The Deceptive Income of Physicians

Doctors do not make as much money as you think

By Benjamin Brown, M.D.

with 974 comments

Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher. Physicians spend over a decade of potential earning, saving and investing time training and taking on more debt, debt that isn’t tax deductible. When they finish training and finally have an income – they are taxed heavily and must repay their debt with what remains. The cost of tuition, the length of training and the U.S. tax code places physicians into a deceptive financial situation.

The road to becoming a licensed and board certified physician is a long one. Physicians spend the equivalent of 20 years of full-time work just learning how to be a physician. First, one must earn a bachelor’s degree. Attending college full time, this will take about four years or 6,400 hours of work. 4 years x 40 wks/yr x 40 hrs/wk = 6,400 hours. To be competitive for acceptance into medical school you will likely spend far more than 40 hours per week studying, doing research and volunteering. However, to keep it simple and consistent we will neglect that extra time. After college future physicians must attend medical school. Medical students spend about 80 hours per week for 48 weeks each year studying and training which amounts to 15,360 hours over four years. After medical school, physicians must complete post-graduate training known as residency. To practice medicine in the United States physicians must pass all 3 parts of the United States Medical Licensing Exam (USMLE©) and complete at least the first year of residency, which is known as internship. Residents work long hours, weekends, nights and holidays. Most approach the legal work hour limit of 80 hrs/wk for 50 weeks each year. Many residents exceed 80 hrs/wk studying and doing research in addition to their clinical responsibilities. To become board certified, future physicians must complete an entire residency-training program and pass all additional exams for that particular specialty. For example, to become board certified in Internal Medicine, one must graduate from medical school, pass all 3 USMLEs, complete a 3-year Internal Medicine residency and pass the Internal Medicine board exam. A board certified Internal Medicine physician will spend about 34,000 hours training. To become board certified in Thoracic Surgery – one must graduate from medical school, pass all 3 USMLEs, complete a 5-year General Surgery residency, complete a 2-year thoracic surgery fellowship and pass the Thoracic Surgery board exams. A board-certified Thoracic Surgeon will spend about 49,760 hours training. The shortest residency training programs are 3 years long and include the primary care specialties of Internal Medicine, Family Medicine and Pediatrics.

Spending 40,000 hours of one’s young adult life learning how to be a physician is an admirable sacrifice, especially considering one must spend more money than one earns to work those 40,000 hours. The long hours don’t necessarily end after residency. In 2007, physicians from over 20 specialties were asked how many hours per week they generally work – the average was 59.6 hours per week.1 So even after physicians finish their 40,000 hours of training they continue to work one-and-a-half times as much most Americans for the rest of their career. In short, physicians work two-full time jobs while in training and one-and-a-half full time jobs when they are finished. They have to work nights, evenings, weekends, holidays and take call. For most physicians, there is no such thing as overtime or holiday pay.

Why does it have to take so long?

There are no shortcuts to gaining the knowledge and experience one needs to be a competent physician, they need to put in the time to get the experience. Because there is no shortcut to gaining the experience one needs to be a competent physician, decreasing resident work hours from 80 hours per week to 60 hours per week is a terrible idea. If such a change occurs, residency training would have to become years longer in order to get the same experience. Making physician training longer will further increase student debt loads and decrease the number of years physicians are able to work after they are trained. It will increase the number of physicians in training and decrease the physician workforce.

Becoming a physician is expensive. For the 2009-2010 academic year, the average total student budget for public and private undergraduate universities was $19,338 and $39,028, respectively.2 If one attends an average priced institution, receives subsided loans and graduates in four years they will have about $100,000 of student loan debt from college. For the 2009-2010 academic year, the median cost of tuition and fees for public and private medical schools was $24,384 and $43,002 per year, respectively.3 This does not include the cost of rent, utilities, food, transportation, health insurance, books, professional attire, licensing exams fees or residency interview expenses. Therefore, the average medical student budget is about $45,000 per year; $30,000 for tuition and $15,000 for living expenses. If one attends an average priced medical school, receives 1/3 subsidized loans and graduates in 4 years; at a 7% APR they will have $200,527 of debt from medical school at graduation. If one borrows $22,500 bi-annually and two-thirds of this accrues interest compounded bi-annually at 3.5% – their total student loan debt for both college and medical school will then be $300,527. Forbearing this debt through 5 years of residency and paying it off over 20 years will cost about $788,880 of one’s net income.

Loan repayment programs such as those offered by the military are not a solution for the majority. Each year, about 22,000 medical students graduate from U.S. allopathic and osteopathic medical schools.4,5 Each year the military matches 800 students into its residency training programs, because that is the military’s anticipated future need for physicians.

The U.S. tax code allows taxpayers to deduct a maximum of $2,500 per year of student loan interest paid to their lender. This deduction is phased out between incomes of $115,000 and $145,000.6 Therefore, this benefit is of no help to most physicians. If one were to start a business, they could deduct nearly all of their expenses. Yet for unclear reasons, one cannot deduct the cost of becoming a physician; not the tuition or even the interest on the money they borrowed to pay their tuition.

During residency, if one makes payments of $1,753 per month, or $21,037 per year, to pay off the accruing interest, thier debt will be still be $300,527 at the end of residency. However, they will have spent $63,111 over the course of a 3 year residency or $126,222 over the course of a 6 year residency to keep their debt from growing. Though paying off the interest during residency is the responsible thing to do; coming up with $21,037 each year from one’s net pay of $40,000 may be quite difficult.

Time spent training, student loan debt and the U.S. tax code makes the income of physicians deceiving. A board certified internal medicine physician who is married with 2 children, living in California and earning the median internist annual salary of $205,441 will be left with $140,939 after income taxes and $106,571 after student loan payments.7 This is assuming a federal Income tax rate of 28%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%. You can go to www.paycheckcity.com to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc. Paying off a debt of $369,425 over 20 years at a 7% APR will require annual payments of $34,368. Those student loan payments will continue to consume about $34,000 of their net income for 20 years until they are finally paid off. What started off as $300,527 in student loan debt will end up costing $687,360. This debt that consumes one-fourth of their net income for 20 years wasn’t accrued because they bought a house they couldn’t afford – it is because they chose to become a physician.

Believe it or not, the amount of money reaching a physician’s personal bank account per hour worked is only a few dollars more than that of a high school teacher.

In order to make this calculation we will neglect inflation of the U.S. dollar by assuming that inflation will increase at the same rate as the purchasing power of the U.S. dollar decreases. We will also assume that physician incomes keep pace with inflation. We will also assume that tuition costs, student loan interest rates, resident stipends, physician reimbursements and the U.S. income tax structure are as described above and do not change.

The median gross income among internal medicine physicians is $205,441.7 The median net income for an internist who is married with two children living in California is then $140,939. Internal medicine is a three-year residency, so throughout residency they will earn a total net income of about $120,000 and spend about 35,000 hours training after high school. The total cost of training including interest, forbeared for three years and paid off over 20 years as explained above is $687,260. One study reported that the average hours worked per week by practicing Internal Medicine physicians was 57 hours per week.8 Another study reported the mean to be 55.5 hours per week.9 We will use 56 hours per week and assume they work 48 weeks per year. If they finish residency at 29 years old and retire at 65 years old they will work for 36 years at that median income.

[(140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)] = $34.46

The adjusted net hourly wage for an internal medicine physician is then $34.46

The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000.10 The median net income for a high school teacher who is married with two children living in California is then $42,791. This is assuming a federal Income tax rate of 15%, California state income tax rate of 6.6%, Social Security tax rate of 6.2% and Medicare tax rate of 1.45%. You can go to www.paycheckcity.com to get an idea of what one’s net pay would be for different incomes, states of residence, marital status, number of children, etc. Teachers spend about 6,400 hours training after high school, the amount of time it takes to get a bachelor’s degree. The total cost of training if one attends an averaged priced institution and pay off their debt over 20 years at a 7% interest rate is $186,072. At this income one would be able to deduct the interest on their student loans from their income taxes; however, those savings are not accounted for in the calculation below. High school teachers have about 10 weeks off each summer, 2 weeks off during Christmas, 1 week off for spring break and 1 week of personal paid time off. Therefore, high school teachers who work full time average of 40 hours per week for 38 weeks each year. Yes, teachers spend time “off the clock” preparing for class, correcting papers, etc. However physicians also spend time “off the clock” reading, studying, going to conferences, etc. If a high school teacher finishes college at 22 years old and retires at 65 years old, they will work for 43 years. Most teachers also receive a pension. We will assume their gross annual pension including the value of benefits is $40,000 which is a net pension of $35,507. If they die at 80 years old they will receive this pension for 15 years.

[(42,791 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

The adjusted net hourly wage for a high school teacher is then $30.47

The median gross income among internal medicine physicians is $205,441.7 The median gross income among high school teachers, including the value of benefits but excluding their pension, is about $50,000 per year.10 Accounting for time spent training, student loan debt, years worked, hours worked per year and disproportionate income taxes – the net adjusted hourly wage of an internist is $34.46 per hour, while that of a high school teacher is $30.47 per hour. Though the gross income of an internal medicine physician is 4 times that of a high school teacher, the adjusted net hourly wage of an internal medicine physician is only 1.13 times that of a high school teacher. Most people would argue that high school teachers are not paid enough, yet for some reason most people would also argue that physicians are paid too much.

Isn’t taking care of patients rewarding regardless of income?

Yes, taking care of patients is rewarding. However, when physicians are unfairly reimbursed for their services they feel exploited. This feeling of exploitation or being taken advantage of is what bothers physicians the most. Physicians spend 40,000 hours training after high school and take out over a quarter million dollars in loans all so that when they are done they can work 60 hours per week, be paid less than they were expected, give about 40% of their income to the government in taxes and pay 25% of their net income to their student loan lender. They feel exploited because after all that they have sacrificed they are enslaved to the highly regulated healthcare industry, which unfairly pays them.

On June 18, 2010 the Centers for Medicaid and Medicare Services (CMS) instructed its Medicare contractors to start processing claims for physician payments at a 21.3% reduced rate.11 Should other payers follow Medicare, as they so often do, physicians may have to find another line of work. Decreasing a physician’s reimbursements by 21.3% doesn’t mean that a physician’s gross income will go from $200,000 to $157,400 – it will likely decrease much, much more. Let’s say Dr. Smith, an internal medicine physician, spends 15 minutes caring for a Medicare patient and bills Medicare $100 for this service. From that visit, Dr. Smith’s profit margin is say 40%, $60 to cover her overhead and $40 profit. Prior to this recent change, Medicare typically paid about 60 cents on the dollar, which is why most physicians barely broke even caring for Medicare patients. The 21.3% decrease in physician reimbursements will likely be 21.3% of that $60, so Dr. Smith will now be reimbursed only $47.22 dollars for that visit which is less than the $60.00 it cost Dr. Smith to see the patient. Therefore, Dr. Smith will spend $12.78 to care for that Medicare patient. This is generous of Dr. Smith and all, but it is unsustainable. It is unsustainable for Dr. Smith and unsustainable for the future of medicine.

In an era of skyrocketing healthcare costs, an increasing need for healthcare services and diminishing resources – Americans need to be cognizant of whom they exploit. Physicians want to work hard and do whatever they can for their patients. And like every other American, physicians also want to be appreciated and fairly compensated for their time and financial sacrifice.

Addendum #1 – The Net Adjusted Hourly Wage of Dentists and Nurses

The median gross income among general dentists who work full time in a group practice is $220,000.(12) The median net income for a general dentist who is married with two children living in California is then $149,681. General dentists who work full time in a group practice with partners work an average of 38 hours per week, 1,727 hours per year.(12) Dentists spend about 17,920 hours training after high school. The total cost of training if you attend averaged priced institutions pay off your debt over 20 years at a 7% interest rate is $558,216. If you finish dental school at 26 years old and retire at 65 years old they will work for 39 years.

[(149,681 x 39) – (558,216)] / [(1,727 x 39) + (17,920)] = $61.91

The adjusted net hourly wage for a general dentist is then $61.91

The median gross income of a registered nurse is $62,450.(13) The median net income of a registered nurse who is married with two children and lives in California is then $51,787. To become a registered nurse via the associate’s degree route takes 2 years, about 4000 hours of training. The average total student budget at a public 2-year university is $14,285.(14) The total cost of becoming an R.N. is then $28,570. If that debt is paid off over 20 years at a 7% interest rate it will end up costing a total of $53,160. At this income you will be able to deduct student loan interest costs from your federal income taxes, these savings are not included in the calculation below. If you finish nursing school at 20 years old and work until you are 65 years old you will work for 45 years at that median income. We will assume you work 40 hours per week, 50 weeks per year.

[(51,787 x 45) – (53,160)] / [(40 x 50 x 45) + (3,200)} = $24.43

The adjusted net hourly wage for a registered nurse is $24.43

What if an R.N. worked as much as an internal medicine physician? Unlike a physician, an R.N. would receive overtime pay for the hours they worked in excess of 2,000 per year.

Variables that will decrease a physician’s adjusted net hourly wage include: a shorter career, increased taxation, decreased income, working more hours for the same or less pay, spending more than average on tuition, spending more time training and decreased resident pay.

Variables that will increase a physician’s adjusted net hourly wage include: a longer career, decreased taxation, increased income, working fewer hours for the same or more pay, spending less than average on tuition, having less debt, paying off your debt early and increased resident pay.

Addendum #2.   Residency Match Data.

Food for thought.

Data of applicants who successfully matched by specialty in 2009 (14-17)

(Calculations include both U.S. Allopathic Seniors and Independent applicants)

Specialty AverageUSMLE
Step 1
AverageUSMLE Step 2 % US Seniors who were AOA Average # Abstracts, Presentations and Publications
Plastic Surgery 242 242 42 9
Dermatology 240 248 51 7
Otolaryngology (ENT) 240 245 37 4
Neurosurgery 239 237 28 8
Radiation Oncology 238 241 35 8
Diagnostic Radiology 238 242 23 4
Orthopedic Surgery 237 240 28 4
Ophthalmology 235 - - -
Pathology 226 227 13 5
Neurology 225 229 12 4
Anesthesiology 224 230 10 2
Internal Medicine 224 229 15 3
General Surgery 224 230 12 3
Internal Medicine/Pediatrics 222 231 21 2
Child Neurology 221 - - -
Emergency Medicine 221 229 11 2
Pediatrics 218 227 12 2
Obstetrics & Gynecology 217 227 14 2
Physical Medicine & Rehabilitation 213 216 4 2
Psychiatry 213 217 4 2
Family Medicine 208 214 5 1

Want to know more about the U.S. medical education system?

 

 

 

 

 

 

 

 

 

 

 

Available in paperback, ebook and kindle formats

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www.BensThoughts.com

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www.WillYourEducationPayOff.com

 

1. Anim M, Markert RJ, Wood VC, Schuster BL. Physician practice patterns resemble ACGME duty hours. Am J Med 2009;122(6):587-93.

2. 2009 Total Student Budgets, 2009-2010. In Trends in Higher Education. The College Board, Annual Survey of Colleges .

3. U.S. Medical Schools Tuition and Student Fees – First Year Students 2009-2010 And 2008-2009. 2010 2010.

4. U.S. Medical School Applicants and Students 1982-83 to 2009-10. AAMC; 2009.

5. AACOMAS Matriculant Profile of 2009 Entering Class. Chevy Chase, MD2009.

6. Publication 15 Cat. No. 10000W. In: Treasury, editor: Internal Revenue Service; 2010. p 40.

7. 2009 Physician Compensation Survey. Alexandria, VA2009.

8. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA 2003;290(9):1173-8.

9. Shiotani LM, Parkerton PH, Wenger NS, Needleman J. Internal medicine work hours: trends, associations, and implications for the future. Am J Med 2008;121(1):80-5.

10. 2010 Occupational Outlook Handbook, 2010-2011 Edition, Teachers—Kindergarten, Elementary, Middle, and Secondary. Bureau of Labor and Statistics, U.S. Department of Labor .

11. Staff N. 2010 6/20/2010. CMS Forced to Begin Processing Medicare Payment Claims at Reduced Rate. American Academy of Family Physicians . 6/20/2010.

12. Income from the Private Practice of Dentistry. 2008 Survey of Dental Practice, Vol. 3: American Dental Association, 2009.

13. Occupational Outlook Handbook, 2010-2011 Edition, Registered Nurses. Bureau of Labor and Statistics, U.S. Department of Labor, 2010.

14. NRMP. Charting Outcomes in the Match. 3rd Ed. Washington, DC, 2009.

15. Urology Match Statistics. American Urological Association, 2009.

16. Ophthalmology Residency Match Report – January 2009. San Francisco, 2009.

17. Child Neurology & Neurodevelopmental Disability Residency Match Comparative Statistics. San Francisco, 2009.

 

 

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Written by benbrownmd

June 20, 2010 at 6:29 pm

974 Responses

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  1. Dr. Brown,

    I applaud you on a well researched, and meticulously calculated article. This article, however, is so far off the mark, it is difficult to know where to start.

    Academically, it has numerous flaws; and worse, rhetorically it is spiteful and rude. I don’t want you to mistake my frankness as a sign of disrespect for medicine or those who practice. I want you to realize though how inaccurate your perspective is.

    Although it’s not what I want to focus on, your estimates are wrong [I'd rather focus on why they're wrong]. You assume the average HS teacher stopped at a bachelors, that is false. Most schools now require masters degrees. Not to purport an ecological fallacy, but my HS alone had over a dozen teachers with PhDs. Your estimates of debt are false. You reported the average gross cost of education/living. This is nowhere near the actual cost incurred by medical students. The [vast] majority of future physicians receive both grants, scholarships, and assistance from their families (which even if you consider a cost to them, does not influence debt from future interest). Your estimation of working/studying 80 hours a week for 48 weeks during med school is laughable; not only does this not account for any schedule I’ve ever seen [a lot] but it sounds an awful lot like a a wall street exec calling a lunch in which he mentions his stock portfolio a business expense. You cannot count a med student recounting his/her optha exam while eating ice cream as work. This segues me into my real point…

    Practicing medicine is a lifestyle. It absorbs your life and creates your identity much like being a military officer, a politician, a firefighter, or a teacher. What I find disconcerting is your lack of reverence and respect for selection of a comparison occupation. You shrug off this “time spent preparing lesson plans, etc” as not real overtime; this is hurtful and callous. I beg you to consider your own perspective a little more, before you decide to exalt the victimized medical establishment. Yes, physicians have a stressful and sometimes thankless lifestyle, but they are far, far, far from alone in that.

    Dan

    July 2, 2010 at 11:38 am

    • “working/studying 80 hours a week for 48 weeks during med school”
      This is accurate based on my experience. Actually most months (surgery, ER, MICU and IM wards, especially on the county and veterans hospital rotations), I worked about 110 hours/week. This includes getting up at 3:30am to get to the hospital to start drawing blood or writing notes and leaving at 7 or 8pm at night. Then getting home and reading a chapter or two before sleeping. My easiest months were 40 hours working + 20 hours studying per week.

      JP

      January 3, 2011 at 5:06 pm

      • My experience is similar to this.

        Anonymous

        January 31, 2011 at 3:54 pm

      • I concur. There is no hour/week limit in medical school and to do well you have to spends ample time outside of the hospital rotation (which alone is at least 80 hours) to read and prepare for the exams. And even with the 80 hour/week limits in residency you still have on-call time and time spent reading and researching.

        Anonymous

        February 2, 2011 at 9:43 am

      • In my experience 80 hours a week is a little on the low end. I do not think you realize the hours 90 percent of medical students have to put in to make it through. There we always be a few that can study less but these students are in no way the average.

        Anonymous

        February 13, 2011 at 9:36 pm

      • I also concur. My experience has been very similar. So has that of my classmates.

        RT

        February 18, 2011 at 12:40 am

      • Dan’s reply is spot on. Brown’s data misrepresents slightly–5 hours a day, seven days a week throughout all of undergrad seems rather too much, especially those medically bound who enter college quite educated–often lucky enough to have been raised in good neighborhoods with excellent high school teachers. The demographic of medical school is predominantly middle to upper class, racially un-diverse, most moving into a career with full sails from the help of social and real capital they have been born into. I applaud he or she entering without it.

        Dr. Brown is correct that at current reimbursement levels, mostly in primary care, Docs cannot survive on their own. But that reflects a broken system of reimbursement, not a superiority of doctors over what are termed “laypeople” because of how tirelessly we, as doctors, think we work, and how hard. I do not find fault with Dr Brown’s obvious argument that reimbursement needs to be changed for physicians (reimbursement would require massive cultural shift in medicine, such as that seen in Grand Junction, Co and focused on health of individual patients and populations of patients, not what doctors or insurance decides they should earn–see NEJM article 2009? by Dr. West) but rather his modeling of a pervasive attitude of woefulness and affliction in medical students, residents, and some grown up physicians. His tone alludes to the lament of the hard working, self sacrificing, stressed but dogged physician doing his/her best, a suffering Prometheus for humanity. In the tunnel vision doctors sometimes feel is required to learn what is, I know, massive amounts of information, they forget–Hard and long work is not unique for humanity–look at the not so rosy history of the country in industry, farming, mining. Ironically, the place place Dr. Brown should look today to best widen his narrow view and consider the toils of others is the very place he seems to devalue, the high school classroom.

        I doubt Dr. Brown has taught. I challenge him, if his bank account can take the hit, to go through teacher training, then teach a low income inner city high school class for a year or two, work the long and hard hours required to do the job well and achieve what is right and fair for those students–that all kids in that class do science, reading, or math on grade-level– and he may have a better appreciation for “laypeople,” and a far more sour understanding of the problems with professional reimbursement. He may also see the difference is that laypeople, instead of bemoaning their work under the pretense of self sacrifice and helping humanity, just bemoan their work (lets be honest).

        Again, thanks Dan,
        Ad, MD

        a

        January 5, 2012 at 4:42 pm

      • My experience is similar as well at University of South Florida College of Medicine.

        Bryan Thomas

        January 13, 2012 at 9:10 am

      • And residency only gets worse, especially if you are in the surgery residencies. My husband wakes up at 4 am to study, leaves for work at 6am and works until at least 6 pm to come home to study for 2-3 hours more at night. Some weekends he follows this same schedule. Being the wife of a surgeon I see how he is sacrificing his life to become a well educated successful surgeon.

        anonymous

        January 17, 2012 at 11:47 pm

      • lol 40 hours a week at most during med school. Gunner work load is NOT the norm for most med students. Every other med student who was posted below is either out of control or full of it. 30-40 hours a week has me near the top of my class. Third year has been a bit more but still lots of free time.

        Anonymous

        January 20, 2013 at 5:18 pm

      • 30-40 hours per week? Top of your class? Where are you a medical student? Anyone who has ever mastered anything, knows it takes a lot of time and effort. Most medical students, who actually learn enough to become useful to society, need to study much much more than that. Given your evident lack of work ethic and dedication. My guess is that you will end up being one of those physicians who calls upon other physicians to a provide valuable services. Please learn enough so you at least know who to call. I received a “wound” consult from an incompetent physician yesterday – patient had dry gangrene of the foot. Told them they should probably call a vascular surgeon. They asked “why?” I said, because there is no blood flow to his foot. Did you do a vascular exam? Response, “No, why would I do that?” …..Why bother to examine a patient and think when you can just pick up the phone and call a competent physician? Unfortunately, that physician was still able to “bill the system.”

        benbrownmd

        January 20, 2013 at 6:20 pm

      • my husband worked 120 hrs per week during his 5 years of residency. I can certainly attest to that. I thought 80 was a gross understatement, if anything. And those 120 hours were not spent eating “ice cream” as PP suggests.

        surgeon's wife

        January 23, 2013 at 3:29 pm

    • not only is PhD education tuition-free, but PhD students receive monthly stipends. so in essence, they will have made even more money.

      Anonymous

      January 4, 2011 at 3:09 am

      • I’m a full-time teacher who is working on my Ph.D. I am paying for my education (like most teachers who continue their education), and no one has given me a stipend.

        Kristen

        February 20, 2011 at 9:43 pm

      • Even if you are not given a stipend, during PhD training, you are typically able to work at the very least part-time. I know of no medical student who is able to even consider that. Medical school is far more obsorbing and stressful to the students than those who have never known someone go through it would understand. There is no comprehensible way you could work to pay for your living expenses let alone your schooling during those four years, adding to ones debt.

        cori

        November 5, 2011 at 11:24 pm

      • Dan–you really have no clue…My husband has been going thru medical school and residency for the last 14 years. We are almost finished! WE HAVE NEVER SEEN A STIPEND, GRANT OR ANY MONEY FROM FAMILY. What a joke. Yes–you go into a ton of debt.

        There is no cap on how much they work–he spends several weeks at 120 hours at the hospital. This is NOT having ice cream and talking about a test. Give me a break.

        Anonymous

        January 20, 2012 at 10:38 am

      • Get real. Physicians have the benefit of having a good paying job when they leave med school. There are no such guarantees when leaving grad school.

        Anonymous

        January 22, 2013 at 9:08 pm

      • that is not true for all phd’s. i am an epidemiologist and i read >30hrs/week to stay uptodate and write studies, reviews, contribute etc…. and no i pay my phd education because in my UC institution the funding for grad students is limited and they cost more than postdocs so most investigators are hesitant to take grad students to their payroll unless their grant specifically pays for them.

        dr brown: in response to your comment for the less studying med student: do think the wound referring physician worked less hours? you don’t know that and seem to have a condescending attitude towards anyone that does not agree with you.

        my husband has been practicing as an oncologist for 20 years and he was top of his class and had his internal med and hem/onc training at exceptional institutions. yes, he worked long hours but nothing as suggested here. some rotations were longer than others but it didn’t phase him and we had more than enough time for fun.

        no one can argue that the cost of medical education is high but i suggest you should also consider these points if you like to make an objective and fair comparison with other professions:

        1. adding the reading hrs into your calculations without controlling in other professions biases your analysis. if one does not have the intellectual capacity to handle the workload, maybe they should consider another venue and for people who made it medical school, reading should not be a big issue.
        2. i would also add that there are many professions that require similar amount of demands and personal sacrifices with much much less financial gain (even after aca) and appreciation (most do their work behind the scenes with no recognition). you cannot properly appreciate some of the values such as respect and trust (definitely >>>>> a lawyer) and admiration by your children you gain by becoming a physician when just adding the $$$s. when you are doing a cost/benefit analysis, you should also factor these externalities into your equation.
        3. you should also incorporate the overall effect of confidence gained by accomplishing something so grueling and intellectual stimulation resulting from life-long learning into your calculations as healthy years gained.

        there is no area of work that everything remains as status quo. when we make investments, we make them to collect benefits in the long-run. just as any investment, if you make the financial aspects of the medicine main profit, there will be disappointments. and yes, some part of that investment may go bad as any, but i believe the medicine has more rewarding profits to collect than many other professions.

        i am all with you for fighting for the physicians’ not being exploited, but do it more objectively and maybe collect more information about other professions if you are making a comparison. if you are using data from other sources, you need to know how they were collected and make sure your comparison groups were ascertained the same way. running some calculations without having all the facts is bad science and as an accomplished physician, who read so many studies, you would not want to do that – and lastly, there is no need to put down other professions.

        ayse

        March 23, 2013 at 7:32 pm

      • HA! PhD being tuition free is not true..I’m a PhD student…my education is far from being tuition-free

        Real PhD Student

        February 4, 2014 at 8:00 pm

    • Dan, you obviously never had a friendship with someone who actually went through residency or med school for that matter. While you have demonstrated that your writing skills far exceed mine (or I just don’t want to spend as much time writing because I have a job) you have also demonstrated your ignorance.

      “Your estimation of working/studying 80 hours a week for 48 weeks during med school is laughable; not only does this not account for any schedule I’ve ever seen [a lot] but it sounds an awful lot like a a wall street exec calling a lunch ..”

      You are a dumbass. I dated my wife all the way from before she got in to med school until we got married during her 3rd year. The research that Dr Brown has done is spot on! Keep in mind too that there are different kinds of students in med school. I would say that 20% of the class is actually smart. In that, they can read a book once, absorb it and move on to enjoying their free time. But for the most part, the average student has to work their asses off to learn what is needed to pass med school and pass the boards. Ironically, I have found that it is these “average” med school students that go on to make excellent doctors.

      Dr Brown, you are in the same boat as a lot of the doctors I know. Trouble is, the people in your profession have not lobbied sufficiently to garnish the much needed support in terms of compensation and reimbursement. A perfect example would be looking at the specialties of orthopedics and neurosurgery. 10 years ago, ortho surgeons and their representatives, spent a great deal of resources lobbying for higher reimbursements for procedures like spinal fusion or total knee replacements. Neurosurgeons during this same time, felt that they did not have to worry about their reimbursement. Since they were more focused on patient care, they figured that all they had to do was continue working hard and the money will follow eventually. Well, today, I see that ortho doc get paid substantially more for surgeries that are far less complex. Surgeries where really, the only risk is infection. Compare that to an average neurosurgery case where the complications start with infection but can also include permanent neurological deficits with one wrong flick of the wrist.

      Okay, now I am rambling on. I am in complete support of this article. Doctors should get paid more. Or at least have their education be completely reimbursed but with one string attached – you must score a certain amount on the USMLE for example. This way, we are rewarding our physicians for academic excellence.

      Dan, get your head out of your ass. Did you actually group Military officer in with politician? And a firefighter and a teacher? Lets play a sesame street game: which one of these people are NOT a hero?

      And lets make a generalization here:

      Military officers: do it because they are leaders – they like taking care of their troops. The risk of death is a real, everyday risk. They are away from the comforts of family life
      Teachers: shape the face of america; very difficult job-kids these days are unruley but can’t punish them or their deadbeat parents, they are definitely heros
      Firefighter: really? not only do they risk their lives everyday like military officers do but they save lives!
      Wallstreet execs/Politicians: care only about themselves. No risk of death at work, they shape america all right – just look at our debt and the bank bailouts. If we were ever to be nuked, execs and politicians would be living amongst the roaches.

      Qbizzy

      January 4, 2011 at 12:31 pm

      • Doctors should be paid more.
        Comparing to CEO or politician, dr are paid NOTHING!

        But I do hear these days some doctors take drugs and graduated from lozzy med school. It is scary to hear those kind of people become our dr. Usually these kind of dr only care about money! These dr are the one who will drive very rich car!

        When I hear story about a good dr, I give them all respect from my heart.

        Doctors, pls have system changed. they are so many wrong things in med care in USA!

        anna

        January 26, 2011 at 9:13 pm

      • As an orthopedic surgeon who works with a great many neurosurgeons, I would take issue that the only complication of orthopedic surgery and joint replacement surgery is infection. The potential complications for orthopedic surgery and neurosurgery are both serious and the people that are impacted by them are disappointed and have significant disabilities to contend with.

        As far as the generalization regarding other professions, everyone in a society has the opportunity to contribute. Many politicians and Wallstreet executives are people who care deeply about others and contribute to the world that we live in and there are teachers, firefighters, and millitary officers that do not.

        The compensation that doctors recieve, unfortunately, more and more is not subject to the free market. If it is going to be dictated by the government, then what we all need to decide is how much it takes to attract competent people to these fields. While doctors have the opportunity to contribute much, they also have potential to cause much misery.

        Brett

        September 7, 2011 at 11:30 am

      • Your response is uneducated and spiteful. Whatever inadequacies have been forced to feel throughout life should not be turned upon someone else in the form of angry rhetoric. I’m glad you are not a doctor, and I hope you are not a teacher.

        ad

        a

        January 5, 2012 at 4:49 pm

    • You are right, his estimates are way off, but in the other direction. If you combine class schedule, saturdays spent in the library reading/studying, and time spent in the lab doing bench research, most medical students spend well over 80hours a week on real work (and sitting in a library in a cubicle for 10-12hrs on a saturday is work). Also, I know very few future physicians who had a grant or family help during training. I could go on, but clearly, you have no idea about what you are saying.

      Anonymous

      January 5, 2011 at 4:08 pm

    • Funny, my husband is a doctor and almost all of the people that we know from medical school, residency and fellowship had any sort of grants, scholarships or assistance from families. In residency and fellowship and now as a surgeon he works over 150 hours a week…has no time for ice cream, let alone breakfast or lunch. Our debt from medical school was more than the mortgage on our house…we should finish paying it off by the time our kids (10, 8, 5) are out of college..after we pay for all of their college out of our pockets..because we are “rich” and would never qualify for one bit of financial aid. We live a nice life, I can’t complain, but it is not a lavish one…we live in a small home that needs complete renovation and yes, we do get to take a vacation together every year…which is important when your dad/spouse works 150 hours a week…….

      Samantha

      January 5, 2011 at 8:32 pm

      • 150 hours per week? Seriously? Are you saying that your husband gets on average 2.6 hours of sleep per night?

        That is not any surgeon I would want operating on me or my family…

        Michelle

        January 24, 2011 at 3:02 pm

      • No Michelle, I am sure he gets plenty of sleep on the nights he gets to come home (6h maybe). But let me tell you from experience, those 3x/wk of forty hours straight!!!!!! is hell :)

        Trevor

        February 1, 2011 at 7:31 pm

      • I’m sorry, but this is a huge exaggeration. Either that or your husband is terrible at managing his time.

        Kick Puncher

        March 23, 2013 at 6:30 pm

    • “grants, scholarships, and assistance” – seriously? I don’t know anyone in medical school or residency who received money from any of the above. And when you get grants in Residency, that goes to support your time spent doing the actual research and NOT collecting any cold hard cash. And then you still have to make up the hours of work you missed on the wards. I was so broke in residency that I was eligible (and collected) food stamps – I figured the massive amount of tax dollars I’d pay in the future would pay that service back and then some. Your ignorance is sad. Dr. Brown’s article is spot on his numbers apply to the global average of what physicians work/make.

      Anonymous

      January 6, 2011 at 4:39 pm

      • I remember being on call and having to take the bus back into the hospital….because I could not afford to put gas in my car. This was before the gas spike. I have a lot of good memories of being flat broke and can handle a debt collector call like a champ but it still sucked!

        Anonymous

        February 20, 2011 at 6:53 pm

    • It is “laughable” to me that you are preaching educated statments while you boldly announce that medical students do not infact spend a ton of time studying and/or working. I am a second year medical student. I have no help from my parents to pay for school and I do not receive any grants or scholarships (though i have applied for MANY), instead I receive loans with intrest that will all have to be paid back. I live a VERY modest lifestyle, in part due to the time I spend studying and learning how to provide expert care for people such as yourself one day. I attend 6-8 hours of lectures everyday and study well into the late hours of the night- all to do it again the next day. I have not seen a free weekend in I don’t even know how long due to studying Saturday and Sunday a minimum of 10-12 hours per day. My older classmates do, in fact, work every bit of thier 80 hour work week allowed by law and they also work every holiday. I will be graduating with near $300,000 in debt. I am truely hurt and offended that you obviously have no clue what kind of time/commitment/sacrifices/and money they have invested in YOUR health. You should be ashamed. Please actually talk to a medical student/doctor before you start throwing around your (once again) “laughable” expert advice.

      N.P.

      January 26, 2011 at 7:02 pm

      • For those who somehow doubt the actual experiences of the vast majority of physicians in this country, I will add in my two cents. This year, I’m a first year resident… meaning I’m one year out of medical school. At the end of residency, if nothing changes, I’ll be about $200K in debt. After taxes I make $33k per year. I work a second job researching articles for online medical consultation websites for a set fee per article (maybe $10 an hour). My average work week is about 70 hours, and I have it easy compared to most. This upcoming month I am working 23 10-hour (12 hours after sign out) shifts in 28 days. I have no weekends off this month. I have 9 overnight shifts and the only days that I have off were scheduled to coincide when I am required to be present in academic meetings. This means I am actually required to work for 27 of the next 28 days. Thanks to my schedule I’m pretty much perpetually single, I can’t own pets and my houseplants commit suicide on a monthly basis. Why do I do this, you ask? I do it because at some point believed, foolishly perhaps, that since I was blessed with the opportunity and ability to be a rather good physician that it was my Karmic responsibility to help others and in the process earn some economic stability. I am 27 now and given the current political and economic climate I will likely be over 40 before I pay off my loans. When I read the ignorance that you chose to share with the world I’m not only saddened the fact that your opinion is shared by so many, but also that you, as a teacher are the self-proclaimed cream of the crop that has elected to teach the next generation of children in this country. If there’s one thing I learned from my teachers and parents it was to think before I opened my mouth to speak. Perhaps you should’ve learned that lesson before you wrote on this comment board.

        Byron

        January 31, 2011 at 9:34 pm

      • Many are called but few are chosen. And the few that are chosen….the many just don’t get it. They have not an inkling of any idea of the dedication, devotion and sacrifice it takes to get there…and to stay there….and to complete the mission. And many…including myself after arriving at that point in one’s life have found …either through naivete being shattered and/or awareness re-surging due to a much needed pause of nasal contact from the grindstone…that many of us have worked so hard…to become little more than salaried serfs, contractually with 24/7 access, paid by a third party payer, further harassed by now fourth party medical management companies all outnumbered by our fellow citizens…and then some not…in this now predominantly based entitlement society. The stories I hear and have heard….I only wished I had heard them before I started this journey. A psychiatrist at the VA being told what to prescribe….by a vote of committee members, most with no medical license, none with direct patient contact of the patient so in question. The voted to start prozac. The psych doc said he didn’t want to put the patient on it. The committee said they outvoted him. Funny. I have never seen a prescription signed by Dr. Committee.

        There is a fundamental issue going on here. Control of a process is now unlinked from the process. At the time of this writing you are third year, correct?

        Disengage your blood sweat and tears now. Go into something like nanotech,etc. Stay out of third party pay. Stay out if you know what is good for you. Don’t get on the plantation. The masters will chain you there. Whether it be an outrageous tail coverage on your malpractice, etc.

        DO NOT BECOME A SLAVE FOR THE COLLECTIVE!

        r58black

        April 2, 2012 at 6:12 am

    • I have known this unfairness to a doctor when my daughter decided to enter medical school.

      It is horrible the society/system treats doctor so unfairly! It is so ridiculous in USA for doctors to have such low pay!

      But what I don’t understand is why doctors put up with these? Doctors are smart and they should be able to change the system in networking with all politician!

      In Asian, doctors have better pay and get more respect. They will not expected to do social worker or any coordiantion stuff! Attending doctor expect residency to do social worker stuff (especially to those very poor and uneducated patients) are wrong. They need to train residency medical knowledge instead of slaving them doing all those stupid things!

      last thing i want to say is the salary should not be that much differences between a family dr with dr specialized. Me, as a patient, so far have not found an outstanding dr specialized in terms of communication! A family dr or a kid dr need to know from top to toes but a eye dr just know about eyes. Family dr are too low pay in USA!

      anna

      January 26, 2011 at 8:41 pm

    • 80hr a week for 48 weeks per year is an understatement. To do well in medical school, you must spend MORE time than that. You may not believe me, but that is how it works. And what you fail to realize is the constant stress that a medical student must endure through this entire process. Constant stress about the amount of information that needs to be learnt and memorized.

      I would have to agree with Dr. Brown in his opinion of the deceptive income of physicians. Physicians are well-UNDER-payed in this country.

      Good luck to you. I am not trying to belittle your occupation or any other, but those who have not gone through medical school, really don’t understand what it’s really like. It’s NOT like college, or a masters degree, or a PhD…it’s it exponentially more difficult.

      kbshah

      January 26, 2011 at 9:29 pm

      • i agree even I am not a med student.

        But I also see some med students take drug and party wildly!

        Anonymous

        January 26, 2011 at 10:08 pm

      • Alright. I have to reply to these overblown statements. I am a third year med students and although the first 2 years are hard, they arent nearly as bad as all these chicken littles are saying.. I made a 3.6 gpa in the first 2 years and a 235 on step 1. Most normal weeks I probably “worked” 50 hours or so a week, only nearing 80 on test weeks. Even then though, my time was very flexible. No one was forcing me to be in a cubicle all day, no one was making me go to meetings. I had plenty of time to work out and even train for a marathon my first year. I have dated throughout my 3 years and have stayed connected with friends., The only people who really are putting in that much time in MED SCHOOL (not residency) are those who are in third/fourth year on hardcore rotations, those who are super gunners, or those who have anxiety problems and can’t relax.

        Anonymous

        January 3, 2012 at 1:19 am

    • the debt is a reality. med students do not receive a lot in grants or scholarships from the med school itself. but they can take a big a loan as they want! $200K-$300K is not unusual.

      80 hours/week to study is an underestimate. in the first two years of med school, classes are 6-8 hours/day, then you go home and study another 4-6 hours. maybe taking off a friday night or saturday night is a luxury.

      then during third year rotations, an overnight call is easily 36 hours so it’s very easy to rack up more than 80 hours in a week.

      my husband graduated from high school in 1994. Only in 2009 did he finish all of his training and now makes a good salary.

      take any high school senior and tell him that after 15 years s/he can make this amount of money…who can blame them for choosing other fields?

      Anonymous

      January 27, 2011 at 4:42 am

    • Whats laughable is that you think 80hrs/week of work as a medical student is an over-estimation.

      Anonymous

      January 27, 2011 at 9:05 pm

    • dan, i don’t know what an optha exam is. but ask a med student (which i was) about how close to 80 hours a week studying happens and they’ll all say it’s short. Dr. Brown is right.

      Anwar

      January 30, 2011 at 7:49 am

    • Actually, Dan, most medical students do not receive grants, scholarships, etc. I should know, I am one.

      Calvin

      January 30, 2011 at 11:16 am

      • Grants do not go to “most” students. I still owe 157,000 dollars after 3 1/2 years of paying loans. No grant for me or most of my classmates in AZ and we graduated in 2003. I did a 4 yr residency and work my butt off. The politicians at least would help if they let us deduct interest on the loans and not place us in the “higher “tax bracket till we pay off the loans….we pay them interest and taxes on the total amount…double dipping a bit. I
        I agree with Dr Brown. Docs are paid well but owe a lot! it will be years before any savings account grows substantially. By then my kids (whom I missed some of their growing up while studying) will be in college. Calvin, I just jumped in here because you stated a comment about the grants and I agreed, but couldn’t contain my thoughts any longer.

        No stat is ever 100% correct (you learned that in one of those undergraduate classes) but this is a good article. At this rate I might retire at age 70 and hope to be debt free..but that depends largely on what happens on govt spending, taxes, my ability to continue working 12 hour shifts 16-18 times a month (turns into 14 hr days) as well as flipping days to nights 3-4 times a month which is rough on the body…trust me after age 40 you will notice.

        Thanks for letting me pipe in. I could comment on most of the posts…and some are pretty dumb….they stray from the point to support “their particular situation” but miss the main theory of the paper.

        CS

        February 1, 2011 at 3:12 pm

    • Dan is clearly way off the mark. He musn’t know a single person who actually went through medical training. 80 hours a week is accurate; most will report having worked much longer hours as I did.

      Anonymous

      January 30, 2011 at 3:38 pm

      • agree!

        CS

        February 1, 2011 at 3:13 pm

    • According to statistics MOST TEACHERS DO NOT HAVE PHDs. This person thinks studying 80 hours a week for medical school is laughable? They obviously do no know any medical students or any physicians. An estimate of 80 hours/week seems like an underestimate. One can never explain how much work it takes, for even the most competitive of students, to be able to learn the etiologies, natural histories, differential diagnoses, interventions, pharmacology, side effects, expected outcomes, etc. of all diseases known to man. My sister, brother, brother-in-law and my friends are teachers. They have the entire summer off paid. They get holidays. They don’t have to stay overnight. Correct me if I am wrong but they government has never had to intervene with an 80 hour work limit for teachers. Some people just don’t know.

      Anonymous

      January 31, 2011 at 3:52 pm

      • LOL, love the last bit.

        Agreed, at my high school only 5% or maybe 10% max had PHDs, and another 15% had masters. Majority were bachelors, and took course loads much easier than pre-med coursework.

        My brother finished med school a couple years ago and put in 80 hours+ most weeks, I know because I went to visit his family for a while and saw it myself- drove him to and from the hospital. My grandpa was a doc back in the more macho/ego male-dominated-culture days, when 100+ plus was normal and you were a wimp if you did less or complained. His kids resent him to this day for how little time and love he had left for them.

        I expect as medicare/medicaid get increasingly overloaded and the population ages, docs will have even more work with lower compensation, and probably higher taxes for the upper brackets. You basically have to be either delusional or extremely passionate and devoted to want to become a doctor; they are the real heros of society in my eyes.

        Trent

        October 23, 2011 at 1:59 am

    • Hey Dan. Please stop talking about things you have not gone through. Dr. Brown might not be 100% on point, but 99.9% of his statements about medical students and physicians is just about right.

      Just77

      January 31, 2011 at 6:07 pm

    • Sadly you fail to factor in the continued education that physicians need to maintain, as well as the plight of academic physicians that in addition to lowered pay, also end up preparing lectures and courses for medical students, nurses and other allied health professionals.

      Jack

      February 1, 2011 at 9:26 pm

    • fuck you pal. i spent at least 80hrs / week in med school and more in residency. and i had no financial assistance from my family, no grants or scholarships. so go fuck yourself.

      md

      February 1, 2011 at 11:37 pm

      • The most down to earth comment I’ve read so far.

        Anonymous

        April 17, 2012 at 10:46 pm

    • My experience is very much like what Dr. Brown said. At the beginning of the year for my class, they showed the percentages of the students with grants, scholarships etc.. It was only 1% of the class. The rest, like myself, are paying this through loans which will need to be paid back.

      Anonymous

      February 2, 2011 at 4:19 pm

    • An example of a second year medical student studying both for classes and preparing for the USMLE Step 1 board exam.

      I woke up every morning at 6:30, worked out/ate breakfast/read the CNN headlines/packed a lunch, and got to the library around 9:30. I studied until my afternoon classes started at 1:00pm (studying while eating lunch). After classes were over, usually 4 or 5, I would study another hour or 2, eat dinner from 6-7 and be back at the library around 7:30. Then I continued my studies until leaving the library around 11:30 to go home and go to sleep.

      I repeated this cycle every single day, including weekends from the end of January until June 5th.

      Sure, I occasionally took a weekend night off to go out/relax but I can count the number of times I went out on both hands during that 4 month period. This may not be typical of all medical students, but I know many fellow classmates who shared a similar experience.

      And the vast majority of medical students receive very MINOR scholarship funds IF any (<<$5,000/year). I don't know where you are getting that information from.

      MH

      February 4, 2011 at 5:55 pm

    • Dan, with all due respect you are truly ignorant. I do not know your education level but i would challenge you to do a 40 hour credit load of hard core sciences. Well 5 of those hours you can pick a goof off class. Then see how many hours you spend studying just to keep up with the class work. Grants? Scholarships? Family Help? I have not idea what delusion you are running with but that is usually reserved for the top 10% of the class and even the ones that do trickle down to the rest of us make a drop in bucket of our debt. I am graduating this year and i will be coming out with $300K. Maybe you come from some area of the country where the cost of living is reasonable or med school tuition isn’t $42K. Please tell me where that blessed land is. I will not speak to your comments on teachers because in that I am ignorant.

      James

      February 6, 2011 at 2:32 pm

    • Most medical students do not receive grants, scholarships and are generally financially indigent during school. I should know. I was one. Research what you say before saying so.

      Anonymous

      February 10, 2011 at 8:49 am

    • There are so many things wrong with your comment that I do not know where to start. Everything you said as a counter-arguement is true for about one in twenty medical students. Maybe someone that just likes to talk?

      Anonymous

      February 13, 2011 at 9:40 pm

    • As a first year medical student, I will agree that 80 hours is an accurate estimate. We are in class anywhere from 4-7 hours every day, and then spend 6-8 studying on a typical day. The amount studying on the weekends varies, but I’d say a good average for most students would be 8-10 hours each day.

      Unless you’ve been in medical school, don’t try to account for how many hours we spend or don’t spend studying. You’re correct in that it’s not a a schedule like anything you’ve seen before; it’s not a normal schedule. I will agree that it is difficult to fathom that much time spent studying, but ask any current medical student, and I’m positive they will give you the same answer.

      MedStudent13

      February 14, 2011 at 1:43 pm

    • 80hrs/week is actually an underestimation in my experience. Some months, my month on neurosurgery, for example, I was spending an average of 110+ hours/week. This included beginning my day @ the hospital at 4:00 am and going home at 9-10pm every night, weekends included. This comment’s author has no basis of experience (clearly).

      TD

      February 15, 2011 at 12:09 am

    • @Dan:

      Gotta love people who offer their unsolicited opinions on issues they know nothing about and in so doing demonstrate their complete ignorance. 80 hour work weeks? Believe it not, some people _do_ have them. Just because it’s inconceivable to you doesn’t mean that they don’t exist for other people. You forget that aside from classes and studying, some students also have to work part time jobs to support themselves or volunteer at hospitals to get more experience (and before you say that that’s a personal choice, let me tell you that “volunteering” just means that they don’t pay you for it, not that you have much choice in the matter – I’ve found that people can be amazingly good at coercing you to “volunteer” for something). As for grants and scholarships, the _vast_ majority of them are for students from low-income families, which most people going to medical school likely aren’t. Furthermore, I don’t think you realize just how many people go to medical school. Do you really think they’re all supported? And if so, by whom? And what residents get paid IS a joke. Postdoctoral fellows (our version of residents) in my field of astrophysics can get almost twice that, and we don’t log nearly the hours that medical residents do (they’re called “residents” for a reason, you know).

      But that’s typical. You sound to me like one of these people who have a 40 hour work week, but have the nerve to complain just how hard they have it. You remind me of all those people who would tell me when I was in grad school just how lucky I was that I was still in school. _None_ of them had ever been to grad school or had even conceived of going, and so they all thought that I spent an hour in class three times a week, partied on the weekends, and had the whole summer off. I always wanted to snap back at them, “Oh yeah? When was the last time you rolled out of bed, started working, and worked all the way through until bedtime pausing only to grab cheap take out which you brought back to your desk to eat… while working?” One notable example was my department administrator who once told me that I was so lucky to be in school because I didn’t have adult responsibilities like paying bills. When I responded that I do pay bills, she stammered finding nothing to fire back at me. This was the same woman who I consistently beat to the office every morning and watched forlornly when at 5:00 (or 20 minutes before) she happily strolled out of the building several hours before I would. But according to her, _I_ was the one who was lucky. But I will say this – the one comforting thought I could offer myself was, “Well, it could be worse… I could be going to medical school.”

      AnonymousStudentT

      February 20, 2011 at 4:21 am

      • oh em gee YES! whats up with ppl trying to criticize something they know nothing about…

        Real PhD Student

        February 4, 2014 at 8:01 pm

    • Dr. Brown’s article is well founded and I agree, an under-estimate. Dan, your response is clearly not founded on any prior knowledge or research. My husband is a 2nd year General Surgery resident and he works well over the 80 hours a week (although he is not allowed to report those extra hours). Every month, he works 6 am to at least 7:30 pm (on good days, 9 pm on bad days) 6 days a week and the 6th day he works a 24hr shift. He rarely has time to sit down to read, let alone enjoy an ice cream cone. Most days he doesn’t even have time to eat lunch.

      When he does get home and spends 30 min with me and the kids, he is required to read and study the rest of the evening for the yearly national in-service exam till about 1:30 am. His one day off a week, he spends sleeping from the time he gets home from his 24 hr shift at 8am till about 3pm and has to go back to work the next morning. Now this is General Surgery Residency which I have been told is one of the more difficult residencies and takes 5-6 years to complete post medical school. He also went to a private medical school which was more expensive than the average medical school and we currently have acrued $353,000 debt from that. After reading this article, it sure doesn’t seem worth the time that it takes for the training. Oh, and by the way Dan, any vacation time is spent trying to catch up on a little sleep meanwhile studying because we can’t financially afford to go anywhere on vacation. Also, the tests, applications, and extra education materials should be accounted for since each of the Board exams that are required cost upwards of $600 each(the 2nd Board exam is a 2 part test, $600 for the written part and a whopping $2,000 for the physical examination part). None of these costs are reimbursed or covered by any grant or scholarship of any kind and are only more acrued debt, which over the course of 20 years, will be somewhere within the amount of $10,000 extra (but who’s counting, we’re rich right?)

      Besides all that, try to buy a home for any amount of money with that much debt and it is almost impossible. Dr Brown, thank you for posting this article, I hope that it will help many understand the great sacrifice it takes for the physician and his/her family to care for others.

      Kim

      February 20, 2011 at 4:24 am

    • Dan,
      What is “laughable” here is a complete lack of your knowledge on the matter. You simply have no idea what it is takes make through surgical training and get a competitive fellowship. 80 hours/week do not even come close. You do not sleep and hardly ever see your family.
      “Lunches with clients”… How about trauma call in an inner city hospital?
      Number of us in surgical specialties spent 9 – 10 years in residency training and then the insurance companies force you into the ridiculous negotiated rates and deny/delay payments on your claims. The doctor is charged outrageous malpractice premiums, and is harassed by bureaucrats from every angle and on every level.
      There is a crisis in American health care. The article below is just too mild, and does not account for medical practice that hostile markets for independently practicing doctors.
      You are right. Medicine is a lifestyle and it adsorbs your life a create your identity. There is absolutely nothing that I would have done differently if I had to do it all over again, but unfortunately the society does not financially value our efforts and does not support practice of good quality medicine. I suspect this will get considerably worse as bureaucrats are gaining more power.
      Sadly, it is administrators, insurance companies, and businessmen in medicine who created this financially unfair system are the ones that take the lion’s portion of the health care monies.

      AS

      February 20, 2011 at 3:17 pm

    • The hour estimates are accurate for me as well. When I was on surgery I worked at least 100 hours per week – there were many weeks when I would work 4:30am to 10pm, and then have to study for the shelf exam in my “free time”. I had similar experiences on OB/Gyn, Internal medicine, and pediatrics. Even when I wasn’t on the wards, studying for USMLE Step I alone called for an 8am to 10pm work day for three months. This doesn’t include the first two years of medical school, when classes are 8-5 and you must study a bare minimum of two extra hours per day to even pass your exams.
      Secondly, sure, some students get money from their parents, but most don’t. Justifying all of the debt by saying that people will get financial help is unfair to those of us who are the first to go to college or the first to go to medical school in our families and simply cannot afford it. Education should be equally accessible to all, not just to those whose parents are rich.
      Third, I think people are missing a large point of the debt reform argument. He quoted numbers for an internal medicine doctor/primary care doctor. You can definitely make more money doing other specialties, which is the path most of us are now choosing for the sole reason that we need to be able to pay back our debt. The problem is that our country doesn’t need more ophthalmologists, we need more primary care doctors. It’s a vicious cycle of the generation above us being overworked, under-reimbursed, and controlled by insurance companies and vast amounts of debt. We see that and stay away from those specialties, but our country has a growing number of elderly and an epidemic of diabetes and heart disease that need consistent primary care. The end result is that America is going to run out of primary care docs very soon.

      anonymous

      February 21, 2011 at 1:31 pm

    • “The [vast] majority of future physicians receive both grants, scholarships, and assistance from their families (which even if you consider a cost to them, does not influence debt from future interest”

      Dan I’d be very interested in hearing about all of these scholarships and grants allegedly available to medical students. I certainly looked long and hard for them to help me finance my $274,000 medical education. I managed to pay for about $20,000 of it through scholarships/grants and the rest is loans I will be paying off for most of my career. Scholarships for medical students are few and far between since we will “make enough money” to pay off our loans so easily.

      As far as families paying for loans – no. I know a hanful of people in medical school who have family support. The majority of us do it on our own.

      AL

      February 21, 2011 at 1:42 pm

    • I am a med student now, and all of my time (except for a few hours a week) are spent studying.

      I paid for my undergrad with grants – or it was paid for for me rather. I was hoping to continue on with my education with this assistance(as I am from a financially poor family), but I was told that: “grants do not exist for medical students – loans at 8% interest do!”

      SP

      February 21, 2011 at 9:40 pm

    • your opinions are exactly what dr. brown is talking about- as much as people respect physicians there is a severe disrespect in terms of how much work we put in. your responses sounds similar to an insurance company who doesn’t want to pay me what i deserve for a necessary procedure. even comparing lesson planning to studying for the MCAT (entrance exam to med school) is laughable. Dr. Brown is spot on.

      Anonymous

      March 3, 2011 at 5:04 pm

    • Actually these estimates overall are quite accurate. It was not uncommon, however, to spend 100+ hours a week on ‘real work’. My wife is a teacher with a Master’s degree. The difference in investment is laughable and I respect the profession a great deal. (she is looking over my shoulder…and agrees)

      Also, I can count on one hand how many of my classmates recieved any kind of grant/scholarship/or significant help from family once Med School started. Dan you could not be any more wrong on this one.

      T Hendry

      March 14, 2011 at 7:31 pm

    • The OP is an absolute idiot.

      “Your estimation of working/studying 80 hours a week for 48 weeks during med school is laughable”
      “Practicing medicine is a lifestyle”

      Obviously OP has never been to med school. People like this make me so damn angry. You have no fucking clue what you’re talking about, and you laugh at others for making a true statement. If you want to have the slightest clue as to what med school and residency’s like, take that dildo you have in your closet, shove it up your ass and live with it for a week. Then you better not come to me claiming “isn’t treating pts rewarding enough”?

      FYI, I’m a 4′th year resident in oto.

      John Doe

      March 15, 2011 at 12:17 pm

    • Count me among the hardworking, in debt docs. I was lucky enough to have no college debt (thanks to a full-ride scholarship) and got grants for medical school, but I will still pay more than $130,000 after interest. I was one of the smart ones who didn’t study much in college, but I remember in medical school having to decide if I could go to sleep at 1 AM when my eyes barely stayed open if I got up again at 4:00 AM to finish studying. I was able to babysit some in medical school for one of my physicians, which gave me some additional income while I was studying, but it was still a struggle. I was in training for 8 years. Now, I am a relatively well-paid surgeon in an easy specialty, but I still work 50-60 HARD hours a week, not counting another 5-10 hours at home finishing charts and trying to keep up on journal reading.

