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, Thu, 4 Dec 2008 10:54:46
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Caarma, was the $22,000 after grad school or undergrad?
I think you've hit the nail on the head regarding salaries for primary care. Great Britain saw a decrease in the numbers of primary care physicians, so they raised their salaries, relative to other specialties, and that evened things out. Of course, the government runs the public health care system, so they can make that sort of change.
The average debt immediately upon medical school graduation was $150,000 in the mid-1990's. I haven't seen any more recent data, but we all know tuition has continued to rise steeper than inflation. And upon graduation from medical school, first year of residency starts at about $35,000 now. Ten years ago, it was in the high $20's. Each year of residency, they pay you about $1000 or $1500 more. During residency, payment on your student loan is deferred, but interest accrues. Student loan rates are not that great, it turns out. Therefore, I wouldn't be surprised if the average doctor now finishing residency is facing somewhere around $250,000 of debt. If you're starting a job after residency at $85,000, about the same time you'd probably like to have a house, and about 7 or 8 years past when you should have started having kids, you can see that we won't see people flocking into this field, at least not anyone who is informed. Many are uninformed, express their desire to go into primary care (which thrills the medical schools), then they run some numbers. Eek.
IMHO, the appropriate level of salary is one that will attract an adequate number of skilled candidates to the field. Not sure what that number should be, but I do know we're facing a primary care shortage in the states. Caama's recommendation to diminish doctor's salaries is unlikely to help this problem and belies a misunderstanding of where the vast majority of our health care dollars go. Anyone happen to know what the CEO of United H**lthcare was paid last year? Check it out. Also check out our healthcare expenditures for the first six months (primarily neonatal ICU) and the last six months (primarily heroic measures, etc) of life. Lots of money spent there (about half our annual healthcare expensditures over that total 12 months of life), but do we really want to change our core values that drastically and eliminate that spending?
Also regarding doctors' salaries, there are some, IMHO, that are overpaid. Surgical specialties, and anything involving radiation, make anything from 4 to 10 times what primary care does. Truthfully, you can't blame doctors for flocking to these specialties. Unless, of course, being told that you could earn 4 to 10 times more would have no meaning to you.
Finally, IMO, attempts to cut costs should be done with utmost care. If you decide to cut the wages of people who are doing the actual work in healthcare, and it turns out that they're being paid at a rate that is causing people to leave the field and others to not be attracted, you're sabotaging the future. Re-starting a medical system after it is depleted is almost impossible, because of the prolonged period between initially being attracted to medicine (usually in high school) and hanging up your shingle (usually age 30-35).
$$ I would propose (but what do I know):
Primary care - $150,000 to $200,000, depending on cost of living in the area, and loan repayment for underserved geographic area/demographic.
Surgeons - I have no idea. Their call is more difficult, training period longer, and so on. But those number will probably have to come down if we want more docs in primary care. Over $400,000 a year is probably too much for a surgeon. Probably. Of course, here we live in a society where athletes are paid millions a year and nobody blinks an eye. In the end, what do we want our people to truly be good at? I'd better stop now. Way too long a post.
posted by 75.100.9...
, Wed, 3 Dec 2008 23:11:12, Fri, 5 Dec 2008 08:27:55, Thu, 4 Dec 2008 10:54:46, Thu, 4 Dec 2008 13:21:03, Fri, 5 Dec 2008 08:15:54, Thu, 4 Dec 2008 13:20:52, Thu, 4 Dec 2008 13:21:37
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