Should Medical Doctors' Salaries be Slashed?

[Marat]

There are several problems with the inflated salaries normally earned by physicians in the United States, which now average around $200,000 a year, according to the AMA.

 

First, these salaries create a class difference between most doctors and most of their patients, and this class difference reinforces the power difference in the doctor-patient encounter. The resulting social and psychological gulf between two people who should ideally bond with each other in a 'therapeutic alliance' undermines the empathy and intimacy which should play an important role in the healing process.

 

Second, these inflated salaries encourage people to enter the medical profession not out of the necessarily idealistic motive to heal and help their fellow humans, but instead to exploit them as sources of wealth. Nothing undermines the development of a psychology of dedication to a patient more than an institutional setting in which the patient appears as a cash-cow to be milked for money-making opportunities.

 

Third, inflated physician salaries violate the public health duties of physicians by putting their services out of reach of many less affluent patients. A recent study showed that the lack of a public healthcare system in the U.S. resulted in about 40,000 unnecessary deaths a year, and at least part of the reason why a public healthcare system cannot be instituted is its high cost, some of which results from overly generous physician remuneration. Killing sick people for money is hardly in the spirit of the Hippocratic Oath. Since there are about 300,000 physicians in the U.S. today, if each of them took a mandatory $100,000 pay cut, that would save society $30 billion a year, which would make a public healthcare plan more affordable for the country or private healthcare more affordable for the poor and the middle class.

 

Since healthcare is not a commodity in the sense that people can freely choose to buy it or not, but rather, biological developments outside their control can force them to need it even if they can't afford it, it is a moral imperative to do everything possible to reduce its costs. Ironically, the main cost control devices proposed usually involve cutting patient care, which is an essential human need, while a truly inessential human interest -- the luxury of a disproportionate salary -- is neve touched in these proposals.

[Mr Skeptic]

I would like to pay less for medical care too, but I don't think I could agree with "cutting" a doctor's salary. (For that matter, I'd like to see more doctors with salaries.) Just how do you propose to "cut" a doctor's salary without setting any nasty precedents or having nasty side-effects?

[insane_alien]

doctors are one of the few groups of people i don't mind having inflated salaries. seeing as its very probable my life will depend on them at some point.

 

I'd rather see a doctor on $200000/a than a basket ball player or a politician.

[zapatos]

Given the time, expense, and effort required to become a physician, along with the amount of time required once practicing, I don't know if I would categorized $200,000 per year as 'inflated'.

 

And if we cut the annual salary in half, I wonder what would happen to the quality of physicians over time, as very talented individuals choose other, more lucrative, fields.

[Cap'n Refsmmat]

I thought there was already a shortage of qualified doctors in certain fields. Also, some doctors already reject Medicare patients because the pay is too low. Reducing their pay would simply exacerbate these problems and decrease access to healthcare.

[John Cuthber]

I thought they needed the money to pay for their insurance because, every time they do something that a lawyer claims is a mistake, they get nailed.

Perhaps we should cut the salaries of the lawyers instead.

[Marat]

The easiest legal way to accomplish this would be to require as a condition of medical licensure in the United States that all doctors work for some government healthcare plan; then salaries could be cut to any amount the public found to the net benefit of society. This is essentially what happened in Britain with the introduction of the NHS in 1948 and is still the case in Canada today. A public healthcare system could also take care of malpractice claims against doctors who were their employees.

 

The risk that doctors would leave to practice in more lucrative environments elsewhere wouldn't be a problem for the U.S., given that remuneration is already highest in the U.S. and even other rich countries simply couldn't absorb 300,000 U.S. physicians with their hands outstretched demanding $200,000 each. Most other countries already have socialized medicine and so physician salaries there are already relatively low.

 

Education should be regarded as a pleasure, not as a burden that has to be compensated by an inflated salary for the rest of one's life. Archeologists require more years of training than physicians do and have to produce a work of original scholarship as well, as doctors do not, and yet their remuneration is pitifully small -- if they can get work at all.