      In addition, because I was a “rich” doctor, when I divorced in my final year of residency, though my salary was equivalent to my ex-husband’s (as a chief, it had been lower for many years) and I had a ton of debt that he didn’t have, he was able to keep our house, our retirement, and got 6 years of alimony plus child support. My lawyers fees were equivalent to 1.4 years GROSS salary.

      I love my job and wouldn’t want to do anything else, but I sacrificed a lot to get here, including a previously unrecognized financial sacrifice. Thanks for demonstrating this.

      S

      April 14, 2011 at 4:35 pm

    • This response is to Dan: I don’t want any of my children to go to medical school. I would be delighted if they became school teachers. I respect both professions a lot, since I practice both: I am an Associate Professor in Dermatology and Pathology.
      The price I had to pay to be a good doctor has been to high, not money wise, but life quality wise. I don’t have time for hobbies or regular exercise.
      My children spent more time with a nanny than with me.
      Etc, etc

      Maria

      May 3, 2011 at 5:27 pm

      • you know, I too will likely discourage my kids from going to med school too. i’m an academic physician and the sacrafice I have personally made in time of my life lost and the money (okay but not great) not being sufficent, to recognize this field is not for the faint at heart. dan’s an idiot and I think everyone knows that. the sad part is those of us in the field can’t seem to engineer this career choice to make it the kind profession we so much hope it would be. My father told me what a great lifestyle being a doctor was…Another outsider who inoocently had no idea on what he was talking about….

        Anonymous

        July 4, 2012 at 5:14 pm

    • Dan,

      I did two surgical residencies, and 80 hours per week is the minimum. Another opinion based on nothing substantial, eh? I hope you don’t teach in this manner.

      And anyone in high school teaching with a Ph.D.? Why on earth would someone so overqualified still be teaching at a high school? No wonder school costs are out of control. Apply to a university. This would assume you can actually teach at an advanced level with your doctorate.

      Bruce

      May 4, 2011 at 4:24 pm

      • You obviously don’t know the heart of a dedicated teacher.

        Lori

        January 29, 2012 at 7:57 pm

      • you are obviously a Dr. you sound like a pompous jerk….and all you crybaby whiners…If your profession is soooo bad…go into sanitation dept…you all sound like you all full of crybaby shit….if you owe money the government gives you the options of working all your loans off in a depressed area for x amount of years and poof you got a free education. I know several Dr.s that did this..but you want to whine about how much you don’t make and how much you education cost you because you want it all…Very Very few that are in it for the love of medicine….power and greed. and Dr. Ben Brown is the biggest crybaby prick I have ever come across.

        Jennie Dunlap

        January 31, 2013 at 5:08 am

      • I am the daughter of a GP/Surgeon and, and taught HS. I certainly understand the hours spent by my father – nights and weekends. He didn’t get rich, but we were certainly comfortable. He did get a 2-day vacation every few years, and a week about every 5 yrs as he got older. I became a HS teacher….so a few comments here. A PhD to teach HS you question. Is that like saying my father should have never called in a high paid specialist for some of his patients? And HS …teacher’s that work 40-hrs per week should be fired…..I knew nary a one! Summer time? Yes, but I spent at least 2 wks+ of each cleaning out/setting up my room, going though old lessons and tests to see what worked best or not at all. A week of inservice is now required by most districts. Some teachers went to school – and small town ones had to travel (technology has helped here) – to get that Masters (which BTW pays about $500 more/yr).

        J. E. Lowry

        November 21, 2013 at 2:52 pm

    • I am a physician. I received NO grants or scholarship for medical school. I have also never heard of a grant or scholarship to medical school. The VAST majority of My medical school class lived on student loans. I also have never left work at 4 pm like most teachers, professors do. Want to talk about what’s fair and unfair? You do my job at the hospital for one week (that’s a 7-11 day work week, FYI), working 12 hour days and throw in a couple of 13 hour night shifts on the weekend…then we’ll talk

      Anonymous

      August 16, 2011 at 5:08 pm

    • From personal experience, working 80 hours a week during medical school is pretty accurate. We often studied from 8am until the book store closed. Of course that could have been different for someone who wanted to go into a noncompetitive specialty. The amount of knowledge we’re expected to absorb is hard to describe. The closest analogy would be drinking from a fire hydrant. And during my clinical years we often worked 80-100 hours a week because work didn’t stop at the hospital…we showed up at 4am to see patients, write down vitals and labs for residents and usually leave around 7pm to go home then read at the end of the day. Not to mention the ridiculous cost of board exams, prep courses for board exams, books and unnecessary medical equipment we convinced to purchase. Step 1 of the USMLE was more than $500, step 2 cost over $1500, step 3 was $750.

      Surgeon

      September 8, 2011 at 1:14 pm

    • 1st year: Residency surgery was 115h/week in hospital and most awake. Half my rotations, I only got 1 weekend day off during the month rotation. Other rotations 1st year averaged 100h/week.
      2nd year about 90, 3rd about 80. Yes this was before the days of the 80hr work week.

      A friend of mine graduated high school and went to work for Lowes at age 19. He retired at 45 with millions in the bank. I will never catch him.

      Anonymous

      September 8, 2011 at 11:18 pm

      • well, if you rather work for Lowes at age 19 all the way to when you retire and have $45M in your bank, by all means, go for it! What a shallow comparison!

        Anonymous

        January 17, 2012 at 7:42 pm

    • Medical students didn’t have work hour restrictions at my medical school, as I do now as a resident. I easily approached 80 hours a week in studying/working in the classroom and on the ward. On my musculoskeletal trauma rotation, I spent 120+ hours a week in the hospital. It’s easy to do when you’re on call every other night for a month. The numbers Dr. Brown uses were accurate at my program then, just as they are now. My fiancee and I laugh at how an 8 hour day (6am until 2pm) is a “short day” for me because I typically work from 5:30am until 6:30 or 7pm in my residency program.

      Dr. Wolf

      October 24, 2011 at 6:00 pm

    • Well, from this reply, its obvious that those who do not experience the rigors of medical training will never understand it. Despite the plain facts that have been laid before the “lay persons” eye, these commentaries are still ridden with rebuttals of justification for the substandard treatment and pay of physicians.

      So to you, oh people with the vehement oppositions to the notion of properly rewarding physicians (pardon the cliche): you reap what you sow. The next time (and God forbid) a mistake is made on you or your loved one, remember to think about the vehemence you so freely displayed on these forums and the resultant and widespread disillusionment that is quickly becoming the norm among the medical community. For YOU will have played a role in the decline of the Quality of care in the United States.

      EmDee

      November 2, 2011 at 1:55 pm

    • Those are some broad, sweeping statements(“most medical students receive grants…). Please substantiate those comments with facts as I think you’ll find they lack substance and support. I commend those in the teaching profession of which many of my family member come. However, a recent report looking at the number of hours a college student studies revealed that education was second to last! Business majors were last. Perhaps they were honing their social skills. A masters degree is required for most teachers. It is often obtained while working or as a substitute when teaching positions are not available. Not to mention that continued education(not to mention the associated expense) is not required as vigorously as in medicine.

      Anonymous

      November 17, 2011 at 9:10 am

    • Dan, the article is pretty accurate regarding hours spent studying in medical school (I should know since I am in medical school)… and I generally don’t sit around studying for exams with a bowl of ice cream in my hand, so I would say that it is still work. As for student debt, you have to keep in mind that the debt incurred during medical school isn’t the only factor. You have to also consider the incurred interest through medical school and over the next 4 to 7 years of residency and fellowship. Residents can barely afford to pay off their daily expenses and are certainly not able to pay back their debt from school. Therefore the debt sits and accrues interest until they are fully licensed and board certified.

      Anonymous

      January 10, 2012 at 2:28 pm

    • I am in medical school right now and 80 hours a week is actually an under-estimate and I am only a M1(first year). Also I have received no grant or outside help as almost all of my classmates and my instate loan is 82,000 (almost all of my class has this or more for out of state). There are little to no scholarships for medical school. So yes these numbers are correct or on the low side (probably same for the teachers).

      jon

      January 13, 2012 at 1:49 am

    • I think the point being made was that teachers and physicians are both under paid. Comparing one group to a group you already BELIEVE is significantly underpaid shouldn’t be an insult to teachers as that second underpaid group. It should instead be an eyeopener. Many of the service jobs where government has control over the income because of direct, or somewhat less direct means… and those incomes are being set by folks who aren’t in the professions, often leads to disparity.

      I’m a physician who is not a great writer. For this I apologize.

      My medical school experience was spot on this, actually even after the law was in place we worked quite a bit more than the 80 hours even at the hospital. Studying was done on your own time when you could fit it in. You still had boards to pass. And if you didn’t learn you killed folks. The curve was steep and the pressure was great.

      As for your comment about them dismissing lesson planning time. I had the great experience of living with my sister who has a masters and teaches high school science with 4 classes: physics, chem, bio, and I forget the 4th. She teaches honors. We graduated at the same time because I was rushing to try not to graduate med school when I was well into my 30′s or even 40 (gotta get paid at some point, if you want a family, yes?) We took almost the same classes in undergrad. I had to take a few higher science labs, but honestly it was almost the same set. I graduated biochem and she graduated ed with science. I think she could have graduated with a science ba if she’d had the option to take 2 labs (just regular screw you out of classes undergrad stuff to get you another quarter of tuition). We had to study quite a lot. And similarly. I had to put in more hours and really push because I needed an A in every single thing I did, because I was trying to get into something very competitive. I didn’t allow myself to take one of my favorite fun electives because I couldn’t afford a B. She would take a course from a prof and let me know if it was going to be something I could stack with some of the harder courses so I could make it through quickly. She never questioned that I had to put more hours in because she knew the difference in trying to get an A and HAVING to get an A. When she took a class and had to prep for it or grade papers, or do lesson plans.. THAT was her homework. She didn’t have to do extra outside of class (unless you count shopping for attire, teachers can be picky). While doing this, I took prep courses in the evenings for my MCAT (medical school entrance exam), and 200 volunteer hours to get into med school (200 in 4 years* and 1000 in highschool). I also had a job or two, something I could study at at all times as did my sister. My life was full, but it was definitely hard. We lived together to save money. She had exams to qualify too. Given that she had a science education background… we both ended up giggling over her practice exam questions and she after an hour realized that this wouldn’t be hard. I kept up 2-4 hours a night of extra review on my coursework at the prep classes for 6 months before my exam. I did well on those exams and got into just about every nonivy league school I applied for. The work I did.. wasn’t exceptional enough to land me anything greater than an in state med school even after all those hours (good thing Ohio has a ton of them). The work I did wouldn’t even qualify as exceptional, just enough to get in. THAT’S how hard it was to even get there. I choose the medical school I was able, with a good name, and with a low suicide rate (because the stress… docs have suicide rates for their schools, as well as the professions they graduate in.. just like police folks, and fire fighters.. it’s a hard job mentally).

      I remember sitting at the TV reading for hours with her making lesson plans and grading papers at night. After 2 hours she’d often be done, sometimes it took a full weekend to put them out. Sometimes longer depending on if she was swapping to a new course and had lesson plans to do. After a few years of this she’s got most of them down. She’s got her tests, her quizzes, her labs figured out. She’s always interested in new stuff and still likes to play with her job. She got her masters online, again more of a nuisance than tough, but she’s a really smart lady. After she’s done with her stuff, my light was always on. I’d swap to the kitchen table, go upstairs in my room, or go outside. Just so I could study somewhere else. So I could pretend it was something different. I knew every coffee shop and which ones I could actually study at or afford. I knew the cost of the day of food or drinks if I could go out or not. I was teased Christmas morning waking up so I could study alone.. just needed to get a chapter or two of microbiology in before everyone else woke up. I remember having a schedule for reading, and review and if I didn’t stick to it I would lose privileges for myself (like no yoga tonight, only have time for a 20 min jog… can’t go get ice cream and flash cards.. didn’t finish that chapter. Don’t make fun of the ice cream and flashcards. Yes, they weren’t a big part of the studying.. THEY WERE CONSIDERED THE BREAK TIME). Always having flashcards or something else about. It only took 1-2 readings to get it down.. if you ever stop you miss so much you can’t function. I remember our study chambers at school. At the end of a year the “social” committee as it was had pictures of all of us asleep at our desks, or under them. We had just enough room to curl up under them and the overhead bin had enough space for your books and a pillow. We had comforts :D No one slept under the desks the first month… everyone was there after about month 4. We’d quiz each other over the stuff we studied the night before over breakfast. We’d swap locations in each other’s houses.. we’d bring flash cards when we were using the gym. I never knew I could study so much. I remember sitting at the edge of the couch arm.. perching.. so if I started to go to sleep I’d loose balance and wake up so I could keep studying. In undergrad.. other than biochem 1.. I don’t think I really had to study. Or I never really understood the purpose or had to read something more than once. I learned in med school. At least this was the first 2 years of medschool. Year 3 and 4 we started clinicals. This is where we work for 40 hours pretending to be doctors then study for at least that much or more. This was mostly just transition, some tears.. hard trying to distinguish oneself. You take call too.. so every 3rd day you wouldn’t sleep. You’d just work. Your work wouldn’t be anything like the work of a resident or a physician yet.. but it was just as hard at that moment… you got better, faster, and less ignorant. You still worked your tail off. They always joke that at that moment you realize.. you only learned a very small part of what you needed to know in the first 20,000 hours of studying. I did this and still went to the cancer hospital and the childrens hospital with a group of medical students and sang Christmas carols, helped organize the free clinic fundraiser and participated in the comedy troupe to raise money for it. I know I did other things.. it’s hard to remember now.. so much of it was a blur. Everyone likes to site those examples when we think “we didn’t study all the time”… but.. it’s hard to describe. Some weeks I’d time myself and it’d be 100 hours that week of just study.. some were more.. some were less. Those weeks where we’d slack at 60.. or *gasp* 40… were very memorable. You had a lot of time off then for other pursuits.. 40 hours of study is very little over holiday. I know there were some that could get by with less and some had to do even more than I did. I can only speak on my personal experience. I worked at the med school library for spending $ for food outside my home and put in 60-120 hours a week depending on what was needed for me for which course, or how close the test was. I always had to make up for a week when I did 60… just couldn’t cut it for my level of memorization.

      Residency.. I can’t even get the desire to argue with you about. You will never understand unless you did it. No one who hasn’t done it.. will ever understand. It’s like trying to describe what staying up for 3 days feels like. It’s the hallucinations from exhaustion, the “I’ll just sleep for 2 minutes at this stop light” sounding like the best idea you’ve ever had, it’s the drooling into a text book, yet the ability to fix things and all of the wonder that comes with it, with an amount of total fear that you could kill someone and likely will. From every family meeting where you hug someone for comfort that it gives you and them, then run from 1 code.. you barely finish in time for the next code or sometimes wonder what you will do when 2 come at the same time, to the rush down to the trauma room even if you are only the foley person trying to absorb what you will do when you are much more… While trying to write papers in your “spare time,” or feeling guilty when you crack out 4 hours of a video game, studying for your next board test, presenting your next journal article, or grand rounds. You have a lot of work to do. After awhile all of your friends are at work. The rest are the ones you get icecream with… who look at you and see normal so they don’t understand… those 2 hours were budgeted in. That 10 hours.. or 30 hours that you can account for that month.. of normal. That kept you going. I remember getting yelled at when I reported that on my rotation it took me 100 hours a week to get my work done. It was then MY fault because I couldn’t get it done in less. Even though I was proud that I never had the patient where they were being treated for pneumonia when they had an MI (both.. short of breath I guess), or the psychosis that never got better because of sepsis because of an untreated ulceration I cared enough to put time in. So my choice was to not report, to leave early and not care, or to continue to report. The choice itself was there because when I was working 80 hours a week, I was working my tail off. When I left I continued working in a different way on different things (see above journals, test prep, article/research, patient research), but it didn’t stop. I know that my sister after she left work.. whatever she couldn’t get done in the 2 periods of lesson planning or study hall administration etc she got done at home, but it is in no way the same.

      Now that I’ve graduated. I bring work home as she did (we now live apart). I bring home patient transfer records, keep my required CME and continue prepping for my board exams on a regular schedule. I choose not to publish as I’ve never been as articulate as some, and choose to have a family once I graduated as I’m female (and every female doc who wants a family has age 35 bouncing in their skulls). She brings home her essays, her lab reports from her kids, and occ reads up on some new fun labs trying to keep the kids engaged. We’re both exhausted.. dealing with folks all day and trying to motivate and care is a lot. She’s still done before me, and I’ve put my time in grading papers for her (though not helped with lesson plans) depending on who has more work that week to catch up on. I always have my stacks of charts I want to review to make sure that I have a plan ready for when the patients comes in (the ones I inherited). Already caught a cancer that would have gotten pushed under the rug.. if I’d not put in the unpaid time. something I’m trying to remain proud of.. to encourage myself to keep going unpaid..

      I know if I ever stop working I’m not going to be able to get back into it. It’s not like my sister who can just stop for a few years then restart because her field is pretty stagnant (though she has to then wait for 10 year again, so she has issues as well).

      The reward for the amount of time worked goes up.. after you cover your overhead (insurance, building costs, etc)… so we tend to work more. Also we tend to work more.. because we thought we’d be able to provide more for our families. It was kinda a shock when (first doc in the family) I realized I would not be able to work 4 days a week and still provide. I don’t feel comfortable working 4-5 with limited hours (40) and bringing home 70k. So you push it to 60.. with overhead covered and making what you “should” be making. What a life. My practice still doesn’t bill for the over night calls, we don’t bill for the paperwork I do after I’m finished with my patients, or the check up phone calls, or the hospital visits to see a patient I wanted to know how they were doing. Those are social visits. Those don’t count towards the 60.

      Everyone wants more for less. The only ones not pushing back are the ones who care. So we (docs and teachers) continually get paid less because we care. I’m glad someone brought it up. And I’m proud to be compared to teachers who are in the same boat. My sister and I complain about it together. Can’t wait to send her the article. As it stands and as I was told when I wanted to be a physician, only go into the practice if there is nothing else you can think of to do. It’s a hard path, with it’s rewards, but there is a lot of sacrifice. As the pay lowers and the time you get to see patients seems to go with it, there will be more resentment and as the cost goes up for folks to come in.. you’ll see them less. You wont bond with them like you did in the past unless you put forth extra time you will not be paid for. It’s strange that my advisers who were in the practice tell me the same thing.. don’t do this unless you are sure. Anything else you do would make more money for the time you put in. You would have more flexibility and a better home life with just about any other job. You are the product as a doc, if you are injured or can’t work you will not be paid, there is no sick time that you are paid for, there is no fmla for you, there is no overtime, there is no income only loss if you can’t complete your job (you still pay your employees). You could put in less time and go into computers and make (as my husband does) the same amount I do with less hours, more flexibility and started making that money 7 years earlier. I still love my job. But it’s not what it was and it’s getting worse, and that is the point of the article.

      Anonymous

      January 13, 2012 at 12:56 pm

      • You are a great writer, Anonymous with the sister who is a teacher!

        Then, my comment on the whole thread – there is a rule of thumb bandied about that you shouldn’t spend more on your education than you think you will make in your first year of work.

        Personally, I made out great. Engineering for undergrad so paid off undergrad loans before med school and lucky enough to get a scholarship for about 20% of med school tuition. Only took out Stafford loans (paid 100K of my own savings) so interest deferred during residency and only 3% rate consolidated right now. Also worked during med school and poor enough to get Earned Income Credit! Then lucky, smart or whatever enough to go into orthopedic surgery so making good money (probably two or three times peds/FP)

        I can’t complain but I do believe most other docs are getting shafted but they also were not smart if their expenses were $15000/year to live and they racked up $300K of debt at 7%. Usually subsidized housing with 2-3 roommates (even in NYC where I was) is about $450/mo and you shouldn’t be spending more than $400 more/mo. You may have the dream but do a reality check before devoting 10 years of your life to it. And yes, I was there when the 80 hr work week went into effect. unfortunately, that was too late to save me from the neurosurgery rotation when days started at 4:30 and ended at 10PM unless your were on call (then they never ended). And if you have never worked for 30 consecutive hours or literally been in the OR for the same case from 9 AM to 2 PM with one bathroom break, I don’t think you get it.

        cs

        February 21, 2012 at 2:07 pm

      • Great reply. I think it pretty well sums up the amount of work a medical student and resident has to put in when they are ‘average’ for their class, and reflects the continual stress and pressure of the process. In my experience, in my medical school, it was only the smart people who studied just hard enough to get by, who had it relatively easy. But if you are like the average medical student, and you want to excel because you realize that in order to be good in your profession you have to know your stuff, then you work as she did. Even now as an attending physician, I feel guilty when I don’t study a few hours a week to keep current or to try to recapture a small amount of what I have forgotten.

        Kevin

        March 23, 2013 at 9:14 am

    • Medical students who put in 80 hrs per week would be far below average at most institutions. I had a strict schedule of 14 hrs/day for the first two years of med school (academic) including weekends. I slept 8 hrs per night, worked out for an hour and had one hour of personal time. Third year of med school was around 70-90 hrs/week at the hospital, depending on the rotation, but all learning was done at home for the exam which was at least a few hours per night averaged over the rotation (typically get through two review textbooks for each specialty). Fourth year was much easier, only having 5 months or so around 80 hrs/week and the rest around 30-50 hrs/wk. Fourth year is considered a vacation year by most.

      Tate

      January 15, 2012 at 9:54 am

    • Your points regarding teachers are accurate concerning lesson plans, master’s degrees and thankless professions. As a member of society, I thank you for your work developing our youth.

      However, I will agree with Dr. Brown’s article that physicians do, in fact, study 80 hours a week in medical school for 48 weeks a year. Studying daily from 6 am to 11 pm with (not counting a few hours to eat, drive etc) 6-7 days a week is an accurate (if not low) estimate. His description of residency training is also spot-on. I commend teachers for their work, but to say Dr. Brown’s points are laughable shows that you (like most of society) don’t appreciate the work and personal sacrifice it takes to become a physician.

      The take home point should be that society believes physicians are incredibly wealthy individuals. My wife and I are both primary care physicians in our early 30s. We have no kids. We live in a small apartment and we aren’t even considering buying a home for about 5 more years. We have no savings. We drive cars that are 6 and 8 years old. It is hard to not be jealous of my friends working in retail and sales buying houses, having kids and driving luxury cars. Dr. Brown’s book should be required reading for anyone considering a career in medicine.

      Anonymous

      January 15, 2012 at 9:00 pm

    • Ummmmm yeah, sorry, just because you can’t comprehend working/studying 80 hours a week doesn’t mean that that is an inaccurate number for a med student. That is accurate to my med school experience at University of Cincinnati. Thanks for playing.

      ER

      January 17, 2012 at 8:04 pm

    • By the way Dan, your initial response was just plain dumb.

      ER

      January 17, 2012 at 8:07 pm

    • I have to correct you on medical students… In fact, very FEW receive financial assistance from grants, scholarships, etc. I cannot speak on % that receive family aid (but I can assure you that those of us whose parents were not large earners were not offered much if any financial aid from academic or government entities).
      I have to agree with the post that medical students put in 80 hrs/wk (and my wife can vouch for that). Your day during the first two yrs was bad enough, but once you start ward coverage there are pre-rounds, rounds, workdays, then studying your patients and prepping for the next day. 80hrs is not far off and this does not lighten through residency.
      While I agree with your last statement that we are not alone in this, I must also agree that it is unfair to make the assumption that MDs make too much money.

      Scott

      January 17, 2012 at 9:47 pm

    • I have to agree with the others replying to you. Teachers perform a valuable and honorable service, but they have not the slightest clue how much harder doctors work than they do. I say this as a doctor who is the son of a teacher. Plus you don’t put your career and everything you own at the mercy of the piratical plaintiff’s bar every time you sign your name.

      John Skookum

      January 18, 2012 at 9:24 pm

    • I was smarter than my teachers by 7th grade. That is why I am a doctor now and they are not.

      Anonymous

      January 19, 2012 at 2:27 am

      • You are pathetic to make that kind of remark! It’s people like you who become doctors with no concern for their patients. How sad.

        Lori

        January 29, 2012 at 8:13 pm

      • Lori -

        How does that comment reflect someone who does not have concern for their patients? Arrogance and apathy are not the same thing.

        JD

        January 29, 2012 at 10:16 pm

      • I was smarter than my teachers by 7th grade also…and that is why I’m a high school math teacher – with a masters, working on a PhD…because some kids need to know that they aren’t the smartest thing in the class.

        I could have been a dr. Did all I need to do and was accepted to med school. I wasn’t willing to sacrifice my family.

        JLG

        February 5, 2013 at 8:13 am

    • Also, you are way off that the vast majority have grants, scholarships, and assistance from their families. This is true for some, but to say the vast majority is way off.

      Anonymous

      January 22, 2012 at 10:35 pm

    • If anything Brown underestimates the work done. Clearly this reply left by a teacher has no idea the hours placed by a resident physician or the sacrfices we make. Additionally medical students are on increasing the amount of time in both college & medical school, extending these times. & the number of MD/PhD (or other duel degree physicians) are higher than that in education. Lets not forget that everytime we transition from college to med school to residency to fellowships we accrue thousands of dollars in debt, traveling around the country to 5-50 interviews during our vacation time !
      This post is correct that most medical students do receive some sort of grant/scholarship monies, I received nearly about 50 grand in both for med school which still left me with 300 grand in debt. I am not underestimating the amount of time “making lesson plans” but we know that much of the work of an educator is repetitive from year to year. Your right eating ice cream & talking about an optho exam is not work, nor is taking a hour to each lunch with your fellow teachers, getting “holidays” or weekends off, being done by 3:30pm on a daily basis, etc.
      However we are not victims, we are doctors . . . & we are taking care of your parents, siblings & children. Think about how much knowledge base & patient dedication you want me to have when you place your loved one on my operating table !

      Anonymous

      January 26, 2012 at 6:30 pm

    • This article is definitely skewed to try to cater to the author’s sentiment. Who come’s out of undergrad with $100,000 in debt? Intelligent and financially responsible people go to in-state schools on scholarships, with a little out of pocket, but to say that $100,000 is the average is a gross exaggeration unless you’re intentionally trying to rack up as much debt as possible (for the purpose of this article) And yes, he conveniently leaves out that teachers can’t teach anywhere that I know of without a masters anymore. Trust me, $4 extra an hour wouldn’t make it possible to buy some of their houses and cars. Sure, it’s a lot of hours, but everyone that goes to med school is aware of the financial reward at the end. Ben Brown’s example shows a massive amount of debt which isn’t reflective of reality. Every profession is becoming more competitive. If it’s not enough money, choose something that is but stop complaining about not making enough money. The truth is, a lot of people like to complain about not getting paid enough but few are willing to choose a profession that pays more because the reality is that there’s no such thing as a goldmine out there. Good luck getting paid big money without hard work, no matter the profession. Successful engineers, lawyers, and entrepeneurs all spend a considerable amount of time to be good at what they do. Try asking why Ben didn’t choose a different field – he’ll probably say because his passion is in healthcare and making people well. If that’s the case, stop complaining.

      DP

      January 30, 2012 at 5:00 pm

      • DP:

        Unfortunately, students who would like to pursue a career in the medical field must carefully choose their institution. Hopefully students will have scholarships and grants, but many scholarships are based on need and if your parents are financially stable and have a good income then those children may not qualify for the scholarship or grant. I am a medical student, my undergraduate debt is about $90,000 or more. By the time I am paying it off it will also have accumulated interest. To say that I am trying to get into as much debt as possible is clearly an opinion. There were many factors that made me choose my undergraduate institution, not the least of which that it was close to home and I needed the support of family.

        “For the 2009–10 academic year, the average annual price for undergraduate tuition, room, and board was estimated to be $12,804 at public institutions (including $4,751 for in-state tuition) and $32,184 at private institutions (source) .” (National Center for Education Statistics, 2011)

        This link will give you a break down of student demographics in the US. There are quite a few that are a part of the low income bracket. Those students may need to borrow money because their parents likely have no savings for their college education.

        http://www.acenet.edu/AM/Template.cfm?Section=Publications&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=28223

        Where is your research to back up the statement that “a massive amount of debt which isn’t reflective of reality”?

        Engineer with a bachelors:

        My point was that physicians cannot be paid enough. Therefore, the arguments about physician pay being too high or not high enough is moot. It is a ridiculous argument. They can only be paid what the community can afford to pay them and there is no dollar amount that you can put on a human life.

        The same could be said for firefighters and other of the individuals you mentioned, except for one small detail, they are all government employees. Physicians are private pay therefore there is a huge difference in market and then you are comparing apples to oranges. It doesn’t matter what I think police officers should get paid, because I don’t directly pay him. (ok, don’t come back with tax dollars and politics, I get that, but for the sake of simplicity what I pay is not directly proportional to their salary.)

        ajones, with a masters and bachelors and soon to have a MD.

        ajones

        January 30, 2012 at 5:53 pm

    • I find it utterly laughable that you think teachers work 40 hours a week. Raised by a family of teachers, I can tell you that their true hourly wage, if all time spent preparing lessons, grading, mentoring, etc., were counted, their hourly wages would easily below minimum wage. You stack the decks in your favor in this analysis by assuming doctors are the only profession in this country that work beyond a 40 hour work week

      Marleen

      February 16, 2012 at 5:14 pm

      • How did all of those holiday breaks, weekends, and summers off treat them (assuming traditional high school schedule)?

        Matt

        January 23, 2013 at 3:36 pm

    • I am a resident about to finish training and the hours during med school and residency are accurate.

      Anonymous

      February 26, 2012 at 11:05 am

    • Whoever wrote this response has no clue what he’s talking about. 80hrs per week is about how much I studied in med school (approx 8AM – midnight 7 days per week for the majority of the year) and I was definitely not the hardest worker in my class.

      Anonymous

      March 28, 2012 at 7:31 pm

    • Fancy number work, but I have a common sense question:

      If teachers have it so good, why are the teachers the ones living in very modest houses while physicians live in McMansions, take exotic trips, and belong to fancy country clubs?

      Sort of defies all those numbers, doesn’t it?

      If physicians have a problem with compulsive overwork, that problem needs to be addressed and not rewarded by additional financial reward.

      We need more physicians, trained with no debt (like in all other civilized countries), not more financial incentives for personal dysfunction. Just because a profession has chosen to deprive its members of a personal life in order to maintain the cartel does not mean they can count every waking hour as necessary work.

      Tom0063

      July 4, 2012 at 5:32 pm

      • You are exactly on the mark Tom0063. We need to train more physicians and ensure that they enter the workforce with less debt, so that they can afford to work fewer hours. They will have a better quality of life, we will get better medical care and society as a whole will benefit.

        But the AMA cartel is not interested in what is best for all of us, they just want to make sure that a few overpaid specialists can continue in the “winner take all” sweepstakes that is modern medicine in the United States.

        The rest of the world has already figure this out, I am not sure why we cannot. I think it is mostly due to the power of entrenched special interests, like the ones who run this blog.

        noevalleyjim

        July 4, 2012 at 6:49 pm

      • It is exactly for people like you that this article is written.

        The point of this article is to discuss lifetime earning. Because physicians defer their earning until their fourth decade(if they go straight through), they concentrate their income in later life.

        Say I finish training at age 32 and pay off my loans by age 42 and have finally saved up for a deposit on a house… Then sure, I can afford an above-average house – at age 45. I have deferred my income (and taken on debt) from age 22-32, and worked my tush off to do it. The teacher has enjoyed income from a much younger age, perhaps buying a more modest house much earlier. That same teacher, if he worked the hours that the physician does and saved up the money for all those years instead of spending it, could afford the exact same house. That is the whole point of this article.

        Understand?

        Mtbwalt

        July 16, 2012 at 12:52 am

    • Most high schools require Masters degrees? Please back up that statement with some data. Most schools are not Philips Exeter.

      There is no need to be so defensive. Dr. Brown’s article does not disparage teachers. It simply tries to point out that the conventional wisdom of doctors as rich, overpaid 1%ers is false.

      When I was in engineering school we performed a financial exercise of determining whether it would be financially advantageous to take an average salary engineer job at graduation, or to go to medical school, residency, and practice as a doc. Using a very modest 3% interest rate and average salaries, indebtedness, deferred income, etc, , the doc catches up with the engineer financially at age 65. If the doc keeps working after age 65, he pulls ahead of the engineer.

      Mtbwalt

      July 16, 2012 at 12:22 am

    • In all honesty, doctors are simply smarter and work harder than just about everyone else. They deserve to be paid and seeing as they have our lives in their hands, I hope we would pay them like they were the best.

      Anonymous

      January 21, 2013 at 8:01 pm

      • bravo, sir. bravo.

        Anonymous

        January 21, 2013 at 8:05 pm

    • In all honesty doctors are smarter and work harder than just about everyone else. Seeing as they have our lives in their hands, I want the best in medicine. They should be paid like it. Many people can teach. Few can cut it as a doctor.

      Anonymous

      January 21, 2013 at 8:03 pm

    • I think you missed his point completely and are being argumentative on a few details. It’s a forest from the trees argument.

      Percy Naranjo

      January 24, 2013 at 3:32 pm

    • I do not know who this “vast majority” of medical students receiving grants, scholarships, and money from family is, but I’m not one and I don’t know very many. I resent your ignorant comments about what medical students actually get. In medical school, the number and size of scholarships just don’t exist the way they do in undergrad, no matter how good of a student you are. The pure fact is that physicians dedicate their lives to medicine unlike anything that exists in the culture of any other career. It’s a way of life. It’s his or her family’s way of life. And when this is a profession where there is more dedication and hard work than in nearly any other profession, it’s an insult to constantly receive undercut payments from insurance companies and constantly fight, worrying whether or not we will even break even.

      There is not a single person in this country who does not rely on physicians to take care of them when their sick, whether it’s with a cold or pancreatic cancer. Physicians are expected by the public to be there and be available at all times of the day to take care of the population.

      A physician’s job does not end at the office or in the hospital. But no, no matter what area of medicine a physician enters, he or she will have to not only be a physician, but must also be a wise businessman, political advocate, teacher/educator, life counselor, and the list could go on and on. The roles of physicians carry across every spectrum of American life.

      It is insulting for a physician’s pay to continually be cut with the amount of hard work and dedication put into the profession by each and every one of us from college through the rest of our lives. It isn’t a job. It isn’t a career. It’s our lives. And with the continued expansion of regulations and restrictions alongside continued cuts in reimbursements, more and more good doctors are leaving the profession because they can’t take it anymore.

      What would you do the next time you really needed a doctor, but there wasn’t anyone there to take care of you? What would anyone do?

      Anonymous

      January 24, 2013 at 7:34 pm

    • “Working/Studying 80 hrs/week for 48 weeks during med school” is an understatement. During my internal medicine clerkship, I arrived to the hospital at 5:30AM, on the days that I wasn’t on long-call I would leave at 9PM. On the days that I was on long call, I would leave by 11PM. In addition to that, I would have to research whatever b.s. research topic my attending felt like throwing at me to present the morning after. On my days off, I would spend at least 10 hours/day studying for the shelf-eek. Oh, and don’t get me started on surgery and psychiatry…For those that are of the school of thought who want to believe there are professions comparable, I vehemently beg to differ. You are dealing with a person’s health/life. It takes a lot of work and determination to be a mediocre physician, but it takes a hell of a lot more work and determination to be a great one.

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        mr johnson

        July 16, 2013 at 3:33 pm

    • People love to tell you they work more than they actually work. I am a med student and so is my girlfriend. We live together, we study together and we play/relax together. On average, I worked significantly less than 40hrs a week in undergrad and I felt like I was working just as hard or harder than my pre-med peers. In med school the ONLY weeks I work 80 hrs are during text weeks and during a few of the tougher rotations. Most other weeks are closer to 50 or 60 hrs. I have an active social life with my peers. We hang all the time, play intramural sports together, and get to travel on some weekends. They are not working much more than me. Before coming to med school, I had a desk job where I worked 60 hours a week. I will admit that for me, studying for 60 hours/week is harder than doing most other kinds of work for 60hrs/week. But still, most of us do not work much more than that a week unless a text is coming up.

      Work hours aside, Dr. Browns calculations are taking into account the average household income. Since this article is about how much physicians make, I’m not sure why he chose to use the household income rather than the income of the doctors. In doing so, his calculations for the hourly wages of an internal medicine physician include the incomes of just as many people who are not physicians as those who are. Further, internal medicine physicians are one of the lowest paid doctors. But, lets stick with them. If you consider the average income of the individual, which is what should be considered, things look different. Even with Dr. Browns over exaggerated work hours, the adjusted net hourly wage for an internal medical physician is $17.43 more than high school teachers, who still work hard, get less respect, and have less job security.

      [(205441 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)] =
      The adjusted net hourly wage for an internal medicine physician is then $52.22/hr

      (50,000 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] =
      The adjusted net hourly wage for a high school teacher is then $34.79/hr

      Being a doctor means working hard for a long time. But you do get paid. I’d like to hear all my peers stop complaining.

      Anonymous

      February 4, 2013 at 3:12 pm

    • I most say that as a medical student, I easily studied and worked at least 80 hrs a week. I am currently a plastic surgery resident and to get to this level, I had to clearly outpace my rivals. I know it is hard for people to believe that medical school is as intense as it is, but it is. Now enter surgical residency. My intern year is documented at averaging 103 hrs per week for 49 weeks. I have to keep working this hard to pay my ever increasing property taxes that go mostly to teachers salaries. Doctors should be allowed to organize and strike as well. Anyway, those that cant… teach.

      Anonymous

      February 5, 2013 at 3:25 pm

    • I think the grants and scholarships and assistant-ships you were talking about applies to graduate students. I certainly did not receive any help during my medical school and the vast majority of my classmates did not either. I got married during medical school, so I was able to start paying back my student loans as soon as I entered residency as my husband has a (real) job. Even so, after almost 3 years of trying to pay them back (on a 10 year repayment plan), the amount I owe has not budged.

      Even though there is a work restriction, we do frequently go over the 80 hours of working time. Of course, that doesn’t include any reading, research, or working from home we do. Working 100+ hours a week during residency is the norm. Holidays of course, do not apply to us.

      Anyone who knows a medical student or resident would know this… your assumptions are totally off, Dan, unfortunately.

      Anonymous

      April 15, 2013 at 9:52 am

    • My sister is a resident, my mother is a high school teacher and my father is an accountant. Let me tell you about our lives –
      Teacher: Get home at 5 PM every weekday and maybe one night a week have some extra papers to grade that were not done during free period at school and/or lesson plans. Summers fully off.
      Accountant: 9 AM to 5 PM every weekday, weekends off. No work at home… ever! Gets upto 1 month a year as vacation!
      Sister: Is out of the house at 6 AM on most days. On a good day, is back home by 7 or 8 PM and on bad days, doesn’t make it back home and catches a nap at the hospital. Weekends? What are those? Has 1 weekend off a month and is on call over that weekend every other month. So, technically, has off for only 1 weekend every other month. Once she’s at home, she spends a few hours reading/studying on most nights. Just counting the time she is out of the house and at the hospital, the conservative estimate would be around 90 hours a week. And I won’t even talk about what she went through in medical school!
      And the cherry on top is that my sister makes less than both my father and my mother. And she has about 200K worth of debt.
      While Dr. Brown may not be 100% accurate in everything he said, he is definitely 99% accurate. Please don’t talk about things you don’t actually know about.

      Anonymous

      April 20, 2013 at 4:00 pm

    • Dear Dan,

      I realize that you posted this over 2 years ago but I would like to tell you my situation as I am currently just completing my 3rd year of medical school. Also, I really want to get some advice on where I go to get all these grants and scholarships that you say most medical students get because I sure do need them! I finished my bachelor’s degree in 4 years and that ended up costing me much less than this article estimates at only $39,647. In undergrad I was able to work as many undergraduate students do and got away with putting in about 40 hours a week in studying and going to class just as the article says. However, on top of all of this, I also had to demonstrate/take on leadership roles in the community, do community service, do “volunteer” (aka unpaid) research ( I did mine on ovarian cancer) and maintain a high GPA in classes like analytic chemistry and biochemistry and courses that are a little bit more difficult than learning how to write out a lesson plan. Please don’t get all defensive, I know that is work but I just would like you to realize that there is a difference in level of difficulty. Also, I did all of this while also being a wife and mother which I usually did on my own because my husband works at sea for 6 weeks which actually works out to be almost 7 weeks with travel time, and then he would be home for 5 weeks (and still working at home too). Now, let’s get into the expense it cost just to apply to medical school (which wasn’t in the article). First of all, you have to take the MCAT ($270). Then you have to apply which costs an upfront fee to AMCAS and then a second fee to the medical school so each school you apply to costs anywhere from $35-100 just to apply and with as competitive as it is to get in, you have to apply to at least 10 to have a shot to be realistic. Of course there is then the whole issue of getting to the medical schools that invite you to interview which can easily be hundreds of dollars if you have to fly there and stay in a hotel. I chose to only apply to local medical schools to avoid this but didn’t get in the first time b/c of that. So, the next year I applied to more and ended up spending about $1000 going to interviews (which isn’t bad compared to some of my classmates). The interesting thing though, is that I taught school for a year while I waited to reapply so I know first hand the life of a school teacher and it is laughable to me when I hear my friends that are still teachers talk about how hard it is b/c these are the same women who I spent my “planning period” gossiping with everyday for 90 mins. Of course we did all have to go “slave away” for our 3 blocks of class that were 90 minutes each so there was some work going on. Yes, there were labs to plan and activities to come up with but that was like coming up with fun stuff to do…not exactly taxing work. And, yes, there were tests to grade(easily done while having coffee with fellow teachers or even while watching TV) and struggling students to help after school sometimes but even still, weekends were mine and I wasn’t having to pay for daycare b/c a bus picked my kids up from my school and brought them right back in the afternoon so that was a huge savings as well. Anyway, I am getting off subject so let me get back to the reality of medical school from someone who is currently living it. I did get accepted into medical school in Washington, D.C. so we had the expense of moving from Georgia to N.Va (which is insanely expensive) on top of my ridiculously expensive medical school. My budget for the upcoming year is just over $71,100. Of that, $24,000 is for living expenses, transportation, books, etc and the remaining $47,000 is for tuition and fees. I have no help from my family (I have been on my own since my 17th birthday) and have been fortunate to get a couple of scholarships through the years but $20,000 over 8 years of college that is going to end up costing me right at $250,000(not including the interest I keep accumulating every day – at 7.8%) isn’t exactly a ton of help. As far as any schedule you have seen for a medical student I would love to meet them too b/c my typical day goes like this: I get up at 4:00AM so I can leave by 4:45 and beat traffic. This allows me to get to the hospital by 5:45. I then go and “pre-round” on my patients and check with nurses and the doctors on call overnight to find out what went on. I then check all their lab work and imaging they had done and write notes summarizing what has occured, how they are doing and what the plan for their continued treatment is. By rushing and working really hard I can usually get done by the time my attending shows up to do rounds at 7:00. We then spend the next 2-3 hours seeing all the patients on our service and discussing our plans and making sure they are appropriate. Once rounds are over, it is time to actually order all the tests and implement the plan we agreed on (usually takes another 2 hours or so). By this time, I am starving b/c I haven’t eaten since 4:30 but there usually isn’t time for lunch because there are new patients to see either in clinic or in the operating room or emergency room so I battle on with a granola bar that I eat while walking. I am usually done with procedures by 4:00 but then it is time to go check on my patients again and make sure things ordered that morning were actually done and there were no complications. After that, we meet with our attendings again to discuss the patients, new and old, again. And then, I finally start to see the end in sight. All I have to do is write more notes and “sign-out” to the people coming in for the night so they are up to speed on what is going on, By this time it is typically somewhere between 6-7PM and I finally get to go home. Traffic in DC is horrible so I spend about an hour and a half driving home. I then get to spend a whole, whopping 30 mins or so with my children before they go to bed. If my day ended here I suppose it wouldn’t be so bad but now I have to go study because I still have board exams coming up next month not to mention 2 “shelf exams” (standardized tests) on Monday. So I will spend the next 3-4 hours fighting sleep and reading and studying before finally getting to fall into bed. A good day for me is a day when I get to go to sleep on the same day I woke up on. Of course, because I am a student I am limited to 80 hours of clinic duty per week so that helps I suppose because it leaves me with another 68 to study and hopefully get a little sleep for the rest of the week. Of course we have to put tons of time into studying b/c our board exams are so expensive ($1300 just for Step 2 that I have to take to continue my education) you don’t want to have to pay for them twice, not to mention, our residency placement is based on our scores which really puts extra stress and pressure on me. So, to wrap this up, I don’t think anyone is ever dismissing teachers or firefighters or cops or military because we all appreciate what they do and recognize that everyone is needed to keep society moving along. The point that the article was trying to make, and that I am trying to make too, is that it is so upsetting to be accused of being greedy and told we are paid too much as physicians but teachers are constantly harping about how they need more money. No other profession has to carry the extent of insurance that we do (which wasn’t even accounted for in the article). For example, to practice as an Ob/Gyn in Washington, D.C., your malpractice insurance is $120,000/year, which in all fairness, they are infamous for being one of the most expensive specialties so we don’t all have to pay that much but it is still insane because there are people who will flat out lie b/c they see a medical malpractice suit as a way to make some extra money (not to say there aren’t true, honest mistakes that people truly are entitled to b/c there are certainly are those cases). I think if you would get the chip off of your shoulder you would see that the article wasn’t meant to be a dig at other professions it was simply to point out that physicians are not wealthy and greedy as we are ofter portrayed to be but actually earning equivalent salaries to a teacher. Also, he isn’t dismissing work teachers do outside of school as not real overtime, he was just pointing out that physicians also have tons of paperwork and planning to do once they are “off the clock” too. I mean, we have to maintain a certain number of hours of training every year just to continue practicing not to mention constantly having to research new drugs and tests and interventions that come out to understand which patients they will benefit and which ones they are contraindicated in, and correct me if I am wrong but the laws of calculus, or literature, aren’t exactly changing on an almost daily basis like medical advancements are. I am becoming a doctor because I want to help ease suffering just as much as someone becomes a teacher because they want to see children learn and move forward, I just wish I wasn’t looked down on and treated like I am a selfish, greedy leach on society because in all reality, I am basically the opposite. I donate my time to a free clinic every other Saturday and will continue to do so as long as I am able but things like that don’t get taken in to account. I would love to know how many teachers you know who have to miss 75% or more of their kids activities because of work because most doctors do, especially during residency. I am surprised you are still reading this, as I am starting to even bore myself now but, I do hope you can try to see this article in a new light and understand that you have no clue what it is like to go through medical school and residency. However, I am still really interested in all these grants and scholarships that you mentioned so please forward me that information. I am at the last year of medical school so it won’t do me much good but 95% of all the medical students I know are in the same boat as me and maybe it could help them. I hope you have a good night, and judging by how defensive you got I assume you are a teacher and on summer vacation and have probably been having a lot of good, restful nights for the past few weeks. I however, am going back to studying. I’ve only put in 14 hours today so far so I am slacking and need to get my butt in gear…pretty similar to how things were for you in college, right? Oh, and the high school I worked at had 37 teachers and only 3 of them had higher than a bachelor’s degree. Good night.

      Liz

      July 19, 2013 at 9:43 pm

    • Vast majority of future physicians do not receive “both grants, scholarships, and assistance from their families.” I’m sorry but even considering the med students with parents that have upper middle class income, the tuition, fees, living expenses ..etc is still way out of budget. Also, excluding the fact that med students and physicians put in an enormous amount of hours for their job, the amount of precision and liability that is placed upon a physician work when they are responsible for a individual’s life is IMO one of the reasons why physicians are paid the way they are.

      AT

      August 22, 2013 at 7:57 pm

    • Dan,
      Wrong. “Most schools” do not require teachers to have an advanced degree.

      Joseph

      November 7, 2013 at 3:05 pm

    • “The [vast] majority of future physicians receive both grants, scholarships, and assistance from their families” Where do you get that from? Most of us did not.

      Doug ROss

      November 8, 2013 at 9:32 pm

    • Sir,
      I am a physician and I would tell you the 80 hours a week studying is not an exaggeration. 9 hours hours every day just on lectures 5 days a week and reading your books and your notes and your medical journals (not having lunch or eating ice cream while recounting the ophtha exam) that would easily take more than 5 hours a day 7 days a week. By the end of one year in medical school one would have gone through reading materials reaching 5 feet in height (i know i measured), and these are not easy to read light reading materials. Then when you go to residency, in our hospital, if you’re in a surgical field, you come in and you don’t go out for an entire week.

      RJ

      November 9, 2013 at 10:12 am

    • Dan, dude, you struck a nerve.
      From the comments, most reading this article, including me, are doctors. So, I guess we are all taking in it personally and are reliving our many hours of training. Some grueling and some fun.

      In the end, we all have chosen our careers, and due to the blood, sweat and tears invested as well as the cost of retooling our skills, we are stuck in medicine.

      I am proud of what I do, but I will also tell you that I doubt I would do it again.

      Don

      December 8, 2013 at 10:29 am

    • Hi Dan. I am a new dentist. I wish those “grants, scholarships, and family help” helped many of us in a significant way. Unfortunately they do not. Most of my classmates are $300,000 to $400,000 dollars in debt. I have a family. In order to support my family I had to put some of my loans in forbearance/deferment. Believe me, we are not living in luxury.

      I am not a doctor. However, I have observed medical students and residents work hard and gruesome hours to the point where it has taken a toll on their health, relationships and even their life. I don’t see what they are doing comparable to a “wall street exec having lunch and talking about portfolios.” Yes, it is a lifestyle, a chosen career. However, there is a danger in this misconception about doctors and what it takes or cost to have this career. It is affecting policies, our medical system, and good doctors who getting burnt out or is unable to provide ideal care. I am not a teacher. I do not know all the challenges and sacrifices teachers have to make. Maybe I should so I can better support my child’s teacher. I am not sure how accurate Dr. Brown in his calculations. I do think it provides a good picture.

      Anonymous

      January 6, 2014 at 2:42 am

    • I wish that you would reply to this very astute criticism, Dr. Brown. I suspect that you hadn’t considered these realities prior to writing your piece, and that you would like to keep it that way. I should think someone with the amount of education you purport to have, would have a little more respect for people who might have helped you along the way. You did yourself a disservice when you chose the angle of your piece. While crippling loan debt might be worthy of attention, it needn’t malign or dismiss a profession most would agree is one worthy of respect, or at least thoughtful consideration. Also, much of your estimation where teaching is concerned is just plain wrong.

      Really, sir?

      February 3, 2014 at 10:28 am

  2. Dan,

    Thank you for your response.

    I’d like to comment.

    1. Teachers don’t need a masters or Ph.D. in order to be paid for teaching. Physicians do need an M.D. and residency training in order to be paid for practicing medicine.

    2. You are correct in that most medical students are not 300,000 in debt at the end of medical school; however, that is how much must be spent, on average to educate a physician. Should only children from wealthy families with generous parents be able to become physicians because they are the only people who can afford it? You are right in stating that most medical students receive grants and scholarships, you are wrong in assuming that this matters. Unlike college students, the scholarships and grants given to most medical students are very small. A $500 scholarship that brings an annual bill from $45,000 to $44,500 is nice, but does little to lessen the debt load.

    3. First of all, NO medical student takes an “ophtha exam” because according to dictionary.com “ophtha isn’t a real word. I assume you mean ophthalmology, which is not a required medical student rotation and therefore is rarely tested. Moreover, medical students often have to study while they eat lunch and residents frequently don’t have time to eat lunch. Medical students and residents work 80+ hours per week. Moreover, few people would disagree that teachers are more likely to have protected “lunch time” than medical students and residents. I didn’t subtract lunch time from the time calculation for either profession. However, because teachers, on average, have more break time during the day than physicians – their adjusted net hourly wage per hour spent actually working would be even higher than that calculated above.

    4. I have the highest regard for teachers. I would not be able to respond to your comment had I not had great teachers along the way. However, you cannot compare the 40,000 hours of training physicians endure to the training of teachers. You cannot compare the sacrifices physicians make to that of teachers. How often do teachers miss holidays because they had to work. How often do teachers have to spend the night at school? Not sleep for 40 hours? Take phone calls at 2am? Spend over half their income on income taxes and student loan payments? Be threatened with lawsuits when their performance is less than perfect?

    5. You have failed to point out my “academic flaws,” moreover, where is the evidence to support YOUR points? The anecdotal assumptions you have made are the lowest form of argument.

    6. Every career requires a “lifestyle” so what is your point? My point is that the lifestyle of physicians requires more sacrifice than any mainstream profession and they should be fairly compensated for that sacrifice.

    The lifestyle of a physician requires an initial 40,000 hour and $300,000 investment. Followed by 60 hour work weeks, working weekends, working holidays, taking calls at night, paying high taxes, etc.

    The lifestyle of a teacher requires an initial 6,400 hour investment and $100,000. Followed by 40 hour work weeks, 3 months off each year, weekends off, holidays off, lower taxes, a pension etc.

    Physicians are not better than teachers, they are not better than anyone. Physicians do; however, sacrifice more for their career than any other mainstream profession. Few people understand the process and the sacrifices and that is what I am trying to explain.

    benbrownmd

    July 3, 2010 at 3:09 pm

    • Dr. Brown,
      I enjoyed reading your article and am persuaded by some of your points.

      While you are correct that secondary teachers do not initially have to have a Master’s Degree in order to be paid to teach, your assumption that they can continue teaching without one is incorrect. In order to keep a teacher’s license in many states (including my state of Tennessee), one must choose continuing education in the form of graduate level course work before their license can be renewed at each re-licensing period. Many student teachers elect to complete their Master’s prior to beginning their careers so that they don’t have to go to school while teaching full time and so that they can fulfill the long term continuing education requirement for the license. Of course, they are still expected to attend yearly continuing education seminars, workshops, and other educational experiences that may not result in college credit, even if they have completed a Master’s degree (just as doctors must continue their educations throughout their practices through similar media).

      Teacher’s kid and wife,
      Rachel

      Rachel

      July 5, 2010 at 8:54 pm

      • And yes teachers can be sued just like doctors. The local school district has more legal suits this last year than the local five hospitals combined!

        Teach

        December 28, 2010 at 11:23 am

      • Teach the lawsuit isn’t against the teacher, it is against the school board. My mother never once had to pays tens of thousands of dollars a year in malpractice insurance. I believe teachers should be paid more, same with police officers as I am the son of both. I feel the same for military officers being one myself. I KNOW doctors should be paid more. No other profession requires more training with lower compensation. I have spent many 80+ hr workweeks despite not “being allowed,” and I pay a school to let me do this. Dr. Brown is dead on in his assessment and it is something that people should look hard at, b/c in the long run the issue will affect everyone.

        Michael

        January 25, 2011 at 6:47 pm

    • I’m not about to disagree with your numbers about becoming a physician. My brother is currently in med school, and I know that even a 10 minute phone call with me sometimes throws off his studying schedule.

      However, I do question the statement that teachers work 40 hour work weeks. I’m friends with a number of teachers. While their mandatory time at school is often around 40 hours, the required time for grading, lesson planning, conferences, meeting students, and keeping up with their license and evaluations usually makes it closer to a 60 hour work week.

      Additionally, they may theoretically get breaks during the day, like lunch, but frequently the teachers I know don’t even get a chance to pee before they get home. Students are constantly trying to get their attention, and if the teachers ask a student to wait, the student frequently doesn’t. Then, when that student gets a poor grade, the parents berate the teacher for not giving their child a chance to meet with them. So, for many of them, it’s easier to forgo breaks.

      This is no way invalidates your point, but I just want to give a realistic idea of what a teacher’s job is like day-to-day.

      Karen

      January 27, 2011 at 2:57 pm

      • I had initially written a long response about my impression of the current state of the public school system. My opinion really isn’t worth your time reading.

        But not going to the bathroom? Your surgical oncologist might not have during your Whipple, but I am pretty sure teachers can make it during lunch or call someone to watch their class when their overactive bladder (which they hope their doctor can fix) tells them it is time to go…..

        Anonymous

        January 27, 2011 at 8:46 pm

      • no, Karen is right… my best friend is a high school english teacher and she deliberately minimizes fluid intake so she won’t have to go to the bathroom. she works close to 72 hours a week, but does have summer and winter break. During which spends some time planning her curriculum

        samira

        January 28, 2011 at 2:20 am

      • Thank you for replying as you took the words right out of my mouth. While I will never doubt how difficult the process in becoming a physician is, this entry is rude and off the mark in its regard for teachers. If you’re going to be using California as an example, $50,000 is on the high end of the average salary for teachers. You also don’t account for the time it takes to get your credentials because it certainly doesn’t take only a bachelor’s degree before you can be paid to teach unless you’re talking about some untrained college grad doing Teach for America. That’s the equivalent of saying physicians in the U.S. are the same as doctors in Mexico who perform surgeries American doctors won’t. A stretch right in my comparison and assessment of physicians in other countries, right? Well that’s exactly what you’re saying in your ridiculous comparison.

        Anonymous

        January 30, 2011 at 3:21 pm

      • I find it funny that this conversation has come to things like bathroom breaks, but if you want to discuss that, here’s another consideration. I am finishing up my residency in Obstetrics & Gynecology. There are days that I am so busy with deliveries, surgeries and taking care of patients in my clinic and in the hospital that I don’t go to the bathroom either. I don’t complain about it though. It’s expected. Often, I may only have time to grab some peanut butter and graham crackers out of the drawer to snack on between surgeries. Is this ideal? Of course not. But how do you expect physicians to be better rested, better nourished and even able to take a bathroom break with the amount of surgeries and patients that need to be seen to make an income at all?

