Because it's a really difficult job that requires a lot of training. The question is not why doctors make that much, the question is why so many other people make so little.
this post was submitted on 14 Aug 2023
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A lot of training that you have to pay a lot of money to get, then more on the job training that you get paid (relative) peanuts for.
A lot of other countries have better support for people during these training periods, so the US equivalent takes on a lot more debt and a lot more risk to attain these higher salaries.
If the barriers to entry in the medical field were lower, the salaries would be as well.
I looked up salaries of Canadian doctors just to compare. Seems like the average is about $300,000 Canadian dollars or about $225,000 USD. So Canadian doctors make about 2/3rds of what they make across the border. That indicates its not necessarily all about training or difficulty.
It's a common problem in Canadian healthcare that workers leave to the US for a considerable pay bump, which is part of what the article talks about. Are American doctors just in it for the money?
Canadians in many fields make 2/3rds or less than their American counterparts.
Also, education is more subsidized in Canada.
Are American doctors just in it for the money?
This is a strange question. You think European or Canadian doctors are just more noble and selfless? They all take the best salary they can get, all other things being equal. But the US has a higher median income along with a convoluted medical system in which profits are unusually high, and doctors get a share of that.
The cost of living in Canada is substantially lower though, so you need to figure that into it.
The cost of living is lower in Canada? That’s gotta be a new one. Literally everybody in Canada complains about how the cost of living there is skyrocketing. Their home prices are worse than Cali. I was just up there in 2021 and it was pennys on the dollar for me with exchange rates, but stuff was definitely expensive up there compared to even Cali where I’m from. The only thing cheaper is healthcare and schooling but that’s just subsidized.
The average cost of living in Canada ($1901) is 18% less expensive than in the United States ($2317)
Or is it related to the fact that the US health care system is a profiteering scam.
[“In general, U.S. physicians are making about 50 percent more than German physicians and about more than twice as much as U.K. physicians,” ]
The doctors being paid properly are hardly what I'd consider a profiteering scam. Attack insurance. Attack billing. The doctors are doing a job.
The very same doctors who are getting paid extra for selling specific brands of drugs and treatments? It's a profiteering scam from top to bottom and the doctors are obviously complicit. "Doing a job" my ass, plenty of unethical things in this world are done by people "just doing their job", in fact - most of them.
Do everyone a favor and never go to the doctor or the hospital when you get sick.
Who do you think writes the medical textbooks handed out to med students? Part of the scam is in the training how and what to prescribe. Many doctors will treat the symptoms while ignoring the cause. A proper healthy diet and exercise could cure a lot of things, but that's not profitable advice to give.
I know a woman who spent years fighting a bunch of skin problems and other issues, visiting all kinds of doctors. Finally she figured it out herself. She had turned herself entirely "vegan" for probably a decade or longer, choosing to forgo all meat, especially red meat. Guess what fixed her big issues? Eating a small filet of steak several times a month - her blood type and genetics required something that she was lacking in all her other vitamins/minerals/etc intake. Not saying eating red meat every day is good for the average person either, but just one example where her condition stumped doctors for several years before she chased down a wild theory herself and it worked.
The doctors in the UK are doing the same job, at 1/2 the cost to consumers. The doctors in Germany are doing the same job, at 2/3 the cost to consumers. It's hard to ignore that the main difference is that the US health care system is a massive profiteering scam throughout the system.
The closest that I would say there is to profiteering is that the American medical education is a very long hazing ritual where the financial risk of not becoming a doctor falls on the students.
Sorry OP. I want the best and brightest in charge of my healthcare. And I’m willing to pay those wages to get it. If you wanna pay less I’m sure there are any number of natural healers that’ll give you an onion or a rock for your ills.
And I’m willing to pay those wages to get it.
But paying AVERAGE wages of 350k doesn't at all get you "the best and the brightest". And capitalism doesn't work in the healthcare industry. You don't get to chose your ER doctor, nor do you even know how much your doctor makes. You have captive markets, so it is a profiteering system. And other people aren't willing to pay a profiteering charge.
It gets me the best and brightest compared to you. I, specifically, want someone smarter and more capable than you working on me. Those people cost more than you do. If you want to look for graft in the healthcare industry look at hospital bureaucracy or insurance companies. Skilled workers are a stupid target. Harassing them makes healthcare worse.
It gets me the best and brightest compared to you.
It does not. 350k salary gets you a completely average doctor. And if the average salary was only 250k we would all still have the same doctors. My doctors are just as good and probably better than yours. And you cannot even chose your own doctors at all unless you have Obamacare. Nobody goes out and hires their own doctors at all lol. You are imagining some ivory tower theory, not talking about the real world of medicine in the USA.
I, specifically, want someone smarter and more capable than you working on me. Those people cost more than you do.
Are you hallucinating? Stay with me buddy. I...do...not...work...in...the...medical...industry. And if I did I would charge you more than 350k/year despite being completely unqualified since my time is worth more than that.
Skilled workers are a stupid target.
Your Dad is a doctor huh.
You're clearly missing his point. He's saying that keeping doctor salaries higher than other fields draws talent to the field of medicine from other fields.
Your point about not choosing your doctors is largely correct, but once again, the target of that criticism should be insurance companies, not the doctors themselves.
First of all, that's not a lot of money.
No. Really.
That's about $197,000 in 2000 dollars. $123,000 in 1985 dollars
Our idea of a comfortable salary largely depends on when you entered the workforce.