[Cap'n Refsmmat]

The risk that doctors would leave to practice in more lucrative environments elsewhere wouldn't be a problem for the U.S., given that remuneration is already highest in the U.S. and even other rich countries simply couldn't absorb 300,000 U.S. physicians with their hands outstretched demanding $200,000 each. Most other countries already have socialized medicine and so physician salaries there are already relatively low.

And as we've already seen in the US, there's a shortage of primary care physicians as doctors head for better-paying specialties. Cut their salaries and this will increase. You'll also discourage future medical school students from ever becoming doctors.

 

Education should be regarded as a pleasure, not as a burden that has to be compensated by an inflated salary for the rest of one's life. Archeologists require more years of training than physicians do and have to produce a work of original scholarship as well, as doctors do not, and yet their remuneration is pitifully small -- if they can get work at all.

Unfortunately that's not how most people think about it.

 

Also, I understand that medical school and residency is not much of a pleasure, by any stretch of the imagination.

[Marat]

Perhaps the experiences of medical education would be made more pleasurable if there were less remuneration offered to compensate for the ugly and utterly unnecessary rituals of training.

 

If the government were employing all doctors as salaried workers within a national healthcare plan, the government could adjust the supply of physics to the rational needs of the community, so there could be the right numbers of people in each specialty and the right numbers of people in all parts of the country, not just in the major cities.

[Mr Skeptic]

Education should be regarded as a pleasure, not as a burden that has to be compensated by an inflated salary for the rest of one's life. Archeologists require more years of training than physicians do and have to produce a work of original scholarship as well, as doctors do not, and yet their remuneration is pitifully small -- if they can get work at all.

 

And expensive pleasure, perhaps. One that frequently involves huge loans, which of course need to be paid back.

 

If the government were employing all doctors as salaried workers within a national healthcare plan, the government could adjust the supply of physics to the rational needs of the community, so there could be the right numbers of people in each specialty and the right numbers of people in all parts of the country, not just in the major cities.

 

The supply of physicians can't just be increased or decreased like that. It takes years to train them, so you have to know years ahead of time how many you need (in each specialty).

[Marat]

Of course it would take time for training to match the demand, but at least if the government were in charge of training doctors as employees of its national healthcare program, the number of doctors in each specialty would ultimately be determined by genuine human need rather than the greed of M.D.s, as it now is. Thus there are too few psychiatrists because they are poorly paid as a specialty, and there are too many people in internal medicine because they make much more money.

 

Because of the prestige of the profession, the very special type of human activity it represents, the instinct in at least some people to help others, and family traditions of medical service, there will always be enough volunteers for medical school even if the salaries are not high. There were more physicians per capita in America in 1900 than there are today, yet then they were not paid as well as they are now, relatively speaking. In countries today where doctors are not well remunerated there are still more than enough medical school applicants to overfill the capacity.

[Cap'n Refsmmat]

Because of the prestige of the profession, the very special type of human activity it represents, the instinct in at least some people to help others, and family traditions of medical service, there will always be enough volunteers for medical school even if the salaries are not high.

How can this be true given the current shortage of doctors in many fields?

[Genecks]

Which fields?

 

To a degree, I agree with insane_alien.

 

America is the problem. Just leave America. Problem gone, right?

Then all we'd be competing for is prestige like some old-school gentlemen?

 

The problem is the AMA. Bust up the AMA and problem gone.

 

Let's also find a way to tax the hell out of everyone associated with sports.

 

I think many medical doctors deserve the pay they get. But then there are other professions that get wayy too much. Perhaps dentists are paid too much. Perhaps pharmacists are paid too much. Perhaps opticians are paid too much... And doctors who never ever do surgery ever and never will? Paid too much.

 

In a lot of ways, this is the issue of a factory worker who is paid a large salary to do very simple things. Given that a person has a level of seniority, the pay may be reasonable. But given that seniority does not exist, the pay is more than the time and effort put into the work accomplished.

 

As I read more about changing economics in the medical field, along with further introduction of physicians assistant's (P.A.s), I am believe that medical administrators are attempting to find ways to slash salaries, replace M.D.s with people who can do the same task for a lower salary, and so forth. The fact that the goverment also grants licenses and certifications to particular persons and gives them the right to conduct such tasks is like saying, "Alright, we'll let you have the ability to pay someone lower than an M.D. for completing darn similar work."

