Damn Greedy Doctors by Pat Conrad MD
If you are reading this, and are a doctor, then admit that you are grossly overpaid, and are a huge obstacle to providing high quality, cost effective, and equitable care for a deserving population.
At least that’s what Dean Baker of the Center for Economic and Policy Research thinks. His premise is that U.S. doctors are paid twice as much as in other developed nations: “Because our doctors are paid, on average, more than $250,000 a year (even after malpractice insurance and other expenses), and more than 900,000 doctors in the country, that means we pay an extra $100 billion a year in doctor salaries. That works out to more than $700 per U.S. household per year. We can think of this as a kind of doctors’ tax.” I’m not that deft with big numbers so I got my calculator out, and simply can’t get to the figure Baker concocted. Then I went back to the article, assuming that I had misread. Then I deduced that the author was either drunk, a liar, or both, which is resume’ standard I suppose for a left-wing economist.
So let’s stick with this interesting premise, that greedy doctors making too much is the driver in health care costs. Baker does not trouble himself with how much hospitals, administrators, Big Pharma, or Big Insurance make. He does not discuss the truckloads of unfunded mandates whose costs are passed on to the physician, and indirectly to the patient, and the enormous inflation and waste added by government medicine. He does not acknowledge that Medicare effectively price-caps physician income per unit of work; but, he does see how Medicare could – and should – limit expenditures by more tightly controlling the supply of specialists, and mandating more residency slots for family practitioners (who better quit bitching, because “even family practitioners clock in as earning more than $200,000, enough to put them at the edge of the top 1 percent of wage earners in the country”). There’s nothing like stirring in a little class warfare to make a serious policy argument.
“The other reason that our physicians earn so much more is that roughly two-thirds are specialists. This contrasts with the situation in other countries, where roughly two-thirds of doctors are general practitioners. This means we are paying specialists’ wages for many tasks that elsewhere are performed by general practitioners.” I assisted on plenty of c-sections in residency, so really, how tough would it be to save on all those unnecessary OB charges? Doesn’t a cardiac catheterization just involve squirting a little dye in a line? There really isn’t a good reason that a competent nurse practitioner couldn’t do that, instead of some lordly cardiologist distracted by her next Mediterranean cruise.
This “expert” also has some good ideas about overcoming the increasing doctor shortage, caused by our “doctors’ cartel”: bring in more foreigners, lower residency requirements, and allow those who have not done a residency to practice as “assistant doctors.” And of course, Baker would reduce costs and increase access by allowing expanded prescribing and procedural independence for “nurse practitioners and other lower-paid health professionals.”
Baker sends us out with one three sneers for doctors who he claims “generally enjoy a great deal of respect in society” (I could not disagree more):
“But if we want to stop paying a $100 billion premium for health care that doesn’t make us healthier, we’re going to need to overcome those political barriers. Getting U.S. health care costs down is a herculean task; getting doctors’ pay in line is a big part of the solution. It’s time we broke up the doctor cartel.
The fact that most people like their doctors will make the effort harder. Most of us like our letter carriers too, but that doesn’t mean they should make $250,000 a year.”
Part of me really hopes Baker gets his wish, and the inexpensive “doctor” that he deserves.
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Unionize.
He wants to talk cartel? Show him the power of docs pulling together and saying, “Enough”.
PS
It will be necessary also to reform public workers pensions. The average state of Illinois worker makes more per hour than I do as a physician
In my training and career I worked 150,000 hours total
The average Illinois state worker has 30 years at 1700 hours a year or 51,000 hours. They retire at 55 and start at 80% of FINAL pay with 3% annual escalations. If you take their lifetime earnings including the value of annuity that would pay that pension (worth about 2 million today) and divide by the hours worked vs my lifetime and divided by the hours worked , they make the same. That does not include the sacrifices, and hardships.
Several problems with this economic argument.
We will have to “dump down” our doctor population or allow it to become all foreign as Britain has become, because the smart people will do other things that pay better for the hours. In Britain immigrants are willing to work for 80k to be a doctor since it is better than their home country. But the British native born seek higher paying careers.Since many other occupations are paid more that will attract those people.
Nursing will have to be cut in pay. Currently if you take the hours in college, medical school, and work, take out the higher tax bracket, add in for years of compounding, a doctor could make more than going to nursing school and working the same hours and banking it than a Doctor paid 150k a year.
Switching to NP and the like has not helped as they learn to bill at doctor rates. Note the CRNA were supposed to reduce anesthesia costs. Now we have CRNA making 400,000 a year after 4 years of nursing school and 3 years of CRNA training. Why go to medical school.
Yes there are some problems Specialties that have mini monopolies are overpaid. Many specialties with easier hours and responsiblities are overcompensated. Previous pay reforms have ended up affecting just specialties that have to sign up for patients and not those with monopoly situations.
I’m thinking about all the docs I know that give up time to work at “free” clinics and donate money to various charities.
Well, if they have so much extra money and time, shouldn’t we just mandate this. We shouldn’t be outrageous though. Maybe just force doctors to give up 10% of time and money to work at government mandated clinics.
Overtime we can gradually escalate the percentage. They won’t notice it.
Oh and will probably need to mandate some burn out prevention courses as well. You know…..just in case
One state at least in the United States has considered it a requirement of licensure that physicians have at least 10% Medicaid billing for their practice. Think that one through.
So working more than an investment banker and giving people the gift of more pain free time on this earth is somehow worth less than a paralegals job??? Since when did this get so perverted?? The clintons can get 750,000 for a speech, but doctors are overpaid? Most people in middle management make at bigger companies make more than doctors without the threat of a lawsuit wiping them out. If you don’t agree, citizenship can be obtained in countries like Venezuela and Russia, North Korea and other fine countries where docs aren’t paid as much.
Hmmmmm. In addition to “left-wing economist”, “sanctimonious prick” comes when describing what I think of Mr. ( or is it Dr.) Baker.
I don’t use these words lightly and usually reserve them for fine people with last names like Slavitt, Emanuel and Gruber.
“For a left wing economist”????
Since when is Libertarian logic considered “left wing”?
Hint: it’s not.
Gary, there is nothing libertarian about this author’s views. He is preaching state planning and centralized control, implicitly recognizing a service as a “right”, and removing voluntary association from the discussion. That is the opposite of libertarian.
Sexist comment of the day:
It’s not how much doctors earn, Pat. It’s how much doctors’ wives spend.
I don’t know about you, but I can tell you that if I bring in $200,000, my wife will spend $210,000, thus creating a continuing spiraling quest for ever-more income.
Want to reduce doctors’ incomes? Prohibit doctors from marrying, like they used to do in the Marine Corps. Hell, I could live comfortably on less than half of what I earn, if it weren’t for my other half.
Lance, as ever you put it all in perfect perspective. Bravo!