        I think the point being made here is that while physicians do choose to dedicate themselves to a higher purpose, just like a teacher, the amount of stress and personal sacrifice is unfortunately unmeasurable.

        My mother is a teacher too. However she is constantly upset at the amount of time I have to spend at the hospital. She worries constantly and feels it’s very unfair.

        Oddly enough, I’ve elected to pursue further subspecialty training after I graduate. It makes me sad to know that while I’ll spend about 30 years making myself a good doctor, lost hours of time with loved ones that I’ll never get back, dedicate those future hours, never take a vacation over 2 week because it would interrupt patient care and almost lost all hope for a life like my non-medicine friends have while in medical school… my patients would only think that “she makes too much money”

        Anonymous

        February 22, 2011 at 6:23 am

      • This is not a question about whether or not teachers work hard! I think that everyone would admit that they do, and are under-appreciated. But there is hardly another profession out there that gets abused as doctors do.

        Limiting your fluid intake for less bathroom breaks? Physicians on call in some specialties don’t get to EAT because they are so busy (as in the case of my husband), let alone use the bathroom. When someone is coding/dying, there are no bathroom breaks.

        When a teacher has a bad day, some kid doesn’t learn something. When a doctor has a bad day, it’s because someone DIES. Have a little perspective.

        Nikki K

        March 1, 2011 at 7:15 pm

      • WoW a 60 hour day? Medical Students and Residents can easily blow that up to 80-100 hours a day. Have you ever tried to study for 3 hours after being at the hospital for 16 hours on your feet dealing with sick people at the worst angriest personality point in their year? As a doctor in training, I’ve studied while taking a shit, studied while eating, I’ve even looked at a piece of paper while taking a shower.

        “Then, when that student gets a poor grade, the parents berate the teacher for not giving their child a chance to meet with them.” Are you actually even attempting to compare the berating of you by a parent? You know what happens with doctors screw up? People die. Lawsuits happen. Careers end. What happens to the teacher that gets a parent angry at him/her? A few moments of mildly uncomfortable talking? The principal will back up the teacher provided they’re not an idiot completely out of line. Your comment is a joke.

        Rob

        December 26, 2011 at 7:27 pm

    • It is your right under the First Amendment to help people to “understand the process and the sacrifices”…but this work incites nothing but a pissing contest. Don’t quit your day (and night, and weekend) job. Most of us are blessed to be able to make choices (it sounds, Dr. Brown, that you are one of the blessed)…some of us are more privileged than others, some of us are self-made, some of us are relegated to a middle-class existence where we pay too much in taxes and reap no reward, and the cliches go on and on. I do not normally blog…but this broke the camel’s back.

      A. C.

      January 29, 2011 at 12:10 am

      • You still didn’t “blog”. You commented on one.

        Anonymous

        January 20, 2012 at 3:29 pm

    • I just want to point out that teachers’ 3 months off are only 2 and that they are not paid for these months off.

      Anonymous

      January 29, 2011 at 11:49 am

      • Are you kidding me? Of course teachers are paid on their months off. It is included in their overall salary. It is not like teachers get paid 9 months out of the year and when the summer comes the school says, “ooh sorry this is your time off, no paycheck for you this month, hope you saved the other 9.”

        Anonymous

        February 1, 2011 at 1:09 am

      • Many days I think that my job as a family physician is easier than my mother’s job as a kindergarten teacher. I used to be “volunteered” to help in my mom’s classroom after I was out on break. She had 30+ kids and only had the aide for one hour. All the projects that kids do in school?? Well, your kid’s teacher has to put those together. At home, after hours, while trying to take care of her own family. I put together numerous projects in my free time in order to help her out. Most of the time, the supplies were paid for out of her own funds as the schools didn’t have money for the teachers. And, she didn’t get paid during the summer months. She had to take a percentage out of her regular paycheck to budget for the summer months, or no income. That 9 month salary has to stretch a lot farther than you think.

        Personally, instead of giving professional athletes $40 million dollar contracts we should pay our primary grade teachers a million dollar salary.

        Melissa

        February 5, 2011 at 4:10 pm

    • Nicely put Dr Brown.

      CS

      February 1, 2011 at 3:18 pm

    • I was a public school teacher (with a Master’s degree) for a few years prior to entering medical school a decade ago. Being a teacher might seem hard, but it is absolutely nothing compared to the training and work demands placed upon doctors in this country. Absolutely nothing. With all due respect, a Master’s in Education is a joke of a degree, and working 8 am – 3 pm (don’t try to argue about lesson planning, etc. because every job has similar after-work demands) for fewer than 180 days per year in a relaxed work environment does not deserve any more than $50,000 a year, especially with the amazing benefits and pension plans that most teachers receive. Also, I’m not fully aware of teachers salaries outside of New York City, but within NYC, most teachers make more than $50,000, with the opportunity to make much more if they’re willing to work a couple hours after school, summers, etc. (i.e. normal hours that everyone else in the country must endure).

      Doctors, on the other hand, are so underpaid that I just don’t even know where to start. The teachers and doctors on this message board can debate back and forth as much as they want, but I have experienced both careers, and I don’t have the slightest, tiniest doubt in my mind that teachers are well compensated and doctors are not.

      Sadly, the teachers unions in this country will continue to protest their way to higher salaries, while politicians continue to cut physician payouts as a simple, temporary quick-fix for skyrocketing health care costs – all while overworked doctors are too busy to organize and do anything about their declining career situations.

      Anonymous

      February 14, 2011 at 6:44 pm

      • Not all doctors are underpaid. Primary care doctors are underpaid. Those who are not underpaid have strong lobbying powers in Washington DC. Otherwise, I agree with the statement “doctors are too busy to organize and do anything about their declining career situations” as it applies to primary care.

        WJ

        February 21, 2011 at 8:53 pm

    • I am married to a teacher and clean houses for doctors, I can tell you that ( as a math teacher’s wife) you can make statistics say anything you want, but the houses (multiple that any doc has) speak for themselves. You can’t be serious. My nephew is a doctor, and democrat, and asks the question,” how much money does anyone need?” Obviously from your distorted site, with only other greedy docs responding,never enough.

      Anonymous

      February 26, 2013 at 7:59 pm

  3. Dr. Brown,

    Thanks for your article, it explains what I can’t put into words when my family/girlfriends/friends ask me why I don’t have time to see or talk to them (for the last 5 years, only 4 more to go). I fear that no one can understand what we do without actually going through it, as evidenced by the guy who compares being a high school teacher to being a physician. Each job is needed in its own right, but seriously, I’m pretty sure I could switch jobs with this guy for a week and be okay, on the other hand he would most likely be responsible for the deaths of every patient on the medicine wards. I guess making life/death decisions everyday, running the risk on contracting HIV/Hepatitis with one slip of a syringe, and telling countless families that their loved ones died not five minutes ago while getting paged to stop the same thing from happening to someone else doesn’t really compare to the stresses old Dan faces every day while hammering out lesson plans. Oh well, everything is relative, I hear part time janitor can be quite taxing as well.

    And Dan’s statement, “The [vast] majority of future physicians receive both grants, scholarships, and assistance from their families” is just an outright lie, there is no other way to put it.

    Arguile

    July 5, 2010 at 8:40 pm

  4. Dr. Brown and others,

    Ok, where do I begin?

    Yes, my comments were anecdotal; something that was very deliberate. I did not perform research before I commented on your article, therefore I did not present any findings or conclusions–what you did was far more egregious.

    You, Dr. Brown, presented data that was half-baked and not reviewed with any level of skepticism. Two tenets of generating a mathematical model [essentially, what you did] tell us to both recognize our limitations and that our conclusions are only as good as our data inputs. Your data is wrong, which necessarily makes your conclusions inexorably wrong. Instead of making a conscious effort to account for nuances within your financial calculations you simply present superficial data. If you did further research maybe you could have reconciled that 38% of college students in the US graduate with no debt at all. No debt, regardless of how tuition was paid for initially, means no interest payments. Your metric does not account for this. Although this does not breakdown by future professions, an overall decrease in debt would favor net income over a lifetime for physicians.

    Your lack of research into the graduate work of secondary teachers is a crucial flaw. Notwithstanding your disregard for the very real education requirements for many teachers–even a lack of requirements would influence your calculations. The median teachers’ income you obtained included many teachers who *do* have advanced degrees, perturbing the income range and leading you to believe that all (including ones with only B.A.’s, etc.) teachers have a higher income; for which you did not allot the appropriate expenses and work hours.

    These are but the more obvious examples of the “academic flaws” I mentioned. What you attempted to calculate is INCREDIBLY difficult, and would take a very long time to confidently prepare for any audience. If you are going to project yourself as an academic source of information, you should be committed to acknowledging inherent biases in your calculations, and make an effort to stipulate which way they may lean. No data, and by definition no model, is perfect–so by all means make estimates; but state their limitations.

    In response to some of Dr. Brown’s and Arguile’s more petty comments:

    Yes, of course ophtha is not a word–and great detective work, I did in fact mean ophthalmology. I will make sure not to write any more troubling shorthand.

    My lifestyle comment was meant to explain why it is so difficult to quantify payment scales for those professions that I see as “self-defining careers”; in other words careers that require a level of dedication and lifestyle organization that set them apart from others, like working a desk 9-5. In short, these hours are not fungible between one-another or careers paid by the hour. You are snide and flippant in discounting the effort that teachers in particular put into their work. You see everything that a physician does to prepare for medicine as work, but for teachers you only see it as classroom time.

    I don’t know where to begin Arguile. I guess I’ll begin with pity. I pity someone that was left so uninspired by his teachers as a child, to have so little respect for their profession. No, I’m not a teacher–I’m a PVT in the U.S. Army. Do you still want my job? Care to guess what I get paid amortized over a lifetime? You are not the only one with lives in your hand. The insidious consequences of a poor teacher in the classroom have the potential to limit and confine the lives of countless young people–yes they influence lives too.

    The world is full of jobs that I’m guessing you don’t want. The fact that you decided to become a physician and not a janitor tells me that there is probably something about it you don’t want to do, so be glad that there are others who *are* willing. Physicians have more rigorous training and as hard a job than any occupation I can think of readily. The misconceived implication that you are not compensated well for it, however, is myopic and an insult to others.

    dan

    July 6, 2010 at 12:32 pm

    • Very well put Dan!

      BO

      January 30, 2011 at 11:31 am

    • “Yes, of course ophtha is not a word–and great detective work, I did in fact mean ophthalmology. I will make sure not to write any more troubling shorthand.”

      Dan,
      You’re use of ophtha as shorthand begins to help highlight your ignorance of medical training. When the medical community wants to use the shorthand for ophthamology, we say “ophtho.” It’s probably a good idea for you to avoid your attempts at medical shorthand.

      YF

      January 30, 2011 at 1:58 pm

    • I think the only appropriate response to your completely illogical comment is to laugh. let me first preface… i’ve worked as a teacher at many levels… was able to get a great job teaching at an excellent high school with only a bachelors (from a top university) and an easy credential. during that time i also taught afterschool for underpriveleged elementary school kids in an urban setting. no doubt one of the most gratifying experiences i’ve undertaken. went on to get a master’s from a premier institution, which i was able to accelerate over one year. During that time I was compensated over 2500/month by working as an undergraduate course instructor, essentially allowing me to pay for my master’s, if not profit from it.

      Then I made the decision to go to medical school. I may have perhaps had some of the preconcieved notions and naive thoughts that you still demonstrate. They were quickly removed in the first month of med school. The work load was insane. It didn’t stop for four years. Transitioned to a top level residency at the biggest trauma center in the country. Averaged anywhere from 110-120 hours per week for 5 years of training. That roughly translates to about $3.85/hour, Dan. During my clinical med school period and residency, never had a Christmas or New Years off. I’m not complaining. Hospital potlucks tend to be the most abundant around that time of the year. and now in fellowship, things haven’t changed a whole lot.

      I understand the plight of teachers. I have many friends that teach at all levels…. a sister-in-law that teaches elementary school. A buddy that is a high school teacher as well as on staff at their prominent football program, and many former colleagues that hold professorships. I get the fact that time is taken for grading, lesson plans, office hours, study session, and for those doing athletics, afterschool practices, film sessions, and games. But to equate that to medical school and residency training is a joke. Anyone that cannot comprehend that is, well…. i couldn’t convince you the sky was blue, so why bother.

      so in the end, will i remain overtaxed and under re-imbursed? will i remain overworked and risk massive litigation? will i work holidays and weekends indefinitely? yes, yes and yes. will i be available to you and your family member before and after they arrive in my OR requiring a life saving procedure? yes. hopefully for you and your family’s sake, physicians will continue to be there when called upon, in spite of your ignorance.

      So before you begin to spew some more garbage, do some research. Dr. Brown has provided a list of references, perhaps you should either refer to them or provide your own.

      ken

      January 31, 2011 at 2:18 am

    • I just want to say that I wish patients knew how hard it was to go through all that shit to treat them….and I want them to appreciate it and not think of me as overpaid but has no problem with lady gaga making 62mil last yr.

      Anonymous

      April 17, 2012 at 3:43 am

  5. I find the analysis persuasive, but I just need further discussion as to why we see more physicians than high school teachers in Porsches, BMWs, Mercedes, Cadillacs, etc. I don’t mean to be snarky, just stating my observations of the physician parking lot vs. high school teachers’ parking lots. I believe it may be based in the greater cash flow of practicing physicians that also gives them easier access to financing of luxury/premium vehicles.

    I don’t begrudge the physician his/her due for the hard work put into education and practice, but even if the perception of the high-living physician is inaccurate, I need to be convinced that physicians should really be living at the level of the high school teacher, because they’re not.

    Signed,
    Son of a Physician.

    Son of a Physician

    July 7, 2010 at 2:06 pm

    • come to the parking lot of the office I work at as a physician. the only BMW’s, mercedes and range rovers there belong to our nurses and office administrators. I pull up in an old mazda protege, other docs drive mini vans, a 15 yr old honda accord and a very fancy toyota. yes there are doctors out there with nice cars but not sure how that fits into the argument. My dad is a current highschool teacher and laughs at the fact there our salaries are almost equal.

      EG

      January 7, 2011 at 1:03 am

    • I’m a doctor and I drive a dented 1998 Camry. My nurse drives a brand-new Lexus. Maybe when I pay off my $196,000 debt from training, I can trade up to her level.

      Andrea

      January 26, 2011 at 5:52 pm

    • Actually, I have a toyota corola (1997). My patients however drive Escalades.

      Melissa

      February 5, 2011 at 4:16 pm

    • It’s because the average number of hrs an average physician puts in during his/her career (training included) is about 3 times the number put in by your average teacher. If putting in that much extra work can’t provide an upgrade from a Camry to a BMW, I’m not sure how many people will be motivated to take that career path.

      Dr. Brown is not arguing that physicians don’t make more money than teachers overall. He’s pointing out that there is no difference in per hour pay, which is really the true marker of compensation. If I flipped burgers at McDonalds 100 hrs per week for 40 years, I would make more than a lawyer who worked part time for 2 years – but that doesn’t mean the lawyer wasn’t getting compensated more for his/her work.

      Anonymous

      February 14, 2011 at 6:56 pm

    • I would also argue that if you are the “son of a physician” that you are witnessing the outcome (nice cars) of a relatively profitable business which medicine was about 20 years ago. This may be a generalization, but I believe physicians in the 80s did profit well from their practices and did not accrue the same debt of our current students and residents. What Dr. Brown’s article hopefully brings to light is the current status of physicians, not that of three decades ago. As another reader accurately commented, it may take another three decades for the American public to understand how broken our system is. For everyone’s sanity and health, I really hope it doesn’t take this long. Thanks to Dr. Brown for attempting to educate the public.

      Wilmington's Jen

      February 14, 2011 at 10:16 pm

    • Hmmm….
      My MD husband’s administrative assistant just bough a 3,500 square foot house. Ours is markedly smaller and with less features (we have no pool and no home theater). My husband drives a 1997 Honda CRV. I drive a 2008 Prius, and we saved for 2 years to get this “new to us” used car. Looking at someone’s choices in consumer goods is NEVER a good indicator of their financial situation or what is their “due”.

      I found this article dead-on to my husband’s experience in medical school, residency, and practice, although I think 80 hours a week as staff is more the norm now that resident hours are mandated at 80 hours per week. I’m still feeling irritated about the hours my husband put in during residency, 120 hours a week on some rotations at the hospital, weeks without a day off, the only light at the end of the tunnel was that life would improve as staff…and the hours still stink. But never mind me, I’m just feeling a little used because my husband is about to be on call 24/7 for a week straight, no assurance he’ll be home at all. What a nice bonus to the usual 12 hour days.

      LF

      January 25, 2012 at 9:00 am

    • You are confusing observed lifestyle with hourly pay.

      Physician income is concentrated in years 45-65 of age. Up until then the doc is training and paying off loans. A teacher’s pay is much more spread out, over ages 22-65.

      If teachers worked the same hours as a physician from age 22 on, and saved up that money to concentrate it later in their life, then the lot of age 45+ teachers would probably be full of fancy cars.

      The whole point of this article is that when you do the math, a doctor makes about as much per hour as a teacher. Their total income is just concentrated on middle age and is augmented by the crazy high hours that docs work in training and practice. For example, I worked 24 of this weekend’s 48 hours in the hospital, with my typical 12 hour scheduled workdays last and next week; my 3-5 meetings per week (cancer conferences, business meetings, computer training, etc) are specifically outside my scheduled work time. No disrespect, but if my friends who are teachers were putting in 80+ hour workweeks, they would demand significantly higher annual pay and the supply of people willing to do that would be lower.

      In practice you will probably observe that medical students and young physicians have a “ramen noodle” lifestyle much, much worse than a teacher who graduated from college at the same time, and older physicians have an income/lifestyle higher due to concentrated income. I got to envy my fellow engineering graduates wonderful lifestyles for many years while I was training and paying off debt.

      Disclaimer – I am a 42 y/o physician driving a 10 year old SUV. My wife’s car is much newer at 9 years old, currently in the shop as the air conditioner keeps failing. My last exotic vacation was to Uganda to do medical relief work.

      Mtbwalt

      July 16, 2012 at 1:26 am

  6. Thank you everyone for taking time to read the article and leave a comment.

    1. I never claimed my mathematical model was without error. No study or mathematical model is without error. However, data and its interpretation is the best logic we humans have to understand our world.

    2. As far as I can tell, the inherent error in my mathematical model does not create significant systematic bias in either direction. Dan, you are right, most students have some type of financial assistance from their family; therefore, their debt isn’t equal to the total cost of their education. This point applies to both future teachers and future physicians. If this point does, in fact, introduce some systematic bias, it would favor a higher net hourly wage for teachers because college students tend to receive more financial assistance than medical students – therefore, those who become physicians would receive a smaller percentage of financial assistance than those who become teachers.

    3. Rachel, you are correct in that some teachers are required to earn a master’s degree in order to keep teaching. You should also know that nearly 25% all physicians and future physicians have either a maters degree or Ph.D. – which I did not account for in my calculation. Nearly 50% of physicians and future physicians have taken at least one year “off” in order to perform full-time research or some other educational venture – which I did not account for in my calculation. Because a fraction of both teachers and physicians spend this highly variable and indefinable time earning a master’s degree, performing research etc; I could not include it in my mathematical model. Because it applies to both parties, it should not introduce much bias.

    4. Does earning a master’s degree make teachers better? (or does it just pad their resume?)

    5. Does earning a master’s degree in addition to an M.D. or taking time off to do research make physicians better? (or does it just pad their CV?)

    6. Arguile, your comment is entertaining; though petty and not entirely accurate. The majority of physicians do not deal with life/death situations on a daily basis. Moreover, physicians tend to overestimate the efficacy of our interventions. Patients who do well, often would have done well without any of our interventions. Patients who do poorly, often do poorly despite our best interventions. Though we are more likely to attribute our successes to our interventions and our failures to the patient’s disease.

    7. Dan, you want so badly for my point to be wrong. However, again, you fail to make any valid point despite your impressive vocabulary. Simply saying my data is wrong means nothing. I reference and cite all of my data which you can access at your leisure. What you are doing is akin to looking at a photo of the earth taken from space and arguing that the world is actually flat – with no evidence that it is flat. “Dr. Brown, your photos are wrong!” I want the earth to be flat! As I explained in #2, the error in my mathematical model should affect both teachers and physicians equally; thereby, not introducing any significant systematic bias. There are a countless number of variable which could affect my mathematical model; however, so long as they don’t introduce any bias, they do not need to be accounted for in a comparison study. Please see #2, BOTH TEACHERS AND PHYSICANS GO TO COLLEGE AND ARE EQUALLY LIKELY TO RECEIVE FINANCIAL ASSISTANCE. If you were doing a science experiment comparing plant A and plant B growing the the same soil , in the same field – would you have to correct for the soil? NO, BECAUSE IT IS THE SAME. If plant A did something to the soil that hurt or helped plant B then that bias would have to be corrected for.

    8. One major potential source of systematic bias I did not account for was the ability of teaches to start saving and investing a decade or more before physicians. That “time” would further increase the net adjusted hourly wage of teachers, but not affect that calculated for physicians.

    9. Son of a Physician. Above is the calculated net adjusted HOURLY wage. Physicians have more money than teachers because they work more hours. The thesis of my article is that fully trained physicians make 4x as much as teachers yet their HOURLY wage is about the same. Fully trained physicians earn more money than teachers because they work more .

    Physicians live worse than a high school teachers during medical school and residency when they are in debt, making little money, working 80+ hours per week, working weekends and holidays. However, the general public wants to suppress this sacrifice and pretend it doesn’t happen. When physicians are finally done with their training it may seem that they live better than teachers (have nicer cars, houses, etc). However, they are still working a lot more than teachers. Working weekends, holidays, taking call at night, etc. They are also being heavily taxed and paying off their debt while their teacher cohorts have had an extra decade of earning time to pay off their debt and start investing.

    Do you believe that physicians should make LESS per hour because they work MORE? Most people make MORE per hour if they work more, it is called overtime. If teachers worked as much as physicians and earned overtime, they would be paid more per hour than physicians.

    10. Again, I have nothing but respect and gratitude for educators. My intentions were not and are not to criticize teachers. I simply used high school teachers as a comparison because they represent a common and honest profession. To distribute the misguided anger, I added an addendum to my article that discusses the net adjusted hourly wage of nurses and dentists.

    benbrownmd

    July 10, 2010 at 6:27 pm

    • Son of a Physician. Above is the calculated net adjusted HOURLY wage. Physicians have more money than teachers because they work more hours. The thesis of my article is that fully trained physicians make 4x as much as teachers yet their HOURLY wage is about the same. Fully trained physicians earn more money than teachers because they work more .
      —————————————–
      I had say something on this. I am sorry to tell you this but I do not think you realize that not EVERYONE gets paid by hours. Why dont you come to engineering world and see how much overtime we get. Try working in silicon valley and see how many ours we put in on paper and how many we dont show as corp dont want to get in trouble. I get paid at fixed rate (salary based) pay and put min 70hr every week. I would be lucky to get sunday off. Heck… we even work on holidays as that is the only time we can really get things done to upgrade after testing things in the lab as people dont want downtime on their production. While all this being said, we still get chump change while CEO’s make millions. why? This is because engineering is not regulated like you guys. Look what happens if they increase the med school or even how many seats each school has for getting into med. I find it funny that how some doctors think its an insult if you dont call them by doctor. We engineers get PhD and never ask to be called as Dr. You will only see that when we publish our books. I dont think that all doctors deserve to be doctors. Just because you passed your exams and done residency, does not mean you are great at it. Just like any profession…not every is great. I say this because I get more tests done by my family doc then required. Everytime i visit my doctor, he asks for blood test. Have backpain? lets do CT SCAN. oops, it did not show anything, we need to do MRI. Lets get that done. Oops, its did not show anything. Just take advil and you will be all set after few days. Not all doctors do this but i see this more and more as some people want to pay off their debt early or some dont have clue on what they doing and just trying to cash in the $$$ by seeing 10 pt’s/HR. Its hard to find good doctors but doc’s who are good, i think only they deserve the 6-fig salary.

      Engineer

      January 26, 2011 at 5:31 pm

      • Engineer, The reason dr need to order all kind of test is to rule out the possible cause in order to obtain the accurate/final diagnosis. Most doctors are not doing that for making money.
        But in my observation, I agree dr are seeing too many patients in one hour. that is a big problem in our med care in USA! Often specialized dr see me in 5 minutes and without any explanation and advise. I am very very disappointed to our med care system and think this will only get worse for baby boomers.
        I also agree there are good and bad doctors out there. Now I go to internet to check out their background. I will not go to a dr who got MD from very lozzy med school. Some dr out there are not deserved to be a dr!
        But overall, TRULY DR are underpay! Only CEO are overpay and treat their employees badly!

        anna

        January 26, 2011 at 9:50 pm

      • If your doc did not do those tests and the zebra in the herd of horses turned out to be your illness, would you sue? Surely not, because you are understanding (engineers know numbers and the $1500 test to rule out the 1:10,000 diagnosis is not cost effective in the face of a $5,000,000 lawsuit) and understand the reasoning. By the way, does your family doc own the CT scanner and keep the $1500 (assuming your insurance doesn’t cut it down a bit)? His malpractice insurance and medical degree sure get to pay for the lawsuit….

        Anonymous

        January 27, 2011 at 10:03 pm

      • Ha! To think the doctor actually profits from getting a CT/MRI… I wasn’t going to comment, but that actually made me laugh…

        Anonymous

        February 6, 2011 at 12:48 pm

      • Doctors don’t get reimbursed for ordering tests. Doctors are not allowed to own their own equipment in many areas.

        Because doctors are sued so much, they’ve developed a defensive mentality when practicing medicine.

        Doctors don’t get paid for prescribing drugs. Maybe a few have incentives… if they own stock in a company, or consult on the side for a device company if you’re an orthopedic surgeon, for example. These cases are the exception.

        Anonymous

        March 21, 2011 at 5:45 am

    • “Physicians live worse than a high school teachers during medical school and residency when they are in debt, making little money, working 80+ hours per week, working weekends and holidays. However, the general public wants to suppress this sacrifice and pretend it doesn’t happen. When physicians are finally done with their training it may seem that they live better than teachers (have nicer cars, houses, etc). However, they are still working a lot more than teachers. Working weekends, holidays, taking call at night, etc. They are also being heavily taxed and paying off their debt while their teacher cohorts have had an extra decade of earning time to pay off their debt and start investing.”

      — You are SO right!!! While most of my friends were partying in their 20′s, I was studying and working > 80 hours per week. While they were going on trips with their friends, I was studying. While they were dating and marrying and having children, I was studying. Being a doctor is SO rewarding — I LOVE it. BUT — people love to forget the fact that as a physician I have given up over a decade of my life to learn and work more than they can imagine.

      And your retort about doctors making more than teachers is dead-on. The hourly wage is about the same. The reason I make four times more than them is because I work four times more hours than they do.

      Andrea

      January 26, 2011 at 5:59 pm

  7. Doctors are grossly underpaid. Blame trial lawyers and now blame our President and his fellow Democrats. How our present system is supposed to take on tens of millions of new patients without sacrificing quality care is ridiculous. Not to mention Doctors and nurses even more over worked. Anyway, some Americans do believe we have the best healthcare in the world, due to amazing Doctors!

    Tom doherty

    July 11, 2010 at 1:36 am

    • Tom Doherty, chied resident, from St. Vincents, Staten Is. circa 1988?

      If so, its an honor. You were one hell of a great doctor. Scuesa and others spoke highly of you.

      Roy Blackburn, M.D.

      February 17, 2011 at 1:41 am

  8. Thanks Dr. Brown, for a very enlightening view of the “physicians situation”. I read with some amusement the banter of comments, which is what inspired me to post this; here’s the bottom line:

    Most, if not all people have previously recognized that teachers are severely under-compensated; it’s a reasonably well known fact. I suspect no one will debate that claim.

    However, not many people are cognoscente of the physicians situation, quite likely because all outward appearances are that most are highly paid (i.e. Porsche, Mercedes, BMW, homes, etc). Yes, they do have the potential to make a great deal of money, once the years and years of tremendous sacrifice required to have the right are done. It’s those years and years of training, and the expenses associated with, that most people do not actively consider, when they see the lifestyle of the physician.

    Those rewards came hard earned, and are well deserved. Go get’em! : )

    TD

    Tony Darst

    August 19, 2010 at 7:33 pm

  9. Let me state clearly that I accept fully your analysis and conclusion: doctors earn more because they work more hours, while earning an adjusted hourly wage only slightly greater than high school teachers.

    Perhaps, then this is the real reward of the hard work of the physician (from undergraduate to residency and beyond): the availability of those “overtime” hours, nevermind that they are not paid as overtime. A Sunday hospital consult is still billable. (It would be the responsibility of the physician or his/her business office to bill for it.) The teacher can never get such overtime at that hourly wage. Even at $20-$40/hr for tutoring, the teacher would not be able to schedule a full week’s work, even with an open schedule in the summer. And in any other part-time employment they may seek, they cannot hope to make $20/hr. (Sorry, no citation. I welcome counterexamples about the average case.)

    But in the end, the physician deserves his/her just rewards. One comedian said that he’d rather see his physician in a Mercedes than in a budget compact. I wouldn’t disagree.

    Regards,

    Son of a Physician

    August 21, 2010 at 11:03 am

  10. Dr. Brown,
    I think you have way underestimated the earnings of teachers. From: http://www.nytimes.com/2009/02/01/fashion/01generationb.html?_r=1&emc=eta1

    “Veteran teachers who add to their pay by working summer school and mentoring new teachers” (at the end of their career) “can lift their salary into the $120,000 to $130,000 range, and their pensions to around $75,000 a year.” Retiring at age 55 and living to the average age of 80, means their pension is like having nearly 2 million dollars in their retirement account, not including the health care benefits. How much can a typical primary care physician save once they finish training at the age of 30, if they wish to retire at age 55 like teachers? I bet it is far less than 2 million dollars, considering their educational debt that has to be paid off. And then again the physician will have to pay for all his own health care expenses until he reaches Medicare age, unlike teachers who in retirement receive health care benefits. Physicians work many more hours per year than teachers and have much worse lifestyles.

    Most of my acquaintances still hold the view that doctors are very wealthy. Your analysis paints a very different view. It would be worthwhile publishing this in a periodical to get greater exposure, particularly during this time of health care reform.

    Dan

    September 30, 2010 at 9:17 pm

    • I am a physician, but you are pointing to significant outlier.

      http://www.teacherportal.com/teacher-salaries-by-state

      Average teacher salaries are 40-50k. With states and counties hurting for tax dollars, most teachers are seeing loss of benefits, loss of bonuses for advanced degrees, and loss of bonuses for experience.

      Anonymous

      December 26, 2011 at 11:45 pm

      • Or just loss of a job. As a physician, I’m glad to have job security.

        WJ

        December 27, 2011 at 12:29 am

  11. I can’t believe I am still commenting on this, but I wanted to make it clear that this recent Dan post was a different Dan. I still feel like your analysis is amateurish, not for lack of effort or intelligence I’m sure–but not one of these posts seems to have any grasp of statistics.

    For Instance:

    Dan #2′s post above mine, indicating that the most educated and hard-working teachers can make 125K. This is soooo rare, and besides you are comparing the select few of the hardest working teachers in select geographic areas with the worst paid physicians. The majority of physicians are NOT PCPs (and make 50 to 200% more), and even a smaller portion of them are coming out of med schools. This is going to drive me nuts, if one more person posts an anectdotal reference comparing more apples with oranges.

    I think this would be a great publication, but your analysis would need a complete overhaul, and I would be happy to point you to some statisticians who can make better recommendations than I.

    The First Dan

    October 1, 2010 at 1:02 pm

    • Why are you driving yourself nuts comparing apples to oranges repeatedly?

      Also, when talking about compensation, should we adress the quality of the product delivered? And before you talk about the quality of healthcare in this country, please address personal lifestyle choices. Saw that that Charlie Sheen went into the hospital today (if his healthcare professional disclosed that, he could be sued). The differential is broad but anyone want to place a bet on acute pancreatitis?

      Anonymous

      January 27, 2011 at 10:15 pm

    • The reason, Dan, that majority of doctors are no longer PCPs is because PCPs are underpaid relative to their specialist peers. However, the last time I checked, the percentage of PCPs was in the 40′s (although decreasing). Similarly, the reason why no one wants to pursue it as a career also has to do with pay.

      My background is both medicine and business and, as part of my training, I have completed quite a bit of research on healthcare reform, physician salaries, etc. The average PCP made roughly 179k a year in 2005. The average specialist made 297k. How can one not want to become a specialist?

      However, it’s been shown that specialists and PCP’s treating the same diseases (ones that the PCP can treat- diabetes mellitus, asthma, myocardial infarctions, for example) spend more, due to ordering more tests, using ICU care more frequently, etc. Also, according to studies, increasing the number of PCPs by 1/1000 people reduces medicare spending by roughy $500 while increasing the number of specialists by 1/1000 people increases medicare spending by roughly $500. You may feel that care is neglected in these cases, however, it’s been shown that increasing number of PCPs actually improves the states health rankings while increasing specialists decreases the rankings. Thus, it is vital that we increase the number of PCPs in the country. However, it is a difficult job that requires coordination of care between different specialities and holistically treating a patient, which takes a lot of time. However, when a lone-practicing physician is pressured to see at least 30-40 patients per day to make due (many times more than this), he/she cannot spend the quality time he/she needs. The constat pressure to see patients, combined with the relative decrease in pay of PCPs, are a couple of reasons why no one wants to do it anymore.

      Thus, I think Dr. Brown makes a good point in that, unless we stop the trend of cutting physician salaries (currently salary rate is increasing at a slower rate than inflation), the number of people who will go into primary care and internal medicine will reduce, further increasing the pressure to go into a specialty, which has been shown to increase overall healthcare spending.

      ortho-res

      March 21, 2011 at 6:16 am

  12. To Dan #1:

    While I think it is obvious that the average teacher earns far less than $100,000 per year, I don’t think that it is rare for teachers at the end of a 30 year career to break the $100,000 mark.

    Did you read the NY times link in my earlier post that quoted: “Nor is Rochester an aberration. Adam Urbanski, who is head of the teacher’s union here, estimates that 40 percent of school districts in New York, Connecticut and New Jersey pay as well as or better than his district.”

    With a quick internet search I was able to find other states with similar salaries and benefits. For example:

    From Illinois (Look at this graph showing some salaries > $100,000): http://www.championnews.net/article.php?sid=2867

    From New York (Shows many teacher salaries over $100,000: http://myshortpencil.com/newyorkteachersalaries.htm
    and (http://www.nytimes.com/interactive/2010/05/15/business/pension.html?ref=payback_time)that shows the 3,700 retired public workers in New York receiving a yearly pension over $100,000 (most paid by the NY State Teacher Fund)

    From New Jersey: http://www.courierpostonline.com/article/20100914/NEWS01/9140333/Pension-cutbacks-planned
    “State reports show that an average municipal police officer retires at age 53 with an average annual pension of $47,623. A newly retired teacher, after serving 25 years, now leaves at age 60 with $49,378 a year in pension benefits.”

    From California (3,000 retired educators take home $100,000 plus pensions):http://www.ocregister.com/articles/school-211721-district-pensions.html

    My point to Dr. Brown is that his comparison between primary care physician salaries and teachers should include more emphasis on the disparity of pension benefits, and the fact that in many states (http://www.cga.ct.gov/2000/rpt/olr/htm/2000-R-1110.htm) a teacher can retire well before the normal retirement age of 65-67. There are also articles about state and federal workers, including educators, who go on to earn additional wages from the same job after retiring and drawing their pension. These individuals can make more than the average primary care physician. http://www.kpho.com/money/19313025/detail.html

    I don’t feel that Dr. Brown’s analysis is an attack on teacher’s salaries. He could have easily used other state and government workers salaries and pension benefits to draw a similar conclusion. The bigger message here is that many, if not most Americans have a preconceived notion that primary care physicians are much wealthier than others (teachers, accountants, administrators, school superintendents, policemen, etc.). What Dr. Brown points out is that this view is incorrect, particularly when you weigh in the educational cost (direct college and medical school expenses & interest; lost years of earnings while training; long work days, evening and weekend/Holiday duties, etc.).

    Our country has a growing shortage of primary care physicians (http://www.newsweek.com/2010/02/25/the-doctor-won-t-see-you-now.html). We need to find ways to correct this shortage. It will be difficult to advocate financial incentives to correct this shortage if many of our citizens have a misconception that physicians don’t need monetary incentives to pursue a career in primary care, because they are already so wealthy/overpaid.

    I admit that I am not a statistician, but I would encourage you to be very specific on how Dr. Brown’s “The deceptive income of physicians” argument would be better clarified, bolstered or reputed with such analysis.

    Dan #2

    Dan #2

    October 2, 2010 at 5:43 pm

  13. I have zero sympathy for doctors who claim they’re underpaid. They’re flat-out wrong. Do you think insurance underpays you? Then stop accepting insurance. You don’t like Medicare reimbursement rates? Stop accepting Medicare. Don’t like being a doctor because the hours stink? Quit the profession, do something else with your life. Go be a teacher.

    I feel bad for janitors. They don’t really have a choice in their field of employment. Anyone who is in a career where there is a lot of competition can cry me a river.

    Teachers aren’t underpaid. We get the quality we pay for (which is mostly lousy, especially in cities). So should we pay to have higher quality teachers? Only if citizens are willing to pay for them through higher local taxes. Given the state of country right now, the answer to that is no.

    Doctors love to think of themselves as the top of the job chain because of all the “sacrifices” they make and the amount of time they spent in training. But that’s wrong-headed. Like everyone else, future doctors are making investments in themselves that they hope will mean lots of cash in the future. Sometimes these investments work, sometimes they don’t. But just because your bet didn’t work out, it doesn’t mean society is unjust. It just means your complaints about the ways of the world are sour grapes.

    Mike

    October 29, 2010 at 2:49 pm

    • In response to Mike:

      Teacher
      Financial investment: $186,072
      Time spent working (lifetime): 71,760 hours
      Financial return: $30.47 per hour
      Emotional return: Feeling good about educating people.

      Physician (Internal Medicine)
      Financial Investment: $$687,260
      Time spent working (lifetime): 130,528 hours
      Financial return: $34.46 per hour
      Emotional return: Feeling good about healing people.

      Teachers and physicians provide an equally important service to society. Because physicians have to invest so much more money and so much more of their life in order to provide their service, their service becomes more valuable; and therefore it should be fairly compensated. Again, I said the services are EQUALLY important but not equally valuable.

      It is a lack of understanding that leads people to believe that physicians are overpaid and teachers are underpaid – even though they are really PAID ABOUT THE SAME.

      “You don’t like Medicare reimbursement rates? Stop accepting Medicare.”
      Physicians should be paid enough that they can solvently accept Medicare, Medicaid and Insurance. It is not in our country’s best interest for physicians to stop accepting Medicare, Medicaid and Insurance – but the direction things are going, physicians may not have a choice.

      “Quit the profession, do something else with your life. Go be a teacher.”
      -It is nearly impossible to do that with $300,000 of student loan debt.
      -It would be a less than ideal use of all that training
      -My biggest fear is that not enough people will become physicians.
      I’m sure your counter argument is that then more “altruistic” people would become physicians.
      Historically, medical schools had the luxury of accepting the top ~40% of all applicants. If it becomes a financial loss to becoming a physician, I can promise you that applicant quality and physician quality will suffer. Moreover, I can assure you that decreasing physician competence leads to increased indirect medical costs due to an increased use of diagnostic testing, referrals and complications. Ultimately, these indirect costs will cost more than paying physicians more in an effort to keep the quality of physicians high.

      You are naive if you believe that people are truly selfless. Humans respond to incentives, whether that incentive is financial or emotional doesn’t matter. There is probably little emotional reward for janitors, therefore the financial reward must make up for that; otherwise there wouldn’t be any janitors. Do you despise janitors for doing their job for money? No, you said you feel sorry for them. Then why do you despise physicians for wanting to be fairly paid?

      Does it really matter whether one’s incentive is financial or emotional? They are both equally selfish.

      Let’s say you need to take a trans-Atlantic flight and you get to choose your pilot.
      Pilot A: 30 years of experience. Excellent pilot. Her incentive is primarily money.
      Pilot B: 2 years of experience. Competence is questionable. Her incentive is primarily emotional; she really cares about getting you to Switzerland safely.
      Which pilot would you choose?

      “I feel bad for janitors. They don’t really have a choice in their field of employment. “
      Why do you feel bad for janitors?
      It is an entry-level job that they CHOSE based on what other jobs were available to them and the incentives associated with those jobs. Janitors are getting paid, paid enough to come into work day after day. I respect them for working. However, I know that if they were unfairly paid, they wouldn’t be there.

      “It just means your complaints about the ways of the world are sour grapes.”
      Mike, so your recommendation is to be complacent and passive?
      Just do whatever the government wants me to do whether it is just or unjust?
      Like any other good American, I am standing up for what I believe in. I am doing that by trying to educate society about the hidden side of becoming a physician; so those high gross incomes of fully trained physicians don’t seem so high.

      It is a lack of understanding that leads people to believe that physicians are overpaid and teachers are underpaid – even though they are really paid about the same.

      benbrownmd

      October 30, 2010 at 12:27 pm

      • Ben,

        Don’t wrestle with a pig in the mud. You’ll just get all dirty, and then realize that the pig actually likes it. : )

        Tony Darst

        October 30, 2010 at 12:44 pm

      • Actually, you get my arguments all wrong.

        I don’t rely on altruism. I, just like you, believe people respond to incentives. But, the implied point of your article is that you think there something wrong with a society that pays doctors and teachers the same amount (assuming your questionable calculations are correct).

        If the janitor CHOSE to go work instead of being educated, you CHOSE your lot in life by going to medical school. No one put a gun to your head and said, “Go to medical school.” Unless your parents were really that overbearing. I have plenty of reasons to feel bad for the janitor and not the doctor, but it has nothing to do with wages.

        Let’s assume your per hour statistics are right. Then the markets are in fact telling you that being a doctor is about equally important AND equally valuable as being a teacher, regardless of your inflated sense of self-worth. And contrary to what your indignation suggests, we can say you are paid fairly because, as a doctor, just like the janitor and teacher, you “are paid enough to come into work day after day.”

        You’re trying to argue that the doctor’s lifetime human capital is worth more than anyone else’s. The implicit arrogance in this is astounding. The invisible hand (i.e. all of society) is telling you otherwise, and yet you think they’ve got it all wrong.

        My recommendation isn’t to become complacent. Just to quit your complaining. Because the only people who feel sorry for fairly paid doctors with ego problems are other fairly paid doctors with ego problems.

        Mike

        October 31, 2010 at 1:55 am

      • “If the janitor CHOSE to go work instead of being educated, you CHOSE your lot in life by going to medical school. No one put a gun to your head and said, ‘Go to medical school.’”

        This is not an argument. Just because he chose to go to medical school doesn’t mean that doctors aren’t underpaid. By this statement, you’re basically saying that anyone who doesn’t go to Wall Street is an idiot and deserves to be underpaid. But what a dysfunctional society we would have if EVERYONE decided to work in the financial industry. [Which, by the way, DOES have too many people. And let's face it, 90% of them do absolutely nothing to benefit the rest of society. Yet, they get paid orders of magnitude more than everyone else. But that's the real issue. Not whether doctors are more underpaid than teachers, but that corporate CEO's and even financial analysts are grossly overpaid. And all because our effed up society values the guy who does nothing more than move money from one part of the economy to another than it does people who actually serve our society like doctors and teachers.]

        AnonymousStudentT

        February 20, 2011 at 8:56 pm

    • Dear Mike,

      Have you ever been sick in your life? I’m just wondering–my guess is no.

      But one day, I promise you that you will be. It happens to all of us. And I promise you that on that day, your views will change. And I also promise you that on that day, one of us doctors will do our very best to take care of you.

      With all due respect,
      Doctor K

      Doctor K

      January 7, 2011 at 11:07 pm

      • Yeah, because then an overpaid doctor too in love with money to spend life living can misdiagnose you, assuming you can afford insurance to cover his unnecessary tests.

        Teve

        January 11, 2011 at 2:54 pm

      • Your assuming we will have a good quality medical system in the future when Mike gets sick. From what I know of current trend and decline, I expect the first word from my mouth when I’m on that gurney in the ER looking up are going to be “Sh*t!”

        Roy Blackburn, M.D.

        February 17, 2011 at 1:45 am

    • I feel bad for your students

      Anonymous

      January 29, 2011 at 9:43 am

    • Mike,
      We do pay for the quality we get. The proof is in the number of private education schools.
      As to the equality of hourly pay as calculated by Dr. Brown or others, he did not include the cost of ineptitude. An inept teacher is shuffled from job to job assuming the union can’t protect them. A doctor is sued, causing either an increased cost of insurance or a loss of insurance.
      Interestingly, parents who send their children to private school are willing to not only pay for the cost of private education, but also to pay for the cost of a public education that their children do not receive. Those private school teachers provide, in the opinion of parents sending their children to the private school, a superior product to the public school. This is without the pensions and other benefits given to a unionized government job.
      Politicians have convinced you that you are entitled to low cost healthcare and a great, free public education. Unfortunately Dr Brown is on the money. You don’t have the great education right now and are in danger of losing quality healthcare…..

      Anonymous

      February 7, 2011 at 2:32 am

  14. Do high school science teachers prepare young men and women to become physicians? Do teachers often spend their own money to attend mandatory training and to acquire advanced degrees? As a former teacher, I was not paid enough to supply my classroom needs and advance my training inorder to prepare students to become physicians.

    Anonymous

    November 1, 2010 at 3:39 pm

  15. Dr. Brown, I commend you on a well written piece. Regardless, of the possible mathematical errors, your point is clear to anyone that has made this sacrifice, gone through college, medical school and residency. I have this conversation time and time again, with friends and colleagues, both physicians, and non-physicians. I believe your argument to be true and sound, unfortunately I think the only people that CAN truly understand it, are people that have gone through it. I think it’s unfortunate for us…as I don’t think we will ever get truly compensated for all those sacrifices; and, we will continue losing potential future physicians in part because of this.

    Often times, I wish I could simulate all the feelings that one experiences during a 30 hour call at the hospital, including the fear/anxiety of hearing “Code Blue” at any minute. If we could somehow simulate just that, and have the general public try it out a couple of times, maybe we’d make some headway.

    LC

    LC

    November 25, 2010 at 7:07 pm

    • The reality is that no one can understand another’s profession or sacrifices to get there without walking in those shoes. Doctors will never know fully the sacrifices made by teachers; teachers will never know fully the sacrifices made by nurses or doctors, and so on. I’ve toyed with asking my internist his thoughts on this topic because he was a high school teacher before he became a physician. Anyway, thank you both for your sacrifices.

      Rachel

      November 25, 2010 at 8:37 pm

  16. To the last comment,
    I believe that doctors do understand considerably what it is to be a teacher as they spend a vast amount of their time during training teaching medical students, residents and colleagues on a daily basis. I also think they understand what it is to be a nurse; at least the ones who work in county hospitals where the quality of nursing is not the best and sometimes find themselves doing the nurses job in addition to their own.
    I am impressed not only by the vocabulary, rhetorical history and amount of information in the article but also the mathematical, statistical and even references used. To make matters better for the author, every single retractor of the article failed multiple times to prove Dr. Brown wrong using lame words and non -scientific supported evidence, shame on you. In addition, his responses to all the comments were straight to the point, well elaborated and again, backed up with scientific data and solid references.
    People, learn that when you want to refute and argue a topic you have to have at least a basic knowledge of it. It this case, basic statistics will help, not to mention that references are extremely important. Anyone can argue but only the best prepared prevail. One more time, this proves how many hours a physician spends studying not only general medicine but topics that should be more familiar to teachers, for example. :)
    I think this article should be published on every major website.
    Thank you for your well thought out analysis.

    son of a physician and a teacher

    November 26, 2010 at 1:15 pm

    • I used to think I knew what being a teacher is like…until I became one. Being paid by a university to teach doctors is nothing compared to the world of K-12 teachers who teach any and every child. Many of my students have extremely difficult home lives, which is much different from teaching adults who have the intellectual ability and drive it takes to get to medical school.

      Kristen

      February 20, 2011 at 10:11 pm

  17. I am lucky to be both a doctor, and a teacher, as I am an assistant professor of surgery, responsible for helping teach both medical students and residents how to take care of all of us in the future.

    I worked/studied about 80 hrs a week as a med student. I remember one vascular surgery rotation where we would come into the hospital at 2:30am, work till about 11:30pm, then go home an repeat every day for a month. No, not every rotation was that time intensive, but if you wanted to do well, many were. I had the privilege of paying some $30,000 a year to do that.

    As a resident, pre the 80 hr work week, I put in consistent 90 hr weeks for 5 years, plus an additional for fellowship.

    Now, I work about 70 hrs a week, including many nights, weekends and holidays. I actually physically stay in the hospital on call for at least 192 hours every 4 weeks, plus another 50-60 a month that I spend directly teaching, going to hospital meetings, or doing other admin work.

    I think a crisis is coming in medicine. Medicine is becoming too unattractive as a profession to attract the best talent. Yes, people always want to help others, but ultimately money talks. If the sacrifice vs gain ratio doesn’t work out, smart people will go work for Google.

    Amongst my friends from med school or residency, some are no longer in patient care and are in some form of consulting, many work part time, and a few are thinking of leaving medicine entirely because it’s “just not worth the stress.”. One can debate about how true that may be, but if enough people think that way, the physician shortage will only get worse.

    When you need emergency surgery in the middle of the night, wouldn’t you like it if a surgeon was available? Many now do not participate in ER call because financially it’s not worth it. When you’re ultimately running a small business, and you’re responsible for the bottom line, it makes a lot of sense to remove the parts of your practice that aren’t financially viable. Unfortunately for the guy with appendicitis and no insurance at 3am, you get screwed. But, that’s what it’s come to.

    Doctor teacher

    December 4, 2010 at 8:22 pm

    • Interesting article, I agree with most of it. While not in the medical profession, I am friends with several doctors and residents who have tried to explain this same point to me.

      The bottom line is whether the “value proposition” for becoming a doctor is appropriate to attract high caliber talent to the profession in the long-run. Since doctor’s salaries are more and more becoming tied to legislation, medicare reimbursement rates, etc – and not the free market – we need to make sure the equation is right. It does not matter what is “Fair” – it matter what will ensure enough bright minds go into medicine – instead of choosing business, engineering, marketing, finance, etc – which often are fields which present a better value proposition, given the lifestyle and compensation vs. training needed. I chose one of those fields, and compared to the stresses doctors go through during training, I can safely say the primary care docs are not overpaid. A percentage of specialists (derm, plastic surgery, etc) are likely overpaid, and are usually the examples brought up as the counterpoint in this debate. Let’s focus on the bread-and-butter primary care, family medicine, pediatrics, internists.

      Unfortunately we can’t wait and see what happens – the lead time on training new doctors is so long that if the balance isn’t right and shortage appear, it takes 10+ years to train new ones (unlike many professions that can be trained more quickly to adjust to supply-and-demand). And not everyone has what it takes — the brains, patience, dedication, poise, etc — to be a good doctor. I would suck at it… bless them for doing what they do.

      Dave Sanders

      January 4, 2011 at 9:35 am

      • The concept of the “value proposition” is the appropriate way to approach this issue, as opposed to “fairness.” That being said, fairness is an issue when legal structures such as the current Medicare/Medicaid reimbursement rules, and anti-competitive practices in the insurance industry prevent physicians from effectively negotiating contracts. I would be hard pressed to believe someone making the argument that there is only no-to-minimal dead weight loss from payor (producer) surplus in the system. (if you don’t understand the division of rent in competitive markets between producer and consumer, please withhold your comments as those terms have a specific meaning that isn’t what it sounds like.) In numerous states are around the nation, insurance companies operate de facto monopolies and fund campaigns generously to keep it that way.

        This definitely makes the value proposition for an intelligent student poorer from a financial perspective. But we physicians do ourselves a disservice to see the rat race of “overpaid” wall street bankers, athletes, and celebrities running by and wish that we, too, for some reason were running alongside them.

        There is no doubt that in the United States, physicians wanting to run in the rat race have ceded the prestige, respect, and much of the honor that our profession was afforded. As Dan Ariely would put it, we gave up the social norms in favor of market norms which included higher salary but also increased litigation and less loyalty and respect. Generalizations to be sure, but not irrelevant ones. There is plenty of blame to go around, but we are partly responsible for the currently poor value proposition.

        Or perhaps the poor value proposition really refers to our society’s misplaced values at large where what teachers and doctors offer is valued at an hourly rate less than our entertainers and aestheticians.

        AD

        January 25, 2011 at 11:09 am

  18. As an individual that has worked in education, most of my friends who have taught and wanted higher test scores for their students, worked 70, 80, 90 or more hours a week.

    Teach

    December 28, 2010 at 11:33 am

  19. Dr. Brown,

    Good article, and I do believe the Primary Care physicians are underpaid, but it’s important for your readers to put it in perspective.

    You, like me, are a plastic surgeon. You earn 500,000-1,000,000 a year easily, and so you personally are compensated far more than the average physician, and therefore even with all your calculations still make out far, far better per hour than a teacher. Also, with the exception of MSIII, no med student works anywhere close to 80 hours a week. Obviously you and I must have topped our classes to gain Plastic Surgery residency. As you may already know, I am a Harvard Trained Plastic Surgeon commonly featured on the E! network.

    But back to my point, most med students don’t work that hard. Even on MSIII, in some rotations like psych and FP, you are working 40-50 hour weeks. It’s much closer to 50-60 hour weeks on average, with exam weeks being more and non-exam weeks possibly less. Also, the loans of a med student are not 300,000, they are actually far closer to 156,000, and generally paid off over 10 years, not 20.

    However, still, I do agree that while we are not necessarily underpaid, it is tragic the way we compensate our pcp physicians so little, and that’s where the focus of “deceptive income of physicians” needs to be.

    Sincerely,

    Dr. 90210 MD

    Robert Rey MD

    January 2, 2011 at 2:05 am

    • Dr. Rey,

      You are absolutely correct. There are physicians who are compensated fairly and even some who are overpaid. Those who fall into these groups tend to be those who rely on payment outside of medicare, medicaid and private insurance. Therein lies the problem. Services that are necessary and therefore covered by 3rd party payers tend to be poorly reimbursed. I am fighting for physicians as a group. Because most of medicine does not function in the free market and prices are set based on theory and speculation – the only way to save our profession from is to inform our fellow Americans, and that is what I am trying to do.

      Sincerely,

      Ben Brown

      benbrownmd

      January 3, 2011 at 9:04 pm

      • This is a good analysis and makes me happy that I flunked O-Chem and ended up in Software Engineering instead of medicine!

        I would like to see the same analysis applied to specialist salaries, since almost half of all physicians are specialists. It is my opinion that primary care doctors are underpaid slightly and that specialists are overpaid but I would like to see the real figures.

        If Doctors want to work less, lobby to make it easier to get into medical school, graduate more students and reduce the work load and pay on current doctors. Most MDs prefer to restrict the supply instead, to create an artificial scarcity. The AMA holds the strings here, by limiting the number of MDs that can be trained every year.

        noevalleyjim

        March 23, 2012 at 1:33 pm

    • Dr. 90210 MD,

      I graduated from medical school last year with debt over 340,000 and the interest is 7.9%. And some of my classmates were in the same range.

      -SB

      Anonymous

      January 25, 2011 at 10:23 pm

    • In terms of medical student hours, I am an MS3 now, coincidentally on a plastics elective, and have completed all my rotations but medicine. I go to a Boston school (not HMS) and can safely say I have blown past the 80h restrictions, particularly on surgery & obgyn. On OB, during which we were required to do 4 overnight calls in a 3wk block, even with post-call days I generally ended up with about 100-110h. Not including studying. On surgery, the only thing that kept me around or just above 80h was the fact that we had 1 day of didactics per week and only 1 weekend call. Even on family medicine, i approached 70h/wk.
      I receive 46k/yr in unsubsidized loans, plus an additional 10k for living expenses. I am additionally sitting on about 80k of debt leftover from college (excluding interest). Excluding the masters degree I am getting next year, I will graduate with roughly 300K of debt, not accounting for interest.
      I think Dr Brown’s estimates are reasonable, and quite troublesome as I consider choosing my career and planning the remainder of my training.

      Med Student

      January 26, 2011 at 5:28 pm

    • plastic surgeon are too overpaid comparing to family dr!

      So ridiculous in this society!

      It proves rich ppl in USA still very rich so they can afford to pay plastic surgeon while lots ppl even cannot afford to have med insurance.

      plastic surgeon are the kind of dr who only go for money as incentives. they are rich people’s product!

      Anonymous

      January 26, 2011 at 10:34 pm

    • you are too overpaid comparing to PCP and ped!

      Anonymous

      January 26, 2011 at 11:09 pm

    • What school did you go to? Did your parents help pay for med school? I am working an average of 100 hours a week. I am making right at $42,000 a year and I think that works out to much less than the min wage. My school loans are over $200,000 and I was very careful with my spending during med school. So, I barely make enough to live. I work more than twice the number of hours of most people. I am expected to read minds and know what is going on with a person without running any tests at all. I am confronted with possible lawsuits with every patient. My schedule now is every 4th night, I am on for 30 hours and that is EVERY 4Th night… Now, tell me how easy it is for me. You’ve either forgotten or else you had someone else paying your way. AND I do think that plastic surgeons are overpaid when you think that most of their work is to help beautify people instead of really curing an illness. Sorry.

      someone who cares

      February 22, 2011 at 9:53 pm

      • Beauti”fication” could be a cure for psycological illness. Low self-esteem anyone.