 

At the moment, more people are becoming physician's assistants, and I believe this will start cutting into the medical industry more and more. The AMA may be able to act like a guild and fight the government in relation to how many M.D.s are certified. However, a government could attempt to fight back against the AMA.

 

I believe these physician assistant's are part of counter-attack.

 

And then you'll eventually have more nurses, and then more CNAs to replace said nurses, and so forth. I've considered the PA to the MD as the CNA is to the RN.

 

I believe this medical salary issue started to be dealt with in the mid-1990s and has slowly been working its way out.

Edited February 23, 2011 by Genecks

[Marat]

If doctors were employed for a low remuneration in a government healthcare system, that same system could also pay for their education so they wouldn't be able to claim compensation for that.

 

There will always be plenty of doctors just because of the special nature of the profession, even if it is not well paid. In Austria today, for example, where the only restriction on admission for Austrian and Liechenstein citizens applying to domestic medical schools is that they possess a secondary-school certificate, there are as many people in medical school as there are doctors in the entire country. And this is despite the fact that physicians' salaries there are already quite low compared to those in the U.S., and will certainly go much lower once the current generation of medical students emerges into practice.

 

But even on basic principles of social justice doctors don't deserve high salaries. They are essentially just glorified refrigerator repairmen, simple mechanics, who do nothing more than tend machines and try to fix them when they break down. Granted, the human body is more complex than a refrigerator, but on the other hand, refrigerator repairmen are much more successful at keeping their machines operating than medical doctors are at keeping their 'machines' alive, so the salaries should balance out. In contrast to genuine scientists, philosophers, and poets, the typical doctor never makes any original contribution to the extension of human knowledge or insight, and he or she never creates anything, but just carries out the established rituals of a highly-regulated craft, like a cabinet-maker.

[Genecks]

If doctors were employed for a low remuneration in a government healthcare system, that same system could also pay for their education so they wouldn't be able to claim compensation for that...

 

I think that's really a good idea in the end. They need to be paid back. Now, from some people (in the U.S.) I've talked to in the past, they are able to receive some kind of funding for medical school if they make some kind of promise with an institution.

 

So, say, I know someone who is going to medical school to be a psychiatrist. That person walks into a low-income clinic, makes a promise with them, and agrees to receive a low salary in the future for the clinic funding that medical student to get through medical school. This could include grants and loans. And it may even include the loan debt being removed once the person fulfils the contract.

 

That's about as socialist as we get, I think. It's also capitalistic in some ways, as it locks a person into a particular wage range and the clinic ends up coming out ahead (and keeping with its mission of being a low-income clinic). I like this kind of deal, because you don't have to become a member of the military.

 

These kinds of deals exist for people. You start to see the greed when people say, "No, I want all of the money and no exceptions."

 

People can either compensate or roll the dice.

 

...But even on basic principles of social justice doctors don't deserve high salaries. They are essentially just glorified refrigerator repairmen, simple mechanics, who do nothing more than tend machines and try to fix them when they break down. Granted, the human body is more complex than a refrigerator, but on the other hand, refrigerator repairmen are much more successful at keeping their machines operating than medical doctors are at keeping their 'machines' alive, so the salaries should balance out. In contrast to genuine scientists, philosophers, and poets, the typical doctor never makes any original contribution to the extension of human knowledge or insight, and he or she never creates anything, but just carries out the established rituals of a highly-regulated craft, like a cabinet-maker.

 

Not all doctors are glorified. We need our surgeons and specialists to a degree, and I think because of the complexity and level of detail to their work, they should be compensated. They are like warriors, in my opinion.

 

We don't need so many bed-side individuals paid so much.

 

Also, medical doctors use to do a lot of research in the past. But this was due to the fact that they had to money to do said research: the socioeconomics of the time.

 

Also, consider what kind of research was possible back then: Equipment didn't cost as much as it does now: The level of complexity to our equipment, the costs of chemicals, and running a lab has greatly increased.

