What We Make by Pat Conrad MD

doctor-dollar

Medscape has published its 2015 Physician Compensation Report, reporting on 19,500 doctors in 26 specialties.

  • -The average primary care doctor made $195,000; the average specialist made $284,000.
  • “Orthopedists, of whom just 9% are women, were the highest earners.” Gotta love the author inserting snarky gender whining.
  • “Those who perform procedures have the highest incomes compared with those who manage chronic illnesses.” A perfect invitation to the “quality” movement to make it all more fair.
  • “Most doctors saw their earnings rise since 2013… family physicians earned 10% more.” You can color me skeptical on that last bit. Did that include one-time EHR reimbursements, or 1% will-o-the-wisp quality measure reporting participation payments?
  • “This year’s survey found that average salaries were highest in North Dakota, Alaska, and Wyoming and lowest in the District of Columbia, Rhode Island, and Maryland.” Did they average in all the D.C. lobby docs working for the AMA and AAFP?
  • Whether doctors think they are compensated fairly varies by specialty. Dermatologists (average salary: $339,000) were happy; ophthalmologists (average salary: $292,000) were not.
  • “Less than a third of primary-care physicians said they would choose their specialty again if they had the chance for a do-over. Still, most would not change their decision to become doctors.” Based on my completely unscientific assessment of the statements from colleagues, I’m very skeptical of this second point.
  • “In fact, doctors with some of the lowest earnings were the most likely to say they would choose medicine as a career if they had to do it all over again. About 70% of physicians in internal medicine and family medicine would choose medicine all over again, compared with just 50% of high-earning orthopedists.” Now I’m really skeptical.
  • “Overall, only about 9% of all surveyed doctors said “making good money” was the most rewarding part of the job. Instead, they cited things like “being very good at what I do,” “finding answers and diagnoses,” and “gratitude/relationships with patients.”” Physicians suffer daily new assaults on their autonomy, their character, and their economic sustainability, and the vast majority never see massive hedge fund, cronyism profits (again, not counting the Dr. Oz or the AMA, et al). I think this 9% is a huge lowball skewed by social desirability response bias, and now I’m calling bullshit.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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6 Responses

  1. Doc Chip says:

    Re what we make!?
    Just once I would like to have someone write one of these articles based on statistics from somewhere and include the complete set of survey questions and answer choices.

    What or how those questions are asked skews the results. This is so clear that Rand corporation and other statistics producers of recognized high quality, spend years qualifying questions and then data crunching them in order to validate the individual questions. They then validate the survey as an instrument before implementing it and then they run prospective survey assessments against known classifications to validate the instrument. This is why you cannot alter the instrument without affecting its statistical reliability. Only then can they can announce something of statistical significance is ready to be used. Long term data collection builds the data fields and stabilizes data so as to create meaning in the trends analysis and balance out the outliers with some degree of context.

    Please publish the survey in its entirety so that we can evaluate it properly (those of us who are interested in how their answers were arrived at) before giving any of their reporting even one iota of credibility.

  2. Bridget Reidy MD says:

    In Canada these numbers always include overhead but are reported as “salaries”. I suspect the same here. I make the same or less than I did in 1987 on an hourly basis. And in Canada as well as in the US I’d make even less if I followed the billing rules to the letter (don’t do anything, including an ROS or complete exam, unless medically necessary, or bill by time unless over 50% of the 20 plus min visit was counseling and coordination of care, when the ones who need at least 10 minutes of such are the ones who need even more time just to give or find enough correct history to get to the point where I know what to counsel on and what care to coordinate).
    Seriously, I’d love to know if any of your readers has been offered a salary like that to work less than 60 hours a week.

  3. Steve O' says:

    The amazing part is that the whole knapsack full of leeches and moochers is being carried by the people – like my surgical colleage above – whom they degrade and despise. [Hey, surgeon – thanks for what you do, from an Internist!]
    People started to get nervous in my Corporation when out of the Fortress of Oblivion, they issued an urgent bundle of nonsense called P.R.O. CARING There were little plastic daisies printed with P.R.O. CARING! Those got paid for by patient visits – there’s no other source of revenue.
    They, like other childish minds, like anagrams. P.R.O. stands for “Personally Responsible for Observing” Caring. It doesn’t seem to focus on whether the individuals are caring or carelessness, but rather watching others for whether they project a sense of caring. One wag came out with “L.A.S.O.O.” with a picture of a cowboy strung up on a rope, and the phrase “Let’s All Snitch On Others!” because that was the apparent purpose of the whole thing. Like many great ideas from the Fortress of Oblivion, it dropped like a myasthenic after a few weeks – but not after we cancelled a few days of clinics to sit through cheerful lectures on P.R.O. Caring!
    Sadly, there is more to the story.

  4. private doc says:

    Yes its BS. Notice they didn’t include hours worked or how said income was generated plus it’s a survey.

    I am one of the hated surgeons because I get paid based on what I do. I work 100 hours per week nights, weekends and holidays. Figure that by the hour and report that.

    That’s not the part that would drive me from medicine though. Gubment and hospital bureaucrats are the ones doing that and they get paid more to harass me than I do to operate on people at 0200.

  5. Sir Lance-a-lot says:

    I agree. I call bullshit on the whole thing.

    As an example, for my completely scientific n of 1, I earned 10% less in 2014 than in 2015, and my pay has declined every one of the past 7 years when adjusted for inflation.

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