        Anonymous

        May 15, 2013 at 2:40 pm

    • Dr. Rey. The salary you mentioned…..would you mind clarifying it. Is it gross? Is it net? Is it after tax income? How many hours did you work to earn that amount per year? How many hours did you work to earn that amount per year when you factor in all the hours of training you had to do ….to get to the point where you now are. I also accidentally clicked on your name…and…voila…your website came up. So, you are good at marketing. You are in Beverly Hills, California. I am not envious of your success. I am glad you are successful. I thank you for your mention regarding PCP’s. I am not a PCP myself.

      But with regards to the top of the class insinuation…I know of plenty of top of the class that went into neurosurgery, cardiology, nephrology…..but there is a distinct difference in what those fields do versus what you do. I am not knocking what you do but I think that for the average Joe Public reader would fully appreciate what it takes for you to do? I do not think they can phantom it…partially because of the way you have mentioned it. I think that it needs to be more highlighted that you are involved in mostly an optional, cosmetic, cash pay service in a wealthy part of the country. I do know of some plastic surgeons who were top of their class in Ivy League Schools (which really doesn’t matter according to a past New England J Med publication) who are not bringing down the implied bucks that you mention. Perhaps they are not as adept as running a business …or marketing…or choosing the ideal location to practice in as you are.

      The trouble I see with your comment is that for the average Joe/Josephine….as they read it, they “see” it…and then they proceed on to their magical thinking…to justify the continued looting of goods and services from other providers……providers who are more involved in the care of chronic conditions as opposed to surgical cosmetic interventions. Don’t get me wrong. I am glad you are succeeding. If you make a better mouse trap, know a better place to have the mouse trap….and worked quite hard to build that better mouse trap….then congratulations. It is simple. It is pure. You have a buyer of a service. You have a seller of a service. Both mutually agree to complete the service. I presume that you, like most cosmetic surgeons I know, take few insurance patients but the ones you do would have good insurance to pay for the services you render. (I am not implying that you need to enslave yourself and take crap Collective insurance either). But as you well know most of medicine and much of surgical care has to do with the management of chronic disease states. It is as you imply…but partially so…that these providers are essentially getting screwed. It was not that long ago that Internal Medicine was considered the intelligentsia of medicine…but it has been on a decline essentially since WW II.

      Why am I ranting in a muted way about your post? Because I can almost guarantee you that some moron somewhere is going to use you as an example of how those wealthy doctors should stop being greedy and just be a good donkey for the Collective. So, I am asking for you to please remember that the bane of most of our existence…is a Collective mentality that …if lucky…reads at a fifth grade level. These folks just hear the numbers you mention…and…off they go. The numbers would be more enlightening if they were broken down to after tax net hourly rate…both on a current basis with yearly overhead consideration…and on a basis of opportunity lost financial impact (i.e. while in school and training) and the cost of training and education. I would consider factoring your pre practice costs (education, etc.) and opportunity lost cost over your estimated working lifetime.

      However, even if you did so it would not surprise me if the looters of the Collective would nevertheless rationalize the continued looting of goods and services (and professional time) of other providers.

      r58black

      May 17, 2012 at 1:56 am

  20. A thanks to Dr. Brown for this provocative piece and your repeated eloquent rebuttals. I think many of us have had this discussion with family members and/or friends and/or pushy dinner guests. The constant is we’re not looking for a hand-out or a ‘woe is me, I deserve better.’ We want the same appreciation that teachers and nurses’ unions stomp and yell for, we just don’t want to take the time from seeing our patients to do so. We’re not saying we’re better or that you’re worse or that our sacrifices are leaps and bounds different; just that there ARE measurable differences. It’s not a demonization of any other profession or union, simply perspective offered. Keep fighting the good fight, if only us inside the profession are hearing it.

    UCSF'er

    January 2, 2011 at 2:19 am

  21. I agree. Informative writing. Thanks.

    Md Karim

    January 3, 2011 at 2:58 pm

  22. Ben-

    Thanks so much for the interesting article.

    As a physician in Emergency Medicine I share your concern about the future of medicine.

    In Emergency Medicine we are mandated by the federal government to see every person who presents to the ER regardless of their complaint. The abuse of the system is incredible. I’ve had teenagers call ambulances for a ride the the local ER for a pregnancy test, for instance. There is nothing I can do to stop abuses like this, and while reimbursements are falling, my work load is increasing every year. Plus, I am held to the level of perfection with every case, regardless of the circumstances/workload during the shift the patient was seen. While attending to all the fakers, drug seekers, and histrionic, if I miss a subtle finding I could spend the next ten years of my life defending my decisions in court.

    Your analysis is right on and is one of the major reasons for discontent in the profession. I have been practicing almost ten years and almost every colleague I have worked with during my career is looking for ways to lower their clincal load or leave medicine. I am very concerned about where the profession will be in 15-20 years. Who will be around to take care of me and my family?

    As an interesting aside, I have had a few family members over the past decade who have had some significant medical needs. Walking with them through these medical issues was very emotional and yet, today they are doing very well. It is an interesting twist when, as a physician, you are either the patient or the family of an ill person. I am so thankful my family members are doing well now and have often thought how things could have been much different. If there had not been individuals willing to sacrifice multiple years post-residency to learn the specifc techniques necessary, my family members might not be alive today (all my ill family members needed very specific, specialty care performed by individuals with extensive post-residency training. These dedicated indiduals (and I am not including myself in this mix) have given me back my family and we have enjoyed years of happiness and memories because of their knowledge and skill. I cannot thank them enough. When my family members were diagnosed, what would I have paid to have them well again? What would it have been worth to me? Well, everything and then some. I would have sold my cars. I would have sold my house and moved. Thankfully, I didn’t need to do those things, but I fear we are quickly approaching a day when even if a person was willing to make those radical adjustments to their life and pay literally everything they owned for a life-saving measure, there won’t be those around who are able to heal them.

    Those who argue that physicians are paid too much have already won the argument, really. Physician salaries are dropping and the workload and stress and legal exposure is increasing. More and more physicians are looking to leave medicine and many rural areas in the next few years will be greatly underserved by physicians. Access to a physician in the coming years will be at a premium, and many will not be able to see a physician in a timely manner no matter how much they pay.

    We’ve lived a generation with healthcare system filled with “overpaid” physicians. What will we do when our physicians become priceless?

    GB

    January 4, 2011 at 1:24 am

    • Agree….4 years out of residency and already tired or Press Ganey and increased requirements to see more patients, faster, never make any mistake. The “business” part of medicine and govt involvement (and yes insurance companies), as well as malpractice premiums, are a big part of the problem. The “medicine” part is fun, and honestly, irritating at times, due to patient “demands” but rewarding. We even spend time “teaching” many patients about their illness and treatments options and often go over it many times. I can’t make you go to follow up after the ER and it’s not my fault if you don’t. Every doctor tries hard to do the best for their patients who are teachers, janitors, engineers, pilots, etc…..(you get the idea) all need someone at some point.

      CS

      February 1, 2011 at 4:38 pm

  23. [...] By Benjamin Brown, M.D. [...]

  24. [...] with 31 comments [...]

  25. As someone who teaches pre-meds and provides many of them with research experience (including uncompensated time writing the grants to pay for salaries, equipment and reagents), I have a good appreciation for the huge investment that doctors make before they begin to earn a dime. If you would have stopped at “Doctors make only ~$35 an hour,” your case would have been much more compelling. Outsiders only see the income and the things it buys and assume that all doctors live the good life.

    Why did you feel the need to defend one under appreciated group by attacking another?

    You cite a study to approximate a typical doctor’s work week as 55 hours, yet simply assume that a typical teacher works only 40 hours. Had you been a teacher writing about a doctor’s work week and made the same mistake, you would have concluded, “My doctor’s office schedules appointments from 9 until 3:30; if I give my doctor a half an hour on the front end plus a half an hour after the last appointment concludes (with a half hour for lunch) for preparation and paper work, my doctor works 8.5 hours a day x 5 days a week = 42.5 hours.” And you would have been well off the true number.

    My wife, a high school English teacher, may not be the best model for a median teacher, but her days are typical of those I know who teach English. She is in her classroom by 7:30, works through lunch, and leaves for home at 5. After the kids are in bed, she works from 9 until midnight every day except Friday, when it’s not unusual for her to take a few hours off at night. She works only about 6 hours a day on Saturday and Sunday, and she graded papers nearly every day during her two weeks of Christmas vacation (and she’ll do the same on spring break). By my count, she’s at 72+ hours a week during the school year, plus 10-20 hours a week during her vacation time for grading, planning, and course work mandated by the state to remain certified. You’ve assumed away half of her work hours for the entire year.

    In other words, you earn a great deal of sympathy from me for the misunderstanding of your work by the general public, but when it comes to teachers, you treat them as you have been treated. I was hoping for much more from this post.

    Eric

    January 4, 2011 at 10:23 am

    • I think this is the best response that I’ve read. I am a teacher, and have never (nor would I ever) say that another profession makes such and such, compared to what I make. I get to school by 6:45 most days, and am there until 4:00 3 days a week, and 6:00 the other 2 days. Most of that is preparing for what I’ll be teaching, grading papers, volunteering my time helping students who just don’t get it, talking to parents, going to meetings and workshops, etc. One of the days that I leave at 4:00, I go to grad. school. Weekends are spend planning units, possibly more grading, and prepping for the week ahead. I think the reason teachers might feel attacked in this is not in the pay rate, but the fact that what we do outside of the classroom is dismissed. While it may not seem intense, it is stressful, and the fact of the matter is that we are still spending that time doing these necessary things. I think it’s amazing how much time doctors put into their career. Please don’t assume that teachers work set hours, though. And especially don’t put it out there that our work outside of the classroom isn’t important. Furthermore, I don’t complain about my salary. While I’m positive that, unless I move to a state that has a high cost of living, I will NEVER make 100,000 – I knew that getting into teaching. I got into my profession because I LOVE what I do. I’ll continue working long hours, even though people will spend their life assuming that I work 40 hours a week, have 10 weeks off in the summer, 2 weeks at Christmas, and a spring break. Yet they do this without ever walking in my shoes…

      Teacher

      January 4, 2011 at 11:50 pm

      • …same person – I apologize for the typos – I didn’t proofread before I posted :)

        Teacher

        January 4, 2011 at 11:51 pm

      • You are one of those very exceptional teachers. However, what do you think of the overall motivation and competence level of high school teachers? If high school teachers deserve praise and recognition, why do our students score so low on math/science scores compared to Singapore and Japan? Granted it’s not fair to compare to these very best countries, we compare poorly to other developed countries as well.
        Could it be true that regardless of all the anecdotal testimony about how tough it is to be a (high school) teacher, the truth is that a sizable number (more than half) of teachers are just not that motivated?

        AKT

        February 7, 2011 at 11:47 pm

    • Out of curiosity, does your wife teach in public or private schools?

      My children attend public schools. I have not seen any of the level of dedication you talk about. School ends at 2:50 and most of the teachers scurry out the back of the school so as not to encounter the parents in the front. Homework assigned is rare for my 8th grader and tests are almost universally multiple choice or fill in the blank. Most of the time, it is verbatim from the chapters so one only has to read and fill in the empty spaces. I used to assume that was to cut down on the workload at home grading papers. Then I found out that the kids merely traded papers in class and graded eachother’s papers while the teacher read out the answers.

      Having come from a private school education in high school, a top ranked college and now medical school, I was extremely let down by the public school system. I will say that I have refreshed my grasp of middle school while teaching my son the classes he did not understand after attending school. This is only my myopic view of the education system, but I have not seen any significant evidence to dispute it. Perhaps the most shocking thing I heard was the principal praising the students in glowing terms as she informed the parents that 58% had met minimum state standards in math. Granted, it was a vast improvement over the 49% from the previous year.

      Anonymous

      March 28, 2011 at 12:30 am

  26. I think the harvard trained overpaid celebrity who is not even board certified by the american board of plastic surgery should keep his comments for his show and let real working doctors who make their living off o medicine not hollywood make comments

    Anonymous

    January 4, 2011 at 10:41 pm

  27. Thank you so much for articulating all of this.

    Akash Kumar

    January 5, 2011 at 1:38 pm

  28. Why, Robert Rey, are you not board-certified in plastic surgery? Just asking, not accusing.

    And Ben Brown, would you agree that you’re overpaid as a plastic surgeon? I’m a general surgeon in New York who can count on close to $300k/year, while my plastic surgeon friends always clear $1m/year. Perhaps I’m paid fairly, and perhaps our internists and family practitioners are underpaid, but where is your blog post, Bennie, expressing your outrage at plastic surgeons being overpaid?

    Maybe you should give some of your money to those poor underpaid pediatricians you feel so sorry for.

    C.I. III, M.D.

    Clayton Indicott III, M.D.

    January 5, 2011 at 3:13 pm

    • I believe that most people who read this article missed the major point. Using teachers to compare income vs. training was only just to pick one profession. The same analysis could be done for any profession, architects, pharmacists, lawyers, etc. Teachers, I believe were used just to cite an example.
      As the son, brother, and nephew of physicians I can assure anyone that it is a life profession, meaning you are completely immersed in your work. There is little time off and the responsibilities are endless.
      My sole observation of this article that I believe erroneous, is that dentists earn twice per hour what is calculated for physicians and teachers. In order to obtain the median income posted for a dentist here, any dentist will tell you that an additional 150,000 to 200,000 is needed to build, buy or start your own practice. And ask any dentist who just built a 200,000 office if they only work 38 hours per week treating patients and I assure you they will laugh at your shortsighted stereotype of our profession.
      MSA, DDS

      Dentist

      January 5, 2011 at 4:12 pm

    • I don’t think we are overpaid as plastic surgeons, but that other physician specialists are underpaid. We are paid fairly based on our services and utility to society.

      Salary isn’t based on subjective things like “fairness”. It’s based on supply and demand, and the marketplace. As the philosopher John Rawls once said, we don’t necessarily “deserve” our income in the sense of moral desert (who really DESERVES anything?), but we are entitlted to it, in that we live in a society where individuals place a primacy on many cosmetic procedures. It’s in the same way that Tiger Woods is entitled to 100 million, or Jay Leno to 20 million. The market ultimately decides the price that we can charge, our worth, while still gaining customers. If we were charging too high of a price for a procedure, and were therefore “overpaid”, we would have no business.

      I do agree with Dr. Brown, to be honest, that other physicians are underpaid, based on the fact that they provide a valuable service to society that entitles them to greater compensation. But I believe it is the structure of the government managed health-care that has caused this problem. The problem is all the government regulations in medicine that keep compensation low and create bureaucratic regulations. We need to transition away from pre-paid healthcare (which is what insurance is now), to a more capitalistic system that has higher deductibles, more direct cash transactions, more urgent care models etc. I truly believe that if we rely far less on the middleman (medicare, private insurance companies), and more on the ideals of free-market capitalism, physicians in all fields will be able to make more money while providing better care to our patients, while costs will go down for everyone. Government and managed health-care, with it’s price-fixing and regulations is responsible for creating an inequitable system that screws over PCP’s and rewards those who are saavy entreuprenurs (like myself and Dr. Brown).

      As for your “board-certification” question, you are correct that I am not board-certified by the American Board of Plastic Surgery. I initially intended to take the certification exams but have been too busy, managing my private practice, Dr. 90210, and my media career. In my opinion, in the free time that I have, I prefer to spend my 2-4 weeks of yearly free time traveling on humanitarian missions around the world to work on children with physical deformities. Nothing against the test, I just think that it really isn’t needed to be an excellent plastic surgeon.

      Robert Rey MD

      January 5, 2011 at 6:47 pm

      • LMAO at this post. You are ridiculous and should be ashamed for exploiting plastic surgery Dr. Rey so you can make millions of dollars.

        anon

        January 20, 2011 at 7:20 pm

      • I have known some very excellent physicians who are not board certified. Mainly because they are not allowed to take the test….they sit on the board. Nevertheless, there has never been any valid scientific proof that board certified physicians have better outcome than non board certified physicians. But board certification and now re certification has become a part of the multibillion dollar CME business. I recall a study where physicians in one state that did not require CME have the same outcomes as physicians in another state that required many hours of yearly CME. The CME lobbyist and advocates, all of whose livelihood depends on this endeavor, responded by saying that it just goes to show that we need more CME (I had a hard time understanding their logic in that response). I attribute the veracity of the support for these bureaucratic “industries” as further evidence of the decline and erosion of the U.S. industrial base.

        Roy Blackburn, M.D.

        February 18, 2011 at 3:09 am

      • Dr. Rey, your third paragraph completely contradicts your first and second paragraphs. The government through Medicare directly dictates prices for much of the market. It indirectly sets prices for just about all of the rest of the market, since many private insurers base their reimbursements off the DRG. I completely agree with your third paragraph- the government is the problem as it has destroyed the formerly free market of medicine, and primary care docs have certainly been on the losing end. That certainly does put a big damper on people going into the field. Most of us in primary care feel that something has to give and that either reimbursements for primary care will pick up to something reasonable or that the government/insurer system will implode and we’ll be back at a cash-pay system. Primary care docs are about the only ones most could afford to see if they had to pay cash or barter, so we’d still be able to keep the clinic doors open.

        As far as not being board certified, it really does not matter if you are in a cash-pay practice like you are. Your reputation is well known, which is much better than just having a bunch of extra letters behind your name. Board certification is really only a requirement for insurance reimbursement- few to no insurers will reimburse you if you are not board certified to perform what you billed for. All you would be doing is paying to take an expensive test every few years, so I don’t blame you for not doing so.

        P.K., M.D.

        Country_Doc

        September 22, 2011 at 9:04 pm

      • ” But I believe it is the structure of the government managed health-care that has caused this problem. The problem is all the government regulations in medicine that keep compensation low and create bureaucratic regulations. We need to transition away from pre-paid healthcare (which is what insurance is now), to a more capitalistic system that has higher deductibles, more direct cash transactions, more urgent care models etc. I truly believe that if we rely far less on the middleman (medicare, private insurance companies), and more on the ideals of free-market capitalism, physicians in all fields will be able to make more money while providing better care to our patients, while costs will go down for everyone.”

        WOW.

        Only a million-dollar plastic surgeon could write something like this.

        For the vast, vast majority of patients– those who are ill and *need* our services (not the ones who want a tummy-tuck), this would be an utter disaster. Almost no Americans can afford the sudden cost of a catastrophic illness on top of their usual expenses. With the ongoing erosion of the purchasing power of the middle class, only some can even manage to afford care for chronic diseases. Without some kind of insurance to even out these costs among the population, you’re dooming massive swaths of people to misery and death from treatable illness due to inability to pay.

        Yeah, I’ll be sure to tell the next $40k/yr sales clerk who i admit for status that her 100k ICU stay will be due in cash, or the 79 yr old grandmother we gave tPA to and then did clot retrieval on that we can do her $250k bill in easy monthly payments. Or that MS patient that, gee, we have a few really good treatments for her but they cost as much as her yearly salary so she’s outta luck.

        I’m the first to agree that *some* of us doctors are underpaid. Fortunately enough that can be fixed when “we the people” determine reimbursement rates. I’d advocate that a fee-for-service truly capitalistic system is fine for genuinely elective medicine, but that to ensure the health of the nation as a whole (and to ensure fair compensation for physicians), a comprehensive national health insurance model with significant physician input is the way to go. Something like Medicare for all, that will be able to negotiate reasonable rates with Big Pharma, imaging centers, etc. (the real drivers of health care costs).

        Mark S., M.D., Ph.D.

        January 24, 2012 at 12:48 am

      • Mark S,

        While I also find it laughable that a plastic surgeon would be commenting on how physicians are underpaid, his specialty does not invalidate his comments regarding a free market system of medicine.

        First, your argument re: those poor patients being stuck with high medical bills. The reason this happens is not the fault of a free market. It is actually the fault of government intervention. You should bear in mind that the healthcare system in this country has not been a free market system for over half a century. Ever since government has tried to intervene more and more with healthcare, costs have gone up. I agree that medicare does help to improve coverage, but in itself it has driven costs up by i) introducing more administrative costs and ii) discouraging competition.

        A critical role of the free market is that it keeps costs down by allowing providers (whether it be doctors, hospitals or drug companies) to compete with each other.

        Furthermore, not everyone needs the same coverage. The United States has a more heterogenous society in terms of health than virtually every other country. Some people take excellent care of themselves, and others are destined for chronic illness. In a universal coverage, government intervention system, coverage will invariably be wasted on some patients, and virtually useless to others.

        In case you think this is is all hypothetical, just take a look at Hong Kong, deemed by economists to be the freest market in the world (the United States ranks 10th, by the way). Hong Kong provides near universal coverage for its citizens, with relatively low health care costs, with minimal intervention from the government. Indeed, the Hong Kong government publicly states that it does not want to play a role in providing healthcare to its citizens.

        Anonymous

        January 24, 2012 at 11:58 am

    • i total agree with your comment.

      PCP and pediatricians are so underpaid and plastic surgeon are too overpaid!

      Anonymous

      January 26, 2011 at 10:39 pm

      • No one is holding a gun to the head of the purchaser of services from a plastic surgeon. It is that buyer’s choice to do so or not…at least on a purely cosmetic basis (excluding reconstruction after trauma, etc.).

        r58black

        May 17, 2012 at 2:07 am

    • He is one of the few that is fairly paid. His clients are paying from their own pockets. If they did not feel his work was worth the money, they could take their business elsewhere and his income would drop.

      Anonymous

      January 27, 2011 at 10:48 pm

  29. If a physician ultimately makes only a little more than a teacher, then why become a physician? I’m a premed student in need of some positive encouragement after reading this article.

    Evan B.

    January 9, 2011 at 1:58 am

    • Because you, like a teacher, firefighter, member of the armed forces, and myriad other professions, choose to make a life of improving the lives of others. Understand though that without what you offer, the opportunity of health, few other professions would be able to offer their benefit to fellow humans.

      AD

      January 25, 2011 at 10:16 am

    • Please do not go to medical school if you are only concerned about the money. Do you want to know what it will be like–a medical career? Spend time in a community clinic. Volunteer at a county hospital. See if you can shadow a physician who owns a private practice (rare these days). If you can’t find something more to look forward to than how much you may make compared to your friends–you will never make it through. It’s very hard to get into the middle of something (med school or residency), feel like you have to change direction, but hate that you are tied to this massive debt (there’s your second house).

      Don’t get me wrong–money is still important. I also think you should spend time with a practice or business manager. Many of us docs have no clue or desire to run our own business–it’s why we end up as employees for a hospital or group. But, we all need to have some sense of market pressures cause this WILL affect our future and our patients’ health.

      Melissa

      February 5, 2011 at 4:42 pm

    • Why become a physician? I chose to do so because the ratio of positives to negatives about the job outweighed that of any other job I was remotely interested in. I like the subject material, the job is overall decent, the job market is excellent, and I can easily live and work in a small town in an area of my choosing rather than some random dirty big city. A good rule of thumb is to look at yourself in 30 years when you are your parents’ age and say “will I still like to do this job then?” That’s really the barometer I used in picking what to do. I ended up deciding on one of the lowest-paying specialties in medicine, but at least I am happy with my choice. Pay can and will change a lot over the years- do NOT base your choice on salary, especially not when you have to devote $200k+ and 7+ years of specialized training towards it. You WILL be unhappy if you do that. I know, I’ve seen far too many people who’ve made the choice based on “well, it pays really well, so I can do it for a few years”… and ended up very bitter. There are gripes about any profession, but they’re a lot smaller and more manageable if you go into the profession because you like it, not solely for the money.

      P.K., M.D.

      Country_Doc

      September 22, 2011 at 9:19 pm

  30. Your article was well written and made some good points only I would like to point out that you under emphasized the cost to a physician. You should discount future earnings back to the present is the most obvious flaw. Future physician earnings aren’t worth as much to a student as current earnings. Any financial decision would discount future rewards to the present at a reasonable interest rate. Second, it doesn’t matter how medical school is paid for either through loans or a generous family when doing a cost benefit analysis you count this as a cost, and also the opportunity cost of this money. Just some suggestions for the future. Great article though.

    Josh

    January 9, 2011 at 2:56 pm

    • Thank you. I said above, that the analysis assumes that the purchasing power of the dollar decreases at the same rate as inflation. I did not account for lost income as a result of delayed investment. The cost analysis doesn’t discount the cost of training from family funding … so it was all counted as a cost …

      benbrownmd

      January 12, 2011 at 9:05 pm

  31. @Evan B.: If you do not know what you’re doing it for, other than the money, and if this article is true, then maybe you shouldn’t become a doctor, seriously. Hospital administration may be a more personally- and economically favorable endeavor: become the employer (true, you’d be employed too, but “over” the doctors), and make the physicians the employees; enjoy travel, albeit often business-related; and listen to the complaints of physicians, but not experience their pressured professional life (or their kind of pressure, vs. that of the management).

    @EG: I suppose, then, that it’s “your hospital parking lot against mine.” The existence of your situation does not negate mine. Could it be a result of variability among markets? Again, suppose that Dr. Brown’s study is true. How does that fit my argument (rather, quest for depth)? The question remains: does not the greater cash flow allow doctors to more readily finance nicer cars and homes? (Down payment and monthly installments.) Is the x-factor benefit that, although the doctor’s average hourly wage is comparable to that of teacher’s, the paycheck today is greater than that of a teacher’s? The resulting perception by the financiers, warranted or not, is that the payments are virtually assured. Because of this perception, physicians don’t have to worry about securing loans. The non-accounting benefits are many, and often result in economic benefits.

    So let us investigate further:

    1. Stratify the data according to specialty. Determine the average hourly wages of:
    a. Surgical specialists and sub-specialists
    b. General surgeons
    c. Medical (non-surgical) specialists (rheumatologists, allergologists, cardiologists…)
    d. Primary care physicians

    2. Stratify the data according to practice type. Determine the average hourly wages of:
    a. Employed physicians whose hospital has hospitalists (caring for those physicians’ admitted patients, thus reducing their hours worked)
    b. Employed physicians whose hospital has no hospitalists. Include their billable visits to admitted patients as part of their income.
    [For a. and b., exclude Paid Time Off from their hours worked.]
    c. Self-employed (privately practicing) physicians.

    We may find that “physicians” includes a wide range of incomes and hours worked. Then the preception of the overpaid doctor may be true for some, untrue for others, but not categorically one or the other.

    Son of a Physician

    January 9, 2011 at 4:06 pm

    • More detailed information by specialty: income, duration & intensity of training, residency training positions vs applicants, USMLE scores, etc. is all covered in my book “Informed Consent.” Which will be released this week.

      benbrownmd

      January 12, 2011 at 9:08 pm

  32. Maybe you should just have made better life decisions.

    Teve

    January 11, 2011 at 2:59 pm

    • Wow.

      Tony Darst

      January 12, 2011 at 8:44 pm

    • It is easy to be a “self-sacrificing idealist” when one has never had to make significant sacrifices.

      benbrownmd

      January 12, 2011 at 9:13 pm

  33. Thank you Dr. Brown for you analysis. Your article is something my husband and I have discussed at length. Perhaps in the past, a physician’s choice to pursue such a lengthy education and training, incur debt and forgo sleep and personal time paid off in financial rewards down the line. But with the exception of medical specialties that are cash up front such as plastic surgery and dermatology, physician compensation does not pay off down the line.
    Our family has sacrificed for my husband’s education and training. The demands of internship and residency are intense and supercede a normal family life with family meals and dad’s attendance at school events. Extended family has not understood how limited vacation time is during training…a week or two at most and how a call schedule dictates the family schedule: on call, sleeping, working etc.
    But what I have found most frustrating is how people complain about physician charges, yet don’t have a problem with the charges of their auto mechanic, plumber, electrician or appliance repairman. In our calculations, my husband’s hourly wage is less than those professions charge. And in the category of too sad but true, my husband’s physician fee for many surgeries are written down by insurance and Medicare to be less than a typical 30,000 mile scheduled car maintenance.
    Our 3 children have seen their father’s sacrifices and by necessity their own and will not consider becoming a physician. I fear that in another generation, our medical profession will resemble that of the former Soviet Union where long hours, low wages attract only mediocrity. I don’t know about anyone else, but I don’t want to be treated by those of average or mediocre intelligence.

    Physician's Wife

    January 12, 2011 at 8:21 pm

    • Very nice, Physician’s Wife; my hat is off to your husband, you and your family for your sacrifices. I too, am worried about the future talent that is attracted to the profession… strictly from a potential patient’s perspective.

      Where is the “Like” button? ; )

      Tony Darst

      January 12, 2011 at 8:43 pm

    • That is what I am fighting for. The only sustainable way to get physicians fairly paid/reimbursed is to inform society about the hidden side to becoming and being a physician.

      If society feels that physicians should be paid less per hour AFTER TUITION TRAINING & TAXES than auto-mechanics, plumbers, electricians, etc. …. Who will be our future generation of physicians? Will they be competent? Efficient and effective with resources? Who will take care of their complications? Who will they consult for help?

      As it stands now, a large minority of physicians bill and cost the system money – but actually accomplish very little for their patients. They order lots of unnecessary tests and consult lots of unnecessary consultants, taking an expensive shotgun approach; but not actually helping anyone – they leave that to the “good doctors.”

      benbrownmd

      January 12, 2011 at 9:22 pm

    • You are spot on Physician’s Wife. My father is a 68 y/o physician who still works at least 60 hour weeks. My brother and I have both been told we would have made great doctors. Note how I said “would have made”.

      Anonymous

      March 1, 2011 at 1:03 pm

  34. While I agree that doctors sacrifice a tremendous amount to reach the end you can’t tell me it isn’t a personal choice. Ben decided to enter medicine because he thought it was interesting, his daddy was probably a doc, and he thought it would offer a secure job with a good income. Is it hard to become a good doc? Yes. Is is harder than working at mcdonalds or wal Mary or a coal mine 40 hours a week for 11 years? Nope. While docs work their butt off during training I am willing to bet they wouldn’t trade for the life of an assembly line worker even if the financial gain was the same.

    I pose this question to dr brown, if you were paid the same, would you work as a clerk at 7-11? What about joining the military?

    If bens honest he will answer NO- and that’s because there are other pros to being a physician. It’s intellectually stimulating work. You make a difference in peoples life. You are constantly being challenged.

    Sure, the expensive, time consuming training is a lot of hard work, but there are other rewards other than money. Also, med school is tough, residency is a lot of work, but it isn’t coal mining. It isnt assembly line work. It isn’t working at a gas station. I know ben would rather do med school and residency then work in a school cafeteria, even if money was the same.

    Also, many docs dont know how to handle their money. They rack up debt on credit cards, spend too much in their rent or cars, and they feel immune to money rules because they are counting on a payout at the end.

    Bottom line: docs work hard and earn their money fairly, but don’t try and act like you are so hard done by. You will make more then enough money, you will have a stable job, and you get to help people.

    Blah blah

    January 16, 2011 at 10:17 pm

    • There is nothing else I would rather do with my life than serve others as a physician.

      My point has again been misunderstood. All I am trying to do is inform people about the hidden side of becoming a physician – the time and cost. Ultimately I want the general public to understand that a $250,000 salary is really about $40/hr after all things are considered.

      I am NOT suggesting that people should avoid becoming physicians.

      Why do some people believe that loving one’s work and making money have to be mutually exclusive?

      Just because you love your work and do good things, doesn’t mean you shouldn’t be paid fairly for your services.

      benbrownmd

      January 18, 2011 at 8:22 pm

      • I agree. This is important information for those considering becoming a physician. I am not certain that all of my pre-med classmates in college ultimately would have chosen a career in medicine if they fully understood physician reimbursement. And after investing (time, energy, and money) in medical school, it is difficult to change one’s professional course. I love what I do and I chose this path for a combination of reasons: enjoyment in serving others, an interest in science and biology, and financial compensation amongst others. Unfortunately, as situations change, it can be expected that young, motivated, talented people (with options and choices) will respond. They should have the information necessary to make an informed career choice. For most people (and that is what doctors are, people), incentives matter. I hope society recognizes the importance of attracting capable and bright people into the medical profession, and that we are honest with ourselves regarding what will be necessary to do so.

        Resident

        January 24, 2011 at 11:05 am

      • Dr. Brown, THANK YOU for all your comments which are spot on. It is the reality that every resident that I know, including myself is faced with everyday. And it’s very depressing to actually see it on paper and then to read the comments posted by people like Dan#1 and blah blah.

        To Dan#1, blah blah, and others who feel the same way: The most amusing part is that one day you may need someone to take care of you and possibly intervene to save your life… and we will be there for you too. However, rest assured that we know who you are because we can see it in your eyes.

        Resident #2

        January 25, 2011 at 3:56 pm

      • Ben,

        can you write another article about pcp and ped are so underpaid for justice?

        I know there are PCP and ped are top of class from top UC med school!

        anna

        January 27, 2011 at 12:03 am

  35. I grew up in family of doctors, my girlfriend is a doctor and I have numerous other friends in the profession. I’d have to agree with the author that the actual savings that doctors are able to generate is far less than the public generally understands. Indeed the job is generally pretty stressful. As for the reference to high school teachers – their job really is stressful too and the author has focused on two of the most difficult jobs around in practice. As a computer programmer I had my business running at a younger age. At age 36 I have saved $2m (although I have worked incredibly hard). If you are choosing to be a Doctor you are not doing it because you want to earn a lot of money – it just doesn’t work that way. You are doing it because you are passionate about the subject.

    Julian

    January 17, 2011 at 1:06 am

  36. Bottom line: I know several doctors, and NONE of them are struggling financially in life. The majority of them live like royalty. So yeah, many of them work their tails off to get where they are, but don’t act like you all need any sympathy. This was the profession you chose, and with the exception of few of you (e.g. doctors who work for organizations like Doctors Without Borders, etc.) many of you did it not ONLY to help people, but also because of the financial rewards later in life. In fact, I know some doctors who did it MOSTLY for financial reasons. Now don’t get me wrong – I don’t think the compensation for doctors is always undeserved, relatively speaking. In the U.S. there far less deserving people making more than doctors do – but I find that doctors make enough where even if one’s incentive is only money, one considers the “sacrifices” worth it. The author seems to be whining about not making enough money etc etc – sorry, but if that’s why you became a doctor then you probably should have chosen another field.

    Seth Cohen

    January 22, 2011 at 8:42 pm

    • your 100% off base. To invest 10+ years with a financial reward way down the line is absurd. There are much quicker paths to wealth like finance, and since doctors are among the smartest people in college (srs) and 95% of ‘pre-meds’ get weeded out, they could easily make it in the ultra-competitive law, business and financial fields and make six figs a few years out of college. No one’s asking for your sympathy, and your judgments are overly simplistic as to you assessing people’s motives for picking a field.

      Many of those doctors with fancy lifestyles that you see are actually living a facade. They may be in large debt, or have almost no savings, and they are merely living as to what an “image” of a doctor is viewed by the general public. Seriously, if you read any study, doctors are among the most financially irresponsible and make incredibly poor decisions with money…

      anon

      January 24, 2011 at 10:51 pm

  37. Dear Dr. Brown,

    Thanks for such an insightful article. As a fellow physician, I find that life is often a comedy of errors when it comes to the plight of the physician – those who are outside of the field often times don’t get it. And then when you try to explain it to them, they’re purposely ignorant and even belligerent about their ignorance.

    In these trying times, I actually find that it’s easier to study than to even contemplate the politics of physician debt and reimbursement.

    The comedy in all of this is that with state governments contemplating defaulting on their debts and the US economy in the shape it is, in the end it is better to have a profession that’ll always be in demand no matter where you go. So in that sense, the last laugh will be on everyone else. :)

    (So keep it up jerks, because one day, you’ll get your dues.)

    Dave

    January 25, 2011 at 11:32 pm

  38. Hello Doctor,
    The one thing you could integrate into your analysis is risk.
    A person entering medicine can look forward to a relatively stable series of future cash flows. The career track is a well trodden path with very little chance of deviation or derailment. Med school, then residency, then practice. Do the work, and the future income will be there and will be relatively stable. The job won’t be shipped off to China; it won’t become obsolete because of new technology (e.g. travel agents). That’s a valuable thing.
    So if you factor in risk-adjustment, Doctors have higher income than at first blush.
    That’s not to say that I don’t agree with your article. Just saying…

    Ahmadali

    January 26, 2011 at 12:24 am

    • Because of the way our health insurance system is structured currently (i.e. a significant chunk of people being insured through employers of themselves, their spouse, or their parents), primary care physicians are not immune to the downturns in the economy. People lose jobs, they lose their insurance. They lose insurance, they stop seeking primary care, and primary care reimbursements go down.

      The costs shift from prevention to pulling people back from the brink. The burden then shifts to the hospitals providing charity care (public hospitals, charity hospitals, and non-profits).

      The money does shift from one doctor to another, but someone has to lose. And if the patient can’t pay, you can’t squeeze blood from stone. That money is written off as a loss.

      Infectious Diseases Fellow

      January 29, 2011 at 9:17 pm

      • Exactly. Insurance should NOT be tied to employment status. I see too many people coming in to my clinic who have lost their jobs, and their health insurance. Seriously, who can afford COBRA payments and still feed their kids?? Maybe the kids can get on medicaid, but the parents go without care. It makes it hard to care for people when they have such transitory status in the medical community. The idea of a medical home should include keeping patients despite changes in their insured status.

        Melissa

        February 5, 2011 at 4:52 pm

  39. Wow. After having spent quite a bit of time reading Dr. Brown’s article as well as the comments I am a bit shocked. I think that his article has hit a nerve in many people and that nerve is money. It is a difficult task to decide who should get paid what due to the variable for each profession mentioned above. I recently graduated from medical school and I am looking down the barrel of $250,000+ debt and it isn’t pretty. I have chosen to go into primary care as a pediatrician, so I am most definitely not in it for the money. That said, I would like to not be in debt for the rest of my life simply for wanting an education. My major issue with education in the US is that we have to pay an every-increasing amount of money for something that is free in other countries. If that were the case here, then I could see the point in not complaining about getting paid as a physician, but that is just not the case.
    Maybe the real discussion should be about how to make education free to everyone, not just those of us who qualify for a student loan, or are lucky enough to pay up front. Truly, whether rich, poor, or in the middle, everyone deserves an education.

    Dr. S

    January 26, 2011 at 4:21 am

    • education cannot be free! it is already free up to high school.

      No the discussion is NOT about how to make education free.

      the issue here is dr deserve to have good pay but with our med insurance system, doctors are forced to see so many patients in one hour! Not only doctors are struggling thru but also we all will suffer due to poor med quality!

      Anonymous

      January 26, 2011 at 11:17 pm

      • I agree. Education needs to be free or at least a lot cheaper.

        T

        January 30, 2011 at 10:39 am

    • Nothing is “free,” somebody has to pay for it. You very obviously just recently graduated from medical school by your comments. You will see just how much “free government stuff” costs once you get your first paycheck as an attending and look at the stub.

      P.K., M.D.

      Country_Doc

      September 22, 2011 at 9:44 pm

  40. While I have deep respect for the amount of work physicians put into their training and the lifetime of service that they provide to their communities afterwards, I find major flaws with this analysis.

    First and most egregious, your analysis includes teachers’ pensions but not those of doctors. Also, your assumptions have calculated the life expectancy of teacher significantly beyond U.S. averages, despite giving no evidence that teachers live longer than the rest of us. This second correction alone would reduce your calculation for male teachers to $28.24/hr (in the still flawed analysis that teachers receive pensions but physicians do not.) Finally, I find your estimates for teacher’s pensions to be overestimated as well. A quick search (and I realize I’d have to do much more research if I were publishing a book) reveals median state worker pension in CA to be $25,212 per year gross. This would further reduce the calculated hourly salary as you have calculated it.

    Sadly, I agree with you that the reduced level of Medicare payments are a problem. However, your exaggerated calculation works against you and makes me less sympathetic to your plight.

    AG

    January 26, 2011 at 7:13 am

  41. Umm… Where are you finding docs receiving pensions? If they work private practice, when they retire, they are done. They don’t work for the state.

    And honestly, i think the comparison is underestimated. I went to school with a lot of people who would become teachers, and I spent a hell of a lot more time in my science classes then they did in their education classes. They are much easier. That being said, my college experience was harder and required more study time. I don’t think people pay enough attention to the difference in graduate education either. In medical school, the average student has 20-25 hours per week of lecture, and dont be fooled, this is NO WHERE NEAR the level of lecture in even the hard undergrad science/math courses. These are very dense and all require pre- and post- readings to fully comperhend and retain. I am not saying teachers shouldnt be paid more – they should – but to say doctors make enough just because they might drive a nice car is ridiculous.

    The problem here is simple:

    If i triple the time training that someone else spends, If i triple the money needed to do it, and If i am involved in something that fundamentally requires someone of the highest level of aptitude, why should i not make 3x as much? And by make, i mean after taxes, loan repayment etc.

    (one other note, can’t physicians incorporate themselves to avoid some of the taxes?”

    JB

    January 26, 2011 at 2:42 pm

    • I’ve never met a doctor with a pension. I’ve met very few teachers without them. My research confirmed this experience.

      Anonymous

      January 26, 2011 at 5:21 pm

    • Why would you even consider teachers should get paid more when their hourly rates are close to that of primary care physicians? Now we comparing the PAY/EFFORT and PAY/ACADEMIC TALENT ratios of high school teachers vs primary care physicians. Could you not also arrive at the conclusion that maybe high school teachers are paid way over?

      AKT

      February 8, 2011 at 12:35 am

    • Incorporation does not allow tax avoidance…any more so than any other venture. Regardless, the odds are stacked against the solo doc. I have known doctors who have been founding members of doctor corporations…one complained about how one third of their retirement just disappeared….some kind of administration fee.

      r58black

      December 17, 2011 at 3:48 am

  42. Ben, you put in 80+ hrs/week for 48 out of 52 weeks throughout med school? That must be how you were at the top of our class and got into plastics because I definitely didn’t put in those hours in either 1st, 2nd, 4th, and probably even 3rd year, haha.

    Good job on the article; very impressive!

    Amber

    January 26, 2011 at 4:39 pm

    • I put in 80+ hours per week for 48 out of 52 weeks from the first day of med school through the end of the second year of med school. Just about everybody I knew did that too, because it was what it took to pass exams. We had a large number of unusually hard exams during medical school (based on talking with people who went to other schools) and the faculty was pretty eager to make people who failed very many of them repeat a year and pay another $30k in tuition. You did NOT want to fail, so you worked your tail off. Intern year of residency, while averaging close to 300 hours per week averaged throughout the whole year, was much easier than M1 or M2 year. At least I got four days completely off per month intern year, couldn’t say that about M1 or M2 year. Always had to have my nose in a book. Third year was pretty similar to intern year but without the pager always going off on you and without the paycheck. Fourth year of med school was pretty cush; I got to take two months off and I did a lot of clinic rotations that were 7:30-to-5:30. It was actually pretty similar to senior year to tell the truth, but without the whole senior resident backup call stuff.

      P.K., M.D.

      Country_Doc

      September 22, 2011 at 10:14 pm

  43. Ben,

    I applaud you on the time you spent on the article and the information that you have emphasized in it. This is the exact thing I’ve told many of my friends and relatives countless times and unfortunately (for our profession) after seeing what I’ve been through and hearing this information they’ve all picked other professions where they are making more money working less hours. I don’t tell them the information for the mere fact of scaring them out of the profession but I just want them to have real knowledge of the sacrifices that we actually make for this field. When it comes down to it, if you are in the field for the “MONEY” then you are in it for the wrong reason and I would rather not have you sharing in my profession (just my opinion). However, with that being said, I agree that we are the only profession who invest so much time to our education/training and collect the biggest debt of any profession when we are done with our training but yet are compensated so little for the time we have dedicated which is a big stressor in life that most of us are ignorant to when we choose to go into this profession (in my case I’ve wanted to become a doctor since I was 5 years old). This is a fact that many will come to realize in the future and sadly, our “shortage” of physicians will only get bigger and bigger for this reason.

    Dr 90210,

    While you were able to NOT spend a lot of time studying in med school, don’t discredit the fact that there are people who do. I can say that I, as well as many of my friends in med school, put in 80+ hours to study our butts off and have made countless sacrifices like missing out on family functions/vacations, friend’s weddings, etc, all for the fact that we had to study for exams or boards. We then worked 80+ hours during residency due to the workload that is imposed upon us during our training while reporting duty hours that were within the constraints of the ACGME. Of course, you can say the ACGME has “80 hour DUTY HOURS” that we are bound to follow but let’s get real here…who can leave a sick patient in their time of need because “OOPS, I’VE MET MY 80 HOURS SO I HAVE TO GO HOME!” If you work that way then you are delivering sub-optimal patient care and do not need to be in this profession!!!! I am currently a Nephrology fellow and I can tell you I STILL get up at 4AM everyday to get the hospital by 5AM to start seeing patients and on average I don’t leave until 7PM. Yes, I do get the occasional weekends off but what Ben says is correct about the time we spend at the hospital. MOST of us hard-working physicians who care about our patients and don’t want to miss any details that could be vital to their care actually spend that much time on our PATIENT CARE then go home to read and research ways that we can further help our patients. I’m glad you have a successful career in the media spotlight but unfortunately that is not a valid excuse for not taking the board certification exam. Yes you are busy managing your private practice and media career but you are forgetting that most of us take our board certification exams while working FULL-TIME after we finish residency. I’m glad that you rather spend the time on humanitarian trips fixing the defects of children in underserved areas, plus, taking the board certification exam at this point would only be a matter of personal preference for you (I don’t think anyone would think any less or higher of you than they do now even if you did pass) since are already established.

    Dan #1,

    Please let me know where to get these grants to pay for my school loans as I am in a tremendous pile of debt for choosing to go into my profession. I am in dire need to help to pay off my loans especially since my take-home paycheck is approximately $1380.00 every 2 weeks after all my taxes are deducted from my PGY4 (4th year residency) salary and I have the mortgage, electric bill, water bill, auto insurance bill, gas bill, home insurance bill, and a $2000.00 a month student loan note to repay since in this time of economic hardship our lovely government has decided to no longer have the economic hardship deferment (EHD) option for our loans and my loan company for an unspecified reason has decided to DENY my application for Income Based Repayment, the new system that was designed to replace the EHD program. I don’t know if my calculations are correct since I haven’t done math in a long time but no matter how I run the numbers the fact that I am taking home $2760 a month with all those bills and a $2000.00 student loan note leaves me in the negative every month. I haven’t even mentioned food yet because THERE IS NO MONEY LEFT FOR FOOD. If it weren’t for the fact that I am taking out MORE LOANS to be able to survive since I don’t want to have to moonlight to make extra money so I can focus on my training I would not even be able to buy food. So please, please tell me where these grants are so I can stop digging a bigger and deeper mountain of debt that I will have to pay off while trying to start a family and providing for them with all these increasing cost of doing medicine and threats to decrease physician compensation in the future. I’m all ears! Oh yea, please excuse my grammar as I do not hold any degress in English and have just gotten off a long 15 hour shift…

    Nephrology Fellow

    January 26, 2011 at 8:23 pm

    • apply for the graduate fellowship deferment… as a nephrology fellow you should be able to get it (every cardiology fellow in our program has for the last 3 years). I personally have used it for my PGY 4-8 years after using the EHD during 1-3.

      TW

      January 30, 2011 at 12:23 pm

      • When I called the loan company the rep on the phone told me I didn’t qualify for that but if you are saying everyone in your program and you had it, I’m going to submit the forms and see if I get a denial letter from them because these bills are getting out of hand. Hopefully the rep was wrong and my deferment goes through.

        Thanks for the info TW

        Nephrology Fellow

        January 30, 2011 at 6:13 pm

  44. I agree with you Dr. Brown, and thank you for this article. I have been waiting for someone to speak up about this issue. I feel as though physicians spend so much time studying medicine — that we don’t take time to master other subjects – such as finance and politics. Physicians need to be more well rounded and educate themselves in those arenas to prevent themselves from mismanaging their future incomes and being taken advantage of by policymakers that don’t have physician interest at heart.

    MS4

    January 26, 2011 at 8:48 pm

  45. On comparing the work physicians do versus teachers, I don’t recall ever hearing of a student that was maimed or killed when the teach “slipped” while giving a lecture, or grading a paper.

    Perhaps that brings a bit of perspective to this; maybe not.

    Tony Darst

    January 26, 2011 at 10:47 pm

  46. I guess I agree with you Dr. Brown because from what I have experienced in the clinical area doctors are cold, heartless, and have too much of a workload. The work they supposedly put into getting into their profession has made them insensitive, leaving the nurse to pick up the pieces that doctors have left the patients in.

    That is why nurse practitioners are on the rise too. Sorry Doctors. That’s what you get for ignorance, pompousness, and letting all the work go to your head… to the point where you are calculating irrelevant numbers such as these.

    Nurse

    January 26, 2011 at 11:15 pm

    • All due respect to nurses (as I respect them HIGHLY and without them I would flounder…ie this is directed at your post and not the nurses I associate with daily), don’t ever use the word “supposedly” when talking about the work physicians put in to their education and patients. As if it isn’t real that we stop our lives at 18 to go to college and perform to get into medical school and perform to get into a good residency and perform to get a good starting position… and on and on? It is actual training, you do realize this? It really is not some rouse that we put on yearly to fool everyone else in the medical profession. Like we hang out and watch television for 4 years only to come out the other side secretly fooling the public into thinking we are physicians? Sorry if your experiences have been bad, but that gives you absolutely no right to make some sweeping generalization about all of us not putting in countless hours away from the people we love and the things we miss so strangers can snub their noses at us when we try to help them. And we come back everyday and take the hit on the chin in hopes of finding that one diabetic who might change the way they live their life or help that one mom deliver her first baby. Incorrigible and inexcusable are the words I would use for your comments to say the least. Quite frankly, your comments are just as bad as the jaded docs out there to which they are attributed. Have some tact in your profession.

      Studen

      January 27, 2011 at 11:13 am

    • All due respect to nurses (as I respect them HIGHLY and without them I would flounder…ie this is directed at your post and not the nurses I associate with daily), don’t ever use the word “supposedly” when talking about the work physicians put in to their education and patients. As if it isn’t real that we stop our lives at 18 to go to college and perform to get into medical school and perform to get into a good residency and perform to get a good starting position… and on and on? It is actual training, you do realize this? It really is not some rouse that we put on yearly to fool everyone else in the medical profession. As if to say we hang out and watch television for 4 years only to come out the other side secretly fooling the public into thinking we are physicians? Sorry if your experiences have been bad, but that gives you absolutely no right to make some sweeping generalization about all of us not putting in countless hours away from the people we love and the things we miss so strangers can snub their noses at us when we try to help them. And we come back everyday and take the hit on the chin in hopes of finding that one diabetic who might change the way they live their life or help that one mom deliver her first baby. Incorrigible and inexcusable are the words I would use for your comments to say the least. Quite frankly, your comments are just as bad as the jaded docs out there to which your post is attributed. Have some tact in your profession.

      Student

      January 27, 2011 at 11:15 am

      • Agree. Nurses are essential. But many of them have doctor-sized egos as well.

        T

        January 30, 2011 at 10:43 am

    • You are sincerely jaded, you cannot even compare the amount of work, education and time spent by a doctor to a NP. They do not even equate. I’ve had to deal with NP, and they cannot and SHOULD not be a replacement or an alternative for doctors.

      The nursing curriculum is vastly different from that of the medical curriculum.

      If you want to play doctor, then go to school to become one-none of the faux doctor crap.

      SM

      February 3, 2011 at 5:36 pm

  47. Great article.. More docs should hire us PAs! We make your work load a little more bearable, expand your practice, and let you go on more vacations. Just my opinion :)

    Michael

    January 27, 2011 at 12:47 am

  48. Thanks Dr. Brown for being someone who sheds a little more light on the world of medicine and the complications we all face. I am an MS2 about to head out on rotations. I got into this business because I love to think, solve complicated puzzles, and most of all, help people. $260,000 dollars in debt (that’s my personal owed amount after the 4 years will be said and done).

    First of all, the esteemed dentist from an earlier post is absolutely correct, at least it seems to me. Teachers were chosen as an EXAMPLE. So stop bickering about a lost point that was buried in conversation (much like Dr. Brown’s original points were buried in so much bureaucracy early on in medicine because people couldn’t look past their own noses).

    Second, I can also vouch for 80h weeks in medical school, and I feel like that is not even adequate to get done what we get done most weeks. I read papers all the time on topics from mounting debt, to psychological strain, drinking, suicide rates rising, and a plethora of other topics specifically looking at medical students compared to other professional and graduate students. I barely sleep myself…literally…I’m on a study break at 12:50 AM on a random Wed. and I have 3 more hours before I can get some rest. The strain and debt are very real things. I have personally been witness to all kinds of ways people buckle under the debt and pressure. We have 4 full time therapists on staff at school and even they are asking for more employees to handle the patient load…and their only patients are medical students…at one school. #1 and #2 reason people see them: Stress from study/training time and lack their of in seeing significant others and their kids, and stress from impending debt, respectively.

    Then to realize we may never be able to pay it all back if things keep up??? That’s terrible. Who wants to leave debt to their children, or never really have the opportunity to experience financial freedom? To say doctors “make too much” is ignorant. We don’t get pensions or stock options (at least the vast majority of us). There is no safety net for us. We make a human error or don’t pay back just enough every year to cover our loans, and it may mean we’ll be up to our eyeballs in it a lot longer than we had planned. I’m not saying we are underpaid. I’m just trying to say there is a balance that needs to be achieved. A balance that things like public opinion, politics, and the shortsightedness in medical education took a wrecking ball to a long time ago. I fully agree that medicine, in its current state and with the present ridiculous back and forth in the political sector from which it is run, will fail.

    Medical schools have been reporting record numbers for the last few years in applications, my school included. But examine those numbers for what they really are. The QUALITY of applicant is fading. More people are applying not because there is suddenly some brain trust coming up through the ranks. People are the same as they have been. However, I am seeing the quality of candidates go down by the month as I interview incoming students to fill spots. More interviews each semester, with more and more difficulty in filling the spots with people we think will actually treat a patient as they should be treated. What is really happening is we are losing viable candidates to other professions (engineering, medical technology, the advanced sciences). Why? Because being a physician is becoming ALL about being altruistic, and not a whole lot else. I would have applied just the same had the government said my medical school would be paid for and I would only make %50,000 a year. That would be fine by me because I wouldn’t be shelling out amazing amounts of my paycheck to the government, and loans would be a non-issue. But it would appear the public, the education systems, and the governmental systems/insurance companies want a combination of factors that leaves physicians at the bottom of the barrel to fend for themselves.

    What if physicians in private practice don’t get the idea to overcharge their patients because they are monetary monsters, but rather, they conger their “scheme” because they know they have to pay rent on the place to stay in business and with the current insurance bits, no one is getting paid much of anything past keeping the lights on? What if they didn’t have the idea out of selfishness, but out of shear fear that money would be hanging over them, their families, and their business long after they were gone? I’m not condoning over-charging a patient, and I’m not saying it doesn’t happen for the wrong reasons. I am simply offering up alternative psychological presence in the face of accusations that all people who do something viewed as immoral in the medical field are suddenly the worst thing to happen to America since Necco Wafers (I hate those things).

    In the CURRENT system, without lying to yourself, ask the question: Does altruism keep the doors of a hospital or practice open in the midst of a capitalistic medical society? The answer to that question is no. You’re pitting a service-based, ideal-based profession against the machine that is economy. Medicine can’t win because it is simply out of the environment in which it can exist. Instead, we have to take the insult added to the injury we get from the public and loans respectively.

    Another question I will pose for debate. Being that the public has all kinds of quick comebacks for physicians who have an issue with the financial situation they face (as if we’re somehow the only people in the world that ever had a problem with something we wanted to see change in our professional atmosphere):
    If we were all doing it for the money, then why
    the hell are we still here?
    Here’s the kicker: there’s no money in medicine. At least not in the context I hear people talking about it daily. People walk around thinking physicians shop at Sharper Image and wear Armani tuxedos to work. I grew up around medicine. I have watched the gratitude and money go right down the tubes over the last 2 decades. I had the ability to see 2 generations of medicine throughout my time so far, and what scares me is that the generation I am a part of is circling the drain in terms of progress. My Gastroenterologist drives a 6 year old Toyota Camry with a busted door handle, and only just paid off his last loan payment 5 years ago. He’s 65, was in the Army (so don’t think that’s all its cracked up to be financially), and has had little time to save for retirement. I don’t even know what the argument is here. So some patients have bad experiences with their physicians and find out they are overpaid. Ok. I’ll give anyone that. But major hospitals employ as many as 1200 physicians at one time. The one or two you or your uncle or your sister may know of pales in comparison to the people who fly under the radar silently paying off their crap loans that they know are so inflated it would be almost funny if it happened to someone else. All because they can wake up at 3AM and actually go out in the world and make a difference. I feel empathy for anyone who has to put up with bickering, banter, and quite frankly insults to their intelligence and life choices just because they want someone to leave their office feeling better than when they came in. And I feel sad for those that have the impression of us that we are some kind of money starved, materialistic population that looks at the world through a telescope rather than up close and through a set of compassionate eyes.

    Med Student C

    January 27, 2011 at 2:10 am

  49. Dear Dr. Brown,

    Thank you for your article. I graduated from med school and have 250k in debt (I do not come from a privileged background and did not have any financial assitance). I am now in my pediatric nephrology fellowship, confronted with academic jobs (it’s very rare to have private practice pediatric specialty jobs) that start at 105,000 per year working 60+hours per week in an expensive area to live. I’ll need to pay off 2,000 a month in student loan payments just to pay it off in 25-30 years. Mind you, dialysis nurses at the same hospital can earn 160k with overtime (and they deserve to be paid well for the specialized work they do).

    This month in Pediatrics there was an article that basically said that aside from cardiology,neonatology and intensive care choosing all other pediatric specialties will deflate your income (up to negative 850,000 over 30 years for an infectious disease specialist, or in my case 700,000k for a nephrologist). For this reason, though I love nephrology and the chronically ill children that required specialized care, I’ve decided after I’m done to be become a hospitalist because my family and I cannot afford such salary deflation.