Now, adjusting for inflation we see that doctors are actually paid slightly better today than they were back then. HOWEVER, we also have to consider the skyrocketing cost of medical school and student loans.
Even if at the end of all the calculating doctors are actually making slightly more than that used to... that's a great thing, right? Shouldn't we all want salaries to trend upward in real buying power over time?
The ONLY scandal here is that all the rest of us have had our share of the wealth WE generate stolen from us.
Sure, people making more money is a good thing. Well, as long as it's distributed relatively equally. The issue that I personally take with their salary, especially when considering inflation (which most of us can't say the same) is the massive decrease in care. I don't think it's fair for doctors to make more and more money every year, while providing CONSIDERABLY less or worse care.
Doctors in most practice settings have very little control over the quality of care these days, believe it or not. Several factors converged. One was an unintended side effect of anti-kickback and anti-fraud laws like the Stark Law preventing ownership of healthcare facilities by the physicians who practice there to prevent the temptation to provide superfluous and unnecessary tests for the sake of extra billing money.
This opened to door to corporate ownership, and doctors gave up too much of their autonomy and control, becoming "mere" corporate employees like the rest of us. The corporations deliberately understaff and just push more and more and more patients onto doctors, nurses, respiratory therapists, everyone all across the board are being expected to take on more and more. Which of course degrades the quality of care.
It's the corporations keeping the excess profit generated, not the physicians. Physicians have finally started seeing what's going on and unionizing (at least up here in Massachusetts - University of Massachusetts and Mass General Brigham are both major hospital systems where resident doctors have unionized.) And it's the resident ("junior") doctors who are currently on strike in the UK.
Honestly, we need to get hospital ownership out of corporate hands and back into the hands of the providers who are motivated to take care of patients. We need to figure out better mechanisms for regulating fraud
A friend who is a recently new medical Dr. also told me about an unintended (well—lobbyist intended) consequence of Obamacare (USA specific ofc). Basically the bill included a clause requiring providers to use electronic healthcare records. This was supposed to be partially so that the hospitals could coordinate patient information better but that bit didn’t work because everyone implemented their own system and the systems largely don’t talk to eachother. But who now gets a tidy copy of all the patients’ charts? Their insurance companies ofc! Insurance companies are using the more detailed info to reject reimbursements if the chart doesn’t include extremely specific language the insurance company can say “that wasn’t documented to standards” and just not pay for it. If providers (doctors as well as hospitals) want reimbursements they have to keep up with all this language specified by the insurance companies and make sure they train everyone on the updates about once every six months. Obviously this puts more strain in smaller systems (and economically disadvantaged ones) that don’t have the money to basically hire lawyers to keep up with the documentation required in order to receive reimbursement. It’s absurd to me our doctors are having to put so much time into paperwork (and apparently having to wait 15 seconds between every click in the EHR databases but that’s almost a separate issue).
This is what I come here for, strong facts based analysis. Thank you for your service.
I'm fully aware of why, but it doesn't change the fact, that I as the end user, get FAR less care than I did 5 years ago. AND I keep paying more and more and more every year for even less care.
I mean yes, I'm not contesting that. But laying responsibility for that at the feet of doctors is not going to fix the problem when corporations are the problem
More accurately, a for profit system is the real problem.
So accurate
Doctors and their pay are the least of the problems in the (U.S) medical system.
I see a lot of reference to Europe-based medical practices being thrown around with no context other than, "This number bigger," so I'm hoping to clarify a few points from my own experience:
For one, the M.D. path for an American student is longer than the bulk majority of European countries you're referencing. European medical training begins after high school graduation, while American students have to complete 4 years of undergrad first. Only then do they complete 4 years of medical school, followed by 3+ (in my case, 5) years of residency. Depending on specialty of practice, a fellowship of 1-3 years after residency might also be required.
That extra four years of undergrad had me starting med school with a baseline of $100k in student loan debt (public, in-state university) that continued to accrue interest while I trained.
Then there's the matter of medical school cost in the US. I went ahead and checked my loan account for you, even though it gives me an ulcer to look at. Just shy of $400k is how much I'll have to pay back for those four years of training. When added to my monthly payment for undergrad loans I anticipate paying about $5k per month in loan bills alone. Medical training in other countries is subsidized to the point of being free for those accepted into an M.D. program. The UK is a bit of an exception, but their average annual tuition is the equivalent of $13k per year and still way, way less than the requirement here. I'd happily take a lower salary if I could know there wasn't going to be a giant debt hanging over my head until I'm at retirement age.
There's also a big discussion to be had about not starting to save for retirement until you're in your early 30s, but I've already gotten a bit long-winded here. The point is this: The salaries are higher because we fully bear the cost of our own training up front--for longer--and are expected to pay it back ourselves.
Others have already made the point for me, but we're a small drop in the bucket if what you're truly worried about is the cost of healthcare in the country overall. For that, you need look no further than hospital CEO salaries, nightmarish insurance companies, and the ludicrous cost of medicines courtesy of pharma.
"guys it will take me like 5 years to pay off my med school debt" is not the argument you think it is.
Facts are, the ADA lobbies Congress to restrict residencies to artificially restrict the number of doctors and that is bad for everyone
I'm all for helping doctors pay for/removing costs for med school, but that's going to be meaningless without changing residency restrictions
Thank you for a reasonable take
They are incredibly useful.
They are incredibly useful in the UK and Germany also, where according to the article they make a lot less.
Now do insurance executives.
Why don't doctors make more?