In the midst of every bout of interest in healthcare, there’s always mention of primary care physicians who serve as ‘gatekeepers’ of healthcare. While it makes sense, there’s one catch–you have to have enough primary care physicians:
But there’s one important ingredient missing from that equation — enough primary care doctors to take care of all these newly insured people. And the big reason behind the lack of primary care docs is the fact they get paid shit — relatively speaking. Unlike the rest of the civilized world, physicians in the US are rarely salaried employees. With rare exceptions – generally public hospitals and university hospitals – they’re independent businesses that get paid based on what kind of work they do. The big bucks go to the procedure based specialties; that’s why surgeons can afford the McMansions. Primary care doctors — family practitioners, pediatricians, internists — who spend a lot of their time ‘just’ talking to patients get paid relatively little in comparison. No big surprise there’d be a shortage. Spend 4 years in school racking up $120,000 to $150,000 in debt (and that’s on top of the debt you left college with), you’re probably not going to want to go into a business that pays between $175,000 and $200,000 when surgeons make $300,000 at the low end to over $500,000 for some specialties. (Oh go ahead and play with the site at the link, you know you want to know what your sykiatrist is making.)
The basic problem is that ‘gatekeeping’ isn’t viewed as a medical procedure, so the renumeration is relatively low:
Under the current system of physician reimbursement, primary care doctors will never be able to make as much money as surgeons or other procedure based specialties. There just aren’t enough ‘procedures’ in their repetoire. They get paid for a basic office visit, or maybe a hospital visit. Period. The surgeon gets paid for the office visit, plus a hospital visit, plus all the various things she does when she gets you in the OR. And there’s really no mystical reason why there’s any more economic value to being able to repair your torn ACL than there is to managing the diabetes that threatens to destroy your kidneys.
And there’s some backwards economics underlying how this works (italics mine):
The easiest way to fix the discrepancies — and thus ease the primary care shortage — would be to allow hospitals to employ the physicians directly, but it’s against the law in most states. If hospitals could hire the docs, over time pay would start to move towards the middle. The orthopedic surgeon isn’t really worth that much more to the hospital than the family practioner. An argument can be made that the FP is actually more valuable since they’re the primary gatekeeper into the whole system. The problem is, most states have what are called ‘corporate practice of medicine’ laws which means only a physician can employ another physician. Restraint of trade at its most basic. And state medical societies lobby like mad to keep things this way.
A friend who was a primary care physician in Rhode Island recently left because the income for PCPs was awful. You would think that PCPs might turn against some of their colleagues–after all, their economic interests are not aligned. Maybe there’s a fracture line here?
If PCPs are this vital, why do we pay them the least?
mikethemadbiologist
Dude, what are you, some kind of fucking communist? The free market makes all this shit work perfectly. Therefore, by definition, PCPs are making what they are worth. Dirty fucking hippy!
You have unfortunately used a source that knows nothing about modern healthcare. PCP’s have been mainly replaced by Physician Assistants and Nurse Practitioners in states that attempt to deliver health care to all residents. PA’s and NP’s do not have the educational and salary overhead of a physician, and act as relatively inexpensive gatekeepers to the the medical specialties.
The aborted national healthcare plan proposed during the early Clinton years realized that U.S physicians could not be first provider and also incorporated PA’s and NP’s.
Wow! Only $175,000 to $200,000. Break out the food stamps! The debt from schooling is not that different from many professionals that go through to a graduate program. It’s expensive for everyone, but not everyone gets the return on that investment that doctors do, even PCPs.
Sounds like they could pay off their debt in one year and live off the remaining $50,000 for a year. Most people live on less than that.
I’m not saying its fair that PCPs get paid less, but a little perspective would be nice. The true failing of our healthcare system is that many americans can’t afford to see a doctor, not that the doctor can’t afford a second home like his surgeon friends.
Look around, other countries have solved this issue without any major problems. The only people who can read this without snorting are those that have never left the US.
A single payer system where they all work for the government would make more sense. Let’s use Europe as a sensible model. Maybe Obama will make everything all right.
