There needs to be room for medical mistakes and compensation to victims in a way that does not bankrupt of physicians or send victimized patients homes with a “whoops, sorry about that.” Instead of capping damage awards, why not cap insurance premiums???
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Instead of capping damage awards, why not cap insurance premiums???
I think Wisconsin sort of does that. Physicians pay into a state-run risk pool, and that pool covers awards over $1 million. They only have to pay for private insurance up to that point. I don’t know exactly how well it works, and there’s some noise that legislators are raiding the fund a bit right now because of the budget crisis, but there doesn’t seem to be a big ol’ brain drain of physicians from Wisconsin.
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Instead of capping damage awards, why not cap insurance premiums???
California capped pain and suffering damage awards at $250K recently and it seems to have resulted in somewhat milder malpractice premiums.
I wonder if it would be better to have more stringent review of physicians’ performance. If someone’s screwing up (drug abuser/alcoholic, gambling, frequent complaints or lawsuits by patients, etc.) then suspend their license until they can clean up their act.
I’ve been reading about doctors “going bare”–ceasing malpractice coverage. They require their patients to sign a waiver of some sort. It probably is not possible to prevent people from filing a lawsuit, but at least people are made aware that they’re not going to necessarily win the jackpot by filing a malpractice suit and may in fact lose a lot of money. All the doctor has to do is file for bankrupcy and the plaintiff is stuck with all the legal bills and no award. I just read about such a case in Florida.
I agree that “deterrent” isn’t the main purpose of Tort law. In another post (one in which I corrected my spelling), I pasted the following info about Tort law:
Below is a quote from the Cornell Legal Information Institute website:
Torts are civil wrongs recognized by law as grounds for a lawsuit. These wrongs result in an injury or harm constituting the basis for a claim by the injured party. While some torts are also crimes punishable with imprisonment, the primary aim of tort law is to provide relief for the damages incurred and deter others from committing the same harms. The injured person may sue for an injunction to prevent the continuation of the tortious conduct or for monetary damages. (http://www.law.cornell.edu/topics/torts.html)
******
It is a very complex issue. Not every lawyer is greedy/bad (my sister is a trial lawyer who represents migrant laborers who are regulary sprayed with toxic pesticides while they are working in the fields) and not every surgeon/corporation is negligent/evil/whatever. Also, I don’t know of many patients who want to accept medical error as “part of the reality” that it is (especially in teaching hospitals)…there’s a great book about errors that occur as a physician works through her/his learning curve (it’s called Complications: A Surgeons Notes on an Imperfect Science by Atul Gawande. He wrote is while a resident).
I also agree with the post that said that part of the solution would have to include examination of insurance premiums, if it’s to be a good solution. I read about a physician who had what he considered to be very low insurance rate because he had been in practice for 20+ years w/no lawsuits. When he added a new doctor to his practice, his insurance tripled. To me, it seems reasonable that the new doctor would have a higher premium given the lack of a track record but I can’t imagine why the rate for the experienced surgeon was increased as a result of hiring the new doctor (although, I don’t know if it was the “practice” that got the increase and not simply the doctor. i believe that a “practice” & an indiv can be sued for the same error). So, anyway, yeah, I agree that insurance premiums might need caps.
Finally, whatever is decided regarding the law, there will be unintended consequences (unanticpated repercussions) that might make things even messier. Yikes.
It is a complex situation and I am wary of simplistic solutions (it’s the greedy lawyers or the incompetent doctors)…As a future physician, and a former lawyer, I know that being sued or subject to litigation will not be an enjoyable experience, but I also know that if a family member of mine died or injured due to a botched medical procedure (removing wrong limb or leaving cotton or scissors, etc. in the body), I’d like some answers and if the physicians and hospitals aren’t forthcoming, as historically they haven’t been, I’d like some legal recourse. The book, Wrongful Death, is a great book for future and current doctors to read…it gives a different perspective…that isn’t about the extreme cases of greedy lawyers or grossly negligent physicians. There are no easy answers, but it is a crisis we will face…I’m guessing the answers lies somewhere in the middle - continued physician/hospital accountability, legislation to discourage frivolous malpractice claims, and as well as an eye on corporate America - preventing premiums gouging. I could be completely off, but I’m just shocked by the knee-jerk reactions I often hear- it’s the sleazy, greedy lawyers (the lawyers certainly didn’t make the doctor remove/operate on the wrong limb, etc.) or the incompetent doctors (everyone makes mistakes, but when physicians make mistakes, it’s not a typo, it’s often life and death - so a medical mistake does not mean you’re a BAD doctor). The system needs to change…capping damages is just a band-aid and doesn’t even address some of the real problems. While I find it hard to believe that physicians are making minimum wage, I do know that they are making LESS than they used…and while some malpractice plaintiffs/malpractice victims and their lawyers have received high awards, by and large, I suspect that, by and large, the decrease in physician’s salary is not going to most victims and their lawyers but rather lining the pockets of insurance executives.
There is an interesting book out called “Internal Bleeding” which addresses the issue of medical errors and discusses many of the things that have been written about in this thread. It is written by doctors, and while I don’t agree with everything they say, I do think it is a fairly even handed look at the issues. I particulary agree with their contention that we need to somehow change the focus of doctors and the public alike to making “system changes” to prevent errors, much as the flight industry has done. One of the points they make, and that I’d learned about in one of our health policy classes is that malpractice suits are a terrible way of identifying bad doctors or compensating the truly injured— I can’t remember the exact statistics, but when cases were reviewed/audited for a study, they found a high percentage of cases were filed where there was no true physician error, and in cases where there was true error resulting in injury, a very small percentage of suits were filed. So if the malpractice tort system is supposed to be either identifying bad doctors, or compensating the injured, it’s doing a lousy job.
I highly recommend the book.
Epidoc
I think that one of the solutions would be to have a jury of fellow colleagues that would know if there was gross negligence involved. Also how come judges cannot get sued? they often make error in judgement allowing someone to go free or whatever and that person ends up killing someone else. How come they are not held to such high standards? they also deal with life and death situations…
Actually, a judge usually does not decided guilt versus not guilty. More often that not, it is by a jury of your peers, unless someone waives that right. In the case of a jury decision, a judge often decides sentencing, although there are states where the jury can make that decision, too. I couldn’t imagine that people could be asked to mind their civic duties of sitting on a jury, if they were able to be sued. Additionally, even if a judge is the one who makes that decision, the reason a judge or any other government respresentative can’t be sued for action arising out of their official duties dates back to the Constitution. Sovereign immunity is very rare and only limited to actions arising out of official duties - hence, why Bill Clinton could be sued by Paula Jones. We can’t just go around giving people sovereign immunity just because we think their job is extra important.
Epidoc, I agree with you that the public and even, or rather especially, the medical community needs to be honest and take a realisic view of why these medical mistakes happen…like NASA and the flight industry…medicine is a highly complex system, the complexity of the system by its very nature will insure that there are going to be errors…aditionally, this propensity is only exasperated when coupled with the human actors and element of the inevitable human errors. That’s why committing a medical mistake, in many cases, should not be seen be seen by the public or lawyers as an indication of a BAD doctor, maybe in turn, the medical community can comes to terms with the fact that admitting that mistake and compensating for that loss is not something that should be fought against so bitterly, perhaps there will be no more need for court battles. In any event, something has to come first, and the ways it’s going, I think it will have to be some sort of legislation.