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Thursday, August 27, 2009

Why do doctors make so much money?

In the discussion of why American health care is so expensive, it is certainly necessary to entertain the question of why doctors salaries are as high as they are. The average American makes $38,000 a year, and the average primary care doctor makes around $150,000 a year. These numbers vary by geographical region, certainly, and the primary care doctors I talk to in my small Idaho town mostly make less than $100,000. But they certainly do command a higher salary than teachers or carpenters or most university professors at our esteemed and underpaid state university. So why is this?

To practice medicine, a doctor has to finish 4 years of university, 4 years of medical school and at least 3 years of residency as an MD in training. In order to get into medical school, they need to be in the top of their university classes, and have finished a set of premedical requirements that is heavy in science and math. Medical school is an order of magnitude harder than university. The first two years are spent trying to memorize a tremendous amount of information on anatomy, physiology, biochemistry and the myriad of diseases of the human body, along with their molecular mechanisms and present treatments. The second 2 years are spent intensively practicing medicine, usually in a hospital setting, under the close supervision of teaching doctors and residents in training. Medical school is long, hard and painful, and is essentially all consuming. After these 4 years an MD degree is awarded and the graduate starts residency. The residency years are paid, but at a lower rate than many jobs. In 1987, in my first year out of Johns Hopkins, I worked about 80 hours a week, was often up all night, caring for desperately sick and wildly complicated patients, and made about $18,000. That was the most money I had ever made in my life and I was very proud. But it wasn't even minimum wage, I don't think. After 3 years of this, the resident becomes a full fledged, employable, and usually indebted doctor. On average, a new doctor will have over $150,000 in educational debt.

So the freshly fledged doctor emerges, blinking, into the sunlight of the real world, with enough debt to have bought a house, exhausted, and jobless. The new job, once obtained, is hard. There are new systems to learn, the pace is faster than in training, and the new guy frequently will be given the extra work that nobody else wants. The hours are long, and many of them unpaid.

Now don't get me wrong. I have no cause to complain. I have the best job in the world and I love it. It was just really hard to get to this point, and I don't think that many qualified people would do it if the salary weren't good.

6 comments:

mank said...

I'm curious to know what the all of the costs of care are, and where the costs come from.

johnflerianos said...

Sorry, but I have got the best job in the world. My profession requires no participation in higher education whatsoever (I did
major in Electronic engineering though), and I make money by doing what I love the most. Now you might say that you love being a doctor the most, but you'd be lying. As you said, you have to stay up over night and deal with any problematic person wants your services. I'm sure that's not the best job in the world. I'm a music record producer, independent and self-employed, and I make 2/3's of the money you do per year.

Janice said...

It really is a great job. You do what you do, which does sound like fun, and not what I do, beause cantankerous people and being up in the night to take care of them are probably deal breakers. That's why they make lots of different kinds of people. It gets all of these different jobs done.

Anonymous said...

I would just compare the salaries on a worldwide basis. Comparing with other 1st world countries, it looks like we are paying to much. I'd rather truncate the education arguement and have the goverment pay for their education, than have the packed on millions after their college loan break even point. Americans have been pretty hood-winked on the whole deal. American doctors have a great deal of political and have been resistent to health care reform. Let's just open up immigration and stop the anti-trust racket.

Anonymous said...

I can say this i paid $30,000 for my degree, another 50,000 in tools that dosent even put a dent in the cost of all the tools i will need. so yeah on that note theres my house. Now i have the posiblillaty to make 150,000 but most of the time because i wouldnt be able to charge someone a rather large amout of money and not even fix the problem i will make 80,000. if insurance companies didnt exsist there would be no way a docters visit would cost 450 and most of the time even more. not only that doctors dont even want to work. my pregnat wife had to tell the doctor that they already took her blood and had it on file when they wanted to know her blood type.

MWP said...

I disagree that medical school is harder than university. Try being a PhD candidate in Computer Science or Electrical Engineering and see if it is harder. Well, maybe harder worker but definitely not smarter work or more mentally taxing. Physicians are like the bodybuilders or science...more heavy lifting but not so much brain.