    Peds Fellow

    January 27, 2011 at 4:03 pm

  50. Dear Dr. Brown,

    Thank you so much for this article. I graduated from med school with 250k in debt (my parents were in no financial condition to help me out which I didn’t expect). Now I’m a pediatric nephrology fellow confronted with the jobs that start at 105k in a very expensive area to live (most pediatric specialist jobs are academic)working 60+ hours a week. These jobs start low and continue to pay low. My chairman is only breaking 160k after working 30 years. Mind you dialysis nurses at the same hospital earn 160k with overtime (and they deserve to be paid well for the work they do).

    There was an article published in Pediatrics this month that looked at financial considerations of pediatric speciality fellowships. Aside from cardiology, ICU and neonatology, all other fellowships result in a significant financial loss, up to 870,000k for an infectious disease specialist over 30 years or in my case 700,000. For this reason I’ve decided to become a hospitalist when I’m done with fellowship. I love nephrology and the chronically ill patients that require a lot of care, but my family cannot afford such salary deflation. Earning 105k per year with 2,000 a month in loan payments (just to pay it off in 25-30 years) isn’t going to work.

    Peds Fellow

    January 27, 2011 at 4:11 pm

  51. How quickly statistics become dated!! The latest MGMA survey data reported the following starting salaries for physicians coming out of residencies:
    Neurology: $200,000 to $230,000
    Non-invasive cardiology: $350,000 to $400,000
    Emergency medicine: $192,000 to $215,000
    Pediatricians: $132,500 (the lowest)

    The average annual specialist salary of $339,738 growing at the average rate over the past decade (3.6%) will be $483,884 in 10 years, $665,240 in 20, $947,493 in 30, and $1.13 million in 35 years.

    If you plan on doing a serious study of the issue of physicians’ compensation, you must take this into consideration. Also, it’s important to discount both the costs and the compensation, given the audience (medical students, I presume).

    The reason you’re getting so much sympathy from this audience is that your preaching to the choir. Think about your premise. A specialist in internal medicine makes $35 per hour. If a construction worker made that hourly wage, working 2,080 hours per year, the annual income would be $72,800. So how is it that the physician lives in a half a million dollar house, drives a Mercedes, and sends his kids to the best private school in town while the construction worker…You get the idea.

    Your argument doesn’t draw much sympathy from folks outside the profession. I’m not arguing with the basic premise–that the high salaries are not exactly what they seem. But only that you’ve got a lot of work to do to convince the vast majority of your patient population.

    Fair & Balanced

    January 27, 2011 at 5:50 pm

    • PER HOUR. PER HOUR. PER HOUR. PER HOUR.

      A nice explanation of fractions can be found at
      http://en.wikipedia.org/wiki/Fraction_%28mathematics%29

      Physicians earn more money than most people because they work more hours, not because they are paid more.

      If the construction worker worked 80 hours per week for 8 years and then 60 hours per week for 30 more years then the construction worker would have MORE money than the physician (construction workers get overtime and have less educational debt) and they could have a nicer car and house than their physician colleagues who spent the same amount of time working.

      I still cannot find the 2010 MGMA data; however, if you have them, please share the median gross income of an Internist – so we can compare it to that used in my analysis above.

      In the analysis above I used the reported medial high school teacher salary of $50,000. Now it is $53,504, a 7% increase over 1 year!!! That pales in comparison to 0.36% per year for physicians (3.6/10=0.36).
      (http://swz.salary.com/SalaryWizard/high-school-teacher-Salary-Details.aspx.)

      What matters in determining fair compensation is how much others are being paid in the economy where one lives and works – it is all relative.

      To have a “Fair and Balanced” argument one must apply “new statistics” to all components of the argument.

      Considering that many people find the concept of fractions (dollar/hour) difficult (see comments above including yours) – I realize I have a lot of work to do convincing people that physicians are not overpaid.

      benbrownmd

      January 27, 2011 at 9:22 pm

  52. I think the real issue is the amount of debt a medical student must incur. If that were reduced, then this would all be a moot point. Also, there is SO much variance between individuals on all of these numbers. My doctor (internal medicine) does not come close to working 60 hours per week. Well, let me just say that he’s not in the office that much, at least. He only works 4 days a week, and the office is only open 8 hours a day, with an hour off for lunch. So that’s 28 hours a week. Now I’m sure he hangs around for a while after he stops seeing patients for paperwork and all, but even if he works 10 hour days on those 4 days, he’s only at 40 hours then.

    As for the amount of hours spent studying, again it will depend on the individual. Some students will be able to soak up all of the information during class, skim through the material to review, and ace the tests. Others will need to spend hours and hours reviewing materials just to get a B. It also has to do with efficiency. Some students just aren’t very efficient when they study.

    I think that Ben’s argument however is valid for primary care physicians. There are many surveys showing that fewer and fewer medical students are choosing to go into primary care. For many the decision is made based on their student loan debt vs. expected income. Why go into primary care for $150k when there are several specialties that will start at $250k+ following residency? With $200k in debt, many are concerned about paying that off as quickly as possible.

    Matt

    January 27, 2011 at 10:30 pm

    • Does your doctor ever admit patients to the hospital? If so he may be rounding on them and treating them 3 hours a day before he shows up at his office. That’s what a lot of us do when we are not in our outpatient office.

      My medical school class had 150 people in it. Not a one of us could skim through the material because there was always much, much more than you could possibly learn, and you could be personally humiliated by not knowing any part of it at any time. Or you could harm a patient.

      Everything was either important or you had no frame of reference to know what was important and what wasn’t. Everyone I know studied to their personal capacity to remain awake. Some would eschew attending lectures so that they could just listen to the tape at double-speed while reviewing classmates notes, in order to squeeze in more effective study time. We organized a volunteer note taking service, and I dictated concentrated notes into a tape recorder while studying so that I could play it on my 12 minute drive in to school so as not to waste those minutes. The really quick learners to whom everything comes easily, they studied as hard as anyone else because there was no possibility of actual mastery due to volume. There were always more layers of detail to peel back.

      It was different in engineering school. There, if you grasped concepts intuitively and quickly you could certainly study less and do fine. But the volume of material in modern medical training makes that technique impractical. One of the most important characteristics for those who want to study medicine is stamina.

      Mtbwalt

      July 16, 2012 at 2:02 am

  53. Interesting analysis but there are, I believe, several flaws that when compounded over and over again distort things dramatically. If I had more time I would dig in but I mention a few in passing:
    (1) You don’t recognize that during the extra years doctors spend in school “foregoing” income, they are still being housed, fed, etc… The teacher is earning money to pay for these things, but you’re counting this only as income for the teacher and debt for the student (i.e., not considering the benefit the student gets). This is analogous to the concept of imputed rent, if you are familiar with that.
    (2) You don’t account for inflation. This will likely reduce the debt burden as a percentage of income over time significantly.
    (3) The doctor is likely to reduce his or her tax burden significantly through itemized deductions.

    I respect your opinion and fully recognize that doctors work very hard and don’t really live lives of luxury (most of the time).

    But now my rant (please excuse me…I took the time to write this so I’ll go ahead and post it):

    My personal view is that doctors in this country are, if anything, overpaid. They are the highest paid doctors in the world, if that means anything. They also have the highest salaries of any occupation in this country. Sure, not more than professional athletes or hedge fund managers, but they do get paid more than any other profession. Doctors also have about the best job security around. How many doctors lost their jobs in the recession? Zero, would be my guess. Doctors are supported by what I think deserves the title of “medical-industrial” complex or something of that nature. The medical-industrial complex takes a big fat percentage of my paycheck every month before I ever see it or have any say in the matter (just like the government). I know that pharma and insurance companies are taking their cut as well, but doctors don’t exactly do much to control costs as far as I can see and bill ridiculous sums for all sorts of routine things. Arguing for higher pay for doctors in an environment where medical spending is crippling our economy, society and nation is not going to curry much favor outside of the profession.

    Also, I would say that much of your misery owes to the system that fosters unnecessary and unhealthy competition (by limiting the slots for medical schools, which drives up salaries for doctors in the long run) that students continue into their professional careers. The long hours you refer to are neither necessary or productive. The human brain can only concentrate for so long and absorb information for so long–I take this fact directly from a family member who has a Phd in neuroscience. Taking a break from studying or practicing will improve performance over the long run greatly. Doctors are the ones torturing themselves and other doctors and for no good reasons. Don’t look for more money, look for fewer hours. That is what will make you happier in the long run anyways.

    Karl

    January 27, 2011 at 11:19 pm

    • how can u look for fewer hours when USA do not have enough doctors for baby boomer?

      anna

      January 28, 2011 at 9:33 pm

      • Let more students into medical school and also have the doctors work less hours. I’m not a doctor but I imagine there is a lot of time wasted, just as there in everything. Secretly, I think a lot of med students and doctors relish their long work days because it makes them feel really important. There are people like this in every profession and they make life miserable for everyone else around them.

        Perhaps tort reform would do something to help the situation.

        Anonymous

        January 28, 2011 at 11:14 pm

      • @ anonymous responding to anna,
        Yes, I can truly say that i relish the hours between 5 PM and 11 PM that I spend “finishing” my work for the day (in quotes b/c it is never really finished). It makes me feel really important to fill out prior authorization forms requesting medications that are important for your health, document something sensible in your medical record so people like you won’t sue me, and missing my family so I can be a better and more important doctor for people like you. Yes, please keep this a secret because I don’t want others to know that this is the only reason why I love my job and most of all, love wasting my own time to feel important. It must explain why my family is miserable. Thank you for shedding light on my situation.

        Wilmington's Jen

        February 12, 2011 at 2:21 am

    • Doctors in other countries have a shorter training regimen (6 years from high school to the MD equivalent (usually an MBBCH)), shorter residency, rare fellowship, fewer hours that they work per week, more vacation, pensions and benefits that US doctors do not get, and almost universally have their entire college and medical school paid for by their government’s taxpayers, often with a living expenses stipend. Moreover, physicians in other countries are almost never sued, and thus have significantly reduced overhead in malpractice insurance coverage (in contrast average US doc sued once every 8 years).

      How many doctors lost their jobs in the recession? Well, when a significant percentage of people stopped paying us for our work because they had no insurance and no money – 30% of the people who come into the ED fall into this “self-pay” category – combined with 5% pay cuts on Medicare/Medicaid patient year after year after year, my group let go 3 physicians and we have foregone hiring others to replace retiring docs. So, just in my local group you could say 3 lost jobs and several more were never hired. However, over half of docs are hospital employees now, and as hospitals have trouble making ends meet they certainly can and do fire physicians who do not meet their productivity and financial goals. So your theory that bad economic times do not affect physicians is completely off. The only ones that do better in bad times are the debt collection agencies.

      Mtbwalt

      July 16, 2012 at 2:25 am

  54. “Yes, teachers spend time “off the clock” preparing for class, correcting papers, etc. However physicians also spend time “off the clock” reading, studying, going to conferences, etc.”

    *****************

    The above comes from Dr. Brown’s article. Yet appears to have been overlooked by quite a few people. I’m not going to go back and count or quote the negative comments directed to the author because they believed he dared insinuate that a teacher’s day is over when the bell rings while a doctor’s day runs on and on. He acknowledged that teachers have a job to do away from school/off the clock. Why can’t people see he wasn’t attacking? It was an analogy.

    If you’ve ever worked for a doctor’s office, you’ll know that while an office may have hours from 9-5, the doctor usually has a day starting well before that. If he has hospital privileges, he could begin rounding at the hospital at 5 or 6 in the morning. His evening ends after he’s dictated the charts from that day. Those 15 or 20 minutes he spends in the room with you don’t magically write themselves in your chart. He has to do that. If he has surgeries, those have to be prepared for and laid out before he actually walks in the OR.

    How is it that the author is catching so much flak for trying to bring home the point that with the continued decrease in reimbursement, America is going to lose its doctors?! It’s not just any population that will disappear, it’s the rural docs or the family medicine types or the pediatricians. The ones that you routinely rely on and think will always be there.

    Dr. Brown isn’t a million-dollar earner saying pay ME more. The likelihood that he is dependent on insurance reimbursements is incredibly slim. Most plastic surgeons I’ve known were cash only, with insurance being billed in cases involving reconstructive surgery. I’ll hazard a guess that telling him to stop taking Medicare was probably a waste of a post.

    You guys who think the author is spewing so much garbage need to take a step back and reevaluate the situation. Make it personal.

    If all primary care doctors (including family practice, pediatrics, ob/gyn) in your area, disappeared tomorrow, what would you do? Would you drive 4 hours to the closest doctor when you thought you had the flu? or would you complain that the doctors got too greedy? The likelihood isn’t that the doctors got too greedy. It’s that they couldn’t afford to be open for business anymore.

    Others have mentioned the breakdown in reimbursements and the answer was to stop taking Medicare. What if all doctors stopped taking YOUR insurance because your insurance wanted to net multi-million dollars profit while paying its CEO millions of dollars but reduced payments to contracted providers?

    http://www.boston.com/business/healthcare/articles/2009/02/28/blue_cross_ceos_pay_rose_26/

    http://www.timesfreepress.com/news/2009/may/13/bluecross-profits-less-healthy-pay-rises/

    http://www.aetna.com/news/newsReleases/2010/pr_4thquarter2009_earnings.html

    http://www.wikinvest.com/stock/Humana_(HUM)#_note-09mainfinancial

    Reform the insurance companies. They are this monopolistic beast that control the purse strings of hospitals and doctors across the country with their slash and burn reimbursement system. A physician’s office or hospital will submit a procedure and by the time the insurance company processes/downcodes/rejects the billing, the final payment can be roughly 1/2 of what was originally submitted. That’s on a good day.

    I commend the author for his post. It’s one I’ve shared with friends and family if only so they can see the time and energy that myself and my colleagues will invest for what will hopefully be a fulfilling career, doing something we are truly passionate about.

    Another Med Student

    January 27, 2011 at 11:53 pm

  55. Specialists’ incomes are up 36% since 2000 – that’s 3.6% per year. I realize that it’s a stretch to say that those same increases will extend 35 years into the future, but it’s no more a stretch than the original analysis.

    The MGMA survey states that the median income for an internist in 2008 was $191,198, up 28% over the 2000 median of $149,104 – that’s an annual compound rate of about 3% (Based on the 2009 survey.)

    Karl is right that all personal maintenance expenses – food, clothing, housing, transportation – are irrelevant in calculating the return on education. You still have to live no matter what you’re doing.

    All of this means very little (including what I’ve presented) unless you apply a discount rate to everything – to make the dollar costs and benefits comparable to today’s dollars.

    Fair & Balanced

    January 28, 2011 at 10:44 am

    • The personal maintenance expenses are not directly in the above analysis. Read it more carefully. They included only insofar as one needs to go into debt to pay for them. They are included in the teacher’s college student budget and the doctors college and medical student budgets. The essence of this article is the calculated ADJUSTED NET HOURLY WAGE. Which is as pure as it gets….the amount of money someone earns for the time they spend providing a service.

      Someone has yet to point out a legitimate flaw (one that can be better accounted for) in analysis.

      If anything this analysis would under-estimate the net adjusted hourly wage for non-physicians because it doesn’t account for the physician’s inability to start saving/investing at an early age. When you live in the red for 15 years, it is not fees-able to invest.

      Anonymous

      January 28, 2011 at 12:29 pm

      • I think people have pointed out many legitimate flaws. One of the biggest is likely applying an interest rate (7%) that factors in inflation while failing to account for inflation in the assumed wages. I would like to see what the analysis looks like if you used an interest rate of 2 or 3% (much closer to the “real” interest rate on student loans). Either way you run the analysis, it is exaggerating how much the cost of education lowers doctors net hourly wage.

        On the issue of personal maintenance costs, the point is that some portion of the doctor’s education expenses are not for the purpose of education to enhance future earnings but rather to simply live on. The teacher who is out of school in this hypothetical is using his or her income to fund those personal maintenance costs. Thus, you should remove the debt associated with these expenses from the equation.

        Another flaw I neglected to mention, the author appears to count the teacher’s benefits as income but not the doctor’s benefits.

        All of these little things, which appear to all bias in the same direction, are likely together distorting the conclusion significantly. I would hazard a guess the hypothetical doctor is earning more like $45/hour net and the teacher around $30/hour. Thus, there is a 50% premium for the doctor’s wages.

        On the investment issue, things work both way. While doctors might start investing later, they are going to have a lot more to invest once they start working. If you include this is your analysis you’ll find that while maybe 10% of the teacher net earnings might be available to the teacher to invest, the doctor might have more like 25%. If you apply a rate of return to these investments, you’ll find the doctor comes out well ahead in the long range, which accords with everyday experience, where one does indeed find many wealthy doctors and teacher all middle class (unless supplemented by some outside income)

        Lowest of the list of any fears I might have about the future is there will be spots in medical schools unfilled. This is simply not a realistic concern.

        Karl

        January 28, 2011 at 8:02 pm

  56. Excuse me, why should anyone reward the poor choices of American physicians with higher salaries because they chose to attend such expensive medical schools in the United States, when there were cheaper options elsewhere, outside of United States?

    What makes medical education so expensive in the Unites States? Why is a medical degree even deemed necessary to take the USMLE exams? If a person can study medical textbooks from home, work part-time, and pass the USMLE exam while avoiding these inflated tuitions, why can’t he be allowed to move straight to a residency/internship? You don’t need to be proficient in dissecting cadavers or dissect a cadaver for a year in anatomy class in order to pass the USMLE or ultimately to be a good physician. If instruction in medical school is so expensive, why don’t we cut down on the number of medical colleges by a third and triple the class size in the remaining colleges, thereby reducing costs? The free market does not operate in American medicine or American medical education. You can blame America’s physician labor unions for this (and the AMA leads the pack).

    Alright, so you have already finished medical school and are in residency training? Guess what your training is worth now? It has a negative value! Residents-in-training, seriously think about this: after 8 years of your training, your hospital is being compensated for your existence in the form of indirect medical education costs, amounting to almost $100,000 per resident, and the indirect costs are almost twice(!!) the direct costs of your education, i.e. your salaries, both of which happen to come from Medicare. In other words, according to the American medical system, residents are a liability on the system, and thus worse than pet animals (nobody pays me to own a pet). In America, the idea that a residency is a mutually beneficial apprenticeship is only a facade. So, if you want higher physician salaries, and some self-respect, then you probably want to leave this country.

    https://www.aamc.org/newsroom/reporter/feb09/87798/feb09_payments.html
    https://www.cms.gov/AcuteInpatientPPS/07_ime.asp

    Anonymous

    January 28, 2011 at 6:24 pm

  57. To both Dr. Brown and his dissenters:

    While sitting at my desk preparing for my Reproductive System final exam this Monday, I was IM’d a link to your article above. Firstly, I would like to say that I really appreciate your explication of this issue in a public forum. I have a somewhat unique background that I think is relevant to many of the comments that were made here, and for this reason, I thought my input may serve a purpose.

    In the past, I worked as a janitor for a couple of years, then as an EMT for a few years, and after obtaining my Bachelor’s degree, as an Adjunct Professor for a year before starting medical school. I can remember putting in 90 hour work weeks as an EMT and that still does not come close to the ridiculous amount of effort that we–my classmates and I–put in week after week as medical students. I think that I speak from a qualified perspective when I say that I could not have anticipated the challenge that this sort of a schedule and lifestyle would present. As a janitor I thought I worked hard–and I did. As an EMT I know I worked hard, there’s no getting around 90hr work weeks being difficult. As a teacher I constantly felt the pressure of schedules. But as a Medical Student, I have never been so entirely consumed as I am now–so much that I regularly close myself in a room on the weekends and break from studying for a 2 or 3 hour nap. My weekdays often end at 3am and begin at 7am. And all of this to score average on my exams.

    I don’t think that most of us in the medical profession are looking for sympathy or even public recognition of our sacrifices, but poor compensation certainly is a reality that needs to be addressed. Addressing this topic, however, demands a thorough investigation into our daily lives, with exactly the sort of due diligence that you have put in here to justify a rational discussion of compensation. In regard to your estimates, I think I fit right inline with your statistics regarding debt. As a second year medical student, I began with $110,000 from undergrad and have added my tuition and cost of living, which has been $71,000 for my first year and $73,000 for my second year. I was the first in my family to go to college, so all of this debt is mine with no assistance from anyone else (they would help if they could, but simply cannot afford to), and yes during medical school I have received one $5,000 dollar scholarship, for which I am extremely grateful! But as you have discussed here, with debt like this, we really are not making a lot of money in the end, given the hours that we work. As it is, $50,000 of my private loans from undergrad are now in repayment and I am stuck making the minimum monthly payment with my cost of living loans. This lifestyle is if anything, a sacrifice, albeit one that I neither apologize for nor care to often bring attention to. I am happy to be in the position that I am as a student and one day, as a physician. I am proud of the fact that I regularly sacrifice sleep to study, staying up until 3-4am and often in class the next morning, because I am confident that this will one day make me a competent doctor worthy of my patients trust. Insomuch as your article here has spurred quite a lot of debate, I can only say that from my experience as a janitor, to an EMT, to grading exams and preparing lectures as an adjunct, nothing in my life has come close to the rigor or demand that medical school requires of me on a daily basis, and I further doubt that anyone who has not experienced it or been close to someone who has can truly comprehend the physical and mental and emotional toll that our profession takes on us. And, for the most part, we endure it silently.

    Joshua Ewell

    January 29, 2011 at 12:22 am

  58. 2 or 3% interest on student loans, Karl???? Seriously?!

    My new loans are at 6.8%, the ones that aren’t handled by Sallie Mae anymore. The Subsidized/unsubsidized that previously came through Sallie Mae have a 7.5-8% interest rate on them. The private loans that I’ve had to take out on 2 occasions are at 8.5%. I’m not sure where you got 2-3% from but you’re very very wrong.

    http://studentaid.ed.gov/PORTALSWebApp/students/english/studentloans.jsp

    “Direct Subsidized Loans:
    Graduate and professional degree students—The interest rate is fixed at 6.8%.

    Direct Unsubsidized Loans—The interest rate is fixed at 6.8% for all borrowers (undergraduate and graduate).”

    To anonymous who suggested medical students have no right to complain because of the choice to go to school in the States, that right comes with a ‘privilege’ if you will to get first dibs on residency spots. It doesn’t mean everyone who graduates from a US school will get into residency but we’re mostly placed first. Do you know that to be licensed in the States you have to complete a US residency? I can’t just go abroad to school and residency and come back here to practice.

    The likelihood of a US citizen going abroad to school and coming back and getting accepted to residency is about 55%. The US medical school graduates getting into residency? about 94%. why would I take the chance of going abroad to school and coming back and not getting into a program for a couple of years. It happens.

    Do you know that if I go abroad to school I can’t rely on the US gov’t ‘low interest’ (if you can call it that) loans? I would instead have to take out a personal/private loan that doesn’t have built in deferment options and such. Oh and the interest rate is closer to 10%.

    I shudder at the thought of someone homeschooling a medical school curriculum and thinking they can be licensed to practice without a single hour of hands on patient contact or any anatomy interaction. Hopefully, your degree from Medical School Home University is displayed prominently on your wall so I can leave before you ever have to attempt to treat me.

    Another Med Student

    January 29, 2011 at 12:32 am

    • I agree…

      I am right now in a library as an OMS2 studying for my Repro Final Exam on Monday morning.

      This whole weekend I will sleep about 8 hours and I do this about every other week.

      I also go to school form 8 to 5 and then go home to study from 6 to 11 every night.

      Sometimes, I sit here thinking why I chose this profession, and I see the smile on people’s faces and I am reminded; I am here to make a difference. But when people take out of context what it means to be paid hourly and dare compare what physicians sacrifice, is just flat out disgusting. To become a physician in this country takes more work ethic than 99% of jobs, only do small time business owners work as hard as we do, but on average, even they don’t come close to investing the amount of TIME physicians do.

      Med Student 4

      January 29, 2011 at 1:26 am

    • You misunderstood the point about the interest rate. Interest rates such as those you are quoting in factor in inflation expectations. In the real world, there is inflation. The op doesn’t account for it in his analysis. There are different ways of dealing with this. One would be to adjust the salary information. The other would be to adjust the interest rate. Either approach would lead you to the same conclusion, which is that this is a serious flaw in the analysis that vastly overstates the impact of student loans on lifetime earnings.

      Karl

      February 14, 2011 at 10:12 pm

  59. The following is a real email conversation between a MD and a recruiter. This explains another aspect of the situation. The MD has not heard back from the recruiter yet.

    Dear Sxxxx,

    This sounds like a great opportunity, 40 minutes (>90 minutes with traffic) from NYC in rural New Jersey. I had some time today, so based on job description I did some conservative calculations:

    120 patients per week. If each pt is seen for 20-30 minutes, that is 55-60 hrs/week
    Hospital census min. 5 per day (conservative estimate each acutely sick patient 40-45 minutes,including admissions & discharge of some of those patients), all 6 days (since alternate weekend call)…. that is 27 hrs/week.

    Even if 2 hours in subacute care rounding, 3 times a week…6 hrs/week.

    4 hrs nursing home round a month…1 hr per week.

    1 hr lunch break…6 hrs/week

    90 hrs work week, excluding ther travel between clinic, rehab, ED and nursing home…2 hrs per day with traffic=12 hrs per week. Excluding travel between home & work, total work hours are approx 15 hrs/ day averaged over 7 days of the week, ONLY if there is no night/beeper call.

    With 2 weeks vacation, 50 weeks of work, for $150 k including bonus= $3000 per week

    Pay per hour $3000/104 hours=$28.84 for an MD working 15 hours everyday of the week, averaged.

    Please help me understand better.

    Thanks,

    SXXXXX AXXXXXXX, MD FACP

    — On Thu, 1/27/11, SXXX BXXXXX wrote:

    From: Sxxxx Bxxxx
    Subject: New Opportunity-Northern NEW JERSEY (little over a half an hour to NYC)
    To:
    Date: Thursday, January 27, 2011, 11:59 AM

    You see an average about 120 patients in the office per week. The hospital census is about 5. The hospital census normally goes up when you take ER calls. Then it falls down to average of about 5. They have patients in the sub acute and Long term in nursing homes. The long term patients need to be seen once a month. The subacute have to be seen 3 times a week. Typical Sub Acute census is about 5 patients.

    The internist will be on call every other week end. The week end call works like this: Office half day from 8 to 12 in the morning and then hospital patients of Saturday. On Sunday, only hospital patients.

    Salary of 145K with 5K bonus at end of every year, 2 weeks paid vacation and malpractice

    Unfortunately, they can’t accept visa.

    If you know someone or yourself who may be interested in hearing more about the opportunity, please call me at XXX-XXX-XXXX.

    SXXXX BXXXXXX

    Search Consultant | Primary Care

    XXXXXXXX Permanent Placement

    Office: # XXX-XXX-XXXX | Fax: #XXX-XXX-XXXX

    docscoobie

    January 29, 2011 at 8:29 am

    • And I thought my job hours and compensation was bad!

      Wilmington's Jen

      February 10, 2011 at 1:10 am

  60. Dr. Brown, I applaud you for your effort in giving the ignorant masses some insight on this subject. I’ve been scrubbing for you guys at a large level 1 trauma hospital here in Connecticut for 8 yrs and see how people/patients abuse the system every day. For those that arent familiar with the inside of the healthcare scene other than the weekly tv dramas and are jealous that an MD has a nicer vehicle than you, try it out for yourself! I am your regular ole taxpaying citizen with some ambition and conviction but find it unreal what these people endure to help people. Fair compensation for what surgeons do? Heck yes! I am very happy knowing that people pursue this career, last thing needed is to make it a less desirable choice of occupation. Did you send this to Hussein over in the oval office by chance?

    John

    January 29, 2011 at 5:00 pm

  61. Seriously? I cannot believe the comments from people who think that arrogant doctors are wanting more money for no reason. Really. Well, let me tell you. I just quit a very emotionally rewarding career in trauma surgery and critical care. I helped injured and sick people everyday. After several years and one pregnancy later, I got pissed. You see, I spent hours at the hospital. 40 hours plus in a row, no shower, nasty underwear sticking to my stinking butt, haven’t eaten in hours, haven’t peed in hours, haven’t brushed my teeth, haven’t seen my baby, leaking milk, breasts throbbing, pager beeping, another gunshot in the trauma bay, cellphone screaming, patient in the ICU crashing, residents demanding an education, families crying, another death, drunk head injury just spit on me, oh, another gunshot wound (someone shot a 3 year old in the heart and I have to fix it), now my socks are bloody, stop to take out an appendix, keep going on and on…

    Yes, I went into medicine, and then surgery, and then trauma for both the tangible and intangible rewards. Well, you know what – I WANT TO BE PAID MORE FOR WHAT I DO. The tangible rewards are not enough any more. I do have loans. I do have bills. Regardless of what the naysayers would say, the mental “coolness” and status of being a doctor does not equal money. Nope. Doesn’t. And guess what. My credit SUCKS. Why? Because in residency, I went into repayment on my loans. I didn’t have enough money TO EAT.

    Oh, and to those people (or their wives/husbands) who have to grade papers until midnight and get to school at 645AM, and give their students time and don’t have time to pee..cry me a river. I’ll do it. I’ll be the arrogant a**hole doctor (drives a Mazda, BTW) and just say it: Your job is NOT as hard as mine. It isn’t. Never will be. Sorry.

    Now I am a general surgeon. I still leave at 6 AM and get home at 8 PM. It’s a little less work. But, I get to see my kid at times and I make a little more money.

    Really.

    January 29, 2011 at 10:52 pm

    • i just peed my pants a little. partly from laughing and partly from not having peed in hours.

      Anon

      February 1, 2011 at 5:39 pm

      • haha, i love this post.

        Anonymous

        February 3, 2011 at 10:37 pm

    • I just got a flashback from my trauma rotation, give me a Xanax quick! AHHHHHHHH!

      ER clone

      February 1, 2011 at 8:36 pm

    • OMG that’s awesome… I remember as an OB-Gyn intern wondering how the hell I was going to get out of the OR with leaking breasts so that I could pump (I couldn’t)… hated that I had a newborn baby at home who I hadn’t seen in 36 hours, on call every other night. Switched to medicine and haven’t regretted it one single day! I hope Dan is reading each and everyone of these posts… but I bet he doesn’t get it….

      Caitlin Foxley

      February 2, 2011 at 12:17 pm

  62. In the end, medicine is still a type of business. And like any business, fundamentally income = revenue – expenses.

    Revenue is dictated by the insurance companies (ie. I can decide to charge $100 for an office visit, but the insurance company will only pay me $60 + patient’s own copay). So I an set whatever fees I want, but I will actually only get paid what the insurance company wants to pay me. Therefore, revenue is fixed and out of our direct control (unless we go boutique and stop taking insurance altogether).

    Expenses to some degree is also out of our control. Yes, we can decide what to pay our staff, what benefits to offer them, which building to rent, etc. But there are other REQUIRED expenses that are fixed: (1) malpractice insurance, (2) licensing fees, (3) maintenance of certification fees, (4) re-certification fees, etc. Thus, expenses are to some degree also fixed and out of our direct control.

    If policymakers, lawmakers, and the public want to reduce healthcare costs, then you need to alter either or both of the variables in the equation: revenue and/or expenses.

    If you reduce doctors’ revenue, then for reasons Dr. Brown cited above you must make it more affordable for doctors to complete training. Loans don’t count, as they they to be repaid at some point. Going into medicine with 6-figure debts and low reimbursement afterwards just is not financially viable.

    If you want to reduce doctors’ expenses, then reform must take place. In my opinion, such reform must include:

    (1) caps/limits on “frivolous” lawsuits that increase malpractice insurance – yes patients can and should sue for negligence, but to sue for silly reasons AND WIN is ridiculous (ex. patient had bad outcome because they had abnormal lab value. doctor called, patient did not return calls. doctor mailed patient, patient admits they got the letter but ignored it, so bad outcome happened. patient sued and won, because patient’s defense was, “if it was that serious the doctor would’ve tried harder to call me.”)

    (2) caps/limits on patients requesting unreasonable tests (ex. patient thinks they have a food allergy and demands testing or a referral to an allergist, even though history is highly suggestive of lactose intolerance; patient has a cough and demands a chest x-ray even though you think it is just a cold, etc).

    (3) caps/limits on patients ignoring medical advise (ie. doctor tells patient to stop smoking, patient continues to smoke and ultimately gets lung cancer … whose fault is that? who should pay for ignoring doctor’s advise? or patient who has high blood pressure and is started on appropriate medication, but patient stops taking it because they feel fine, then winds up with a heart attack … who pays for the hospital stay and the treatment?)

    In the end, it all comes down to simple math: income = revenue – expenses. Which variable(s) can we reasonably manipulate for the better?

    Sympathetic

    January 30, 2011 at 9:07 am

  63. A LITTLE hard to swallow. Take a drive with me around town–let’s compare the average teacher’s house to the average doctor’s house. Then let’s have a look in both garages. Which do you think contains the Mercedes?

    I know it depends on the specialty, but I promise you there are doctors I know who have regular, manageable hours, and never bring work home.

    My job as a teacher rarely stops–weekends, nights, you name it. (I got in a lot less golf than the average doctor, too.)

    I have the utmost regard for the medical profession. But if the money and the task were that imbalanced, we’d have doctor shortages on the level of teacher shortages in this country. We don’t. All in all (and once the student is through that training that is–admittedly–grueling), it’s still a pretty cushy life. Sorry: no pity here!

    Defensive Teacher

    January 30, 2011 at 10:38 am

    • Defensive Teacher,
      Give me a break. You think all doctors play golf, right? And you think they come late to appointments because they were at the country club all morning?!? Get a reality check. The doctors in the hospital I work at get there at 5am and leave around 5 pm. Trust me the residents work a heck of a lot longer than that too. They are constantly harassed by patients and sued in frivolous lawsuits which have crushed the healthcare in this country. Thats a cushy lifestyle?
      Thank you for having “upmost respect.” However your analysis of a doctors life is uneducated (irony be damned).
      And most of all, WE DO HAVE A DOCTOR SHORTAGE IN THIS COUNTRY!!! A HUGE ONE!!! And its only predicted to get MUCH, MUCH worse these next 20 years as the geriatric patient population grows from the baby boomer generation.
      Sincerely,
      Go back to school.

      Defensively Defensive

      January 30, 2011 at 2:51 pm

    • Defensive Teacher,

      Please allow me to reply, and feel free to comment. Please excuse my grammar as I have been up a very long time. I have a unique view of the situation as I am the grandson of steelworkers and coal miners, and the son of public school teachers. I, in no way shape or form, come from wealth or a long line of physicians. I have the utmost respect for both professions. In the past I’ve had great teachers who encouraged me to push the limits of my ability and experience that “wow” moment when I finally did understand a complicated subject. These are the teachers who were meant to teach. Fortunately, they were much more common than the opposite: a teacher who passed out books, made us read them in class for 10 minutes, then sent the pretty girl to the map to identify China as the rest of the class giggled when she pointed to Canada.

      In college I picked a hard science discipline which left me studying long hours, giving up free time, and slaving over the books. I have to admit, at a state “teacher” college, while many of my very close friends were preparing to become teachers, I was envious. Everyone worked hard at what they did, but the rigors of study were not comparable. While I slaved away in a lab with math calculations and integral calculus, they complained, with good humor, about memorizing kepler’s laws in into to astronomy —a fact that some of my very close teacher friends still joke with me about today.

      My parents saved hard and paid for every cent of my college undergraduate education. I got a great undergraduate education at a state “teacher” college at a great value for my parents. My father still loves to chime in with the fact that he paid for my entire college education—-and I allow him that—he deserves it.

      My parents had always encouraged me to become a teacher referencing their summers off and favorable work benefits. My parents though were proud as peacocks when I told them I was accepted to medical school.

      Medical school is expensive. My tuition in just my first semester (one of eight) in medical school was far more than all four years of college combined. Like everyone else in my class, you finance finance finance everything—but the money is available. No one who gets accepted to medical school does not attend because they can not get loans. The banks and lending institutions know as a physician you are a pretty safe bet when it comes to repayment.

      While in medical school my parents did not understand why I could barely stay awake sometimes during our weekly phone conversations. Or why I seemed to be constantly studying even during rare vacations and could not come home for the holidays. They were soon about to find out.

      Following medical school I was fortunate enough to “match” into an internship in my home town. For those not familiar an internship is a one year generalized medicine or surgical training year required after medical school for a variety of disciplines. It builds a foundation for further training and quite frankly shows you that you barely scratched the surface of knowledge in medical school. For financial reasons I would live with my parents for this year. They were working their final few years as teachers prior to retirement at the time. It was a real eye opener for them and finally they understood the rigors of medical training. As has been spelled out in detail in numerous posts prior to this, I often worked longer in one shift than they had all week. Complaints about getting report cards done on time or having to take bus duty on a friday did not come up much after seeing my bloodshot eyes after a long shift where I detailed our efforts to revive a patient who had overdosed on narcotics which resulted in the patient spitting in my face and a prompt letter from the family and attorney alleging malpractice.

      Suddenly they kinda understood this was not all just studying. They understood why the new golf clubs they got me for graduation still stood in the corner of the garage with the tags still attached. They started to understand this “job” paid me less than half of what they made, but required extraordinary resolve. It was a real eye opener for the both of us.

      Following internship I moved away and completed residency successfully. Of course my loans with compounding interest followed me. I have to admit I really do not understand why student loan interest is not tax deductible. When you can finally afford to start to pay off some debt, the deduction is invalid if making over 125,000 per year. Hmmmmm, So at age 32 I can finally get my first job but actually my interest and tax bracket increase so there is actually less in the pot to pay back. But I digress.

      I enjoyed this article and it reminded me of a recent story.

      Both teaching and medicine are great professions with their own rewards. I know both sides of the coin.

      Now employed as a full time physician, I was fortunate enough to get some time off over the christmas holiday and decided to spend it with my parents. They are now retired (both 60 years old) and as such spend the winter months in florida in a very modest house they purchased to escape the harsh northeast winters. It was a joy to spend the holiday with them in the “retirement village.” Just in conversation after a round of golf I mentioned over a few beers with my father and his friends I had set up my retirement account with a target retirement date of 2040. Well what do you do?, One of his friends asked. My parents always the proud parents said I was a physician……..OOOOO they piped up, I thought you would be a little better at golf since you probably play alot. My parents and I both chuckled. Tell them the funny part my dad responded….Ok ok I replied: ” Im scheduled to make my last student loan repayment in 2037.” Everyone burst out in laughter but then died down when I said, no Im serious!!!

      A bit later a round redfaced gentleman inquired about his granddaughter who had expressed an interest in going to medical school after college. He asked me what was involved in preparation and the like. I inquired as to her motivation. She had always enjoyed helping people and shaping youth and wanted to become a pediatrician. I asked if she had ever considered teaching. Yeah he said but she is convinced there is big money in medicine. My dad, mom, and I just looked at each other and laughed. I just told him to encourage her to work hard, keep her grades up, and volunteer at a pediatric clinic.

      Later that night, as I was scheduled to fly back the next day, my dad asked me if I didnt get into medical school what I would have done. Well probably try to do some research, improve my board scores and the like, try again the following year. And then what if you didnt get in? And in all honesty replied, “I would have been a high school chemistry teacher.” And I meant it. You could do much worse he told me.

      What does your schedule look like for next week he asked me. I work all week and the weekend—probably 70 hours. Well I will tell the guys on the golf course tomorrow what a glamorous and exciting week you have lined up.

      Later that week my father called me from the golf course. He and his buddies were just tickled they got in 18 holes and a cart for 20 bucks. They wanted to say hello and I was jealous as I just got done working for 14 hours. My dad asked me when I would be making it down again. Probably next year I told him. I missed the weather in florida and the company, but just could not get the time off. He asked me if I had any regrets about becoming a physician. All the guys down here think you are rich, play lots of golf, and have beautiful nurses chasing you around the hospital, but I give them the real story. I know I know. I will make it back when I can. So you would not trade places with me he asked, like no regrets?………..Not for a second I told him. Money is not everything, but hopefully one day I can retire like a teacher.

      Just my 2 cents.

      Comments welcome

      unique view

      February 9, 2011 at 11:48 pm

  64. Excellent! Hopefully this will shed light on the discrepancy!

    Anonymous

    January 30, 2011 at 2:53 pm

  65. I know I am just belaboring the points made by many others, but I felt the urge to respond.

    College
    I spent about about 30 hours per week in class, disregarding labs. I spent 20 hours working as a research assistant including weekends. I then worked 20-25 hours per week in fast food to make ends meet. I had to ‘make ends meet’, because my parents couldn’t contibute much. One was in the military and one was a nurse. They made just over the limit for me to qualify for any assistance. So, I graduated with about of 40k in loans. My best friend from highschool had foregone college, gotten married, bought a house, and had a daughter.

    Med School
    For the first two years, I attend class 45 hours a week. Add to that about another 60 hours of home study and article review.

    The second two years were spent in clinical rotations. The medical students were expected to have seen the patients before the residents arrived and have a brief report ready. On surgery, we scrubbed in on all available cases. On medicine, we attended all ‘teams’ grand rounds.

    In response to a previous posters comments about Family med docs, we rotated in the community, we showed up at various community hospitals at around 5am to round on their inpatients before traveling across the county to their office. We treated office patients till 6pm. This was interspersed with one of the docs having to travel to the ER to admit one of their patients to the hospital. That doc alternated call with another one in their practice to cover admits.

    My best friend and roomate from college got married, bought a house, and is expecting.

    Residency
    I’m an emergency medicine doc. We are the 24-7 doctor’s office. We treat and stabilize all of the shootings, stabbings, MVC’s, MI’s, strokes, etc. We also do the same for all of the coughs, insect bites, drunks, chronic back pain, need a work excuse folks as well.

    When I’m working in the ED, I work about 60 hours a week with 6-10 hours of lecture. Add to this the 20 hours I spend reading articles and studying.

    When I’m working off service it’s a much greater workload. I am an acting Ob/Gyn, Orthopedic, Peds, Trauma, ICU, anesthesiology doc. We have our clinical duties and didactics as well as our baseline emergency medicine studies. In fact, I’m reading and writing this on one of my 4 only days off in the ICU this month, where I am running the ICU for 30 straight hours when on call. Some months are better and some are worse.

    Financially, I have garnered about 200k in debt. My friends are close to 10 years into their retirement/pension savings, spend their evenings with their kids and spouses, and their weekends doing yardwork. I’m not bitter or jealous in the least. I’ve had a precipitous newborn named after me (I tried to change their minds) and I’ve had to tell parents that their son died.

    I love the work that I do and can’t think of doing anything else. However, it does chap my hide when I hear the “docs are overpaid” mantra. I’ve made it to 32, have 200k in debt, work/study on average 80 hours a week, and am responsible for life/death on a daily basis.

    EM Resident

    January 30, 2011 at 11:06 pm

  66. http://www.payscale.com/research/US/All_K-12_Teachers/Hourly_Rate

    Average hr. rate for High school teacher is: $15.28

    Seems hard to imagine that when you factor in 4 years of schooling that their average pay per hour goes up by about double.

    There is some validity to the point that doctors are not paid outragous sums for the amount of time they have to put into their careers. But why get in a pissing match with other professions. Also I think most doctors know before hand that it is going to be about $300k in debt and 4 yrs of med school, and 3-6 yrs residency and then possible fellowship, etc. Most know going in that they will have to study none stop and then work long hours. If you didn’t know that who’s fault is that? The data is freely available. If you did know that then you could have quantified the the sacrifice beforehand and saved everyone from listening to all this crying and chose to become a teacher and live the high life.

    Nate Jones

    January 31, 2011 at 12:35 am

    • First: Your website is simply looking at a cross-section of teacher salaries. It has not adjusted for lifetime earnings or any other variable for that matter. If you looked at a resident’s $40k earnings at any random point in time you would find that it too is very modest.

      Second: I hate to belabor an ongoing misunderstanding but the original post by Ben was not intended to be a “pissing match.” Teaching (as a profession) serves as a model for comparison because it has easily accessible characteristics – such as: underpaid, is rewarding work, tons of social perceptions etc. If you look at the purpose of Ben’s post then you realize he is not discrediting teachers but instead uncovering a common social misconception – that doctors are grossly overpaid. By pointing out the similarities with teachers (who we all know are NOT overpaid) then his purpose is achieved.

      Third: Regarding another commonly repeated argument – that doctors know what they are getting themselves into. I agree. We generally do know what we are getting into. I say generally because what can be assumed is the academic workload, loan money, whatever. However what we can’t predict is the backlash from just being a doctor. We’re not asking for anyone’s sympathy. But it would be nice to not be ridiculed for our sacrifices. It is hard to want to help people who have a general disgust for you.

      Anon

      February 1, 2011 at 5:31 pm

  67. [...] much more than they would have earned without a J.D. But what about doctors? Is it worth it. This article says no: Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount [...]

  68. Dr. Brown,
    Thank you. I did work >80 week in medical school and did work over 80 hours / week in residency. I am talking about “in house work”. In addition to that I then had to study for boards. I missed weddings, baby showers, holidays ever since I made the decision to become a doctor. In residency I was not been able to maintain my weight because I never have time to eat. One of my co-residents cried every day after she returned from her 4 weeks of maternity leave because she only saw her new born baby awake once a week. This is the reason I did not have children during residency. Not to mention I was paying for school until I was 28 and did not actually have any real income until that age. (real income means 45,000/year). The sacrifices made are not worth it. By the end of training, most of us end up as bitter jaded physicians who do feel unappreciated. My goals of “helping heal the world” have disappeared thanks to people like Dan who do not understand, ungrateful patients, rude nurses, etc. Now, I just want out but I am stuck with 200,000 in debt.

    Bitter doctor

    January 31, 2011 at 4:21 pm

    • Spread your story to others who consider making the same error. Let them make a more informed choice. It is enlightening that 80% of all family practice physicians discourage their children from becoming physicians. I know several physicians who sent their children to college on one condition- that they would not be premed.

      Declare bankruptcy if you can. Find another profession that you can live with and that pays you an acceptable hourly rate.

      I am sorry for your plight and wish that you would have known before hand. I, myself, did not know because the transitions were occurring while I was in medical school and residency. Ironically though, my mother, who had several physicians in her family, some well known, was trying to talk me out of medicine when I was nine years old. Essentially, it was when Lyndon B. Johnson started Medicare, etc. I was probably the only kid on the block whose mother was trying to talk him/her out of it. The others were saying, “my son/my daughter the future doctor”. My mother was a woman of great intellect and foresight. It is an act of rebellion that I regret to this day.

      Roy Blackburn, M.D.

      February 13, 2011 at 6:10 pm

    • Hello – I can’t tell you how I agree with you. My life has been on hold for the past 5 years and I have 2 1/2 more to go before I complete residency. If I had it to do all over, I would have made a different decision. I would not be in medical school to be an MD. I might have become a NP or PA. Their hours are decent. The Dr has the responsiblity, not the PA or NP and as well, the salary is very good. You are not going thru years of study and losing your life to working 100 hours or more a week. I can’t do anything but move forward because of the debt. I still want to help people, but between the lack of support I’ve received from nurses who have no respect for residents, to Doctors that don’t include you in the decision making or even at like you are around, to those patients that won’t listen and those people that have no respect for what you are doing. On top of that, the government does not even support the doctors, – how could they if they are charging 7% ib school loans? It is not a win/win by any means. Think long and hard before going into medicine. Teachers – I’d gladly take your job. I just can’t now.

      someone who cares

      February 25, 2011 at 2:42 am

  69. I have several issues with your calculation. Let me go through them here.

    In calculating net teacher income, you include a pension benefit of 35,507 for 15 years. Yet, the assumption neglects the teacher contribution to this fund. In California, teachers are REQUIRED to contribute 8% of their pre-tax salary to the retirement system (http://tinyurl.com/69eevs2) . For the example given, that would be a contribution of 4,000 dollars. The equation changes slightly then.

    (42,791 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $30.47

    (39,840 x 43) + (35,507 x 15) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $28.70

    If the contribution is more conservative, say 6% contribution and takes into account the loss of $3,762 in social security lost due to pension, the results look like this:

    (40,596 x 43) + ((35,507-3,762) x 15)–(186,072)] / [(40x 38x43)+(6,400)] = $28.36

    In contrast, the equation fails to account for retirement benefits given to doctors. Part of this is likely due to the fact they are far from uniform (401K matching, ownership of practice, etc) yet the benefit does exist. Therefore, ignoring the pension benefit for teachers seems to be the most reasonable.

    [(42,791 x 43) – (186,072)] / [(40 x 38 x 43) + (6,400)] = $23.05 Teacher/per hr

    Perhaps you disagree with that notion. However, if 4,000 dollars per year is invested, compounded yearly and earns 5% in a tax deferred account for 43 years, the teacher would have $633,170, or 42K over the same number of years, a higher number than would be gained by the pension benefit calculated. If the doctor had this same investment, either through self funding or matching from company/ hospital it would not be included here. Therefore, I think it should be left out.
    Next I call into question the math on total teacher hours worked. The author estimates 38 weeks worked per year, 10 week summer, 2 weeks Christmas, 1 week spring break. Subtracting from 52, the number should be at minimum 39, resulting in the following equation.

    [(42,791 x 43) – (186,072)] / [(40 x 39 x 43) + (6,400)] = $22.50

    Now, the author suggests that 10 weeks summers are the norm. In fact, 10 week summers are normal for students. However, teachers are typically expected to begin work 8-10 days prior to the first day of class. In addition, several days after school are required to finish paper work, clean up, and inventory the class room. A conservative estimate would have 10 weeks reduced to 8 on average.

    [(42,791 x 43) – (186,072)] / [(40 x 41 x 43) + (6,400)] = $21.50

    By these calculations, the difference between teacher and doctor is $12.96 per hour (34.46-21.50). In addition, with the number of teachers I know personally, I am amused by the idea that they work a mere 40 hours per week, but have no hard evidence to prove it. Perhaps I know only hard workers. The hours worked also do not account for other areas including student teaching, required continuing education courses, recertification and licensure, etc. In addition, the author points out that having a masters is not required for some high school jobs and does not include its pursuit (cost or hours) in his calculation. Using this filter, I next address the hours worked by doctors.

    The author states clearly that 34,000 hours are required in training. It breaks down as follows: Undergrad + Med School (1,2nd yr) + Med school (3, 4th) + Residency
    6400(40x40x4) +7680(48x80x2) +7680(48x80x2) + 12000(50x80x3)= 33760 Hrs

    Some have regarded this as too little and some as too much. I have the following modification and my thought process. Firstly, the number of weeks of medical school should be adjusted. Based on the academic calendar from John Hopkins medical school http://tinyurl.com/62ajab ; 44 weeks are outlined for 1st and 40 weeks for 2nd year students. In addition, each of these years includes 3 weeks for Christmas and Spring break every year, leaving on average 39 weeks for each of the first two years. People have mentioned several other things expected of students including extra specialized classes, summer research and community service. But, just as a masters is not required for teachers, these extras should not count toward the averages necessary for doctors. Adjusted

    6400(40x40x4) +6240(39x80x2) +7680(48x80x2) + 12000(50x80x3)= 32320 Hrs

    Next, examining the 80 hour per week spent in the first 2 years of med school. Based on various sources, the class schedule has 3.5 to 6 hours of class on any given day. This is balanced out with patient time. In general, 6 hours of class/patient time seems to be a reasonable average. Adding additional study time to result in 80 hour weeks would require 5.5 hours of studying each weekday, plus 11 hours on each Sunday and Saturday (30hrs of class/50 hours of studying). While some people have responded this as accurate, this is unlikely to be everyone. Therefore, I have adjusted the calculation to 60hr/week; leaving an equal balance. Perhaps you disagree, but I argue, that 12 hours a day, 5 days a week is probably reasonable for the average medical student. Those at the top of their class may be higher, but again, this is not required to become a doctor.

    6400(40x40x4) +4680(39x60x2) +6240(48x80x2) + 12000(50x80x3)= 30760 Hrs

    Next, tackling the last two years, we return to the Hopkins schedule. Again 40 weeks are outlined for yr 3 and 40 weeks in year 4 with 3 weeks for Christmas and Spring break each year. Therefore 37 weeks for med school year 3 and 4 (down from 48). I will not quibble with 80 hours per week, however, the requirement varies greatly by rotation. Some will have very reasonable (read 60) others will approach and surpass 80 hours. Overall, I think the number maybe high for most, but low for some, therefore a reasonable “average” to use.

    6400(40x40x4) +4680(39x60x2) +5920(37x80x2) + 12000(50x80x3)= 29000 Hrs

    Previous Calculation
    (140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (34,000)]=34.46

    The adjustment bumps the total up nearly a dollar. A pittance you may argue, but a over 6% increase per hour for a teacher.

    (140,939 x 36) + (120,000) – (687,260)] / [(56 x 48 x 36) + (29,000)]= 35.83

    Now to tackle the biggest issue: investments, upfront and future. Much is made of the high cost of attending medical school. With nearly 300,000 estimated in initial cost (undergrad + med school), the final tally ends at nearly 700,000 dollars in debt to be repaid. This takes the nearly 5.2 million dollars earned and $41.30 per hour average down to $35.83 after adjusting for debt payment. This number is indeed a staggering debt and reduces after tax total from 140939 to a mere 106,939. But imagine instead, that the doctors chose to limit themselves to the salary of a teacher until the debt was repaid. This would mean taking the extra $64,148 and apply it towards your loan principle. The result would have the loan repaid in a mere 4 years from start. The total cost, including accruing interest during residency, would total $430,624 (370,000 for principal plus added interest during residency, $60,624 in added interest). This savings in interest by living at a teachers wage for the first 4 years after residency adjusts the doctors cost per hour.

    (140,939 x 36) + (120,000) – (430,242)] / [(56 x 48 x 36) + (29,000)]= 38.05

    Now, you argue that the doctor had to defer income during med school and residency and the teacher was able to get ahead there. Therefore, the next few years, the doctor should catch up. In the 7 years, the teacher made $299,537 while the doctor made $120,000 during residency. Now, the doctor also had 15,000 used for living expenses during med school that was added to the loans and teachers have living expenses too, so we will add the 60,000 to the doctors total and the equation (changing the total to $38.53/hr). The discrepancy is made up in a single year. You may argue that the teacher was paid in more valuable dollars from the past. Controlling for that the roughly 120,000 dollar difference over that time would equate to roughly $147,000 given 3% inflation year over year. This is a simplified equation, but roughly illustrates the loss due to later payment. Still, 1 months has the doctor even to the teacher in terms of cost.

    Having reached this point the doctor earns on average $38.53 while the teacher earns $21.50. Is this a sufficient spread for the doctors?

    But one more point remains. Several people have commented on the opportunity cost of going to med school in terms of return on investment, that not investing early costs the doctor. What is not calculated is the return on investment for the extra money the doctor has during time. If the doctor chooses to live like a teacher (in wage) what return on investment is the teacher missing out on that the doctor is privy to. With this in mind, the doctor having broken even with the teacher at year 12 (34 years old), will continue to live like a teacher until he retires and invest the extra $98,000 per year for the next 31 years in various investments. Now again, the doctor must live like the teacher in terms of wage. He has everything he needs, much like the teacher, but cannot have an expensive house, cars, vacations, etc. The following totals are if his returns are 5, 7, 10% over the next 31 years.

    5%= 7.7 million dollars 7%= 11.5 million dollars 10%= 21.5 million dollars

    Taxed as a long term capital gain, each of these totals would be reduced by 15-20% depending on how your state taxes it if it were not tax sheltered. Assuming a 20% tax rate the numbers for adjusted pay per hour equals the following

    ((140,939 x 36) + (180,000) – (430,242)+(5% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 87.33/hr

    ((140,939 x 36) + (180,000) – (430,242)+(7% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 111.50/hr

    ((140,939 x 36) + (180,000) – (430,242)+(10% ROI x.80)) / ((56 x 48 x 36) + (29,000))= 174.47/hr

    Even a 3% return on investment (ROI) would average $72.06 per hour. Now if unlucky (3%) , average (5%), or lucky (10%), the doctor would earn $50.56, 65.83, or $152.97 more per hour than a teacher respectively. Assuming they could live at the wage of a teacher. Is this sufficient for the doctors?

    While I see a problem with recruiting people to medicine, most notably primary care, simply increased pay and payout will not alleviate the problem in my opinion. Options should be discussed. In dragging teachers into this discussion, I feel you hurt your case by implying you deserve more than teachers (as some commenters have voiced) rather than saying that doctors should not be a target for the “tax the rich” consortium. Highlighting the plights of doctors is important, but there are many people who work just as hard and get paid less per hour. In addition, there are several people, myself included, who chose not to go into medicine for the reasons you’ve outlined. We as a society need to decide if that is what we want. Simply put, you should’ve used a government employee (read IRS agent) as your model rather than a teacher.

    Fuzzy Numbers

    January 31, 2011 at 11:48 pm

    • I really like your exposition on supposing a physician lived at a teacher’s salary for the couple of years immediately following residency.

      People need to wise up and do more research for themselves BEFORE they apply to medical school.

      Enriquo

      February 4, 2011 at 3:43 pm

      • …..Continuation

        While medical students do in fact spend well more than 60 hrs/week studying/observing/etc., there are the summers, breaks, periods following exams, etc. If you average in these down periods, I am comfortable saying that the medical student commits on average 60hr/week.

        Enriquo

        February 4, 2011 at 3:46 pm

    • Excellent analysis. Bravo.

      Karl

      February 14, 2011 at 10:24 pm

      • give me a break – please .

        someone who cares

        February 22, 2011 at 10:00 pm

  70. Doctor Doctor

    me

    February 1, 2011 at 2:27 am

  71. Dr. Brown may not have been very accurate from an actuarial point of view, but his point is well taken. The career in Medicine is unnecessarily arduous.