 

But we don't have medical doctors really doing this kind of thing now. We do have our medical scientists, but I think they stick around because they do things that others can't do, because of government regulations.

Edited February 23, 2011 by Genecks

[lemur]

Imo, there is a false dichotomy between free market medicine as being high-cost and public (government controlled) medicine as lowering costs. I think the issue comes down to funding-pools. If insurance or government creates a large pool of money for health-care, suppliers figure out ways to tap into the pool(s). If, on the other hand, no such pools were available, medical costs would be limited to what individuals could afford to pay. When I tell this to people, they say that no one would go into medicine but I think people still would, since it would still be a lucrative business compared to many others, if nothing else because of volume-sales (everyone needs it sometimes).

[zapatos]

Because of the prestige of the profession, the very special type of human activity it represents, the instinct in at least some people to help others, and family traditions of medical service, there will always be enough volunteers for medical school even if the salaries are not high.

 

They are essentially just glorified refrigerator repairmen, simple mechanics, who do nothing more than tend machines and try to fix them when they break down.

 

Which is it?

 

In contrast to genuine scientists, philosophers, and poets, the typical doctor never makes any original contribution to the extension of human knowledge or insight...

I cannot think of a single thing a poet has ever done to improve my life, but the procedures developed by 'glorified refrigerator repairmen' have drastically improved the lives of millions, including those in my family.

 

I cannot figure you out.

[Marat]

The fact that doctors really are just equivalent to refrigerator repair men in terms of the remuneration they actually deserve is not inconsistent with their being falsely 'glorified' in the view of society and in their own minds. Medicine has been conducting a long propaganda effort for years to inflate their standing in the community from the backdoor tradesmen they used to be regarded as in the 19th century to the Gods they now pass themselves off as being.

 

While there has been some medical progress in the past, most of that ceased around the mid-1950s, and since then there have been only incremental advances, though the medical propaganda machine would have you think otherwise. Since the polio vaccines of the mid-1950s, no major disease has been cured, and nearly 60 years with little to show for it is not consistent with what a modern science should be doing.

 

In any case, medical research is done by medical researchers, who are sometimes M.D.s, sometimes just Ph.D.s, and sometimes Mudphuds, with both terminal degrees, but they are an entirely different group of people from the brainless repairmen who wear a white coat, try to push you through your medical appointment in under seven minutes to squeeze more cash out of the day, and whose only research work is comparing the golfing vacations in the Bahamas with those in St. Lucia.

[Mr Skeptic]

But even on basic principles of social justice doctors don't deserve high salaries. They are essentially just glorified refrigerator repairmen, simple mechanics, who do nothing more than tend machines and try to fix them when they break down. Granted, the human body is more complex than a refrigerator, but on the other hand, refrigerator repairmen are much more successful at keeping their machines operating than medical doctors are at keeping their 'machines' alive, so the salaries should balance out.

 

Do you know why doctors are worse at "repairing" humans than refrigerator repairmen are at repairing refrigerators? Because people throw out refrigerators and get new ones. Seen any 100 year old refrigerators around have you? Do you think we should just throw out "broken" people and buy a new one?

[imatfaal]

Marat - where is all this bile coming from? Doctors spend less time studying than archaeologists? Well - the longest archaeology degree in UK is 4 years full time and the shortest medical degree is 5 years. No medical advances since the 50s - where is this from - better not tell all the people with Heart transplants/bypass surgery, those who have survived cancer, or are on anti-retrovirals. Doctors in the UK are also very well paid - so i don't think any movement to a more socially funded model will make an enormous change

[Marat]

In comparing medical doctors with archeologists I am considering the terminal degrees in each profession. Someone with a Ph.D. in archeology, because he has had to learn not just ancient history, literature, philosophy, architecture, and science, but also the forensic methocs of archeological investigation, plus a host of difficult languages, such as Latin, Ancient Greek, Egyptian hieroglyphics, Babylonian, Sumerian, etc., is usually regarded as having had to spend the longest time in his educational preparation of all academic disciplines. But the archeologist's remuneration will be only a fraction of what a medical doctor gets for applying the extremely narrow range of FDA-approved procedures and drugs he is allowed to use, like a chef with a cookbook. Diagnosis in medicine is increasingly computerized, because it is not allowed to involve any original thought, such as every academic discipline positively insists upon. Original thought in medicine, however, counts as malpractice in the current dogmatized construction of the discipline in North America.