A couple of points: avg PCP salaries are much lower than you’ve mentioned, and avg debt a bit higher.
Also, the whole “gatekeeper” idea has pretty much fallen away, except for certain types of health plans.
As an internist I use my brain, rather than my hands, to save lives. I am not compensated well for controlling diabetes, preventing a heart attack, etc. Too bad, really. If I could just cut out a “diabetes” I’d be a wealthy doc.
“Wow! Only $175,000 to $200,000. Break out the food stamps! The debt from schooling is not that different from many professionals that go through to a graduate program. It’s expensive for everyone, but not everyone gets the return on that investment that doctors do, even PCPs.
Sounds like they could pay off their debt in one year and live off the remaining $50,000 for a year. Most people live on less than that.”
There are three things you have to consider when comparing a physician’s pay to your average person who goes to undergrad and gets a job after. The first is the debt load is greater. The second is the actual difference in pay. The third is the differential start time of working.
Mary and Phil both graduate from college in 2000. Mary goes to med school, Phil gets a job after undergrad making $60,000. He ends up with $50,000 debt, she has 120,000 debt.
Lets say screw the COL, just calculate total they are net worth if they saved every penny:
2000: Phil +10,000, Mary -120,000
2001: Phil 70,000, Mary -120,000
2002: Phil 130,000, Mary -120,000
2003: Phil 190,000, Mary -120,000
2004: Phil 250,000, Mary -90,000 (she starts making 30k/year as a resident)
2005: Phil 310,000, Mary -60,000
2006: Phil 370,000, Mary -30,000
2007: Phil 430,000, Mary 0
2007: Phil 490,000, Mary 120,000 (ave PCP income)
2008: Phil 550,000, Mary 240,000
2009: Phil 610,000, Mary 360,000
2010: Phil 670,000, Mary 480,000
2011: Phil 730,000, Mary 600,000
2012: Phil 790,000, Mary 720,000
2013: Phil 850,000, Mary 840,000
So after 13 years, they will be even…. and that is assuming that Phil’s pay stays flat, which it doesn’t. And don’t even get me started on the magic of compound interest.
Trust me, you don’t go into medicine to make money.
“Mary and Phil both graduate from college in 2000. Mary goes to med school, Phil gets a job after undergrad making $60,000. He ends up with $50,000 debt, she has 120,000 debt.”
I was comparing comparible degrees, such as graduate degrees MS and PhDs, where getting an MS is like going to medical school and earning a PhD and subsequent Post-doc appointments are like a residency. A Masters through a Post-doc appointment can span 8 years of additional training, at least in my field of the biological sciences. No one is questioning the finacial motives of PCPs. Lots of people don’t choose careers based on income (except apparently for Phil).
Additionally, let’s continue the Phil and Mary scenario using the same pay of 60 and 120 grand. After another 13 years, Phil’s net worth is 1.63 million while Mary’s is 2.4 million and the gap will only widen as Mary and Phil work towards retirement. My point is that Mary is not hurting financially and the cost of her education is far outweighted by the finacial gains over her lifetime, not just the first few years, regardless of her altruistic motives.
Doctors clean up.
And even according to the AMA they kill over 100,000 a year through fuck up and get away with it.
You have more chance of dying in a hospital through “mistake” than though crimes, car wrecks, and drugs combined.
Who ya kiddin?
Doctors clean up, eh? Tell that to the MDs I work with, they need a good laugh. I love how people pull numbers out of their asses about the figures that other professions make and then state those numbers like it is take-home pay. When you get right down to it PCPs (and I’d have to say doctors in general) don’t make nearly as much as people like to think they do after you take insurance and taxes into consideration.
And Grady, what about the hundreds of thousands of people they heal every year? Errors happen in every job regardless of how careful people are. It’s unfortunate, but part of the system when dealing with the ill that when a doctor screws up people can die. But you know what, people die even when the doctor does everything in right. Don’t bother thinking about how wrong you were because I have a feeling you will never think otherwise.
And please do tell your PCP about how they kill 100,000 people a year through fuck ups and get away with it; I bet they’d love to hear your thoughts.
thanks