    NO NEED FOR A BACHELORS DEGREE TO QUALIFY FOR MED. SCHOOL

    There is NO NEED for a full Undergraduate Degree to get into the Medical Program. Students incur a load of loan studying subjects like History towards their bachelors degree. They get into the Medical program after their brain power has maxed out and begins to decline. The AMA should push to require only High School Diploma and at best a years worth of core subjects to qualify someone to enter the Medical Program.

    NO SLAVE DRIVING, LOW PAYING RESIDENCIES.

    Residency has become Slave Labor in our system. It too is very wrong. It is reprehensible to make a doctor overworked and tired and push him to make life & death decisions in that state of stupor in the name of training. This isn’t a real life situation and hence should not be emulated in residency. The practice of farming our residents to Hospitals and indentured labor is wrong.

    Doctors need to collectively take it up with their association (AMA). Making Medical Education arduous and expensive started off as a quest to be an exclusive group of people who figured that this would eliminate that segment of the society that wasn’t affluent to begin with or that which had broken families where the family support component was missing. Well, the guillotine now threatens the one who designed it. The doctors will have to fix it themselves.

    Government can make healthcare more affordable by allowing interest free loans to Medical Students – as an investment in the Country’s future.

    Rakesh

    February 1, 2011 at 9:45 am

  72. I am a med student, 80 hours a week is plausible when class is in session, maybe, but what about the 1 month winter break, fall break, spring break, 3 months of summer break, all the time 4th year when you do nothing.

    Also 7 days a week is implausible, Id say maybe 6 days a week. Your number is grossly off, Id say maybe maybe 60% of the time is true.

    And 300K in debt!!?? Out of purely educational expensive, (not personal which dont count), its not going to top 170K. Which can often be tackled with moonlighting in residency.

    Also did you compare job security….no?

    You compared one of the lower paying medicine specialties. With most of those fellowships you mention as “extra” training you would be earning 400K not 200K. Throw that into your calculation…..

    Bill

    February 1, 2011 at 1:08 pm

    • Just wait until you’re a resident and see how much time and energy you have to do moonlighting to pay off your loans … and the moonlighting money often ups your tax bracket and you do have to pay taxes on your moonlighting money … Just saying …

      Anonymous

      February 1, 2011 at 7:57 pm

      • Many residents can no longer moonlight, due to restrictions placed on them by their programs. Work-hour regulations also make moonlighting difficult to fit in.

        benbrownmd

        February 6, 2011 at 9:07 am

    • clearly your just a med student still. wait until you get to residency and the real doctor practicing life…….and you will have to swallow what you just wrote. Job security?????yes is true………income security? not at all. Fellowship for 400K………..????????what world are you living. If you know of it let me know and I will be a fellow forever.

      coral

      February 13, 2011 at 12:24 pm

    • Oh, Dear Bill. You may be very sad in the near future when reality dawns on you. I did a fellowship…I make $130K as a subspecialist. I don’t know a single person who “tackled” their med school debt with moonlighting. MANY programs now have restrictions on moonlighting to meet the work hour requirements. I have a $198K of debt. I wasn’t even able to pay the interest during residency and fellowship.

      Are you really a med student? There’s no fall break, spring break, summer break. There was a holiday break each year at Xmas and about a month after 1st and 2nd year which most people spent cramming for the USMLE exams.

      Anonymous

      April 14, 2011 at 2:54 pm

    • FYI: many residents are not allowed to moonlight.

      Mark S., M.D., Ph.D.

      January 24, 2012 at 1:22 am

  73. I think Dr. Brown’s analysis and comments would go a lot farther if they weren’t delivered in such a egotistical manner (Was it necessary to direct someone to a Wikipedia article on fractions? Really?!). That being said, here are my two cents… for whatever they are worth.

    Most teachers aren’t paid enough. Most primary care doctors aren’t paid enough. Lots of other professionals are not paid enough, including plumbers. Plastic surgeons appear overpaid in comparison. But, as Dr. Rey pointed out, there are some specialties in medicine that are more driven by the market and based on supply and demand. One can enter those specialties and make a pretty decent, or even opulent, living because patients place a high enough value on those services to pay for them out of pocket (or at least a large portion). Most primary care doctors do not have this luxury.

    The problem is not how long one had to train and what you had to sacrifice to get to where you are or comparing who is paid what and making sweeping statements at doctors being more valuable than other career fields. The problem is that Americans are an instant gratification people with huge entitlement issues functioning withing a consumerist culture. They are not interested in preventing illness later. They do not understand that primary care could help prevent a lot of morbidity and mortality if only the patients (consumers) were willing to pay them to take the time to do so and then follow through with the lifestyle recommendations, preventative exams, and appropriate treatment. Instead, the instant gratification mentality lends itself to a high value being placed on procedures; in which you go in, find a problem, fix the problem, and that is the end of story. Patient all better. Americans place a premium on a “if it feels good, do it” lifestyle and would rather pay the surgeon who does their quadruple bypass to save their life then take the steps necessary to avoid that in the first place. And while we’re at it, please don’t ask them to take any personal responsibility for their health. Incidentally, this mentality is also what devalues the teaching profession. Why invest in the future of our children when we could spend our money on MORE STUFF?!

    There is a shortage of primary care physicians in this country and in another decade or two there will be a large shortage of physicians in general. Because it takes at least a decade to produce trained physicians, this country is on the brink of health care crisis. Perhaps that would force some common sense reform in terms of equaling compensation.

    And, for the record, I’m a psychiatrist with quite a bit of student loan debt to pay down, but I live a nice life. It’s frustrating that I have been given the choice to spend an hour doing real therapy with a patient and get paid X or do 15-minute med checks and reduce myself to a Pez dispenser and make 4X. I have personally chosen to split the difference and do 30-minutes appointments with med management and brief therapy. Yes, that means I make half as much money… but I know I provide much better patient care and that’s payment enough for me at this stage in my career. Those priorities may change when it comes time to finance my child’s education.

    And yes, this comment contains some generalities about American society. I realize it doesn’t apply to everyone and do not intend it to be taken as such.

    Anna

    February 1, 2011 at 5:19 pm

  74. I’m your huckleberry.

    Doc Hollywood

    February 1, 2011 at 6:32 pm

  75. Ben, Thanks for the article. I wish everyone could read it. I think some people missed the boat on your main objective. Correct me if I’m wrong, but it sounds like you just wanted to inform the public that in the long run, and over all, physicians in general don’t make the kind of money that the public perceives we do. He compared us to teachers as they traditionally are thought of as being underpaid, while we as physicians have the reputation of being overpaid. Only because I am a physician, I get asked to donate to various causes weekly (nothing really wrong with that, other than I can’t afford to donate a significant amount of money to the majority of requests). People assume that I live “up on the hill”, and that I have a second home in Costa Rica. Most my shifts I am expected to foot the dinner bill for everyone.
    Sure my salary is more than most. However, I clearly remember visiting my friends during medical school and residency and feeling envious with their modest homes and toys. I knew it would be years before I did not have to rent low-income smoke-odored apartments or before I could buy a new pair of skiis. I remember telling my friends who had normal jobs at the age of 24 (drug reps, accountants, physician assistants, teachers, physical therapists etc) to pick a lesser-expensive place to go out to eat as we had no money. How easy it is for people to forget or disregard the 10 years of sacrifices with fairly low living standards, and to focus on our current way of living. We give up some of the most precious years of our life, think about it. Our whole twenties is spent studying or working a ridiculous amount of hours for NOTHING. So heck yeah, I think we deserve to live in a nice house and drive a pretty nice car, and go on a trip every now and then without the snide comments about our wealth. Believe me, I’ve heard it all.
    I went into medicine for the job security. I was tired of filling out endless job applications in college to no avail and ended up painting to get by. I hated it, thus decided to go to medical school. Tough as nails, but now I can say that I really am “living the dream”. After 8 years of practicing, the only real downside is the fact that my 401K is a fraction of my friends thus I won’t be retiring at any relatively young age with all the loans (about 200K left). Is there another profession whose salary seems to get less and less each year? Seriously, each year I submit my taxes my accountant says the same thing; “Looks like you made a little less this year compared with last year.” I’m working the same amount of hours! I see myself needing to work for at least another 20-25 years. Those night shifts full of drug seekers and drunk belligerents are seriously gonna be the end of me at that age. I have some friends that will retire with a good retirement package 20 years after they started their jobs working for the government. That’s only in 3-5 years for some!
    I am 41 years old. I received my first real paycheck when I was 33. I bought a BBQ for my backyard, a fly rod, and a bicycle for my kid with that first pay check. I was in heaven. We have owned our first home for 5 years (had to wait 3 years after residency to save some for a home as I couldn’t get a decent loan). I went on my first trip out of the country 3 years ago, and I just bought my dream truck (toyota tundra) 2 years ago. My point is this, we as physicians live a good life now, but it is debatable whether it makes up for the loss of our early years as well as our later years. I keep reading that my shift work and lack of sleep is comparable to smoking a pack a day of cancer sticks. Nice. We aren’t looking for pity, just some mutual understanding. A lot of people are empathetic as they often say “I don’t know how you do what you do!” I usually reply, “I don’t know how you do what YOU do!” I am dead serious. I truly empathize with office workers, teachers, coal miners, law enforcement etc.
    I believe Ben underestimated the number of hours we spend in medical school and residency. I still have PTSD from my burn and trauma rotation where we were on call every other day which equaled 120 hours a week for 3 months. That is no exaggeration folks.
    As for Bill the medical student above. I should have gone to your school! However I hope you are prepared for residency with all those breaks you get! I didn’t get any! Ben picked an average-salary specialty (internal medicine), some make more and some make less. If you make more, than that means you probably spent a few more years studying and working like a slave while you deferred a decent income and your loans accrued more interest. It isn’t perfect, but Ben thought this out well.

    I thought the majority of the posts on here were well-thought out and informative. Until I read the bone-head remark from Anon about Dr. 90210 exploiting is profession and talents as a plastic surgeon to make money. How can you argue against those cut-off scrubs?! No really, So are the professional athletes exploiting their talents and unearthly freaky genes to make money too? Maybe, except many do it for 100 times (literally) more than I make. But I can’t complain because I watch them on TV and like to spend money for tickets occasionally to watch them in person. That’s just how it goes in the USA. Go Jazz!

    ER Doc

    February 1, 2011 at 7:40 pm

  76. I’m having a hard time getting my longer post to go through, any ideas?

    ER Doc

    February 1, 2011 at 7:41 pm

  77. Ben, Thanks for the article. I wish everyone could read it. I think some people missed the boat on your main objective. Correct me if I’m wrong, but it sounds like you just wanted to inform the public that in the long run, and over all, physicians in general don’t make the kind of money that the public perceives we do. He compared us to teachers as they traditionally are thought of as being underpaid, while we as physicians have the reputation of being overpaid. Only because I am a physician, I get asked to donate to various causes weekly (nothing really wrong with that, other than I can’t afford to donate a significant amount of money to the majority of requests). People assume that I live “up on the hill”, and that I have a second home in Costa Rica. Most my shifts I am expected to foot the dinner bill for everyone.
    Sure my salary is more than most. However, I clearly remember visiting my friends during medical school and residency and feeling envious with their modest homes and toys. I knew it would be years before I did not have to rent low-income smoke-odored apartments or before I could buy a new pair of skiis. I remember telling my friends who had normal jobs at the age of 24 (drug reps, accountants, physician assistants, teachers, physical therapists etc) to pick a lesser-expensive place to go out to eat as we had no money. How easy it is for people to forget or disregard the 10 years of sacrifices with fairly low living standards, and to focus on our current way of living. We give up some of the most precious years of our life, think about it. Our whole twenties is spent studying or working a ridiculous amount of hours for NOTHING. So heck yeah, I think we deserve to live in a nice house and drive a pretty nice car, and go on a trip every now and then without the snide comments about our wealth. Believe me, I’ve heard it all.
    I went into medicine for the job security. I was tired of filling out endless job applications in college to no avail and ended up painting to get by. I hated it, thus decided to go to medical school. Tough as nails, but now I can say that I really am “living the dream”. After 8 years of practicing, the only real downside is the fact that my 401K is a fraction of my friends thus I won’t be retiring at any relatively young age with all the loans (about 200K left). Is there another profession whose salary seems to get less and less each year? Seriously, each year I submit my taxes my accountant says the same thing; “Looks like you made a little less this year compared with last year.” I’m working the same amount of hours! I see myself needing to work for at least another 20-25 years. Those night shifts full of drug seekers and drunk belligerents are seriously gonna be the end of me at that age. I have some friends that will retire with a good retirement package 20 years after they started their jobs working for the government. That’s only in 3-5 years for some!
    I am 41 years old. I received my first real paycheck when I was 33. I bought a BBQ for my backyard, a fly rod, and a bicycle for my kid with that first pay check. I was in heaven. We have owned our first home for 5 years (had to wait 3 years after residency to save some for a home as I couldn’t get a decent loan). I went on my first trip out of the country 3 years ago, and I just bought my dream truck (toyota tundra) 2 years ago. My point is this, we as physicians live a good life now, but it is debatable whether it makes up for the loss of our early years as well as our later years. I keep reading that my shift work and lack of sleep is comparable to smoking a pack a day of cancer sticks. Nice. We aren’t looking for pity, just some mutual understanding. A lot of people are empathetic as they often say “I don’t know how you do what you do!” I usually reply, “I don’t know how you do what YOU do!” I am dead serious. I truly empathize with office workers, teachers, coal miners, law enforcement etc.
    I believe Ben underestimated the number of hours we spend in medical school and residency. I still have PTSD from my burn and trauma rotation where we were on call every other day which equaled 120 hours a week for 3 months. That is no exaggeration folks.
    As for Bill the medical student above. I should have gone to your school! However I hope you are prepared for residency with all those breaks you get! I didn’t get any! Ben picked an average-salary specialty (internal medicine), some make more and some make less. If you make more, than that means you probably spent a few more years studying and working like a slave while you deferred a decent income and your loans accrued more interest. It isn’t perfect, but Ben thought this out well.

    I thought the majority of the posts on here were well-thought out and informative. Until I read the bone-head remark from Anon about Dr. 90210 exploiting is profession and talents as a plastic surgeon to make money. How can you argue against those cut-off scrubs?! No really, So are the professional athletes exploiting their talents and unearthly freaky genes to make money too? Maybe, except many do it for 100 times (literally) more than I make. But I can’t complain because I watch them on TV and like to spend money for tickets occasionally to watch them in person. That’s just how it goes in the USA. Go Jazz!

    ER clone

    February 1, 2011 at 7:45 pm

  78. A lot of readers responding to this article get hung up on little details instead of focusing on the thrust of the article itself.

    I wrote earlier that a full Bachelors Degree should not be required for entry to Medical School. As Engineers do, the entry point should be a H.S. Diploma, a few prerequisite courses and a qualifying exam like MCAT.

    It is extremely expensive to produce a Physician. We, as a society, should make the best use and the longest utilization of this persons talent. By eliminating a bogus 4 year Bachelors degree requirement, we can get 4 more years out of the doctor’s career. Society benefits that way.

    Additionally, the time value of a loan magnifies the student loan taken out during the first 4 years Bachelors degree. It sits compounding for the next seven years during the time the individual goes through Medical school accruing more loan. Finally, the impact of the loans during the first 4 years is much greater on a doctor than it is on an Engineer who goes to work after getting his BS degree and starts paying off his loan.

    AMA should push for legislation to factor in educational loans as Tax Credits during the residency and first few years of a doctor’s career so that the burden of paying excessive taxes is reduced during the time the student is paying off his/her loans.

    Medicine should not be purely business in nature. Unless the society treats its healers right, we will have greedy and opportunistic doctors trying to ‘shark’ out money from patients to pay his/her ‘loan sharks’. By the time the loans are paid off, the ‘sharking’ becomes a matter of habit and begins to define the medical profession as a whole.

    Rakesh Chaubey

    February 2, 2011 at 10:49 am

    • Agreed! The minute details don’t matter. What matters is the big picture – we physcians take on huge debt in our lengthy process to reach our goal,and as such, our disposable income is not as great as it may seem. Factor in the tremendous time commitment we sacrifice in med school and residency (80-120 hours per week), which continues into our professional career, and compound that with the ever-looming medico-legal threats and CMS cuts, well, it’s really not much money on an hourly basis! However, I LOVE my job, and consider it a privilege to take care of patients. So, Dr. Ben, thank you for pointing out what is obvious to those of you in the field, and to you Dan, stay healthy… you never know where one of us might pop up and have to take care of you! :-)

      Caitlin Foxley

      February 2, 2011 at 12:06 pm

    • I don’t think society wants their lives trusted to a 22 year old physician who did not have at least some college experience. A bit of liberal arts mixed in with all that science is part of what makes a physician able to connect with her patients.

      Wilmington's Jen

      February 12, 2011 at 2:49 am

      • If Dad is paying for the liberal Arts college, yes. But then, you are paying by the lost time of your career. Be mindful of that. A lot of other professions work fine with people without the Liberal Arts. If you study Liberal Arts, become an Author or a Historian. Don’t waste your time and your / your dad’s money. Spend the time studying medicine. If you finish at 22 and still don’t have confidence that people will trust you, do a fellowship. Enhance yourself as a Doctor.

        Rakesh Chaubey

        February 18, 2011 at 2:23 pm

  79. Lets just say that people who have not been through it or have not known anyone very close go through becoming a physician have no idea and will never have an idea of what it takes to become a physician. The only people who understand are other physicians and then people think we are just complaining back and forth with our silver spoons and butlers. I am currently in my 2nd year of residency working anywhere from 60 to, yes, 100 hours per week. a 60-70 hour week is great. I might actually have free time those weeks and be able to enjoy being married and picking up parts of my life i left behind 6+ years ago. So, yes, physicians should have their education completely reimbursed and physicians should get paid more. Imagine giving up your entire 20s by having your nose buried in books, research articles, and stuffed in hospitals.

    Anonymous

    February 2, 2011 at 10:19 pm

    • To spend ones 20s “buried in books, research articles, and stuffed in hospitals” doesn’t sound bad at all to me compared to the jobs that most people in their 20s have (if they are even able to get a job)

      It’s true though that if your desire is to maximize income and are an intelligent individual, then becoming a doctor is not the way to go. However, being a doctor has many non-purely financial rewards which undoubtedly factor into peoples’ decisions when choosing their careers, and hence why so many people choose (or desire to choose) to become doctors

      Anonymous123

      February 4, 2011 at 5:37 pm

  80. I’m not sure that one is going to generate a great deal of sympathy for the plight of MDs by comparing their pay to that of teachers (and thereby, intentionally or not, casting teacher pay in a pretty unfavorable light). I work with several MDs and I don’t know of one who struggles to make his or her ends meet. They tend lead very comfortable lives in substantial houses and are far more worried over malpractice insurance than income level.

    Having been a classroom teacher who put in half as many hours outside the classroom as in, you’re not garnering much sympathy from me with your ’60 hours a week’ figure. Welcome to the professional world, kiddo. If you want to do your job and do it well, you put in the time that’s required. Should doctors be paid more? Probably. Should teachers be paid more? Definitely.

    Troy Robertson

    February 3, 2011 at 10:39 pm

  81. Hi Dr. Brown,
    I am an ER physician’s wife in NY. Taxes are pretty heafty in NYS, not to mention my husband went to a private medical school. His total debt is now at 200k. We brought it down some during residency and since June, when he became an attending. My husband makes a decent hourly pay but I get what you are saying. We couldn’t use his loans or my grad school payments as a write off. He made to much.Now don’t get me wrong we both drive fancy cars, we bought a new house and I don’t work; I’m a grad student. However we will be paying that debt down till we are 60. If we’re lucky there will be some $$ to retire at that point.

    TheDocsWife

    February 3, 2011 at 10:46 pm

    • In my humble opinion, Doctors, teachers, fireman, police (non-corrupt…sorry, I’m jaded) and other profession’s that have a clear value-add should be propped up on the cultural and financial pedestal. What do I-Bankers add? Isn’t that what all of this comes down to? Enough of people saying doctors make too much. That’s the last thing to enter you’re mind when you or a loved one go to the hospital, correct? You think, “I want the best, I deserve the best, and I demand the best.” Guess what…those at the top STUDY HARDER and god FORBID we say they deserve to earn more…right? If you are top of your game as an I-Banker, making money for your company hand over fist, well, you command TOP DOLLAR and NO ONE questions it. But if you are a brain surgeon who is TOP DOG and want MORE MONEY for your SERVICES, you are a capitalist dog who doesn’t get it. Guess what…we should value, understand and compensate doctors better (perhaps through federal funding) and enough of IBankers of all types getting paid ridiculous amounts for simply working 18 hours a day. It no longer works that way. I don’t care if you crunch numbers all day and night…what VALUE ARE YOU ADDING
      That goes for all companies/professions…No, I’m not a doctor…No, I’m not an I-banker…Yes, I had the choice to go into Banking and I chose not too…Why?…Cause they didn’t hire me! Just Kidding. Because I wanted to excel at ONE THING, and that wasn’t “making money” it was providing a needed service to consumers across the world. And guess what, consumers don’t need i-bankers…
      Am I generalizing? Yes I am…But I’m sick of I-Bankers making money and adding nothing back and then our friends at AIG (and others) SUPER OVERLEVERAGE themselves and we have to pay for it…and then they have the gall to say, “It’s not us! It’s everyone else!” It’s a spiderweb of BULLSH*T.

      Ladies and Gentleman, my new years resolution is to add value to consumers, and perhaps make money while doing it, but not rob anybody while doing it.
      Give Doctors/Teachers/Fireman/Cops their due, and enough of these banking jerkoffs

      Mike

      February 4, 2011 at 12:11 am

    • …or you could chose to live within your means and pay it down in 5 years

      Enriquo

      February 4, 2011 at 3:49 pm

  82. this guy sounds nuts. so much time spent making an argument that is on its face ridiculous. so basically he’s saying the only reason for any difference between the living standards of a surgeon and, say, a 7th grade math teacher is because the surgeon has such a towering work ethic? ha. talk about delusional.

    Anonymous

    February 4, 2011 at 8:52 am

  83. this guy sounds nuts. so much time making an argument that is on its face absurd. so basically he’s saying the only reason for any difference between the living standards of a surgeon and, say, a seventh-grade math teacher is because of the surgeon’s towering work ethic? talk about delusional.

    ummm

    February 4, 2011 at 8:54 am

    • Somebody has difficulty with reading comprehension and drawing a valid conclusion.

      Tony Darst

      February 4, 2011 at 9:58 am

      • just because his analysis is long (and long winded) doesnt mean its sophisticated. its not like doctors are the only ones with school debts and debts only have meaning in relation to income. i would guess that a teacher who makes $35,000 who has $50,000 in debts (from undergrad or maybe grad school if he or she lives in a state where masters degrees are required) is going to be paying off their loans far, far longer than a doctor who owes $300,000 but makes $200,000. i know someone who has a full-time job, who pays student loan bills every month, whose debts have only gotten bigger because she can’t afford to even keep up with the interest thats accruing. and im sure his analysis accounts for the reality (i didnt read it all because it was too long and too ridiculous) that teachers can expect to lose their jobs from time to time, and make nothing at all, when their state governments have financial problems while doctors rarely lose their jobs because of the economy. and then theres the facts that are right in front of our faces: doctors drive mercedes and teachers typically do not. yet he would have us believe they make roughly the same amount per hour. so how does he account for their different living standards? apparently its because doctors just work more hours.

        Anonymous

        February 5, 2011 at 9:46 am

      • well just because his analysis is long (and long winded) doesnt mean its sophisticated. its not like doctors are the only ones with school debts and debts only have meaning in relation to income. i would guess that a teacher who makes $35,000 who has $50,000 in debts (from undergrad or maybe grad school if he or she lives in a state where masters degrees are required) is going to be paying off their loans far, far longer than a doctor who owes $300,000 but makes $200,000. i know someone who has a full-time job, who pays student loan bills every month, whose debts have only gotten bigger because she can’t afford to even keep up with the interest thats accruing. and im sure his analysis accounts for the reality (i didnt read it all because it was too long and too ridiculous) that teachers can expect to lose their jobs from time to time, and make nothing at all, when their state governments have financial problems while doctors rarely lose their jobs because of the economy. and then theres the facts that are right in front of our faces: doctors drive mercedes and teachers typically do not. yet he would have us believe they make roughly the same amount per hour. so how does he account for their different living standards? apparently its because doctors just work more hours.

        ummm

        February 5, 2011 at 9:49 am

    • My adore many of my high school teachers and have the utmost respect for them. Many of them had the innate ability to become a surgeon. They COULD have. So what is the difference between a math teacher and a surgeon, TRAINING.

      Thanks to my 10 years (4-5 more to go) of post-secondary training, I’m quite confident that I could teach a high school math as effectively as the average high school math teacher – tomorrow.

      Could the average high school math teacher show up tomorrow as a physician and take care of my patients – NO.

      So yes, the difference between a high school math teacher and a surgeon is TRAINING.

      Both have the ability to do both jobs, only surgeons are trained to do both jobs.

      benbrownmd

      March 2, 2011 at 6:27 am

      • Full disclosure: I am a high school science teacher. Great article. It certainly is a shocking conclusion that seems to follow from the numbers. I have a brief quibble with this comment, however.

        While I would argue that you have the CONTENT knowledge to teach mathematics (or any other subject, most likely) without a problem, you may lack PEDAGOGICAL knowledge (how to teach) that is essential to being even an average high school teacher.

        Dr. Brown, you have obviously spent more time in training, but your training has been of a DIFFERENT NATURE than that of a teacher. Effective teaching is more than knowing about math and good communication skills; there are lessons and skills that teachers must learn that are specific to the pedagogy of their particular subject area. Teachers must become intimately familiar with the set of knowledge, called standards, that their particular state and district deems important, and must have the training to pace their class accordingly. Additionally, formal education in a skill called differentiated instruction, the ability to simultaneously teach students with different learning styles and ability, a knowledge of special education, adolescent psychology, and, in this tort-addled society, a basic knowledge of school law, are all important skills to develop in a teacher preparation program. Physician training, to my knowledge, does not include this training.

        Many college professors, especially in research universities, are unskilled at teaching. Their training has primarily been in the area of research, not pedagogy. Learning in this setting is often more difficult than learning than in high school, where a teacher is likely to have a higher level of pedagogical skill. This is not to say that there aren’t research professors who are excellent teachers, but I would contend that the average high school teacher has a much greater level of teaching skill than the average university professor at a research I university.

        Similarly, having a thorough knowledge of human anatomy is insufficient to become an effective surgeon. You have to know a whole bunch of other… stuff . It’s a measure of my ignorance that I don’t even know what I don’t know, despite an undergraduate degree in cell biology with a focus on pre-med. Many people simply assume that because they know a great deal about science, English, or history, they can teach that subject. We spend a significant amount of our life observing teachers, and it may be true that familiarity breeds contempt, or familiarity breeds a false confidence that “what they can do, I can do better.” This may be true in many cases, but we’re talking about averages.

        It is important for the future of education in the United States that people view teaching as a skilled profession; we are not factory workers who can simply be replaced by unskilled labor. I don’t think it’s fair to physicians to compare the stakes of unskilled labor in both professions; with untrained doctors, people die, with untrained teachers, students fail to acquire knowledge. But I think we can both agree that if student learning fails to happen or happens less, our nation is in hot water.

        In short, while physicians require a significantly greater amount of training (and are underpaid upon completion of this training), teachers require training as well. While you, on an individual level, may be able to walk into a high school and teach without much trouble, I don’t think the average physician could teach high school as well as the average high school teacher with formal training.

        Mark

        January 13, 2012 at 12:03 pm

      • I’m not surprised a doctor thinks he could go into a high school classroom and be a great math teacher because they’re pretty good at math. After all, algebra and geometry and the quadratic equations, those are easy, right?

        If you think that knowing the math is all there is to being a good math teacher, it’s pretty much a given that you’re going to be a terrible teacher.

        Angela Winderlinck

        January 30, 2013 at 9:45 pm

      • Dr. Brown,

        This article who have do a lot and communicate the intent better, if specialists pay were part of your equation.

        I would like to know what your thoughts are because, I just don’t see how some specialists that make, say $400K can be compared to a teach.

        Anonymous

        May 15, 2013 at 1:32 pm

  84. A few observations…(Interesting article)

    If doctors get paid such a relatively low amount, why do so many students still want to become doctors? (i.e., Why do such a large % of students in top universities start as pre-med? Why are med. school acceptance rates so low?)

    Either these aspiring future doctors do not understand the time / financial ramifications when selecting their career path, or they become a doctor for reasons which go beyond the financial (e.g., desire for meaningful work, prestige, feel it is their calling, etc.), or some combination of these factors.

    Regardless, there is no shortage of talent applying to medical school, and I am sure that many highly qualified individuals who would make great doctors do not get accepted into any Med. School, or are weeded out by the application process before actually even applying.

    However, for teachers, due to many factors (e.g.., Difficult work environment, lack of prestige, low potential for career advancement) the brightest in the US are not applying.

    I would argue that teachers are a key ingredient (perhaps the key ingredient) for building the foundation of the economic future of our country, and as such, we should do more to attract the brightest students to this profession.

    For doctors, the brightest are already being attracted, with a surplus supply, so there is limited justification for higher pay which would continue to add to already disproportionately large medical expenses in our country.

    Anonymous123

    February 4, 2011 at 5:24 pm

    • The reason so many high school and college students want to be doctors, parallels what most people believe about physicians – they do good things, get lots of respect and make lots of money.

      They, like most of Americans, do not know about the “hidden side” of becoming a physician.

      A survey given to first year allopathic medical students by the AAMC illustrated how uninformed they are as nearly 40% didn’t understand what being “Board Certified” meant.”
      GQ Medical School Graduation Questionnaire FINAL All Schools Summary Report 2009.

      My primary motive for writing the book “Informed Consent” was to explain the U.S. Medical Education System and all its nuances. Too many of my colleagues regret going into medicine at all or would have chose a different specialty, etc. – if only they had “known” before it was too late, if only they had been “informed” before it was too late.
      The book, by no means, discourages people from going into medicine. It simply explains the process so they can make more informed decisions.
      http://www.InformedConsentBook.com

      benbrownmd

      February 6, 2011 at 9:04 am

  85. [...] And I’m starting to seriously wonder how the hell all of this will be paid for.  *see http://benbrownmd.wordpress.com/2010/06/20/informedconsent/ for depressing details.  Stay tuned for a rant here on this very [...]

    97 | jonesie | blogs

    February 5, 2011 at 1:42 am

  86. I don’t think “bill” is a med student – and if he is, not at an even “average” medical school. My medical school had summer break between MS1 and MS2 year – after that, no break. About 3-4 days of spring break, 3-4 days winter break, both spent studying for exams. Add USMLE step 1, 2, and 3, and the shelf exams for each core rotation. 4th year is spent interviewing at residencies – if applying to a specialty that requires interviewing for both internship and residency, that’s even more interviews – that i had to pay for out of my pocket. Add the cost of all the exams and the match. Interviews go until February. Some of us did get about 3 weeks off between graduation and start of internship. But internship orientation took up a week, ACLS/BLS/PALS training also took time. Moving took time and money. Maybe “bill” will realize this when he finally gets to 4th year if he truly is a med student at all.

    I spent 4 years of med school, 1 year of internship (working >100hrs/wk before 80hr work wk regs), 3 years of residency, 1 year of fellowship and finally started practicing. My loans were about the amount of an average mortgage. Compare that to my friends from college who spent those 9 years earning $$$ on wall street, or going to law school for 3 years then working. Even my friends who became teachers – earned 40-50k/yr x 9 years = 360-450k during the years I was accumulating debt and interest.

    I delayed starting a family, buying a home, and drove an old used ford the whole 9 years. I had one suit that I wore repeatedly for all my interviews. The rest of the time I lived in scrubs.

    Now that I am in practice – my overhead is average $60/patient – to pay for my staff, building, supplies, computer system (including the EMR that the govt is going to require), billing/coding/collecting, etc. Medicare averages $60 per patient follow up. My Medicare patients are the most medically complex with multiple medical issues and multiple complaints. Many of the providers in my area have stopped taking Medicare – then the patients get upset saying it is because we are greedy. Then for maybe $20 more, I get to deal with the private insurance companies – I have to write letters of appeal, take “peer-to-peer” calls from nurses(not truly peer) and other doctors, write off uncovered services, and spend hours of my time dictating and documenting, and writing letters to get patients disability, temporary handicap status, hardship to dip into their retirement, get out of their gym membership, etc. I can’t get paid for my time – just a $10-15 clerical fee. Patients get upset about that fee.

    I recently needed a real estate attorney. He charges $300/hr. He billed for 1.5hrs of “consultation” (most spent on the internet researching), 1 hr of “research”, 1 hr to “write a one page letter”, and 0.5hr to “exchange email with client”. Grand total: $1200. His only overhead is his secretary and building rent and computer.

    Dr. B also forgot to factor in malpractice insurance premiums. And – the time and energy spent fighting/preventing/worrying about frivolous law suits. I took care of a pregnant lady who smoked pot and drank throughout pregnancy – then won her lawsuit against the ob-gyn for her infant having respiratory issues and needing to stay in the NICU. Also had another patient try to sue for “almost slipping” outside my office and aggravating her back pain – which she had from another fall at the local Chinese restaurant chain. She had sued the homeless shelter 3 years prior for another fall and had successfully gotten disability for that injury.

    Of course, there are moments of gratitude and appreciation that make up for the negative – but these moments are rare and fleeting. It’s especially hard to hear the Medicaid and Medicare patients complain to me about all the greedy doctors out there not taking their insurance because they want to make more money and pay for their golf club membership. When I tell them that I’m actually losing money by seeing them, they shut up but I’m sure it doesn’t stop their complaining. Americans have the attitude that healthcare should be free or almost free – yet they will pay cash for cosmetic procedures, orthodontics, facials, massage, nice meal at a restaurant, nice cars.

    none

    February 5, 2011 at 9:24 pm

  87. Not that this really matters, but I am a family practice resident and my husband is a teacher. He thinks my job is horrible and would never want to do what I do. He is interested in it from a science stand-point, but after what he has gone through with me, he wouldn’t think of doing it. Also, his teacher friends tell me that I have put to rest any desires or aspirations they ever had to become doctors. They say this is due to the long hours, lack of sleep, society, and the constant being available. How many times does a teacher get woken up at 2 am for an algebra question? I have yet to see it happen in our house. As for the times I have been woken up…well we’ll just say I can’t remember the last time I slept a full night without being woken up for some patient situation.
    Just a different perspective since in our household we have both physician and teacher. Take what you will from it.

    Lindsey

    February 6, 2011 at 2:52 pm

  88. Emergency workers: Here to save your ass, not kiss it.

    ER clone

    February 6, 2011 at 10:14 pm

  89. My cousin is a dentist. Started working when he finished his studies at 27. Now, at 36, he owns his own practice, works 4 days a week MAX and probably nets well over 300K a year. Nowhere even close to a teachers salary. and thats not including the value of his practice.

    Brad

    February 6, 2011 at 11:34 pm

  90. You have convinced me viscerally that a physician making $200,000 is not overpaid. If you do a separate analysis involving physicians (specialists) who make $300K-$400K, the hourly rate will increase substantially. Now that’s where the debate will be more vigorous. A $300K-$400K physician will be very wealthy indeed! Our medical structure will now have to address the pay differential between primary care physicians and specialists. Notice that I am now questioning why PCP’s are paid so low compared to the specialists.

    When you compare the $200K physician to the high school teacher, instead of sympathizing with the lowly physician, you will actually have me wondering whether the high school teacher is being paid too much. I’ll posit that teachers who have acquired protection under the “Teaching Establishment” (a.k.a teachers unions) have earnings that are “off the books.” These are the privileged (high school) teachers that you are comparing with. There are younger teachers who are very talented and motivated and hardworking, but have not and perhaps never will achieve the security of the privileged group. The enormous national debt and deficit, along with discontent over K-12 education achievement, will make it that much more unlikely that the younger teachers will achieve privileged status. As a broader sweep, a generation of government type workers of years past has secured compensation that are “off the books.” This will result in a pension crisis, which is a topic for another day.

    Back to the lowly $200K physician. Is that why we have a shortage of primary care physicians – the very types that we’re told are needed to alleviate the health care crisis? Students opt for the specialties with a huge increase in pay. Maybe some medical students really prefer to be PCP’s. I personally prefer having a wide scope rather than a narrow specialized scope. Do we need that many specialists? Why is there such a large pay difference? Do the specialists deliver that much more value compared to PCP’s? I’ll posit that the specialists make too much, and the PCP’s make too little.

    Under free enterprise theory, increase in pay will attract more supply. Since government is so interlinked with healthcare, we can no longer assume physician pay is a result of free enterprise. The inequity between specialist and PCP pay took away from the PCP supply. Subject to debate, I have read propositions that there are cases of specialists excess; some specialists are underutilized, or engage in primary care, but bill at the specialist rate. Now I really won’t be popular (with this audience) suggesting these inefficiencies are generated from a skewed Medical Establishment – a complicated dance between medicare, pharmaceuticals, insurance companies, and not to be excluded, AMA. I’m still waiting for the genius to fix this.

    Finally, I will address your calculations. Because I don’t work at a think tank, I will not spend time dissecting your analysis line by line. I have used investment calculators, and I can calculate my future networth with very different conclusions based upon varying assumptions, changing and tweaking numbers here and there. Economic models also contain multiple variables; the slightest change and interactions among the variables will result in widely diverging outcomes, which is why we make fun of economists for predicting way off the mark.

    I will use an amazingly shorthand method of analysis that does away with the multiple variables that you’ve presented. From the comments, I see that some doctors actually have substantially lower than $300K debt. Nonetheless I will use $300K as a starting point.

    I’m a lowly doc making $200K/year at age 30. I will net a little over $100K take home pay. I’ll either live at home with my mom and or stay in that stinking rooming house that I’ve been living in all those years. I’ve lived poor all my life and I’m used to it by now, so what’s a few more years? I’ll live on those peanuts exceeding the $100K, so I will still have close to $100k/year left over to pay off my debt. I’ll be free and clear at age 33, at the latest age 34.

    Most likely secure reliable income for the next 30+ years, plus mucha respect – unlike the loser engineers who’ll get laid off somewhere along the line – career derailed or replaced by the increasingly efficient Chinese and Indians, and having to retrain and miss a few years of work. Very latest at age 35 when I’ll really start enjoying my $200K, I’ll start building up my wealth and trade up to living like a school teacher, and finally becoming a rich guy. And if you don’t want to live like a school teacher, why compare yourself with a school teacher?

    Not a few 29-30 year old docs can use this strategy. Not impossible for those who are married, or even have kids. In today’s depressed economy, 30-year old liberal arts majors haven’t even gotten their careers launched yet. Physicians are quite capable of delayed gratification. Why so many didn’t requires another study.

    I have changed a variable, and the result is entirely different. By spreading the debt out over 20 years instead of retiring it off early, the physician has allowed the magic of compound interest to work harmfully in reverse. Add on a brand new Lexus or BMW, and you’re playing with fire. Let the nurses have their fun, but you know better right?

    There are 5 physicians in my family. 2 are the young ones. 3 are beneficiaries of the “golden age of medicine” back when physicians really rake in the big bucks, and lived in mansions. The three didn’t live in mansions, half the size or smaller, but nice houses nonetheless. By conserving, the money went to work when luck presented itself – bull market luck combined with respect for Efficient Market Theory and tax efficiency – no pretense of investment guru status. Now money is given away to philanthropy and one got into medical politics. The 2 young ones will have to adjust to global and local economic and political forces, resulting in a new compensation structure. Simple needs, watchful expenditures, and a fulfilling life. Not bad.

    AKT

    February 8, 2011 at 12:14 pm

    • The point of the blog was not to reminisce about the great 70′s or before when oil was cheap and times were good. There is a fundamental shift going on in addition to the obvious global economy. There has been essentially an unlink of control and responsibility. That is to say that a party in control of a process is not responsible for that process. This deception was accelerated in medicine when tricky Dick Nixon applied ERISA to health care- it essentially gave HMO’s legal immunity for their control. What is the difference between a tyrant who has control but no responsibility? This unlink has been fueled by the public demand of something for nothing and the lying politicians who promise to deliver it to them; apparently all standard protocol of legal plunder in a system where over half the voting population pay no significant federal income tax but yet clamor for more and more ineffective government programs that are funded by a shrinking tax paying minority. The justification of allowing this tyranny to continue because everybody else does it and we have to adapt to a global economy is rubbish. American business would be even more competitive on a global market if it were not required to be the harbinger of socialism; not to mention that employees would have greater economic mobility since the fear of losing their health care benefits would be unfounded if they owned their own policy. Employee sponsored health care should end as it was supposed to when WW II ended- it was only meant to be a temporary solution to labor management strife during WW II.

      You say “not bad” but you are not really in their shoes, are you? It is bad when someone is salaried, owned essentially 24/7 by an entity whose administration may not hesitate to use you as a human liability shield for their control- to experience subtle but effective coercion to not do the right thing by a supervisor who, if things really go wrong, will not be there to take the blame for their management decisions or tell you that what they told you do is really what they meant. So, do you want the two young ones to be serfs? Is that a proud destiny for your ancestry? Are you OK with that arrangement? The local economic forces you refer to are essentially a command economy based on Medicare RBVS; it is not a free market, not at all, nor has it been so for quite a long, long time. In addition, the blog also brings out that as an investment in one’s future, medicine is really no longer a financially viable option- i.e. the return on investment of education and training, in addition, to time opportunity lost is not much better than a high school teacher. In addition, in south LA its not much better than an electrician nor a plumber in north Georgia. It may take three generations or so for the public to wake up to this fact.

      Roy Blackburn, M.D.

      February 14, 2011 at 1:58 am

  91. Hi all,

    Wow, this blog is huge and I haven’t been able to read every comment, but I do need to get to sleep and thought I would post this thought, which hopefully is only minimally redundant, though reiterates Dr. Brown’s point.

    Ultimately, I think physicians would just like to be paid a fair salary for what might be a 40 hour work week. If, as a PCP, I made $150 K for a 40 hour work week, I would be ecstatic. The issue is that PCPs make $150K for an 80+ hour work week; and a hard week at that. We all dream of having a 40 hour work week, but in primary care, that is virtually not possible. We see patients w/in a 40 hour work week, but the extra 20-40 hours goes into charting, filling out forms, calling patients back, refills, being on call, the list goes on and on. In the end, we don’t get compensated for that overtime. So, yes, $150K is a very nice salary and affords us more luxury than the median population, but for the amount of work it takes to get there, well, sometimes we feel sorry for ourselves when we can’t see our kids, don’t have the energy to talk to our family on the phone, don’t have the time or energy to enjoy the blue sky on a Saturday, look in amazement on our one day off as we walk past a restaurant at 5 PM and see massive numbers of 9 to 5′ers in the 40 hour work/week work force, enjoying happy hour (what’s that?). Yes, we chose this profession, we are an altruistic bunch born with rose colored glasses, we found it in our hearts that helping others is more satisfying than taking care of ourselves, we find the satisfaction in being valued by our patients who thank us all the time for our work… but it would just be so nice to for once, just once, have the system give a little, to have a little understanding of how broken medicine is now and that it needs a very large, deep fix that includes fair physician compensation. PCP salaries need to be more congruent with the work we do. Many of us are feeling so overwhelmed, undervalued, and underpaid. And we can’t put a stop to the inflow of work that does not pay us anymore for a 40 hour week vs an 80 hour week. For those of you who are skeptical and are wondering why we don’t just go home at 5 PM, call it quits and stop our whining, it’s called responsibility and an overdeveloped sense of conscientiousness. And be thankful that you live amongst people like us. Not everyone can handle it. Not everyone should be a physician. Not everyone physician should be a primary care physician, a surgeon, or a radiologist. Not everyone should be a janitor or a teacher. Should those of us who are privileged to be physicians and serve our patients be paid more? Does your plumber charge more for coming out on a weekend to fix your bursted pipes? When you car mechanic fixes your car and gives you a bill for $700, do you say, I’m sorry, only $100 of that is reimbursable, your shop will have to swallow the rest? And just remember the time when you will be thankful that your doctor stayed late to call you back at 7 PM before she left the office to make sure that you had your urgent question answered or refill that medicine that you accidently left at your grandma’s house. Aren’t you glad your doctor didn’t call it quits at 5 PM? (Sorry, doors closed, we’ll help you in the morning for that urgent problem). Boy, that would suck, wouldn’t it? Hug your physician. Tell her how much you appreciate her. It will soften the blow until things get better.

    Health care reform! I look forward to it!

    Good night, all!

    - One faculty FP trying my hardest to inspire my med students to go into family medicine

    Wilmington's Jen

    February 9, 2011 at 4:24 am

    • I can attest that primary care physicans are ridiculously poorly compensated for our level of education and our work. I’ve been a physician for 10 years, Family Med. I work four 9 hours days a week in order to have time with my 2 preschool aged children. Working 34 hours a week I make about $70K a year. No benefits, I have to buy my own insurance at $400/mo. I’m on the 30 year med school loan repayment plan at $950 a month. No pension plan, I have to save whatever I can for retirement. You can do the math on all that, but if I subtract student loan payments and insurance from the gross income it puts me at about $30/hr. And that’s not even figuring in the many years of no wages for training. I no longer encourage my rotating med students to go into primary care.

      Family Doc

      March 2, 2011 at 12:35 am

      • So very, very sad, the state of primary care. Why should one go into primary care when one or two more years of residency/delayed gratification can get you twice to three+ times the amount w/a better lifestyle to boot? It was a hard question to answer when I was a medical student contemplating family medicine and it’s an even harder question to answer now that I am living the life. In the end, though, I wouldn’t want to be looking at skin conditions all day or sitting in a dark room reading x-rays or looking at freaky eye conditions. And I actually think even worse are those IM docs who did a fellowship and still get underpaid despite their extra training when compared to their colleagues who are more procedurally oriented (e.g. an endocrinologist or rheumatologist gets paid so much less than a cardiologist).

        Primary care is why most medical students went into medicine; it is medicine at its purest. But HELLO AMERICA, there is no way we are ever going to recruit more students, boost the morale or improve this underpaid field with the current situation. Major reform needs to occur and don’t worry specialists, it doesn’t necessarily mean less money in the pocket for you b/c I do truly feel that the person who provides brain surgery to my patient should be paid a large sum for their services. But how about fairly appreciating the doctor who diagnosed the condition in the first place and helped you navigate the system to get the surgery? Should we really be paid just a pittance of what was paid to the radiologist who read your head CT and didn’t even talk to you? Should we really be allowing our best and brightest to make decisions about their future career based on their stress of having to pay back $300K in loans? How sad it would be for someone to be yanked from their dream of entering their dream field of medicine just in order to be able to pay back loans. Or how sad it is for the potential role models of primary care to discourage their students from entering primary care in order to save another future doctor from the pain they are going through (been there, done that, and my student, now dermatologist hopefully has a better life than I)? Folks, it’s not going to change until all physicians are valued for their hard work. There needs to be some equality. The proof is out there. It’s not just about money. The USA consistently ranks at the bottom of the list when it comes to health outcomes. Here is just one source: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best–Results-from-the-National-Scorecard-on-U-S–Health-System-Performance–2008.aspx

        “What?” you say. “How could this be? I can go to straight to my XX specialist and get whatever I want. Isn’t that good care? Isn’t that freedom and what the USA is all about? Why are we at the bottom of the barrel?” Yes, please sit down — it’s because we have such a broken primary care system.

        Why do we have such a broken primary care healthcare system? Because the public thinks going to a specialist is better care. Because there is no understanding that while prevention is not as “sexy” and “heroic” as getting your chest cracked open and the doctor saving your life, the latter is NOT better care. The Emmy should go to the next producer who can make a TV show that makes primary care look sexy. But here’s a big headline: “PREVENTION IS BETTER CARE.” But back to the question of why we have such a broken primary care system, I ask “why would a student want to go into primary care to make Americans healthier when the reimbursement to make people healthy is so undervalued?” It’s much more lucrative to save a person from their unhealthiness. Uncle John just spent $12,450 on a diagnostic coronary angiography which then led to the $44,820 CABG operation to save him from dying, all in the span on one month? Oh, but SHxT, maybe Uncle John won’t even make it through the procedure — and his family will still have to pay his bills. Doh! So, let’s all think about this long and hard: wouldn’t it have been a smarter use of his $67K to find a PCP and get advice about how he could prevent this in the first place, maybe blow his monthly fortune on a $4 prescription for lovastatin at Walmart and maybe over a 30 year lifetime, pay at most $10-20K in primary health care? That’s 47K in the bank to pay for the extra years of excellent quality of life that Uncle John will now enjoy. How much would YOU pay someone who could keep you from getting your chest cracked open, legs deveined, and a future life half-lived? Shouldn’t that be… well… priceless? Apparently not in today’s system. Clearly, our value system is turned upside down.

        @ Family Doc: you sound like you are drowning and I completely and totally empathize. Sadly, though the part time is supposed to help you to work less, I suspect that the percentage of time you put into your practice compared to your pay is 20% worse than if you worked full time and got a full salary and benefits. Sigh. Yet, your last statement “I no longer encourage my rotating med students to go into primary care” is the saddest testament of the shattering of your last pair of rose colored glasses. And, if it could be any sadder, you are not alone. Good luck!

        Wilmington's Jen

        March 2, 2011 at 2:12 am

      • See addendum #2 above. What are your thoughts?

        benbrownmd

        March 2, 2011 at 6:28 am

      • OK, Thanks Dr. Brown for the Addendum #2 way above in original chapter (took me a while to figure out to what you were referring).

        While there are many ways to interpret this data, my simplistic way of viewing it from a PCP standpoint is as follows:

        US medical graduates are not very attracted to specialty fields including family medicine b/c it does not pay well or get any respect amongst other specialty fields. Family medicine in particular has very little leeway to sub-specialize. Most other primary care fields have the sub-specialty option, and thereby more earning power. The best and the brightest (as measured by their test scores) are putting their brains where they see the money and respect are. In other nations, where there is great respect and more comparable pay for the well-rounded family physician, medical students are more likely to choose this field.

        This brings me back to my original point which is that the US health system is in crisis b/c too many US grads are choosing to go into specialty fields where the higher pay is. The system is disjointed, costly, and inefficient. The value system is skewed in the wrong direction. The proof is in the fact that the US has the worst health outcomes compared to other similar nations.

        I hope this data that you posted does not deter more students from going into primary care specialties. There are many other ways to measure intelligence than how one performs on a standardized test. Physicians need to respect and value the primary care fields more. When this occurs, medical students will follow.

        Wilmington's Jen

        March 5, 2011 at 4:55 pm

      • Regarding:

        Addendum #2. Residency Match Data.

        Food for thought.

        Data of applicants who successfully matched by specialty in 2009 (14-17)

        (Calculations include both U.S. Allopathic Seniors and Independent applicants)

        Specialty Average

        USMLE
        Step 1
        Average

        USMLE Step 2
        % US Seniors who were AOA Average # Abstracts, Presentations and Publications
        Plastic Surgery 242 242 42 9
        Dermatology 240 248 51 7
        Otolaryngology (ENT) 240 245 37 4
        Neurosurgery 239 237 28 8
        Radiation Oncology 238 241 35 8
        Diagnostic Radiology 238 242 23 4
        Orthopedic Surgery 237 240 28 4
        Ophthalmology 235 – - –
        Pathology 226 227 13 5
        Neurology 225 229 12 4
        Anesthesiology 224 230 10 2
        Internal Medicine 224 229 15 3
        General Surgery 224 230 12 3
        Internal Medicine/Pediatrics 222 231 21 2
        Child Neurology 221 – - –
        Emergency Medicine 221 229 11 2
        Pediatrics 218 227 12 2
        Obstetrics & Gynecology 217 227 14 2
        Physical Medicine & Rehabilitation 213 216 4 2
        Psychiatry 213 217 4 2
        Family Medicine 208 214 5 1

        I chose Family Medicine because I believe in keeping people as healty as possible, preventing fires instead of putting them out. Also, I’m a DO, and our training is skewed toward encouraging people to go into primary care. But I didn’t HAVE to choose family med. My board scores on parts I, II, and III were Percentiles 90, 96, and 99 respectively.

        I will admit, though, I don’t have good business sense…

        Family Doc

        March 5, 2011 at 11:07 pm

    • Very, very well put.

      Mark S., M.D., Ph.D.

      January 24, 2012 at 1:32 am

  92. I read through the article and every post made so far and there are some things that I noticed. Those arguing against this article always seem to mention some mathematical inaccuracy that invalidates the whole article, but always fail to mention what that critical bit of math is or what these errors might be. Technically by comparison doctors are underpaid because they don’t get overtime. Had I read this article before I went to medical school, I don’t think I would have gone. I’m preparing for my step 1, but I feel disappointed. I like helping people, but my family is really depending on me to be able to support them. Because I’m a fmg I don’t have a chance to get one of the higher paid specialties. I really messed up.

    neil

    February 9, 2011 at 8:52 am

  93. FYI I’m pretty sure that Dr. Rey failed his plastic surgery certification, there isn’t a doctor stupid enough to be practicing uncertified on purpose. Than saying he fixes deformed kids in third world countries to cover it up is sad, like those people in the military who do stupid things and try to cover it up by throwing around the words, “protecting your freedom” like it’s candy.

    neil

    February 9, 2011 at 9:11 am

  94. The market pays what it pays, folks. Like someone mentioned in an earlier post, it pays you enough to keep coming back to work day after day, right? There’s no use getting your panties in a twist because you feel that you’re “underpaid”… please 99% of us feel that we’re “underpaid” in one way or another.

    And to address all the hate directed towards the finance people: keep in mind that the average Wall St. salary is $150k, all while living in NYC. And before you mention bonuses, a lot of $0 bonuses were handed out this year especially in S&T. Yes there are outliers, but there are outliers in the medical field as well.

    We’re all overworked, we’ve all transfered our wealth to academia, we’re all underpaid, and we all wish we worked for Google. Wow, surprise, that’s life. Suck it up.

    Finance Guy

    February 9, 2011 at 3:37 pm

    • That would be a reasonable argument IF medicine were a free market and IF there was job fluidity with respect to physicians leaving medicine and new physicians entering.

      benbrownmd

      February 11, 2011 at 11:50 am

    • “And to address all the hate directed towards the finance people: keep in mind that the average Wall St. salary is $150k, all while living in NYC. And before you mention bonuses, a lot of $0 bonuses were handed out this year especially in S&T.”

      Yeah, THIS year. And to the low man on the totem pole. And what kind of credentials do you guys have? An MBA, if even that (because not all of you do)? And how many hours did you spend working/studying in your grad program? And how many of you use just about every tax shelter and loophole you can exploit? And how many of you pay only 15% taxes because your income is listed “capital gains?” And how many people live in NYC who don’t get paid nearly that much? Your suggestion that Wall Streeters are similarly overworked and underpaid is laughable, at best.

      AnonymousStudentT

      February 20, 2011 at 9:21 pm

    • I’m finding it hard to see where you think there is a parallel here. You seem to think we should pity you for your $150k; as a research technician in NYC, I make less than $40k. It may not be enough to live the lifestyle you must think you are entitled to, but it’s enough to get by in reasonable comfort. How’s that for perspective?

      DBA

      February 20, 2011 at 9:41 pm

    • Yeah, ummmm…. I have an M.D. and a Ph.D…. I save people’s lives or, hopefully, improve their quality directly. I help find cures for disease and increase human knowledge. I help teach the next generation of people who help do the same.

      I make 50k/yr. In Los Angeles. If I’m lucky that will go up to 150k someday. I’m in my mid-30s.

      Forgive me if I don’t feel bad that some of you didn’t get bonuses for clicking the wrong buttons on your spreadsheets, nearly plunging the world into economic depression, and had to survive on $150k.

      Boo hoo. You have no idea what overworked is.

      Mark S., M.D., Ph.D.

      January 24, 2012 at 1:37 am

  95. this web site is crybaby central

    uh

    February 12, 2011 at 1:16 am

  96. Silly posts. Obviously too much time went into many of them.

    I remember seeing in one of the posts something about comparing “apples to oranges”. This was probably the most relevant post I saw in this sadly pathetic train of “waa waaa” arguments. Dr. Brown, I think you did a great job with this article, but at the end of the day, the average hour spent by a teacher in academia in no way relates to the rigors of the average med-school class hour. I do believe that you used this “equation” to keep from undermining a respectable and essential profession in our society (teaching) but the truth is the truth and you shouldn’t ever say otherwise.

    Prior to medical school, I tutored SAT and taught after school / summer classes. Let me tell you, I knew enough from my undergraduate studies in biology to be considered a great teacher (I tutored Math, Science, and English), a teacher to many of my students who knew more and did a better job at facilitating information to them than did their real teachers at school. Now I understand that my class size (10-15 students on the average day) was typically smaller than the average high school class size and in no way am I saying that I would be capable / or more realistically, willing to, teach high school English in an underprivileged area of the United States. I’m simply saying, that on average as far as the amount of knowledge you need to become the average teacher in comparison to what you need to become a doctor? It is like comparing the size of the fly on the elephant’s rear with the size of the elephant itself.

    For those of you teachers who are crying about the amount of time you’ve spent in post-graduate educational programs (PhD or masters programs), I’m not trying to say what you went through wasn’t difficult, but come spend a day in the life of a medical student and do what we do, and tell me that the workload (or more specifically, the intensity of the workload) that you were given even comes to close to being equal to what we have to deal with.