 

I didn't say that there was no progress in medicine since the mid-1950s, only that no diseases had been overcome since polio was eliminated as a threat to the developed world by the polio vaccine nearly 60 years ago. The overall picture of stagnation in modern medicine is striking. In 1942 there was renal hemodialysis which could save the lives of patients with endstage renal disease but only at the cost of utterly destroying their quality of life. The same situation obtains today. In 1922 there was insulin to treat diabetes, but the treatment dosing was onerous and dangerous, and no amount of precision obtainable could prevent neurological and vascular complications and premature death. The situation is still the same today. In 1900 cancer treatment was so horrible and ineffective that many patients preferred not even to attempt it and just chose to die with nothing more than palliative care. The situation is still the same today with many types of cancer.

 

If you contrast what medicine achieved in the century between 1855 and 1955 with what it shall have achieved in the century from 1955 to 2055, I think you would agree that our present era will fall far behind the progress that was achieved in the previous century. This situation is what the famous historian of science, Derek Price, described in 'Science Since Bablyon' as dying science, when a science reaches a point of maximum development and then gradually calcifies into a fixed dogma, whether all the empirical challenges facing it have been met or not.

[John Cuthber]

There's a lovely story about two men who get chatting in a bar. One is a mechanic who repairs vehicles; the other is a heart surgeon. The mechanic says "Basically we do the same job, we both clean out the junk from old machines and put them together again so they work better."

 

The surgeon says "Sure, but do you do it with the engine running?"

 

As for "Perhaps the experiences of medical education would be made more pleasurable if there were less remuneration offered to compensate for the ugly and utterly unnecessary rituals of training. "

Do you really want low paid doctors without training?

No problem; I can be a quack. I have no idea what I'm doing, but I can do it for half the price of a real doctor.

Now, what treatment would you like?

[Marat]

I'm not saying doctors should not have training, or even just as much or more training than they now do, only that it shouldn't have to be so ugly and stressful as it is now made to be, with hospital shift work lasting many more hours per week than any human being can tolerate, with abusive scoldings, with deliberate cultivation of high-pressure or embarrassing situations by the mentors, etc. All of this unnecessary cruelty only first arises from the fact that the reward being offered is a ton of money; if the monetary reward were not great, then the atmosphere in medical training settings would then reflexively have to become more relaxed, since it would have nothing to induce people to endure such a hazing. There's no screaming at new students for their failures along the learning curve at the local community college arts and crafts program.

[lemur]

Do you really want low paid doctors without training?

No problem; I can be a quack. I have no idea what I'm doing, but I can do it for half the price of a real doctor.

Now, what treatment would you like?

I can more quickly answer the question whether I want to hear the same rehearsed political arguments that I've heard so often before once again mentioned in yet a new situation. The answer is NO, I DON'T need to hear someone mention for the 1000th time that discount medicine will provide a sub-standard quality of care that I should fear and thus resist.

 

I'd rather transcend fear in favor of sorting out which typical treatments can be performed by experienced yet relatively low-status practitioners. There's no reason to take your car to the dealership for an oil-change so why should you need a doctor to do something that a less-trained, lower-paid professional can do? Imo, there needs to be basic enough knowledge among patients to know when they need a second opinion or not. I don't see any reason why patients should be taking a totally passive attitude toward care in the 21st century.

 

 

[imatfaal]

Lemur - when you are ill, who works out what is wrong with you in order that you can be put on track to the correct level of medical attention? If we all knew, in advance, what was wrong with us then medicine would be a great deal easier. Levels of triage work very well in situations where many of the ailments can be easily identified and most fall into similar categories; but GPs train so that they can spot the outlier, the rogue extreme and that is what makes the highly trained generalist very useful.