    But at the end of the day, what we all do ultimately stems from choices that we made in life. Doctors chose to become doctors, and teachers chose to become teachers (I’ve only been comparing these two professions because this seems to be the comparison that is at the root of all of the whining and crying). We (medical students / Doctors) chose the route of more extensive sacrifice and no matter what, there will always be people who will say we deserve less (in terms of financial compensation, etc.) But then again, they’ve never lived a day in our shoes, so we can’t expect them to understand. In fact it’s something that doctors are trained to do — patiently deal with ignorant people who think that it makes sense to compare apples to oranges.

    p.s. besides, the only people who really do get paid too much in this country are the damn celebrities / athletes.

    Andrew

    February 13, 2011 at 2:24 pm

    • Andrew,
      Just as you say someone who hasnt gone through med school cannot appreciate the work load, your tutoring a couple kids part-time cannot even come close to what teachers today actually go through.
      When I began teaching straight out of undergrad, I worked a consistent 80 hrs per week. I was up every morning at 4AM to get to school and get things ready for the day, stayed after school for tutoring followed by coaching which typically kept me at school until about 6PM. Ignoring game days and weekend tournaments I easily worked at least an 80 hour work week.

      Teaching a small group of motivated students science or SAT prep is easy, keeping almost 200 17-18 year old students (most not college bound) engaged with British Literature is MUCH more stressful than trying to cram Biochem or Immunology in my own head. How many hours a day do you actually even spend in a med school classroom and how much of the time do you actually spend in the comfort of your own home learning what you need. I can tell you as a former teacher, class is always mandatory, if youre having a down day you cant jsut stay at home and read your books. Youve got to suck it up and actually be present…ALL DAY.

      Had I stayed in the profession I would most likely have kept up that workload for close to a decade until I could afford to back off and take on less responsibilities at the school. That sounds pretty on par with 7-9 years of post-grad training in medicine. That decade of hard work wouldnt have maybe jumped me up to 60k a year…not the 150k of a starting FM doc.

      Yes, we all make choices on what we want to do with our lives. While I chose to leave teaching and pursue a career in medicine, I applaud those good teachers who stick with it. I think you need to get off your high med school horse and acknowledge that there are other careers out there that may be as stressful and time consuming as your oh so awful life in med school.

      Med school is tough…Im struggling through it now myself, but the hard weeks here arent any more difficult than a hard day teaching. Physicians dont need any more pay cuts…but teachers certainly need some raises or all the good ones wouldnt run off to other careers where they can make a living.

      Med Student

      February 13, 2011 at 3:19 pm

      • I agree that high school teachers probably need to be paid more. But I am going to point out that 13 years ago, my starting salary as a family doc post residency was closer to around 110K, and it is now 150K base and if I go in for deliveries or see more patients, then I can get a bonus of 15-30K. My husband who works at a student health center as a primary care doctor is now making a whopping 115K which allows him furlough time similar to what a professor at the university has. I don’t think his work load is any easier and he can’t get bonuses for seeing more patients. He has 23 years under his belt. And let’s see, a PhD professor in math at the university makes 160K, about 20 years into his profession, and gets summers and all those spring and winter breaks off. So go figure. It’s all apples and oranges and we are all glad that there are other rewards other than monetary. Otherwise, we wouldn’t keep going.

        What’s hard for another person is easy for another. In my neck of the woods, physicians are also teachers. So hopefully as a former teacher, you will also impart some of your new learned knowledge onto your future learners and feel satisfied that your volunteer time for teaching and preparing for case presentations, grand rounds, M&M is as worthy as the satisfaction of making some bucks to see patients. A clinic 1/2 day without a student is much easier than a day when I am solo, but the stimulation I get from having that student far outweighs the extra time it takes. Life as an attending does not get easier folks. Residency was a cinch b/c you knew it was going to be over after x number of years. Attending life is the constant grind; and it’s not like a teacher who prepares lectures and then can at some point start cutting back, get TAs to teach and grade papers, or go back and reuse the same thing that you prepared five years ago. The first few years are probably tough as you rebuild a new curriculum. The good teachers come up with innovations in their teaching and therefore need to do more prep. The good physician teachers do the same in their volunteer time. But it’s all on top of the patients (and possibly research and grant writing and hospital committees).

        Not trying to whine. Just painting a realistic picture for those of you not in touch with the attending world.

        Wilmington's Jen

        February 13, 2011 at 3:47 pm

      • Unfortunately, the Collective is trying to make donkeys out of teachers too. How many teachers out there are coerced to purchase school supplies for their students, not a contractual obligation but has become an expectation that can cause problems for the teacher if they do not become part (the donkey part) of the team. What rubbish. If I were a teacher in that situation I would tell them to go to hell.

        Roy Blackburn, M.D.

        February 13, 2011 at 4:10 pm

  97. Dear Dr. Brown,

    Thank you so very much for your article. It accurately but not completely reveals what is actually going on with the profession. Add on the liability cost and exposure that physicians have and it is even more disheartening.

    For those health care professionals that dismiss this article they are free to do so. But I would tell them- nose to nose if need be- that they have a character flaw- they endorse looting and are looters themselves. Not part of the humanity that I want to be associated with.

    The downward course of medicine is unlikely to change until the political parasites, I mean leaders, are forced to walk the talk. Currently the federal representatives have a sweet heart health care plan all at tax payer expense and life long even after just a few years of parasitism, I mean “service”. The end result is clear as has been the historical outcome in other countries pursuing this folly of deception, self deception and looting- equal access to sh*t for 99% of the population while the 1% political elite have their own tax payer funded health care. For those who try to use the statistics of these state systems those statistics do not reveal a prevalent fact- tipping, which one often has to do to get something done.

    Your article should be required reading for all who are currently considering a career as a doctor if they want to not be a serf/donkey to the Collective.

    Roy Blackburn, M.D.

    February 13, 2011 at 4:06 pm

  98. Not that government has any Constitutional right to be involved in health care but if the Collective wishes to pursue it then

    IF THE PEOPLE OF THE UNITED STATES WANT UNIVERSAL HEALTH CARE THEN THE ONLY WAY WE ARE GOING TO HAVE AN ETHICALLY VIABLE AND ECONOMICALLY REALISTIC SYSTEM IS TO:

    1)MAKE THE POLITICAL LEADERS WALK THE TALK-I.E. THEY MUST HAVE THE SAME BENEFITS THAT THEY ARE FORCING UPON THE GENERAL POPULATION,

    2)ALLOW ALL U.S. CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A TAX DEDUCTION/CREDIT FOR THE PREMIUM OF THE HEALTH INSURANCE POLICY OF THAT INDIVIDUAL’S CHOICE,

    3)ALLOW ALL U.S. CITIZENS AND TAX PAYING LEGAL RESIDENTS TO HAVE A HEALTH SAVINGS ACCOUNT

    4)ALLOW ALL U.S. HEALTH CARE PROVIDERS TO GET A TAX DEDUCTION/CREDIT FOR THE CHARITY HEALTH CARE THEY PROVIDE IN THE UNITED STATES (NATIVE SOIL, TERRITORIAL WATERS AND AIRSPACE)

    5)HAVE TRUTH IN PRICING-I.E. TELL THE CUSTOMER, THE PATIENT, THE ACTUAL COSTS OF GOODS AND SERVICES PRIOR TO PURCHASE IN NON-EMERGENT SITUATIONS.

    Roy Blackburn, M.D.

    February 13, 2011 at 4:23 pm

  99. Med student.

    You missed the boat. I was simply illustrating that the amount of education needed in order to become a teacher is nowhere near the amount required to become a physician. It was an attempt to refute what people were saying in regards to the amount of “educating” that they needed to undergo in order to become a teacher. But apparently you interpreted my words in the wrong way. It would’ve made more sense if your argument was directed at Dr. Brown instead of at me.

    If you look at my intro, I applauded Dr. Brown for refraining from undermining the level of difficulty of the academic course load required to become a teacher, versus that required to become a physician (he weighed each hour spent in studies equally between the two professions) Hence, the rest of my post followed suit: comparing the two professions from an academic standpoint.

    Furthermore, if you ahd really looked at my second paragraph where I described my experiences as an after school teacher/tutor, and had you read it carefully, you would’ve also noted that I explicitly wrote that I probably would not be capable of (let alone willing to) teach a full-sized class in an underprivileged area of the US (and in all honesty, anywhere in the US – it’s mentally draining, and stressful – and contrary to what you believe, most of the students I had were not motivated – they were forced to be in the after school programs by their parents and in fact resented me from day one. It was a challenge to get them to “like” me let alone listen to me, and it is a challenge I’m sure public/private school teachers face every day). Again, I was simply noting the fact that education wise, it is safe to say that it takes a lot less to do what a teacher does.

    I respect individuals of every profession and I understand that each profession has difficulties that are innately unique to that particular profession. Janitor’s have a tough life too – full of sacrifice I’m sure (a life that I could not live) yet I’m pretty sure that the amount of time a janitor spent in school could never equate to the amount of academic hours that are required to become a physician. Again, to drill home the point, I never meant to imply that teaching was not hard or stressful and I applaud you for contributing to the future of our society by spending time teaching yourself – God knows I wouldn’t be here without some of the great teachers that I have had. I am sorry that you wrongly interpreted my post and believed that I am some sort of “cocky” medical student who has no appreciation for other professions. I am not here for the money, nor am I complaining about what I have to go through, I was simply illustrating a point.

    Andrew

    February 13, 2011 at 4:30 pm

    • Is that a salaried janitor or one who gets paid by the hour?

      The point is that no profession should be made into serfdom. The greatest reason for health improvement in the last century was housing and nutrition. Yet, I don’t see the occupying government trying to do to chefs, restaurant owners, plumbers, carpenters, etc. what they are trying to do to doctors. No surprise because if they did there would be blood in the streets. Nor would I tacitly accept or endorse such government attempt at collectivizing those professions. They tried that crap in Eastern Europe. IT DOESN’T WORK!

      Roy Blackburn, M.D.

      February 13, 2011 at 4:40 pm

  100. Andrew,

    I did not miss “the boat.” I am aware that there is much more knowledge required to be a physician than a teacher…what I was saying is that many careers begin as rigorous as the couple months youve spent in med school. I know its a big change from undergrad or your part-time summer job at the smoothie shack and good for you for working hard to get there but youre not the only person in the world working hard.

    When I was teaching I would come home 5 days a week to eat something resembling dinner then pass out to wake up at 4 the next morning. Can you honestly tell me you dont spend a few hours a day playing video games or watching Scrubs and House in your “rigorous” med school life? Yes its hard, but I dont see why you are so bent on med school being harder than any other graduate program.

    Med Student

    February 13, 2011 at 7:13 pm

    • umm… Because med school is harder than most others Med student.
      I’m also a former teacher, for schools in south ATL (I know about the worst of the worst), turned med student.

      There is no need to have woken up at 4am, you’re just saying that to credit a point you’re trying to prove.

      Have you ever considered that you were just a poor teacher, and poor cook?

      um.. wake up

      February 13, 2011 at 9:48 pm

      • South ATL…gasp. Isn’t that where Chick-fil-A started? Cant be that bad
        I did actually wake up at 4AM, in med school I get to sleep in until 5.
        I dont see how any of that would lead you to believe I was a poor teacher…thanks though.

        Med Student

        February 14, 2011 at 6:55 am

  101. You are still missing the boat.

    I am not saying that you didn’t work hard. Nor am I complaining about my work load now or commenting on any work load I’ve had in the past. So I’m still not really sure why you are still so adamant that you have some sort of legitimate argument going on here with me. To be honest, this lack of sense that are exhibiting here is starting to get a little embarrassing – especially since one day you will be representing my profession as well. That is, if you really are in a legitimate medical program in the United States of America.

    I’ll say it once again, I respect any individual who spends their life working hard to make an honest living — and this includes teachers. But that was never my point. My point was that medical school is much more rigorous than most other pre-professional program (definitely a masters in education, or a BA in education) — sorry to say, but that’s a fact. If you’re not able to agree with me, then I’m not really sure what medical program you’re in, because it must not be one in the States. Either that, or your pride won’t let you admit that you made an error in interpreting my original post. It’s either one or the either. Regardless, you are really starting to look foolish.

    And for the record yes I still have fun, in fact, I have a lot of fun still. But again, that was never the point. And actually, I am quite overweight and do love a good smoothie and I would’ve worked at Smoothie King (not shack) over the summer if there were jobs available. But again, that was never the point either. The boat is long gone man, give it up.

    Andrew

    February 13, 2011 at 10:15 pm

    • Youre right, I just felt like picking on a little muscle bound asian.

      Med Student

      February 14, 2011 at 6:43 am

  102. p.s. for the record, i just wanted to add that I think large teachers who are extremely tall deserve the least money. They take up so much space, and are a safety hazard. Who really cares how hard they work? After all, the harder they work, the more oxygen they consume, and the more risk the children of the United States are exposed to. The local Fire Marshalls need to do something about these large teachers who are plaguing our schools.

    Andrew

    February 13, 2011 at 10:31 pm

    • I don’t think anyone should ever take a job for the money! If you don’t love what you do, get out of it! God created us as talented and beautiful people. We are all so completely different. Who are we to say that teaching is harder than being a doctor or vice versa? Every job is complicated and very demanding if you do your best. Sure there are lazy doctors and lazy teachers and lazy police officers and lazy firefighters. When it comes down to it, it really doesn’t matter what people make. I know people that make a whole lot less than me and they are the happiest people I know. I’m a teacher and I would love to make more than what I do, but reality is, it’s never going to change. But I do love my job. I love the fact that I can influence kids in a positive way and hopefully change lots of lives while doing it. Every job is incredibly important. Even the person that is a greeter at Walmart!
      I went to Africa last summer and people there have no food to eat and they will never have a chance at getting a job that will take care of their basic needs! Americans are so incredibly spoiled and ungrateful for what they have! Appreciate the fact that you can even sit down for a second and have a bite to eat. I’m just appalled at how many people are complaining about what they make! When we have so much to be thankful for! I can honestly say that I can’t imagine making over $100,000 a year and even utter a word of complaint! Unless we are in other people’s situations, we will never understand what it’s like to walk in their shoes.
      Thank you for sharing this article. It is very eye opening. I know that doctors work many hours, but there are jobs everywhere that people spend their lives working at. One job is not more important than the other. We can argue all day long about which ones are more important but we are really just wasting our breath. Let’s try to have some respect for everyone else and appreciate what we have. Here are some statistics from what is going on in our world today. 963 million people do not have enough to eat, more than the US, Canada and the European Union combined. -800,000 girls and women have crossed international lines as human slaves and sex trafficking.- Approximately 1 million abortions a year. We weren’t meant for this… I think there are more important issues going on rather than arguing over who needs more money or who works harder. Who really cares! Maybe we should spend our energy trying to fix these problems that are more important!

      Sweetia

      February 17, 2011 at 8:09 pm

      • You are diffusing the focus of the issue in this article. The focus is to show that the public perception of those “wealthy doctors” is false. That same false perception is further contributing to the decline of medicine due to ad populum misapplied democratic legal plunder of a non federal tax paying voting majority who seems to think that all those wealthy doctors can afford further reductions, forced labor, special taxes to their profession only, etc. Government officials often refer to a study where people voted on how much they think that doctors should make. Voted. What kind of crap is that? It is a command economy system whose end results are typified by the oft heard expression in the former Soviet Union- “they pretend to pay us so we pretend to work.” It takes much more than love of money to complete premed, med school and residency…..much more. Your reference to the misery in the rest of the world, in addition to being off topic, is reminiscent of misapplied relativism of happiness- i.e. one shouldn’t complain about one’s situation because there is someone else who has it worse. The trouble with that approach is the converse equivalent- i.e. others must be worse off than you are for you to be happy. Again, this article is not about world hunger or human trafficking.

        Roy Blackburn, M.D.

        February 18, 2011 at 2:54 am

  103. “I don’t think anyone should ever take a job for the money!”

    I am just now pondering over your statement. I am curious. Is that your perspective for yourself? Are you saying, “I don’t think I should ever take a job for the money?” If so, have you ever taken a job for the money?

    Or are you actually saying that ‘no one, including yourself, should ever take a job for the money.” If the latter is the situation, are you not speaking for others without that person’s permission? Is that not an intrusion?

    Roy Blackburn, M.D.

    February 18, 2011 at 5:00 pm

  104. I love how the first response was over a page long and all the doctors’ (MD’s not PhD’s) responses are short. This is probably because we are working those 80 plus hrs a wk. For example, I am reading this on my 15 min lunch break at 2:30 on a Sat. afternoon.

    MS III

    February 19, 2011 at 3:39 pm

    • 15 minutes. That’s pretty good. In our on-call room (that we never had a chance to sleep in) there was a poster. It was a drawing of a first year resident. The resident had a foley catheter, rectal catheter, a knapsack that had lab sleeps and magic gold guiac solution hanging out of it; also, had a tube coming out which was a feeding tube, presumably for food (if it were your lucky day). Oh yea, the drawing of the intern also had roller skates on. And their hair was a mess. Your probably not a kid but I am going to tell you what I have told all of my kids (and I should have listened to my brilliant mother in 1969)- THERE IS NO FUTURE IN THIRD PARTY PAY! I REPEAT, NONE. Or to be more precise, there is no future that is worthwhile in terms of reasonable return of the blood, sweat and tears that you put in with regards to your outcome. However, if you are a glutton for punishment, have some twisted psycho social dysfunction with disruption of personal boundaries and concern for self well being, then go ahead and knock yourself out. If you want to be Jesus without overhead and have no regard for justifiably anticipating gratification after years of delay then go ahead. Otherwise, realize that your noble pursuit of making the world a better place makes you currently vulnerable to enslavement by a population plagued with entitlement.

      Roy Blackburn, M.D.

      February 23, 2011 at 3:34 am

  105. There seems to be a lot of animosity from commenters on both sides of this discussion. I hope you will not mind if I express my concern about the content of this article. I’m not sure why you did your own calculations for student indebtedness rather than using easily-located figures from the literature, but your assumptions are not backed up by evidence. According to the AMA, the average total educational indebtedness of medical students graduating in 2010 is $157,944, not $300,000. For the internist you cite as an example, and assuming 6.8% interest on the entire amount, this loan can be repaid comfortably (i.e., at <10% annual income) in 20 years at a cumulative cost of $274,000 or so, about $500k less than your figure of $788k. Finally, your choice to calculate net hourly wage is deceptive since occupations are generally compared by gross pay. By accounting for these points, we see that the average Californian internist has an adjusted hourly wage of around $54/hr, a less dramatic but more realistic figure.

    I suspect your exaggeration of the financial woes of specialist physicians is an attempt to make your point without appearing tone-deaf. After all, for doctors making in excess of $200,000 a year to complain about their salary at a time when unemployment and worker discouragement are near historic highs, smacks rather strongly of an entitlement complex. But one hears such complaints with increasing regularity: one doctor I know, who recently moved her family into a $1M house in a tony Chicago suburb, complained bitterly that she had to render free care to indigent patients while she "struggled to make ends meet."

    Doctor pay is indeed a problem, but not because specialist physicians aren't paid well enough. Rather, as I see it, the problem is that six-figure debt forces many students to choose highly-specialized training over more socially beneficial, but less lucrative posts in primary care. According to a report from the American College of Physicians, only 19% of first-year internal medicine residents planned to pursue a primary care career. The entrenchment of the fee-for-service system, as well as the rising number of Americans who undergo unnecessary specialty care, are both direct results of this imbalance. It is de rigueur to lay the blame for skyrocketing health costs at the feet of insurers; the unpleasant but inescapable truth is that most of these costs must be attributed to the fact that a large and increasing proportion of the American health-care system is a treatment in search of a disease.

    I'll go to medical school in the fall, probably to undergo years of specialty training, so perhaps it is hypocritical for me to make these arguments. But I believe that we will not succeed in controlling the rise of healthcare costs in this country until we can come to grips with this imbalance between primary and specialty care. A good place to start would be to offer strong incentives for students to choose primary care, such as tuition benefits or loan forgiveness. There are already a few such programs (such as the National Health Service Corps) in place on a small scale. But I don't think an increase in pay for specialists can be part of any sensible solution for the problem.

    DBA

    February 20, 2011 at 9:31 pm

    • Write back once you’ve gone through 4 years of med school and are in your first year of residency. Luckily for you, the hours you are allowed to work will be 16 straight in the first year. That law takes effect next year for 1st year residents. If I only worked 16 hours straight I would feel like I was on vacation. You may never know what it really is like today or was like for Doctors before us. I would like to hear your comments in a few years.

      someone who cares

      February 21, 2011 at 10:39 am

      • This doesn’t address my comment at all.

        DBA

        February 21, 2011 at 3:53 pm

    • Spoken like a true Savant…..without experience. In loan debt, there is also the consideration of opportunity lost. That is to say, how much would the debt actually be if I had an income at that time (which I could not have because I was training) which would have further negated the need for school debt.

      “A good place to start would be to offer strong incentives for students to choose primary care, such as tuition benefits or loan forgiveness.”

      Wow. Sounds like the feel good Utopia legislation that has been a part of the major cluster flock that we are now experiencing the joyful consequences of.

      If you were my kid, I would tell you:
      - You’re (probably) a good person, maybe even an angel
      - But this damn sure ain’t heaven
      - You are about to embark on a journey that used to be historically noble and well intentioned
      - However, the current and foreseeable reality is such that the power elite want to turn you into a serf to placate the rabble call for the “right” to health care
      - If you want to be a serf, then go ahead
      - If you do not want to be a serf/partial slave, then realize that there are other ventures just as interesting and, if you are very successful, both personally and financially rewarding that may allow you to do further noble things if you so chose-for instance, the recent discovery of implanting Anopheles intestines with a Vector that decreases their viability may save more lives than the best surgeon in Manhattan.
      - Also, realize that even the most noble plans, if not sustainable, will eat you up if you are part of them. But that is OK if you believe strongly in a cause. What I ask is that you evaluate the reasons for those beliefs and not let misguided subconsciousness lead you like a lemming over the cliff.

      Just my humble opinion. But I could be wrong.

      Roy Blackburn, M.D.

      February 23, 2011 at 3:51 am

      • @ Dr. Blackburn. Could you elaborate on your response to this statement? I obviously need to buff up on the hx of medicine as it exists today in the USA. Are you referring to the implementation of HMOs?

        ““A good place to start would be to offer strong incentives for students to choose primary care, such as tuition benefits or loan forgiveness.”

        Wow. Sounds like the feel good Utopia legislation that has been a part of the major cluster flock that we are now experiencing the joyful consequences of.”

        WJ

        February 23, 2011 at 5:34 pm

    • Your impression of the doctor moving into the million dollar house may be misleading. Net worth is not always so apparent. In addition, this country should have a flat tax with a set percentage above 10,860$ and no exemptions. The notion of one’s house being a bank is an illusion. It is nothing more than a durable good. Regardless, are you saying that the above doctor is obligated to give “charity” care- actually an oxymoron if one is forced to do it.

      Roy Blackburn

      February 23, 2011 at 3:56 pm

    • The average debt of graduating medical students is skewed by those whose parents paid the bill. The point I am trying to make is the COST of becoming a physician, regardless of who pays for it. The system should be set up so that ANYONE can afford to become a physician – not just those with generous parents.

      It is ridiculous to compare careers and specialties by gross pay. Gross pay doesn’t matter, it is net pay per hour worked that matters. That is why I calculated the “adjusted net hourly wage.” If you can find a more pure way to compare, please share it with me.

      benbrownmd

      March 2, 2011 at 6:02 am

      • You are absolutely correct that it is ridiculous to compare careers and specialties by gross pay. For years, I have encouraged my complaining colleagues to put their pen to the paper and calculate what their actual hourly wage is. Many are shocked when they have done so. Several state they are afraid to do so since it would be more depressing than it already is. Several have made career changes.

        It is comparable to comparing unit price in a grocery store. Keep shining the light so that the truth will be known.

        Roy Blackburn, M.D.

        March 2, 2011 at 11:00 pm

  106. here are actual facts. 1st year resident, my schedule is working 30 hour shifts every 4 days. That is 30 hours straight. There is barely one of those nights that I can get in 15 minutes of a nap. I try to get something to eat if I can but I’ve gone the entire 30 hours without eating. My average # of hours worked is 95. Average. The person that wrote something about residents/students sitting around eating ice cream – you have absolutely no idea what you are talking about. The decisions Residents have to make every day can save lives or harm someone. It is a shame to compare all the careers mentioned like police, fire fighters, teachers because they all are important and do have educational requirements that must be met before they can go into those fields. BUT I will tell you from experience being a 1st year Resident. I have over $200,000 in debt. Actual costss were around $150,000 for the 4 years of med school but when you add interest at 7%, then you can easily see where the $200,000 comes in. I think the point in the arguement was that Doctors do not make what people think they make as a whole. Yes you have some that have very large salaries but I promise you with the risks they take, they have earned their place. If I had gone into a field, say as a Financial Advisor, today at 29 I would probably have a great savings/401k plan, a house, and a family. However at my stage, I have no savings, a 401k that I just started, a house that I was able to get into because of the tax credit and I’ve not started a family because I have no time. I will be at least 5 years behind everyone else my age. Yes, by the time I am 45, then I may be ahead financially but I promise you, it will take until then to do that. …And that is hoping that someone does not sue me or that I don’t just get burned out and go to another profession. I’ve worked my rear end off – I chose to do this – no one made me – but I promise you, I’m putting in more hours than any profession that I know other than a soldier that may be in battle. Lets not try to determine who it the best and biggest but lets just pay respect to all of the service occupations and know that yes, some have steeper requirements that others. I will say that I had no idea what Med school/residency was really about until I got in the middle of it. It is so much harder than you can imagine. If you don’t have any time, then what good is money. Read Dr Blackmans comments above. He is totally on base with his comments. There are not many people that could walk in the shoes of a medical student/resident. It akes alot of time, energy, dedication and desire to be able to make it thru the years leading up to when you can become a practicing physcian. Walk in my shoes.

    someone who cares

    February 21, 2011 at 2:08 am

    • Blackman or Blackburn?

      Anyway, you are right. There is no profession more demanding in terms of delayed gratification, training, education, etc. None.

      But the problem is that we (physicians) are too civilized and too busy for our own good. We do not have time or energy to raise our head above the fray to realize what is happening to our profession. The Ninja slow bullet approach is being utilized to destroy once what was the greatest noble profession in the world. We cannot serve two masters. We cannot ethically realistically serve third party pay- both insurance and/ or government- simultaneous while serving who should be our true master, that one patient/their appointed spokesperson whom we are face to face with. The older I get the nastier I get with the entities or their pawns that try to further degrade our profession. I recall telling a case manager, probably with a GED, who needed a detailed explanation that they could understand for medical indication of something I ordered. I told them it was nothing personal. They were not the decision maker in this mess. Then I proceeded to tell them about my time, many years ago, while visiting a friend in Communist Hungary. At my friend’s graduation ceremony, we were in a student beer hall. There were several Soviet soldiers next to our table. We were all having a festive time. We talked. I was chatting with the Soviet soldiers, specifically one. The conversation progressed. I told him he seemed like a nice guy. Not really a bad person. I enjoyed talking with him and told him so. However, I also told him that if he ever went to the West as an invader I would not hesitate to kill him. He looked at me. I looked at him. I told him you know what I mean. If you try to be any part of exporting that shit philosophy by force, even if you are just following orders, I will kill you. That was the end of our conversation. Put a little chill on the evening but I felt, and still feel pretty good about it. And I still mean it.

      Roy Blackburn, M.D.

      February 23, 2011 at 4:09 am

  107. Oh and I left something off…once I complete the 30 hours shift, I go home, sleep for 4 or 5 hours, get up and eat, go back to bed so that I can be back at the hospital for another day which usually is a 12 hour day. I forgot to mention that fact. Out of 28 days this month, I am off 3 days in total. Then I have things to read up on, investigage, or learn about as I can while I am away fromt he hospital to be ready for the next day.

    someone who cares

    February 21, 2011 at 2:11 am

    • During my residencies (did two) I knew it was a good day if I had time to use the bathroom.

      Roy Blackburn

      February 23, 2011 at 11:36 pm

      • Oh that reminds me of one 36 hour shift I was on while sick- I’ll spare the gory details but let me just say I ended up moving all my paperwork into the bathroom to save time running back and forth. Sorry to all the patients that could have been exposed to something but calling off sick is not an option, at least not when you are in training. Another time my then-husband was very ill and really needed me at home to take care of the kids. Too bad- he had to fend for himself.

        Anonymous

        October 29, 2011 at 8:43 am

  108. Thats why you become a pharmacist instead

    The Highlander

    February 21, 2011 at 6:25 am

    • amen – or a NP or PA or anything besides a Doctor of Medicine, but once you are in so deep, you can’t turnaround and go back. Not that you would want to but you can’t because of the debt and I always felt my calling was to be a Doctor. Again – I don’t think the original articile was to dimish the role of any other occupation. I think it was to make the point that for the most part, Doctors are underpaid and he was trying to show why. Again, all the money in the world doesn’t help if you don’t have any time. Time becomes the real commodity. Have a good day.

      someone who cares

      February 21, 2011 at 10:36 am

      • I know of several instances where nurses do much better financially than physicians on a per hour pay basis. Several years ago I was more than curious. I called the state nursing board and told them what my credentials were (double boarded, etc.) and I was interested in getting a nursing license so I could work as a nurse. The Nursing Board chairperson told me that I would have to go back for training. I then asked what kind of training. She then stated that I would have to start over from day one in nursing school. I then re explained to her that I had a degree in Biology, I had completed medical school, had completed two residencies, was double boarded and was in good standing with regards to my medical license. She then told me I would still have to go back and start day one in nursing school. I then asked her if there were some sort of proficiency test I could take to exempt out of some (perhaps even all) of these requirements. She then reiterated that I would not be given any such test and that I would have to start over day one in nursing school. So, I would have to take the nursing version of anatomy and physiology, etc.

        I’m going to go out on a limb here. No disrespect for nursing. I respect and appreciate the hard work and care that they do. But..and this is only a conjecture….I speculate that there is a fairly good chance that nursing school is not as hard as medical school. And that nursing clinical training is not as demanding as residency. Foolish me. There is an ancient dark saying, “No good deed goes unpunished.”

        So, the bottom line is that a physician who wants to change their position in health care in what is essentially an academic downgrade but a financial upgrade is restricted from doing so. Very interesting, indeed. It almost makes one feel like a serf…an indentured servant.

        Roy Blackburn, M.D.

        March 2, 2011 at 10:46 pm

  109. Just commenting on one of the posts above claiming teachers have only 2 months off a year…I’m sure if that person grabs their local school’s academic calendar, they’ll find that after they add to the 2 summer months all the days off in the fall, 2 weeks for Christmas, and the days off in the Spring…time off for teachers actually is just a hair over 3 months every year…even after subtracting workshop days…My mother has been teaching for over 20 years in different school systems and nearly always has about the same number of days off.

    Anonymous

    February 21, 2011 at 9:40 pm

  110. My sister and her husband are both doctors, so I know how hard they work. It’s true that the general public is very much unaware of how much is required of a doctor.

    I just wonder if we must compare these two professions in such a formulaic way. I am a teacher. I worked hard to earn my Master’s degree. I have a lot of student loan debt. I easily work 80 hours a week during the school year. I stay at school hours after the kids are long gone. I spend every Sunday grading papers from morning until night. I pull several all-nighters every school year and then go in the next morning to teach 120 teenagers. Holidays and vacations are for the kids; I always have a 3-foot tall stack of papers to grade. I spend my summers cleaning out the classroom, prepping for the next year, then setting up my classroom. Usually I have to take a summer job, too, since my salary doesn’t pay my bills through the summer.

    Yes, both professions are grossly underpaid and under-appreciated. But to the folks who think that teachers somehow have it easy, try teaching. Just for one week, not even a whole school year. Then come back and tell me how easy it is.

    At the end of it all, I love my job, even though it’s damn hard. I imagine you doctors love your job, too? I hope you do.

    Steph

    February 22, 2011 at 12:45 pm

    • I don’t think that being a good teacher is easy at all. I believe that in the public schools today it must be very difficult for many reasons. Your job is not easy. You probably are a great teacher because you spend that extra time trying to do the best job you can do. Safety for teachers is a huge concern today. But I think what you do is more than what alot of teachers do. You are not really required to do all that you do – you do it because that is the kind of person you are. However as a Resident, I have no choice in the matter. I work 30 hour shifts every 4th day and I am making decisions that could be life-threatening with each and every decision I make. I think it is hard to compare that to grading papers or setting up a room for the next class year. I can also tell you that I have no time off except 2 weeks in the spring and I’ll have 2 more in the next year. There are no weekends off, holidays off nor sick time unless you are near death. As the Doctor, I am expected to be there no matter what and no matter whether anyone else shows up or not. I have to tell people they are dying. I treat children and adults with cancer and other horrible diseases. I love what I get to learn and I love that I can help others out but along with that comes grueling hours, chance of lawsuit with every patient and really very little respect by anyone in the community. On top of that, there are no grants or any program that helps with loans. When the government allows interest rates of almost 7% on school loans (higher than mortgages), then I wonder how much they really value the American public getting an education. The grass is always greener on the other side.

      someone who cares

      February 22, 2011 at 9:35 pm

    • “At the end of it all, I love my job, even though it’s damn hard. I imagine you doctors love your job, too? I hope you do.” — Like and totally agree with this statement.

      Just wanted to add another note of woe…
      With the advent of electronic medical records, it is nearly impossible for a doctor to “turn off” the spigot and go on vacation with a true sense of freedom. Spent many first few days of vacation “cleaning up my inbox” only to feel like there is constant drip that trickles back in and makes it feel like the work is not done. Not sure why this feels so different than paper records, but for some reason, that constant electronic messaging is really going to lead to some rapid physician burn out. I guess it’s because with EMR, more of the work is put on physicians and we have fired all our transcriptionists, medical records people, and coders. Have not seen the money in my pocket that we saved on these firings. Could hire my personal transcriptionist, but as a primary care physician, who can afford that? See that cardiologists, ENTs, and other subspecialties are still dictating and getting transcribed; guess they can afford it. If burn out doesn’t get me first, then it will be carpal tunnel syndrome. Ugh! Stop the insanity! We already have a shortage of PCPs; just wait for the exodus of the ones who are PCPs now who are getting burned out.

      WJ

      February 22, 2011 at 9:55 pm

      • I used to like it….before the profession was raped by the process of unlinking control from responsibility and plagued by the epidemic sense of entitlement that is destroying not only the profession but probably the whole damn country with it. I like my patients. The one’s I don’t I don’t see anymore. The problem is that I don’t seem to work for them anymore. I seen to work for this third party pay tyrant entity that wants me to pretend that the customer is right in front of me in the exam room.

        If I win the lotto I’m flushing this toilet. I’m out of here. (Probably have to buy a ticket first).

        Roy Blackburn, M.D.

        February 23, 2011 at 5:20 am

      • @ Dr. Blackburn
        Yes, I also “love” that despite all the EMR and the gazillions of dollars we spent on implementing it, there are still 10 page wheelchair forms, prior auth forms, nursing care forms, yada yada yada to complete. There is absolutely no gratification in this part of medicine. And who decided that an insertion of an IUD should cost less than removing it? Duh! I, too enjoy the patient-physician interaction and feel sad that the “tyrant” has ruined the party.

        WJ

        February 23, 2011 at 5:31 pm

      • Unfortunately, it is a tyrant of legislative making via application of ERISA to health care. The driving force behind the decline has been the public demand of something for nothing or little more than nothing and the lying politicians who promise to deliver that demand. All of which now occurs in a country where now over half the voting population pay little if any federal income tax yet that same non or near non tax paying voting majority clamors for more and more ineffective government programs that are being paid for by a tax paying dwindling minority.

        Roy Blackburn

        February 23, 2011 at 9:09 pm

    • I’m also a teacher and it is an incredibly difficult job! There are so many demands that students, parents, administrators and the public put on us. I have around 100 students and they all learn on different levels. I agree that people need to just spend a week in the classroom or maybe even a couple of days with the stress that we have. They would appreciate our jobs so much more! They would quit bringing up all of the “breaks” that we have and just show a little bit of support. I’ve also gone in and worked a lot during summer and the breaks we get throughout the year. But that is what being a good teacher is all about. :)

      Steph you did forget to mention students and parents cussing us out after we have poured our lives out to teaching them. They don’t come to school ready to learn or have any respect for us. A couple of days ago I had a student call me a horrible name and when I called her parent I got no support. She pretty much blamed the incident on me. No surprise to me, but it’s not like I can just stop teaching that student. Last year I had a student bigger than me and he cussed me out every day. He was “special ed” (emotionally disturbed) so we couldn’t send him some where else. He would make comments about hitting teachers all the time and we got no protection. He ended up kicking two police officers. He was in 6th grade by the way! We also had another student bring a huge knife to school. He stuck it in the toilet so he wouldn’t get caught. So yea people need to wake up and stop putting our jobs down. Show a little respect.

      One more thing, our new program at school requires us to have observations throughout the year. We follow a 6 page rubric with all kinds of stuff that we have to have in our lessons. A really good lesson takes FOREVER to plan. It’s not like we have lesson plans fall into our laps. If you want to be an effective teacher you have to work your ass off for it! If we get low scores, we get fired. If students don’t learn we get fired. I know that every job has pressures of its own, but people need to realize that it is no walk in the park.

      I do love my job and even if I won the lottery, I would still do it! I hope doctors feel the same way. I would hate to have a doctor that didn’t have a desire to help people.

      Sweetia

      March 4, 2011 at 7:14 pm

      • Apples and oranges, apples and oranges…

        WJ

        March 5, 2011 at 4:00 pm

  111. Dr. Blackburn,

    As a first year myself, I’m not disillusioned into thinking that life for me is going to be easy at all (like some of the other students on here) any time soon (and maybe ever). However, I entered medicine knowing my area of passion, and the two fields I am highly interested in don’t seem to have many naysayers amongst their specialty (my father is in one specialty himself) — obviously this is subject to change. I completely agree with your point of view that if students simply make themselves aware of the REALITY that is medicine today that we’ll see more happier physician faces in the future (I think you wrote something along the lines of this, haha).

    Honestly, I think the drastic changes in health care policy, regulation, compensation that hit in recent years really should affect only the veteran physicians like yourself —- the ones who knew what it was like when it was a LOT better, or the new physicians who didn’t really know what they were getting themselves into. Not to say that the new medical students should not enter the political fight, because after all, getting paid for our work is nice.

    Anyway, just wanted to let you know that I think your entries are great. But that aside, (and I don’t mean this to be offensive at all), I’m just curious, it seems to me like you have a lot of time to read these posts/respond to them. What field of medicine are you in, if you don’t mind me asking? I apologize in advance if you’ve already mentioned it somewhere on this thread, it’s just so incredibly long and I’ve only had the patience to read the entries towards the end of it.

    Andrew

    February 23, 2011 at 9:35 pm

    • More happier faces? I don’t know. Some people are better at voluntary smiles than others. Regardless, facial appearance aside, the point of the matter is that if one is happy being in a position of responsibility for things you do not control or doing work that is non reimbursable then that is how it is for that individual.

      I have never been in the golden years of medicine that you refer to. I noted drastic changes circa 1997…or maybe I just had an epiphany after a moment of rest.

      Time? I read fast. I type fast. These are issues that I have commented on before and have had much forethought about it. I now limit my practice to outpatient pain management. What field strikes your fancy?

      Roy Blackburn

      February 23, 2011 at 11:47 pm

    • First year what?

      Roy Blackburn

      February 23, 2011 at 11:48 pm

  112. When the voting majority becomes dependent on the working & taxpaying minority …. we are in big trouble.

    benbrownmd

    February 24, 2011 at 10:54 am

    • Ben, We’re already there. About 2005. Karl Marx would be very happy here now.

      Roy Blackburn, M.D.

      March 1, 2011 at 3:59 am

  113. You may feel like a hero if/when you work for free (or pay to work); however, your need to feel like a hero is coming at the expense of creating an unsustainable situation. You will just be adding to our country’s sense of entitlement.

    I LOVE doing mission work. Why do I love it?
    Because it is an opportunity to truly help people in the purist sense.

    Why is that different from working for free in the U.S.?
    Because most patients in the U.S. have the means to pay for the best health care this world has to offer; they simply chose not to make it a priority – because there is little incentive to make it priority. I once had a young lady in a county hospital ER yell at me for the “long wait.” She had just been in a motor vehicle collision with her new Mercedes. Did she have health insurance? Nope.

    When you work for free in a 3rd world country you are not making that society dependent on an unsustainable system. Your mission is temporary, because it is unsustainable to stay there forever unless some organization gives you funding. You go in for a finite period of time with finite supplies, do the best you can and go home. Not staying long enough to create dependency and entitlement.

    I once was on a mission where the village leader asked that we make patients pay for services, 20 Lempira for a lap chole, which was like a dollar. Some of the other Americans on the mission freaked-out “What! We are here to work for free!” I then posed the question, “Are you here for them or are you here for you? The group mumbled “them.” I replied, “Regardless of what you are willing to admit, our incentive for being here is a combination of wanting to help them and feel good for doing so. But if we have the opportunity to help them in 2 ways; medically and teach them a sense of responsibility…why would we not want to do that?

    When you work for free in the U.S., because it makes you feel better than other people (you self-sacrificing hero!) you are actually doing your country a disservice. You are removing an incentive for your fellow Americans to work and contribute. Moreover, your heroism will be unsustainable because you can’t pay off your loans, pay your living expenses and pay to take care of your patients forever …. eventually the bank will shut you down …

    benbrownmd

    February 24, 2011 at 11:19 am

    • Good points Ben. Not to mention the mission work was voluntary. Who knows. Maybe we’ll see signs over the medical clinics here one day “Work means Freedom”.

      And once the bank does shut you down one would hopefully have learned the lesson ..both viscerally and intellectually…that a philosophy, even though well intentioned, that is not economically sustainable is exactly that…..not self sustainable.

      Roy Blackburn, M.D.

      March 1, 2011 at 4:04 am

  114. To start, I am not a teacher, nor will I be. None of my family members are/were teachers. Similarly, I am not a doctor, nor will I be. None of my family members are/were doctors. I have, therefore, read the original article and all following posts from an un-biased point of view.

    I believe that many careers are difficult. I know being a teacher is difficult – a friend of mine is studying to be a teacher and she always comments how stressed she is developing lesson plans and keeping up with her own schoolwork. I am not arguing that teachers do not work 80 hours per week on occasion. I am arguing, however, that I believe these two professions are different. A doctor is stressed because he or she is dealing with such grave issues. If a doctor makes a mistake, an innocent person may die. Besides the weight of such a mistake on his shoulders, he then must deal with all the legal issues and (depending on the situation) possibly lose his job and his practice. If a teacher makes a mistake, perhaps the student’s mother will call complaining that little Billy should have gotten an 87% and not an 85% on his spelling quiz.

    I do not think Dr. Brown’s point was to argue that doctors should make more than teachers. I think he was arguing that doctors should simply make MORE and I agree. Many people have complained about their PCPs and say “all they care about is money” and so on. I can’t say I agree. I love my PCP. Mid-50s, long gray hair that makes me think he was a hippie back in the day, always a smile on his face, and such a sense of humor. At the end of any appointment, he always asks if I have any other problems. He doesn’t care that I didn’t schedule a specific appointment for it. He just wants me to leave his clinic feeling cared for – and I always do.

    But I digress. Honestly I think people will think what they want to think. It’s very difficult to persuade people after they’ve made a decision. To me, it doesn’t matter if Dr Brown’s math is slightly off or if he didn’t take some factor into consideration. The main point I took away from the article is to be more grateful for my PCP and more fearful of the future of general medicine. I’m sure many people are grateful for plastic surgeons, but I don’t need them. I need a PCP that I can reliably see when I have a medical problem. Honestly reading this article almost spurs me to apply to med school! Not because I welcome 100+ hour work weeks, but only because I worry that my future family and I won’t be able to see the doctor when we need to.

    It saddens me that so many people are so jaded and disillusioned. Do you HONESTLY think that people would work 100+ hour work weeks just so they could earn a higher salary in the end? As many people have already mentioned, there are so many careers that are more immediately fulfilling. I am not going into veterinary medicine because I will earn the big bucks. I probably won’t – with the failing economy, the veterinary field is on the decline. People would rather (understandably) pay off their mortgage than take Fido to the vet for his rabies vaccine. I am studying to become a vet because I have a passion for science, medicine, and animals, and there is conveniently a career that combines all three. I’m sure there are exceptions to the rule, and I’m sure there are doctors who are only in the field for the money. But I like to think that they are minority. Even the specialists – I see a podiatrist every two weeks and she is always so cheerful, helpful, knowledgeable, it’s hard to think she is a podiatrist for any reason other than she has a passion for…feet.

    In the end, even if the math is slightly inaccurate, I am grateful that Dr Brown wrote this article. I can truly say my eyes were opened, as were many of his readers, and I hope this pleases him as I’m sure it was partially his purpose. I am not pursuing a career in politics and probably won’t be able to lobby for pay raises for doctors, but am more grateful for the PCP and specialists I see and will no longer pay my $30 copay begrudgingly.

    (I apologize if I rambled. I have been writing a paper all day and rambling tends to occur when I write for too long.)

    Future Vet

    February 24, 2011 at 9:09 pm

    • Bravo! I heart your post.

      WJ

      February 24, 2011 at 10:57 pm

    • great points made!

      someone who cares

      February 25, 2011 at 2:46 am

    • Veterinarian medicine began to change with the advent of agribusiness. Regarding your friend, the podiatrist, perhaps there is an element of pedophilia?

      Nevertheless, the point of all this discussion is too shatter the public misconception that physicians are all wealthy and can therefore afford to give up some more. Nothing is further from the truth. The essential problem is that I am now forced to live in a society that now has an inbred sense of institutionalized entitlement. If I could afford to be an international citizen I would be out of here tomorrow. This public social disease of something for nothing (or even paying less than fair market value) is epidemic due to distorted democratic means of legal plunder. If I failed due to the free market (one which we have not had in medicine for many, many years) then I would learn from my experiences and move on. But any such current failures that I see now are due mostly to an unrealistic command economy of a once great Republic that has been over run by looters and moochers. It shouldn’t happen to teachers. It shouldn’t happen to plumbers. It shouldn’t happen to any profession in which there is NO correct Constitutional right via Enumeration of Powers for the government to intercede in. I am referring to the original version of the Constitution,not the modified version “modified” by treason by both predominant political parties hiring a bunch of professional sophists/attorneys.

      Roy Blackburn, M.D.

      March 1, 2011 at 3:58 am

      • correction: to shatter

        Roy Blackburn, M.D.

        March 1, 2011 at 10:58 am

      • I don’t see how my podiatrist enjoying her job has anything to do with inappropriate relations with children. I do believe you mean “podophilia” not “pedophilia.” Regardless, I’m assuming your comment must have been in jest, because I’m having a hard time believing a doctor such as yourself would be so cynical as to think that any doctor must be in the business for unjust reasons. Personally, I’d rather not see people’s problematic feet everyday, but on that same token, why would someone want to be a obstetrician or gynecologist? Are you suggesting that ob/gyns have illegitimate motives?

        Future Vet

        March 1, 2011 at 2:30 pm

    • Thank you for the correction. My apologies. Late nights..paper work, etc. Now 2 am. Just got word that a workman comp carrier who demanded a detailed report that took two hours of my time will not pay for it, etc.

      Cynical? Probably more realistic. Definitely experienced many work settings- hospital based, multispecialty clinic, solo practice. Nothing wrong with charity care AS LONG AS IT IS VOLUNTARY and best separated from a practice- i.e. one can express one’s charity urges at a local charity clinic whereby one does not have personal negative overhead impact.

      Illegitimate? Unjust? Not sure what you mean by those colorful terms. Viva la Revolucion? For me it is quite simple. A buyer should be able to contract with a seller in a free market to purchase goods and/or services.

      I did not say or imply that OB/Gyn’s have illegitimate motives. Nor would I speak for any such individual or group without their permission. If I were to do so that would make me an *sshole …and there are already far too many of those around. If you ponder the answer then ask one but realize that the one you ask can only truly speak for themselves. Its not group think.

      Doctors are like any other group. There are good and bad in all crowds. I am talking about character issue..not intellect…not training….character.

      “I’m having a hard time believing a doctor such as yourself would be so cynical as to think that any doctor must be in the business for unjust reasons.”

      Response: Belief means knowledge without proof. Cynical? I though I was refrained. Your reference to absolutes – “any”- is rather sophomoric. I am not sure what you mean by “unjust”. I will only speak for myself. I was once naive before I started this long journey. Now I am not. I went into medicine because it was only one of two things that ever interested me. I like problem solving. I like optimizing individual’s independence. I will not bother with those that are able but not willing to help themselves. I anticipated that after years of delayed gratification, essentially giving up my youth to study..work ethic thing…reap what you so.. would come to fruition whereby I would earn a decent income consistent with my training and expertise.

      I can accept failure at the hand of a free market. I would learn and grow stronger. But the situation in medicine is not and has not been a free market for a long time.

      You can be a Vet. Run your practice as you see fit. But realize that the public Collective is not crying out for their right for free pet care. That didn’t even happen in Canada…which is why service in a Canadian Veterinarian’s office is better that the local government clinics. But alas the citizens are not dogs so it isn’t interchangeable. However, where you may get screwed as a Veterinarian is if you start taking pet insurance. The concept of insurance as a prepaid health plan is a fool’s game. It’s appropriateness is only in its applicability as insurance for catastrophic major medical.

      Roy Blackburn, M.D.

      March 2, 2011 at 5:17 am

  115. Sounds like you need a different job

    wtf...seriously?

    March 1, 2011 at 5:30 am

  116. A letter from Dr. Starner Jones to President Obama.

    Dear Mr. President:
    During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone. While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman’s health care? I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture”, a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”. Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.

    Respectfully,

    STARNER JONES, MD

    benbrownmd

    March 2, 2011 at 7:33 am

    • Thank you Ben for the letter posting. I remember when I was in medical clinic in New York, a Medicaid patient wanted me to write a prescription for cough syrup for his chronic smokers cough. He smoked three packs per day. I asked him why he needed a prescription for an over the counter medicine. He said I didn’t understand. He then explained to me that if I wrote the prescription for it then Medicaid would pay for it. I then went through some math with him and told him that if he reduced his smoking to two and half packs per day he could probably buy the cough syrup himself and the reduction in cigarette use may even be helpful for his smoker’s cough.

      Roy Blackburn, M.D.

      March 2, 2011 at 11:17 am

      • This Rant was originally sent to me by someone who works in a hospital on the border. The unfunded mandates are killing them. The rant is applicable to all institutionalized dependence.

        Roy Blackburn, M.D.

        March 2, 2011 at 2:05 pm

    • He should P.S. ask where’s that birth certificate? Probably irrelevant since even McCain didn’t actually Constitutionally qualify; he was born on a base in Panama.

      Roy Blackburn, M.D.

      March 2, 2011 at 10:52 pm

    • Well the patient may have stolen the tennis shoes. I have students come to class every day with new clothes on, but they live in a shelter. Not sure how they can afford new clothes but not have a home to live in. I get frustrated with the parents. I think the government is definitely enabling them and hard working citizens’ taxes are paying for the rest. I work my ass off just to get money taken from me to pay for people that don’t care anything about providing for themselves. I knew a lady that had 2 kids and she was on government assistance. When she got her taxes back, she wanted to get a boob job! Not try to take care of her family, but she wanted to get her boobs done! I really wanted to give her a piece of my mind. Now the government gives them free phones and free assistance for their home. I totally understand if people are on government assistance, but not for the rest of their lives. People are so stinkin lazy and they don’t care anything about their health. They just want to sit around and have the government take care of them. But it is affecting everyones jobs. Especially doctors. I’m sorry that you all have to put up with people like this. I hope things change soon.

      Anonymous

      March 4, 2011 at 7:33 pm

  117. Gosh. Someone took the rant link down. Its at American Rant Network- The Bird Feeder

    Roy Blackburn, M.D.

    March 2, 2011 at 10:06 pm

  118. According to the federal gov. stats: “in 2007-08, and the average student loan debt among graduating seniors (undergraduate) was $23,186,” NOT $100,000

    Teachers are required to have more preparation than just a B.A., they also volunteer, they have exams, interviews and generally take their preparation as seriously as any other profession.

    In this article you are assuming the worst case scenario when it comes to expenses, which implies the student pulled no stops when preparing, yet you have assumed one of the lowest salaries. You take no consideration of the fact that if you did pour in all those hours of time, effort and money –you would actually make a lot more than $200,000.

    lor

    March 4, 2011 at 8:03 pm

    • Dr. Brown was talking about the average school debt for physicians, not the average student.

      “You take no consideration of the fact that if you did pour in all those hours of time, effort and money –you would actually make a lot more than $200,000.”

      Your statement reveals a lack of understanding of the salaried position that doctors are often forced to accept- i.e. they own you 24/7. So, if have a secret way of creating time or being in two places at once (assuming that one has abundant personal energy) please share it with the rest of us.

      The “volunteering” that you refer to, is that required?

      Roy Blackburn, M.D.

      March 5, 2011 at 5:48 am

    • The cost of education used in the above analysis is the COST of attending an average priced college and and average priced medical school. It doesn’t matter who pays for it – the point is it costs a lot and that cost must be deducted from one’s income to really appreciate how much they actually EARN.

      NOT all college graduates who become TEACHERS are $100,000 in debt either; however, that is how much it COSTS to graduate with a B.A. from an average priced institution – so that is the figure I used.

      I kept everything consistent, the numbers don’t lie.

      My point challenges stereotypes and dogma – people don’t like that. Ignorance is bliss…. but it is also dangerous.

      benbrownmd

      March 14, 2011 at 12:24 pm

  119. Dr. Brown,
    Thank you for your efforts. Perhaps you would step on fewer toes if you wrote another, modified analysis simply reporting on the cost of medical education in dollars and time, the average debt with which a residency graduate enters the work force (comparing the various lengths of residency and fellowship training) and the average income available for those various specialties. Physicians traditionally are not good business people, but we can still do basic math, and the numbers for virtually everyone completing their training do not add up when considering primary care, unless one is determined to take a vow of near poverty (perpetual debt would probably be a better description). The risk vs. benefit ratio in primary care is astoundingly high. I don’t know if Portland, Oregon is representative, but only 3% of their IM graduates are going into primary care. We have a top bureaucrat, Mr. (Dr.) Berwick, who believes that 80% of primary care visits are a waste of time and resources, so perhaps this is just a reflection of the economy/government driven dismantling of the physician as a professional. Either we quickly equalize the pay for primary care physicians or all our primary care will be rendered by NP’s and PA’s (good luck finding a physician supervisor!). I think the general public is so far removed from the reality of this situation that you have addressed that by the time they “get it” and want to or try to do something about it they will not have any options left. Teachers are wonderful by the way.

    Paul T. Armerding, MD

    March 10, 2011 at 8:22 pm

    • Well said Dr. Armerding.

      Family Doc

      March 10, 2011 at 10:51 pm

    • An adjusted net hourly wage is just an arbitrary number unless it is compared to something else. I chose to compare it to an common, honest and well-respected career – teaching. I am amazed by how many people were/are appalled by this. No where did I say anything bad about teachers. I never said they were underpaid. I simply challenged everyone’s misinformed belief that physicians are overpaid. That is all. Don’t hate me, hate the system.

      The adjusted net hourly wage for all the specialties, time spent training, etc. – can all be found in my book. http://www.InformedConsentBook.com

      benbrownmd

      March 14, 2011 at 12:18 pm

      • Ben,

        Don’t be amazed at the response of many. Much of it most probably has to do with social envy.

        Roy

        March 16, 2011 at 3:21 am

  120. Would it be possible to incorporate the cost of malpractice insurance into this? I realize the cost varies among the specialties and states, but I think is it a significant factor in calculating the income.

    confy

    March 22, 2011 at 3:38 pm

    • My understanding is that most physician’s malpractice insurance premiums are expensed prior to receiving their reported “gross income” and therefore are already accounted for in the analysis above. I’m sure there are exceptions to this; however, if MOST Physicians pay their premiums with their personal gross income – I will incorporate that into the analysis above

      benbrownmd

      March 23, 2011 at 1:38 pm

  121. Very interesting article! Could you update your STEP 1 and STEP 2 average numbers? They seem a bit dated; I know this year for instance Emergency Medicine passed radiology in degree of competitiveness (applicants to openings) and their average scores have gone up as a result.

    Michael

    March 25, 2011 at 5:33 pm

  122. Accurate article. Nice to see someone else gets it. Although he didn’t mention that once you start on the path to medicine you are trapped on it because nothing else makes enough income to pay off the debt, I hear stripping is close though, and therefore you will be stuck in an ever worsening healthcare system for a very long time or be going back to school, as if we need more school.
    Someone needs to send this to Obama so that he realizes eventually no more Americans will want to become physicians, which is sad. Many of non American physicians practicing here paid less or nothing for their medical degree and not having that debt makes all the difference, I envy them.
    The more you cut reimbursement, create new rules, increase overhead, and give the masses mediocre coverage, the more physicians will abuse the system to make the money they deserve and practice defensive medicine, instead of practicing medicine correctly, like they wish they could. This does not lead to a healthy population and will only increase costs in the future. Push stupid people into a corner and they stay there or crumble. Push intelligent people in the corner, they will push you out of the way and walk, or find a loophole out.
    The key to long term reduction of healthcare spending without screwing anything else up, is prevention and education, which physicians do not have time for. We have to see more people now, in less time, to make what we did 15 years ago. We have insurance companies telling us how to practice medicine. Every year we are asked to work more, but instead of raises, we get cuts. If we faithfully serve a hospital for 25 years, or a practice of patients, do we get a pension and healthcare when we are finished? No. Factor that cost in too.

    To Dan (#1 the ignorant one) – Physicians are teachers too. They are teachers, counselors, businessmen, and lawyers all in one.

    To Mike – “to give anything less than your best is to sacrifice the gift” (Steve Prefontaine). Some of us do what we do because we have the capability, and therefore feel somewhat obligated to do what we do. It’s called, we’re good people. Many of us are capable of being successful in any career. If I became a state trooper I would have no debt, way more money right now, and probably much less stress. Not to mention I’d work for 25 years and retire with full pension and benefits and no worries of lawsuits.

    Dr. Ben Brown – You’re right, nuff said. Spread the word.

    Now, lets all go take some SSRIs.

    Justin

    March 27, 2011 at 12:33 pm

  123. Truth.dat is d truth everywhere in d world,irrespective of country.

    Michael Adeyemi

    March 27, 2011 at 12:50 pm

  124. True talk,irrespective of region or country, medical doctors are grossly underpaid.

    Michael Adeyemi

    March 27, 2011 at 12:55 pm

  125. They are underpaid worldwide, but like I said before, take into account that in some other countries it costs much less time and or money to obtain a medical degree, so there is a relativity factor. Imagine if the US did not allow foreign medical graduates or non native born citizens to practice medicine here. There would be a huge shortage of physicians. There are less and less American born and schooled physicians who come from non wealthy families going into medicine, because it just isn’t worth it anymore. Nothing against the FMGs and such, many of them are my friends and excellent physicians. They are also in a better financial situation than myself.

    Justin

    March 27, 2011 at 1:10 pm

    • The may be underpaid here in the United Socialistic States of America but they damn sure ain’t under-sued or under-judgemented agains

      Roy

      March 31, 2011 at 4:22 pm

  126. correction: against

    Roy

    March 31, 2011 at 4:23 pm

  127. Oh my ! What a pity ! I see that you want to make more money. Now that is a very unique aspiration. How come more people like engineers, nurses, scientists, police, teachers, janitors , journalists, accountants, firefighters, miners do not think like you and realize their profession does not compensate them adequately. I applause you for figuring that the world and society is ripping off you and doctors. After all in which profession do you work so hard and get paid so little.

    Sam

    April 5, 2011 at 10:02 pm

    • Re:”How come more people like engineers, nurses, scientists, police, teachers, janitors , journalists, accountants, firefighters, miners do not think like you and realize their profession does not compensate them adequately.”

      I suppose you mean why more people….

      First and foremost Sam, I would suggest you talk to those individuals about what they may or may not realize. Do you have their permission to speak for them?

      Second, those individual professions you mention- many get paid by the hour. The notable exception is teachers who are getting screwed.

      The demand ON ANY PROFESSION to do something for nothing is nothing more than a variation on slavery and the road to serfdom. I think that ANY professional OR ANY LABORER must be cautious with their existence as a salaried employee – i.e. one whose essential productive time is owned by the employer 24/7- or as an individual in a profession that is inundated with unfunded mandates. Either way its a screw job. If I were teacher and someone kept asking me to sacrifice more and more of my time for nothing my first thought in my mind would be, “f**k you” but what would come out of my lips would be, “Let me get back to you on that.” And societies that try to function on that self deception and deception basis often break down to a status of “pretending to work because they pretend to pay us”.

      If perchance you advocate that one profession has a right to overpower, enslave or indenture another profession simply because that profession may be a numerical minority susceptible to democratic legal plunder then I would encourage further introspection and ask under what moral justification, if any, does such plunder take place?

      Oh, by the way. Its almost midnight. Just finishing up some paper work. Much of it with unpaid time.

      Roy

      April 6, 2011 at 3:06 am

  128. Doctors are “enslaved to the highly regulated healthcare industry?” Really???

    I understand that doctors don’t like to accept contract reimbursement rates from insurance companies, but medicine (as currently structured) is the only business in America where the client/patient doesn’t care what the service costs (due to the fact that a third-party is generally paying the bill). Try being in any other business where the client actually has to pay out of pocket with real money and you’ll see how tough it is to make a decent living.

    Brian

    April 11, 2011 at 8:53 pm

    • Yes, really… and with some noted distinction requiring further comment.

      A doctor cannot pick up a phone and discuss prices with another doctor. It is a RICO violation or rather a misapplication of a law intended to fight mob racketeering (but plumbers can do talk about each other’s prices). Doctors are no longer allowed to refer to a website previously known as doctorsknowus.com which listed patients who had litigious natures and their multiple lawsuits against physicians was public record knowledge anyway but the American Society of Trial Attorneys had it taken down; yet doctors who have been sued have their malpractice history available online.

      Are you equating doctors as being synonymous with the health care industry? They are not. The health care industry is multifaceted. Doctors who do now want to accept contract reimbursement rates can simply chose not to sign a bad contract. The biggest reason for increasing health care cost has been the cost of technology, not the labor. But the people who make the technology are not as stupid as the doctors because they wouldn’t put up with the crap of a Collective entitlement hive demanding their product for less than fair market value.

      I respect those that make a living for what the client pays out of pocket but there is some difference in the toughness of the existence of the physician. People tend to sue doctors more often, for higher amounts and more frivolously than other professions such as a plumber. It is hard to get a multi million dollar judgment award against a plumber for a leaking pipe due to pain and suffering caused by that leaky pipe.

      This country is so full of social animosity that doctors are the second most likely group to be audited by the IRS. The first group is ex cons. This is true even though of the millionaires in this country only seven per cent are either physicians or attorneys; most are small business owners.

      To top it all of there is an unrealistic public view of health insurance as a prepaid health care plan. It is not. It is like auto insurance. If you are smart you want the highest possible deductible with the highest ceiling in order to financially withstand catastrophic major medical events, the number one cause of personal bankruptcy due to medical illness/injury. Its not a bunch of little copays that wipe people out. It is the uncovered catastrophic major medical that usually does it. People have to understand that buying insurance is like going to Vegas. The house never loses. The insurance house will simply jack up their premiums next year. The best one could hope for is to let the house win less against one’s self- i.e. high deductible, high ceiling, and an health savings account if eligible (even though Nancy Pelosi has limited that one). But so many patients seem to think that once they pay for that visit encounter with the doctor that they can have free random 24/7 access to the doctor’s service and time; and yet those same patients will bitch when you are running behind schedule because some other patient thinks they have free random 24/7 access. Try pulling that crap with a lawyer. I once had a patient call me at 2 a.m. to help them with a math problem. What bullsh*t is that? They saw me leaving the hospital at 1:30 a.m so they wanted to ask me about the math problem and was hoping I hadn’t gone to sleep yet (even though I would be seeing them again at 6:3O a.m.) If I called a lawyer that late for a math problem what would he/she bill? I would tell that lawyer if they did not bill then they shouldn’t complain about such calls but I would suggest that they should bill for such calls? (But doctors are often not allowed to do that by regulations in several states). If a customer demands that a plumber doing an insurance job buy more expensive pipe that was initially in how many times will the plumber get suits against them compared to the malpractice suits against doctors for not agreeing with that customer’s unrealistic demands. I have had patients demand unnecessary test. When they do I open a crack between the upper blinds in the window and I ask them, “Do you see that big arm in the sky?” They look at me. I ask again. Then I add, “the big arm passing that money out”. They look at me. And then I answer, “there is no big arm passing the money out”. When I hear them say well my insurance will pay for it. I then ask, “So, are you gong to complain next year when they increase your rates or decrease your benefits or both?”

      The Greek symbol for tragedy is a triangle. And so has this three way relationship of the actual customer (the third party payer), the seller (health care provider) and the one who thinks they are the customer (the patient) been a tragedy….except for the CEO’s of the large health insurance companies who are federally protected from their medical management by misapplication of the ERISA law. The best reality is to get back to some basics, cash based practice, tell the patient that as a provider I try to be a good servant but I cannot serve two masters – both the patient and the third party payer- and that the insurance policy they have is between them and the insurance company.

      Oh, and don’t forget the regulation of requirement for years of training and education. What other field can you think of where one has to have years..premed…med school..residency, etc. to get the credentials that the regulators say you must have to do your job. In some states, the issue of continuing medical education requirements, a state regulation, has no scientific proof of impacting outcome of care but the CME industry has become a multibillion dollar industry. Ohio requires 80 hours of CME per year yet its provider outcomes are no better than states that require 20 or even less hours. Why do some states have their own special courses such as domestic violence courses but will not accept the CME credit of the same course from another state for a doctor who has licenses in both states?

      So, there are many rules and regulations that are applied specifically to health care providers that are not applied, nor should they be, to other professions.

      Understand?

      Roy

      April 13, 2011 at 4:15 am

  129. I am one of the few Physicians/Medical Students that got a scholarship in medical school. There was one catch- it was a full 4 year deal with the Army- now I am an Officer and a Physician. I have deployed before and will deploy again. It was worth it for me, but it might not be for everyone.

    Kal

    April 14, 2011 at 12:28 pm

    • Army medicine structure is vastly different than civilian. One thing you should be aware of, especially if you ever transition to civilian medicine…the army/armed services will settle a malpractice case against you without you even knowing it. It pops up later on when you try to leave. Be safe

      Roy Blackburn, M.D.

      April 17, 2011 at 4:01 am

    • Well, hopefully you won’t be fired upon from individuals in a Mosque in Iraq since current rules of engagement as ordered by U.S. army superiors do not allow for one to fire back at the Mosque even if one cannot run for cover. Sounds like treason, doesn’t it?

      r58black

      December 17, 2011 at 3:55 am

  130. if you disagree with this, then modify it with your own numbers or post your own analysis. if you reach a different calculation the conclusion will be the same. . . doctors are underpaid. many doctors and medical students realize this and are leaving the profession. someone who is smart and disciplined enough to be a doctor and willing to work 100 hr weeks is incredibly valuable in a lot of other industries.

    while there are docs out there that will work like dogs b/c they love it and wouldn’t do anything else, those who want to rely on doctors’ collective altruism will be sadly disappointed. as in all things, incentives count, and they’ve been gutted along with the profession’s prestige. chalk it up to the consumer culture or political tinkering, it’s undeniable.

    Grant

    May 19, 2011 at 2:59 am

  131. Thank you Dr. Brown for this pointing out this injustice that is apparent to all physicians when they finally complete their training, but is most evident to those of us in academics. We want to embrace the principles of altruism and generosity with our time but this sacrifice comes at a considerable cost. What is covered in this article is the lack of financial compensation for the practicing physician. We are a 2 physician household and what is most painful is, that because we always do the right thing for our patients, and take our uncompensated time to do it, our evenings and weekends as a family are largely nonexistent. The toll it will take on my children is not apparent yet, but large numbers of my colleagues have gotten divorced in recent years. It infuriates me to be told what to do, after 15 years of training and countless hours at besides, by an MBA who can’t fathom that one would sacrifice without a pricetag. There are so many similar comments on your blog but why can’t physicians organize to be their own advocates? Until we unite effectively, medical training is nothing more than a pyhrric victory.

    academic

    May 31, 2011 at 9:18 pm

    • You must get your head out of your heart and realize the boundaries between work and home. Remember, if you would rather be at home with your significant other or family then it is work. IF you do not have a significant other or family but you would rather be doing a hobby, etc. then it is work. IF you have no hobbies, no family, no significant other, no life outside of your work as a provider, then statistically it is unlikely that you will genetically pass on your professional abilities/interests to offspring though you may inspire a few more converts to what is essentially a non sustainable career.

      Understand fully the phrase of “they will be known by their deeds”. That is to say that they will not be known by their words or mannerisms. That is to say that those that may appear well mannered, civil, etc. but command your time via entitlement are in essence looters. The looter may look like your grandmother but they are still subhuman looters if they want your time, for nothing, that takes away from your family/hobbies/significant other time. DO NOT WORK AS A SALARIED EMPLOYEE.

      r58black

      June 2, 2011 at 6:19 am

  132. The calculation is flawd…. If you make the same arguments for teachers then they earn $10/hour. Future MD’s will be able to pay their loans and still earn much more than others in highly trained carreers. Nadies les va cojer pena. ;)

    Scientist

    June 16, 2011 at 7:43 pm

    • The public perception of physicians’ income based on yearly salary is deceptive. The calculation is not flawed but the comparison may be. That is to say that teachers who are salaried are also not paid by the hour. The net hour income earned by physicians is not much better than high school teachers when one compares the teachers’ pay as a salaried- i.e. not paid by the hour- employee.

      I do know that when I pinned down an hourly rate of pay from a local major employer for physicians that the rate was less than what a journey man plumber and/or electrician gets per hour.

      The article does not say that it is OK for teachers to get screwed out of their pay….and believe me…many are. The concept of converting one’s profession to a salaried public “servant” is nothing more than a ruse for serfdom.

      RE: “Future MD’s will be able to pay their loans and still earn much more than others in highly trained carreers.”

      Your remark is a prospective prediction that may or may not hold true. What I currently know is that I have colleagues who are still struggling to pay their student loans 20 years after graduation. Also, it is unclear how much training will be required in the future for careers that pay better…per hour…for doctors and teachers. Maybe one needs simply to study acting to learn to lie well in order to enter politics and assure one’s retirement and health plan after only a few years of “service”. At this time I do not know of any current other highly trained careers that command so much time in training as medicine does. Not law school. Not grad school. Nothing. Residency barely pays a living wage for many and often,when calculated on a per hour basis, one earns less than minimum wage which the labor board seems OK with since residents are usually classified as students and therefore do not have the same rights as an employee.. And don’t forget that with the recent changes in both allowance of deferment of student loans combined with limitations on resident work hours post Axel rod it has made it even more difficult for those residents, especially for residents that have families.

      Is your perspective such that it is OK for further deterioration since ….as you “predict” that physicians will be relatively better offer than other highly trained careers? Your presumption is that “highly trained” careers that are pretty much “nationalized” either directly or by proxy will pay actual net worth per hour. I remember in Eastern Europe before the Wall came down hair dressers were actually making better money …especially per hour….than the physicians.

      My point is that to expect a career, any career that requires much “high training”, to be sustainable at a high level of quality in a specified geographic region – i.e. country- then the net income per hour achieved, including consideration of time required to train, must realistically reflect that benchmark. If it does not then those individuals will gravitate towards equal paying careers that are started sooner, have less rigorous training and less school debt and/or simply emigrate to another country to work. Many U.S. physicians have already discovered better opportunities abroad for their services.

      Anonymous

      June 21, 2011 at 5:33 am

    • ooh. A scientific soothsayer. Love it.

      r58black

      December 17, 2011 at 3:49 am

  133. Reading through these comments one wonders why anyone would become a doctor. Based on what is written here, the costs (monetary and personal) far outstrip the rewards (monetary and personal). Since entry in med school remains competitive (fewer spots than applicants), and acceptance to med school requires high grades and test scores, one wonders why the “best and brightest” continue to choose this career path — rather than what seem to be obviously more lucrative (and far less demanding) careers such as nurse or high school teacher. Please don’t say that med students don’t know what they are getting into until they are there… none of this is secret information, and I suspect that the demands and sacrifices are made well known to students BEFORE they embark on a path that requires a minimum of 10 years (from high school) and hundreds of thousands of dollars. If doctors spend so much time and money in school and then make no money when they are finally able to practice, what’s the attraction? Why would anyone — let alone the best and the brightest — choose medicine?

    NotADoc

    July 4, 2011 at 12:35 am

    • The best and brightest are no longer gravitating towards medicine.

      Anonymous

      July 6, 2011 at 4:39 am

      • I disagree. The best and brightest are still gravitating towards medicine. Many of us chose this career for what is beyond the salary.

        Anonymous

        August 25, 2011 at 8:44 pm

    • There are a couple reasons why the “best and brightest” still choose it. Medicine is a very fulfilling career. There are a lot of joy that comes with working with people and helping them. The money made once a doctor is finished with school, residency and training is rewarding. It’s how you look at it when you finally make money. Of course a huge chunk of your salary for years will go towards debt, at the same time you will be able to save some money and have some for fun (wait, what is that again, it’s been so long that I don’t know if I remember what that is, haha jk). But what I’m saying is the salary looks good when you’re making it and that is attractive to people. If someone said you are going to make $300,000 a year to be a cardiologist, a lot of people would love the sound of that. This article give good insight to those people and says that they need to look at the bigger picture and realize they may be on a payroll for that much money, but they won’t be actually making that kind of money until their loans are paid off because so much of it will go towards that. So again, the “best and brightest” are still going into this profession. They are doing it for the prestige, the fulfillment, and the money they will eventually make if they stick with it. I chose PA (physician assistant) because it’s less schooling, less loans, and very little if any malpractice insurance (which by the way really brings down a physicians salary if they are specialized in something). My wife is a med student who is in her third year and she has spent way more money than my two full years of training to be a PA and she still has one year left. Fortunately for us, we only need loans for tuition because my job makes enough money to cover bills, rent, etc. In the end, her salary will be more then mine but paying off her loans plus mine will take a long time.

      P Martin

      October 6, 2011 at 9:21 am

      • RE:”So again, the “best and brightest” are still going into this profession. They are doing it for the prestige, the fulfillment, and the money they will eventually make if they stick with it. I chose PA (physician assistant) because it’s less schooling, less loans, and very little if any malpractice insurance (which by the way really brings down a physicians salary if they are specialized in something). ”

        Response: Somewhat of a contradiction, is it not? Be clear on the matter. The article relates to doctors…not PA’s….not NP’s….but doctors. Furthermore, the paid per hour PA and/or NP is probably still economically valid. Your statement, if applied to the facts and the experiences of those who actually are doctors, is nothing more than an exercise in self deception.

        Yet. My hat is off to you. Because you weren’t dumb enough to go into medicine.

        Your predictions regarding your wife’s career are prospective and speculative…fresh meat always sounds optimistic but much less so after being in the trenches doing the actual task after a couple of years. Wake up and smell the feces.

        r58black

        December 17, 2011 at 3:44 am

    • You think teaching is a lucrative job opportunity? You need to wake up…

      AJ

      January 18, 2012 at 1:51 pm

      • what is being said is that anyone becomes a doctor for the money is either 1) weeded out a long time ago 2) foolish because it is is easier to make money in other fields like business for the amount of work you put in…point is that people who say that doctors are in it for the money are just foolish and ignorant because of these other factors. Doctors arent saying they dont love their jobs…they do…they dont say they dont make any money…they do…what they are saying is just that they put in a lot to make that money and it isnt as easy as people make it out to be. In fact it is one of the hardest things you could go through occupationally if not the hardest. Then after all that, to have people that are ignorant to it becomes annoying

        jon

        January 18, 2012 at 7:06 pm

      • I teach as an adjunct in a local college. My take home pay there is only 1000 per month less than my take home pay from my practice.
        You have insurance paid for you. You have three months vaca. You have sick days that are paid, then you have short term and long term disability insurance.WE ARE SELF EMPLOYED WE GET NONE OF THESE.

        DR D

        March 31, 2012 at 4:16 pm

    • Not you really do not know that the night calls will continue ALL YOUR LIFE. You expected that the on call status would end when the residency did. WELCOME to the rest of your life. every third night call. For specialists, especially in rural areas, you are always on call.
      WE have a shortage of doctors, and it is going to get a lot worse.I can not charge an after hours fee that will get paid. I can charge it and the insurance will ” write it off”. How about the service call charges like my plumber and electrician get. 45 bucks on a weekend, just to leave the drive way. time and a half?
      I was once told by a patient’s parent that she did not understand why we were tired of taking call. Afterall the insurance companies paid us to take call. I asked her where I signed up to get paid for being on call.

      DR D

      March 31, 2012 at 4:11 pm

  134. Physicians need to grow some balls and tell the medicare/medicaid and insurance companies they no longer are welcome.

    Until the profession grows a pair, nothing will change.

    sn

    July 18, 2011 at 5:42 pm

    • Strong ovaries work as well too. I know several well respected female physicians who have done so. Submission is gender neutral.

      r58black

      July 19, 2011 at 3:40 am

  135. Most teachers and nurses get their advanced degrees piece meal… My wife is a nurse and laughs at the small amount of time she needed to invest to get a masters in nursing… She’s the first to joke about it.

    Definately different and a lot easier than the way a medical degree is earned.

    Anonymous

    July 18, 2011 at 5:54 pm

    • At current time, it is not cost effective to invest in pursuing a career in medicine beyond the academic requirements of a nurse practitioner or physician’s assistant (on a pay per hour, not salaried, basis).

      Anonymous

      July 20, 2011 at 11:11 pm

  136. Highly informative article, a must read in my opinion; especially given the fact that most career decisions made by young people don’t consider costs vs. Benefit. Instead like most entrepreneurs w/an idea, the allure of the perceived prize/reward (*order varies depending on individual*-perceived/anticipated high compensation feeling of satisfaction drawn for providing relief/”treating” patients social status/prestige other personal reasons, e.g. Following in footsteps of father, mother or someone you greatly admire…). Note many argue that getting into a specialty/specializing is partially the answer, as one makes more money, though based on variables such as debt and taxes incurred, I am not sure as to the whether or not the additional hourly income is justified.
    I therefore have the following questions:
    1. Why don’t physicians interest groups lobby w/greater determination to modify the tax code in their favor, like investment banks or big oil? Or should I ask, why have physicians interest groups not been more effective? 2. Where could one find an analysis such as this one, but which focuses on various specialties? 3. If the outlook is so bleak or not as rewarding in actuality, why do many still pursue medicine? Is it emotionally driven, as opposed to fact-based, like so many human actions/decisions? 4. Aside from the data in this article, is the general consensus that dentistry is more financially sound? Thx in advance to all those who provide feedback/input.

    Chief52

    August 29, 2011 at 6:36 am

    • REPLY TO Chief52

      August 29, 2011 at 6:36 am
      Reply

      RE: I am not sure as to the whether or not the additional hourly income is justified.”

      RESPONSE: The article is not advocating an ADDITIONAL hourly income. Nor would I advocate as such. It is more financially realistic and accurate to be done on ONLY an hourly income….not in addition to some other guarantee or stipend.

      RE: I therefore have the following questions:
      1. Why don’t physicians interest groups lobby w/greater determination to modify the tax code in their favor, like investment banks or big oil? Or should I ask, why have physicians interest groups not been more effective? 2. Where could one find an analysis such as this one, but which focuses on various specialties? 3. If the outlook is so bleak or not as rewarding in actuality, why do many still pursue medicine? Is it emotionally driven, as opposed to fact-based, like so many human actions/decisions? 4. Aside from the data in this article, is the general consensus that dentistry is more financially sound? Thx in advance to all those who provide feedback/input.

      RESPONSE:
      1) Physicians, from a regulatory point of view, are second class citizens in this country. You must be an employed physician if you want to join a union (I do not). Also, there are lobby groups who advocate for physicians- most notably, American Association of Physicians and Surgeons. But the focus is not on changing the tax code. The tax code issue is of concern to anyone with a brain and a concern for the future of the country and their children. As a soliloquy, I advocate a flat tax of set percentage starting above the poverty level (currently about 10,860$ per year) with NO EXEMPTIONS and to include real time asset valuation of goods/stocks/etc given in lieu of services rendered. Physician groups have not been more effective because of several reasons. First and foremost is the un-level playing field- most notably, the application of ERISA (employment retirement investment securities act) to health care whereby insurance companies essentially have control of a process but little if any accountability- i.e. very difficult to sue them in federal court. This application of ERISA is all part of the legacy of “tricky Dick I’m not a crook” Nixon. Furthermore, physicians are a minority in this country…..a democracy in which over half the voting population pay little or no federal income tax yet that same voting majority clamor for more and more ineffective government programs and all done with legal plunder of either goods or services of others.

      2) Ask Ben. Maybe he’ll write a sequel.

      3) Numbers alone do not tell the story. The best and brightest are often not going into it anymore. Furthermore, the best and brightest are often discouraging their children, even the ones who show an interests, not to go into it anymore. I knew of a husband and wife internal med couple who sent their four kids to college on one condition- none could be premed. About ten years ago, over one third of the thoracic surgery fellowships went unfilled in this country. That gap was unheard of before. I know of a professor at a medical school who has been teaching for years was actually asked to dumb down his course for the “new” students. I think kids watch T.V., Dr. House, etc. and they get intrigued. However, those shows have little if any real life representation of what it actually means to be a doctor. For me, the driving vector of applicants are basing their expectations of years gone by….and most are sorely disappointed when they get in the trenches (even beyond residency) to understand that they are often a glorified, highly educated clerk filling out paperwork. One can always place “bodies” in boots, medical schools, whatever. The government could flood the market with medical schools if it wanted to. But it will not address the quality issue. Furthermore, it has been my experience based on Eastern Europe, that such social change (either up or down) will take about three generations to take mental hold; mainly because the professors that teach are inexperienced with the changes. Why would anyone delay so many years of their life, accumulate debt, have high malpractice exposure in a civil court system where causality and liability often have nothing to do with each other….when one can actually earn more per hour as a plumber or an electrician (as is the case in North Georgia and Southern California). So, don’t be surprised in the future when a mother tells her child, “I’m sorry you couldn’t get into electrician/plumbing school. Have you thought about going into medicine?”

      Regarding the dental question, my father was actually a well known and respected orthodontist. For years we argued about whether or not I should go into dentistry then orthodontics and join his practice. I thought how boring…just the mouth. In retrospect, I was an idiot and should have listened to my father. However, even dentistry can be ruined if it submits to all the vagaries of third party payers, whether private or government. Also, in terms of the overall health care dollar spent in this country, dentistry is actually a small piece of the overall bill and therefore has been much less of a target of government and/or lying politicians who promise to give away legal plunder for a vote as compare to the health care bill of medicine. Footnote on last sentence. Alan Greenspan pointed out that most of the increase in health care costs has been due to technology. The government and the third party payers have targeted an already beaten down labor pool of physicians but companies such as GE who make CT scans would have people like Jack Welsh telling them to go to hell. I also suspect that physicians, being the cerebral group they tend to be, neglect the use of some parts of their brain…mainly the one that has to do with self preservation. If the U.S. government tried to do to truck drivers what they have done to doctors there would have been blood in the streets a long time ago.

      I do not know the line of work you are in. But imagine if you built a factory from the ground up. You worked hard. Many hours. You forgo many of the pleasurable things in life that many youthful people take for granted. After many years you build up a successful business. Then imagine if government representatives/soldiers came to your factory and said, “Comrade, we are pleased to inform you that we are nationalizing your factory for the people.” How would you feel? Pissed? It is the same as has been done in medicine….just in a more stealthy, slow bullet fashion……but the process is the same…legal plunder…..for the “people”. How would you feel?

      Roy Blackburn, M.D.

      August 31, 2011 at 6:02 pm

  137. This article is pure unadulterated bullshit. The reason physicians are able to rob is because they operate under a cartel where access is tightly controlled and they are offering a service that can’t be refused. It is as simple as that.

    C. Fawcett

    September 23, 2011 at 10:02 pm

    • Gee. Sounds like the battle cry of the rapist, “What, I’m not good enough for you”. Looters pretty much say the same thing. As pleasant as they outwardly appear when they condone or vote to pirate the mechanism of democracy to utilized legal plunder of others’ goods and services …they are what they are…looters. THEY WILL BE KNOWN BY THEIR DEEDS!

      r58black

      December 17, 2011 at 4:02 am

    • Cartel? Damn. You caught me. Guess I better get on my camel and head out of here.

      Now lets review the use of the word Cartel:

      1.an international syndicate, combine, or trust formed especially to regulate prices and output in some field of business.
      2. a coalition of political or special-interest groups having a common cause, as to encourage the passage of a certain law.
      3.a written agreement between belligerents, especially for the exchange of prisoners.
      4.a written challenge to a duel.

      #1- No, no real international syndicate that I know of.
      #2- No. Doctors are actually quite divided and in fact I have no use for Doctors that are looters, moochers, *ssholes, bullies or tyrants. The other doctors I seem to get along alright. We are free to join such great organizations as the Association of American Physicians and Surgeons but membership is voluntary and not all doctors are in that great organization. Not really seeing where #2 applies here.
      #3- The only doctors I know that have a written agreement between other doctors are those in large practices or group practices but the tend not to be belligerents to each other on a long term basis because usually in such a situation someone just moves on out of the practice. Exchange of prisoners. (Give me a second …have to put the shackles on the patient while I finish here). No, don’t really exchange prisoners.
      #4- A written challenge to a duel. Unfortunately, dueling has been outlawed but missed by some as an effective mean of fighting to the death for what one believes in. But there’s always paint ball but that’s just for fun. No real Cartel talk going on there that I know of.

      Is there some other derogatory, inflammatory word besides Cartel that you may have been trying to use?

      r58black

      December 17, 2011 at 5:06 am

      • I dunno, how about a syndicate? The AMA controls licensing of Medical Schools and certainly acts as a cartel to artificially suppress the supply of MDs, keeping salaries high.

        noevalleyjim

        July 4, 2012 at 6:51 pm

  138. The person who wrote this article is obviously insane. He wrote: “…the amount of money they earn per hour is only a few dollars more than a high school teacher.” Give me a break. A family practitioner 3 years into practice makes on average between 125K (if he works for government in a a poor state) and 250K, a cardiologist after 3 years in practice make more than 800K. Both these figures are before benefits! Just a few dollars more per hour than a teacher? This guy has truly lost his mind!.

    C. Fawcett

    September 23, 2011 at 10:15 pm

    • Cardiologists don’t make $800,000/year. I’ve never met one or heard of one making that much money. Actually, I’ve never heard of a doctor in any specialty making that much money on salary alone. There are doctors who also do research, have other investments, etc, that might give them yearly incomes of close to that but not on salary alone and that extra money isn’t coming from the hospitals or your pocket either. It comes from wherever they do their research or wherever they have their investments. Not sure where you are getting those figures but you should check to make sure it is from a credible source. Also, family practitioners make money only if they have patients. They run their own clinic a lot of the time have to keep up the costs of equipment and the salary of nurses they employ plus other staff like secretaries. Family practitioners truly get paid only if they work. Cardiologists and other specialties get paid a base salary plus bonuses every year. A cardiologist might not do a single surgery for two days but he gets paid the same. His bonus is where you see how much work he puts in. Family practitioners never have the same salary because they don’t see the same number of patients every year and they don’t get a base/guaranteed salary.

      Please do some research before spouting off numbers and acting like you know what it takes to go through med school and the training it takes to become a doctor.

      P Martin

      October 6, 2011 at 9:01 am

      • Primary Care including family medicine sees just as many if not more patients then subspecialists. The reimbursement rates for primary care is a lot lower, though which largely accounts for the salary discrepancy. Depending on where you work, primary care may also have the same pay structure as what is cited above: a base salary with a bonus for seeing more patients +/- a subtraction from base pay if you don’t meet your base numbers. This is changing as we speak and primary care will soon be incentivized for keeping people healthy rather than just based on the numbers of patients seen. Primary care will also be incentivized for just being in primary care. Primary care is getting a second coming and it is well deserved.

        As a family physician (and I am certain this is true for other specialities and subspecialties), for every four hours of work I put into physically seeing patients (reimbursed time), I put in another 2-4 hours of non-patient care (non-reimbursed) which includes charting, refills, filling out prior authorization paperwork, returning patient phone calls or electronic communications, coordinating care with other specialities, reviewing results and conveying them to patients, not to mention updating my knowledge on a particularly challenging case.

        In my opinion, the non reimbursed work is where the salary per hour amount starts to reduce to the point of matching the salary of any other lower paid (though not less appreciated) job whether that be a teacher, a plumber, etc.

        WJ

        October 6, 2011 at 11:44 am

      • @WJ- I agree with you 100%. Being a family physician, you would know how much time is spent with patients, charting, etc. Also, it’s definitely true that family physicians see more patients then subspecialists and they still make less money. I have head of family physicians getting bonuses as well but if they run their own clinic, there are going to be tough years where there isn’t any money left for a bonus after all the other costs to run the practice are paid for. I hope you are doing well (it sounds like you are) and it’s good to see that primary care is getting a second coming because these are the doctors that get overlooked the most in my opinion.

        P Martin

        October 7, 2011 at 3:51 am

    • DITTO RESPONSE AS BELOW: Well, since you are such a good scientist surely you must know that if one is alert, oriented times three, not suicidal, not homicidal (excluding justifiable self defense) and does not have any auditory or visual hallucinations then it is highly unlikely that that person is insane? Or do you call all insane that do not agree with you?

      By the way, is that your expertise diagnosis of insanity? It sounds very reminiscent of public misuse of the word. Not quite as bad as the Soviet psychiatric treatment of dissidents. But still quite a sophistical misuse of the true meaning of the word “insane”.

      C.Fawcett…your comments are consistent with those of entitlement mentality. A.K.A. looters. I would not treat you….nor would you probably want to be treated by someone like me. So, at least we can agree to avoid each other….now if I can only figure out how to escape that legal plunder thing.

      r58black

      December 17, 2011 at 4:46 am

  139. “At this time I do not know of any current other highly trained careers that command so much time in training as medicine does. Not law school. Not grad school.”

    You, who wrote the above are very out of touch. The training of Ph.D. molecular biologists, biochemists, chemists and physicists is just as extensive, if not more so, and very expensive. Law school no. But the hard sciences are called hard for a reason. Ditto, theoretical mathematics. Get a grip, will you?

    Medicine, as practiced day to day, is a trade. As a physician who specializes you see the same thing over and over, you are an above average in intelligence trained monkey waiting for the drug detail man to stop buy and push his latest. The scientist’s I mentioned don’t see the same things every day but have to be constantly learning and thinking.

    C. Fawcett

    September 23, 2011 at 10:30 pm

    • You don’t think Doctors are constantly learning and thinking everyday? You are crazy! Take it from someone who is married to a medical student and has worked in the medical field for 7 years and been around a lot of doctors. For an example, I will use a cardiologist. There are tons of different surgeries that they have to perfect and learn in order so save someone’s life or improve it. Heart surgery doesn’t mean the same thing every time, it depends on what kind of surgery the person needs. Also, they study, go to seminars, research, etc, to learn new and better techniques and ways to perform surgery. For you to basically say that they just stop learning after they become doctors is insane. Doctors save lives, and they spend a good portion of their young adult life learning their “trade.” At the end of the day, I’d rather pay high health care costs and get a good doctor who is knowledgeable and still learning everyday, over one who gets paid less, can’t stand his job, and hasn’t learned anything since graduating from med school.

      I agree it can be expensive to get trained as a molecular biologist, biochemist, etc. At the same time it doesn’t cost the same as going to medical school. Even if you go to a Ph.D program that is four years long, the total cost will not come close to $300,000 (I know this because I majored in biochemistry and looked into pursuing a Ph.D in that field but decided on the medical field instead). Also, when you are done with those four years you are ready to get a job and start living in the real world making pretty darn good money, while beginning to pay off your loans and saving a ton of interest. Doctors still have to do a three year residency where they will be lucky to make $45,000/year. Try living on that while paying off a debt of $300,000 plus any undergraduate loans you might have. Then, on top of that, if you want to specialize in cardiology, nephrology, surgery, anesthesiology, etc, you can expect 5-8 years more training and still make less than $100,000 until you are finally practicing on your own where only then do these guys make the big bucks. I don’t know about you, but after paying for my bachelors degree with loans, med school with loans, and doing 8-11 years of training after finishing med school, I would expect to make a couple hundred thousand dollars a year to save your life or anyone else who came to me. If you don’t want to pay to see an extremely well trained physician, then go to Mexico or somewhere else where the training isn’t as draining or significant, spend less money, and have a doctor treat you there. Otherwise, be glad you are getting the best care possible.

      P Martin

      October 6, 2011 at 8:43 am

      • A little tip from physician parents whose kids are doing much better than they are…bioengineering. One kid…first year out…doing better than the old man. Old man happy for said kid but still somewhat taken aback by the mixed emotions of realizing the way things are.

        r58black

        December 17, 2011 at 4:50 am

    • C. Fawcett: You just took a commanding lead in a tough field of “most ridiculous replies” with the sum total of your 3, combined. Not an easy task; congratluations!

      Tony D

      October 6, 2011 at 9:25 am

    • Well, since you are such a good scientist surely you must know that if one is alert, oriented times three, not suicidal, not homicidal (excluding justifiable self defense) and does not have any auditory or visual hallucinations then it is highly unlikely that that person is insane? Or do you call all insane that do not agree with you?

      r58black

      December 17, 2011 at 4:06 am

    • C. Fawcett,

      As someone who has BOTH an MD and a PhD in molecular biology, and who practices medicine AND conducts molecular biology research, I will say that you are a moron who does not what you are talking about.

      Anonymous

      January 15, 2012 at 7:52 pm

  140. Hi, Neat post. There is a problem together with your website in internet explorer, could test this? IE nonetheless is the marketplace leader and a good part of folks will omit your magnificent writing due to this problem.

    Mortgage

    October 8, 2011 at 7:11 am

  141. hey remember when america had the best healthcare system in the world that covered everyone AND was super affordable… oh wait.

    sm

    October 21, 2011 at 2:07 am

  142. Excellent article. I truly love my work but if I had to do it over again I would choose a different healthcare field. Dr. Brown didn’t mention some of the costs involved- licensure and DEA registration- hundreds of dollars each. I paid $2000 for my board exam and it is time limited, meaning I will be paying another $2000 in a few years. AOA dues about $800 a year plus state and local memberships which I don’t do- too expensive.

    Anonymous

    October 29, 2011 at 8:15 am

    • My CME costs at one time were approaching 12,500$ per year. Multiple certifications, etc. Return on investment was such that it was no longer cost effective to do so in that manner.

      r58black

      December 17, 2011 at 4:53 am

  143. Does “median salary” include the dividends/capital gains of a physician who owns his practice in the form of a C corporation? I doubt it. Therefore, we can’t really say what they make.

    If I run a more mundane business and pay myself a $200,000 salary but my corporation earns a profit of $500,000 and take that in dividends, I made $700,000, not $200,000. The $200,000 was what is usually used by sloppy researchers to determine “income”. They’re not synonymous.

    It’s the same for doctors. Salary is not equal to total income. So studies citing “low pay for doctors” exclude these other sources of income for physicians. Many physicians eventually own their own practices so capital gain/dividend income may vastly exceed their “salary”.

    I won’t even get into the “games” people play with the tax code to transfer personal costs of living to the business. From a PC bought for your kid to play games on that gets expensed to the practice, to the Mercedes used to visit patients at the hospital being written off 100%.

    Doctors deserve to earn a whole lot. The system depends on that, as otherwise they’d take easier paths and we’d have a shortage. But anyone who can do basic math knows the MD living in the $1M home driving a Mercedes S class and putting 3 kids through college and paying off an ex-wife doesn’t make just $200K a year.

    These studies are self-serving, to say the least, though well-intentioned (trying to overt cuts in payments from insurers and government) ..

    But what we need is market forces and that means intellectual honesty on both sides. Part of the reason a medical education is so expensive is that the “guild” of medical professionals want it to be. Erect barriers, make it expensive and difficult, and you get fewer physicians and presto….higher rates!

    Try requiring doctors and providers to publish electronically all rates, by insurance code. Then you’d see what the market price really is. But right now, when you walk into an office or need an emergency procedure, you never know what the bill will be. How many other fields do you see that in? “Yes ma’am, we’ll get that new roof on your home. But you won’t know what it costs till a few weeks later.”

    Even lawyers post their hourly rates. If you can’t match their low bar, that really says something about the ethics of your profession.

    Bruno Tata (@AnonymousHench)

    November 10, 2011 at 12:49 pm

    • Education in general could use a little overhaul. Online stuff. Like University of Phoenix. Financial reckoning is coming for education …out of necessity and historical neglect of use of tools of better efficiency.

      It is unclear what you mean when you say that these studies are self serving. Do you mean to say that the studies are fraudulent and therefore an elaborate ruse of sophistry? Do you mean to say that the studies show the plight of what many doctors already know to be now true?

      Fully agree with market forces. Insurance codes are proprietary…and doctors don’t own them. The AMA does…and it gets a tidy 240 million per year or so for forcing the rest of us to use them. Many doctors post their rates. Online can be problematic due to digital manipulation of manipulative individuals who have nothing better to do than spend their time arguing. Where I work rates are clearly posted on the board. If someone calls they are told current rates. Nothing hidden. If they don’t like it they can go elsewhere.

      Intellectual honesty cannot occur on both sides since one side is definitely getting screwed and treated like second class citizens through the onslaught of unfunded mandates, misapplication of RICOH and, even more so, misapplication of ERISA to health care….not to mention the f**ked up civil court system this country has where there is little if any recourse for frivolous law suits.

      Your comments regarding ethics is somewhat prejudicial and naive. Even though a profession may proclaim ethics for its profession it is the behavior of the individual that actually determines ethics or lack thereof…..and, unfortunately, they don’t teach character in school…not in law school…not in medical school. In fact, I think this country would be a helluva lot better off if it actually prevented certain bad character types from ever reaching any position of authority, regardless of any ephemeral test scores or IQ.

      r58black

      December 17, 2011 at 4:20 am

  144. One more point. You include the hours and expense of a 4 year bachelor’s degree as “training”. By that logic you should include the 12 years of education an accounting clerk or salesman gets before he practices his trade. That would take that $25/hour wage down to what, $5?

    Until you start medical school, you have no more “training” required than people who start at jobs making $30,000 or $40,000. So why include that in the numbers?

    Short of about 1/4 of the courses in a “pre-med” course of study, you’re no more trained than someone studying Sanskrit for a major. Or does that English Lit and Sociology help you cure patients?

    Bruno Tata (@AnonymousHench)

    November 10, 2011 at 12:56 pm

    • Where are you getting 12 years of education for accounting? All it takes is a bachelor’s degree in college and you can work as an accountant. So in figuring your training cost, you can include those 4 years just like Dr. Brown did. Also, your view on a typical doctor is way off. You think that every doctor lives in a $1 million home, drives a Mercedes S Class car, puts 3 kids through school, and has an ex-wife. You watch too many movies or read too many books. You are way off on that mark. There are tons of professions out there where some people are like that, not just doctors. Also, you say “many doctors eventually own their own practice.” False again. Most the doctors that own their own practice are family physicians, not surgeons, cardiologists, nephrologists, etc. Those types of doctors almost always work in hospital or clinic settings that they do not own. I know this because my wife is a third year medical student and I attended the same school as a PA student and have been around a ton of doctors. My wife is thinking of being a family physician and she has looked a lot at what they make even if they own their own practice. Believe me, they make nowhere near $700,000/year. Not sure where you are pulling those numbers from. You can’t just make up numbers to sound intelligent. After a doctor takes their salary, most of the money their practice makes goes to other staff (nurses, secretaries, etc), equipment, and things like that. And, assuming that at least half the family doctors out there accept medicare and medicaid patients (even though it’s probably more than half) they are lucky to break even with those patients, and a lot of the time they actually pay to see such patients. I just wish you and others would really research or talk with other doctors to find out facts and figures because too many people are just spouting off random salaries and statistics when they have no idea what it takes or costs to get the proper training to become a doctor.

      P Martin

      November 11, 2011 at 6:10 am

    • Did Dr. Benjamen say down to $5 as something that should be legislated? I don’t recall that statement. It is interesting analogy though only for comparison as few would tolerate such a reduction….but many expect it of physicians. Thanks for pointing it out.

      The training in medical school is not only an added expense but time loss of income earning years which is further compounded against you when one considers the power of compound interests…against…not for..you. It becomes like a snowball effect that leaves one in a financial blizzard at the end.

      RE: “Short of about 1/4 of the courses in a “pre-med” course of study,”

      RESPONSE: And the applicability of that statement is what, exactly? Especially since premed is a mother but not nearly so as med school and further more it requires 4/4 of the premed curriculum just to get invited for the more fun intense studies in med school.

      r58black

      December 17, 2011 at 4:26 am

  145. My father and wife are doctors. The arrogance of this article is astounding. I would not want Benjamin treating my family members.

    Anonymous

    November 22, 2011 at 11:06 am

    • Lineage and marriage does not equate to primary experience. If you think it is arrogant for a physician to point these issues out then what does that say about your character and/or expectations of other providers…besides being born from them or married to them?

      r58black

      December 17, 2011 at 4:28 am

  146. 1. A number of overstatements in regards to the calculations offered by the author have been exposed already; Fuzzymath provided a pretty clear response.

    2. The number of posts in which some doctor or med student is compelled inject their own circumstance to evince the truth of these estimates is pretty amusing.

    Why yes, the automobiles here in the physicians’ parking garage are remarkably similar in make, model and year to those at the local high school….

    Yawn.

    Aaron

    November 22, 2011 at 11:10 pm

  147. I would encourage all physicians to do the following:

    Refuse to treat looters, moochers, *ssholes (those that speak for others without that person’s permission), bullies and tyrants.

    In so doing you will find that you may actually like your patients. You may actually be proud of your patients. You may actually avoid engagement with subhuman characters that are plaguing humanity.

    The clinic where I work does not take Medicare. We lose less if we go fishing. Several years ago, a pleasant appearing but obvious looter demon middle age lady who had no business being in the office proceeded to call me a pig because I was a provider at this clinic. My first thought was to say , “Comrade bitch, get the f**k out of the office” but I politely refrained and informed her that she was not welcome here, was not a patient here, had no business being here and that if she did not leave then security would be called immediately to make her leave. I also told her that she had a choice and could go elsewhere because I told her, but in hindsight it was probably an error to do so, that it was still a free country. I also informed her that the clinic does also see patients on a cash pay basis if needed.

    The clinic has of late learned to be more savy in dealing with the protesting looters in that a no trespassing sign is now clearly posted which allows the clinic to charge such individuals not only with trespassing but also with burglary..Yipeee!!!!

    r58black

    December 17, 2011 at 4:37 am

    • To provide a quick and easy reply to this: this is not possible, as it goes against the Hippocratic oath that every physician takes before he/she is allowed to practice medicine with his/her degree. There may be a small handful of physicians out there who would go against the Hippocratic oath, but likely not many.

      Anonymous

      January 24, 2013 at 7:59 pm

  148. Thanks God I don’t live in the United States. Everything is so expensive there, man.

    Azlanshah

    January 5, 2012 at 2:43 pm

  149. I’m more than midway through a surgical sub-specialty. There were definitely weeks where I’ve worked >110 hrs and a few times where I didn’t go home for several days straight. Compensation is going down, it’s true. The only part that really bothers me is the fear that I won’t be able to practice medicine the way I’d like to practice. Litigation and learning to CYA has resulted in expensive unnecessary tests that drive up the cost of medicine, ridiculous heroic measures at the brink of death, skimping on primary care, etc. etc. I know plenty of people – esp in the food service industry, or people who live and die by their small private businesses that bust their asses working >80 hrs week. My parents have never taken more than a couple of days off. They can’t afford health insurance, have no retirement saving and are barely scraping by. That’s the state of the economy. People are struggling to find jobs. As doctors, we’ve got decent job security and for the most part, we’re treated really well. Lets get more accurate representation in Congress so that compensation is better justified and our practice and treatment is not dictated by compensation for the procedures. Lets stop with the stupid rules that won’t let interns take overnight call. Medicine requires a commitment to excellence. It’s a lifelong commitment because you’ve gotta keep up to make sure that you do right by your patients and provide care based on evidence based findings. Lets stop whining about our hours and how miserable our lives are.

    Anonymous

    January 7, 2012 at 8:18 pm

    • You can stop whining about your hours…but as you say you are in training. And…if you chose later on…you can continue not to whine about your hours. You may even consider not accurately calculating your take home pay by dividing it by the actual hours worked to get it. Ignorance can be bliss…if that is what you chose. But chose it for you….not me. And there are those of us that do more than just whine. If you want to be a good little serf …and that is what you truly want…and what makes you happy…then great. Kudos for you. But for myself….after years of training as well….I have come to viscerally realize that the combination of being salaried in a system based on third party pay in an entitlement society whereby looting is legal via civil courts that have essentially little if any connection of liability with scientific causality is the ultimate cluster flock…the ultimate. Enjoy your sanctuary ….while you can. If you have a spouse don’t forget to ask them about your choice as well.

      r58black

      March 7, 2012 at 9:57 pm

  150. Interestingly, 1 1/2 years later the debate continues. I actually enjoyed reading the comments as much as the main article. I am a general surgeon in private practice. My own thoughts:

    1. The point is: there is a huge cost to becoming a physician and based on that, physicians are underpaid.

    2. Whatever margin of error there may be in Dr. Brown’s analysis does not refute his main argument. I’m not sure why some replies focus on the accuracy of his data. So what if he is off by a few thousand dollars? His argument is still sound.

    3. Like many other professionals, some doctors have made better financial decisions than others. That is why some of them drive nice cars and others drive beat-up Toyotas.

    4. Contrary to popular belief, there is no financial reward for doctors to order extra tests. We do not own CT scans or labs (except those who are in that business). Some surgeons own surgery centers, but there are strict federal regulations about that.

    5. Physicians are poorly trained in the field of Business Management, but they are expected to run a business when they graduate. Many physicians complain about going bankrupt, but they have no business assistance. There are consultants, but many are just vultures (sorry, my opinion.)

    6. A piece of advice: If you want to go into medicine to make money, think twice. Many doctors went into it because it is a “calling”. People climb Mt Everest because it, too, is a “calling”, despite the huge sacrifices. (I read “Into Thin Air” and couldn’t understand why anyone in their right mind would even try to climb it.) Do people become doctors because of altruism? Honestly, I doubt it.

    7. Medicine must be a great profession: why else would anyone in their right minds choose to pursue a career that is underpaid, overworked, highly regulated by the government, and enslaved by the insurance companies?

    8. “Quit if you don’t like it”… Well, by the time you have everything invested into this job, it’s a little late to do anything else with your life. In deed, you are not trained to do anything else, so you would have to start from scratch. Most docs are in their early to mid 30′s when they start practice, with a family and a huge debt… too late to start over. However, many docs do quit, in fact, and go into business, law, administration, etc.

    I can go on, but most points have already been made. Here is some simple advice for everyone:

    For non-physicians: Demand to your congress members to fix the SGR payment system for Medicare, and request greater oversight over the greedy insurance companies. For-profit insurance companies don’t care about your health, they are out to make money for their shareholders. Do you know how much UnitedHealth executives made last year while raising premiums and decreasing reimbursements? Look it up.

    For physicians: If you are a student/resident: demand that your program include a business management course in your education. You might learn something that you can use later to save yourself from going bankrupt.
    If you are a practicing physician: Join your state and national medical associations (e.g. CMA, AMA). They are the only Lobbyists we have, and the government does listen to them. No one else will represent your interests like they can.

    Another surgeon

    January 7, 2012 at 9:27 pm

    • f**k congress. f**k government medicine f**k serfdom. f**k legal plunder.

      r58black

      March 7, 2012 at 9:59 pm

  151. i was a high school teacher & am now a family physician so i feel i can speak for both. your calculations are as accurate as can be given minute to minute ever changing variables & if anything, you went far too easy on the doctor work hours.

    Tommy

    January 8, 2012 at 2:09 pm

  152. The statement “decreasing resident work hours from 80 hours per week to 60 hours per week is a terrible idea” rubs me the wrong way. This attitude toward unreasonable and even damaging levels of overwork always strikes me as a form of hazing. I will give that you’re speaking about education and time spent learning, but based on my conversations with (admittedly somewhat disillusioned) residents, they stop being able to process information efficiently or learn anything after about the 20th hour straight. We know that people don’t work or learn well under conditions of sleep deprivation. And the argument that they will need to know how to work through a lack of sleep for their practices is ridiculous: few (if any) board-certified physicians work anything like the hours of residents. To hospital Administration, residents are cheap labor to be exploited, and established physicians just want residents to go through it because they had to go through it.

    Zak R.

    January 8, 2012 at 2:51 pm

  153. A good and thought provoking piece, thank you

    Conor Mccartney

    January 8, 2012 at 7:35 pm

  154. I’m really glad that this article was written so that all of you physicians can have a place to complain about how tough your life is. Last I checked, medical school is something you CHOOSE right? My only hope is that your family, friends, and/or significant other were granted some reprieve from your constant complaining and narcissism while you all posted your comments (complaints).

    Also, I have some violins to play some sad music for all of you physicians if you need a good cry.

    Andy

    January 8, 2012 at 10:56 pm

    • Hey Andy,

      If you were severely ill and my patient, and you said the above to me, I would STILL work as hard to save your life as for anyone else.

      There are two reasons I am a doctor…one is because I chose to. The other is because I am better than people like you.

      Anonymous

      January 14, 2012 at 11:13 pm

  155. I am a radiation safety officer at a large urban university affiliated medical/trauma center. I am not a physician, but I work very closely with physicians, residents, and medical students. I have seen the work that goes into becoming a physician, and frankly, I would want no part of it. A physician is not only a chosen career but a chosen lifestyle as well. Most new graduates sitting for their boards tell me that if they knew then what they know now, they would have gone into engineering.

    Bil

    January 8, 2012 at 11:17 pm

    • I am in Engineering and have been for 10 years, but guess what? I am thinking medicine!

      Anonymous

      May 15, 2013 at 11:14 am

  156. This comment is not directed at the author of this article.

    Medicine has suffered many huge setbacks of which I was planning to address; that is until I flicked through some of the comments. One of medicine most insidious erosion goes largely unsaid, which is conveniently embodied by the medical students who have commented here. Before you cry the blues ask yourselves if you have any real sense of what’s really broken with the system? Have you ever read a newspaper? What about historical fiction? How narrow is your life prospective? The Golden Age of medicine is long over and the next cohort of physicians better be damn well sophisticated in knowledge, and equipped with an actual backbone, so stop being sheep.

    Furthermore, do not ever blanket statement someone “stupid and ignorant” while preaching greater moral and industrious rectitude. Eat some humble pie. Patients don’t rely on you for your arrogance, empty wisdom, and lack of equanimity. Old medicine understood the role of physician as it also understood the role of physician in the community. that most office visits aren’t arranged by patients with the intention of any real curative inquiry, but out of reassurance and to be heard. But boy has the definition of Doctor been rewritten today. Insofar as the parented browbeat students of today enter medical school day one keen on dermatology and plastic surgery, only to subsequently “suffer” up through residency, I think we’re commuting a once intellectual institution for a vocational mill. It has its consequences. If I were currently undergoing life’s toughest vicissitudes, I certainly wouldn’t rely on any of you for support. What was your notion of medicine before any of you embarked through medical school? What is the role of a physician? What is well being?

    From my experience most of the students who cycled through my office were a-curious and disaffected champions of rote. I no longer subject my patients to them- their lack of rapport is astounding. We’ve lost the appreciation for classic physician. Hence the ensuing “traumas and regrets” of medical school and residency, purveyors of bad medicine, and angry dejected practitioners who continually whine but do nothing to correct what they can of their bad business model.

    Also, the physician lobby is pathetic. No surprise there. Furthermore, in your own practice or larger llp you can innovate and provide better care. The feckless physician lobby is not your only source of change or advocacy. You’re a person. You have a mouth. You have agency. You can improve your business model, and provide better care. And yes, you’ll always have to work hard. But your profession is not lugubrious (try typing in a cubicle or squatting in the fire station drinking beer all day). Fulfillment does matter.

    Stop being so myopic; you’re de-evaluating my profession.

    Anonymous

    January 9, 2012 at 3:49 am

  157. DAN DAN DAN — you are utterly wrong in almost every way. I will give you a live perspective.. I agree that its painful and times tasking at times to grade papers of college or highschool students and preparing lectures for them as well ( i was an adjunct prof. at a College and now with an MD degree), it by no means compares to the hours spent preparing for cases, exams, research activities and in-training/board reviews , not to mention the 80+ hours (underestimated) of mandatory clinical responsibilities. “Medicine is a lifestyle” Really??? like choosing to be an actor so you can be a celebrity, or chasing political tittles to dwell in pompous positions of power, or having vacations and spring breaks when your students are also on vacations and spring breaks or every other freaking holiday for that matter – Dan, that it is a very daft statement you made and complete nonsense. And who is to say that there isnt any teaching done by physicians, we also have to teach our peers and subordinates – medstudents and underclass trainees, prepare for lectures: clinical department conferences, grand rounds, didactic lectures and present research projects etc. All of which don’t overlap with mandatory readings for cases and preparations for in-training exams and day to day cases and keeping up with the medical literature. The fact is that there is truly not enough time in a normal persons day to achieve all of this without becoming insane but one has to literally steal’ time from everything else: Spending time with family, routine exercise, hubbies/sports, going out to eat and spending time with significant other, time to just sit and think/reflect, going to Church, Mosque, Temple, watching a TV show, read a novel, be involved in Child’s affairs, attend best friends wedding, see family overseas, a REAL VACATION (which is typically spent catching up on reading, sleep and research activities) — all of which are joyous activities and should afford one serenity or plain SANITY. Theres no doubt that medicine recruits a special breed and one has to be a machine to survive it, and we do… this once upon a time was rewarded fairly and reinbursements kept your family sane and allowed you to say at least they are not suffering and I can work slightly less (at least 60hrs) andspend the rest of the time with them. at the rate things are going the work hours will be the exact same as the hrs spent in training. Quality of life which you say we chose, “the lifestyle”, is not existent anymore buddy.. Doctors of chosen to make some of the Greatest sacrfice in order to serve, you included… and this should not be forgotten. We give up way too much and fathom the anguish of missing out on very important things in (couldnt even see my terminally ill parent because of call duties) and should be spoken of with more sensitivity. There is a gratification that comes with providing care for the sick and seein them get better, but it should come at the cost of ones own life… Many Drs today would say they are either unsure or wouldn’t choose medicine if they had to do it all over again. Us who still choose to do medicine despite the mediocre expense and quality of life are those who flat out answer the Call of duty – just like going to war and dedicating your life to service.

    Maybe you should have your child go to medical school and then fund his way through and tell him life will be very rosey once he’s done and its just as easy as being a teacher… and I promise you that he will love you for giving him such an accurate description of what medicine is like today.

    Anonymous

    January 9, 2012 at 12:59 pm

  158. Just 2 things: Why is it that, compared to other 1st world nations U.S. physicians are considered “well paid”. 2) You chose to compare an Internist to a teacher. OK. Now…how about a cardiologist, or an Ophthal