"If freed from the farcical intrusions of hyper-regulation and stifling administrative burdens, almost all doctors would doctor for less. And we would clearly be less inflamed and happier. Guess whether quality would be better?"

 Herein lies the crux of the dissatisfaction of the American physician, John. What they (we) are really saying when stuff like "I'm underpaid" or "i wouldn't be a doc if I could do it over again" is that it doesn't feel OK to have so many, many people saying such unkind things about physicians. It doesn't feel OK to be forced to cross ridiculous "t's" and dot worthless "i's", to have a chart that is not a guide for past and future care but is rather a legal mine field waiting to trap and destroy your career...you. 

We live in a world where we can do exactly the right thing for our patients, and it can be exactly the most dangerous thing for us, the physician, because of some vague and sinister rule or regulation put in place by some someone who never took care of so much as a hangnail.

Like everywhere else in life money doesn't bring happiness. It never did in medicine. What it did (and does) is make it somewhat more convenient to live with the rest of what goes into being a doc in today's America. We live at one end of the stethoscope, still, but now sqarely in the middle of the crosshairs.

How much money is enough when you see that little red circle on your chest?

 

Darrell 

Should I counter with a blog on "When doctor's make little salaries?" :) But it is true, when I'm in a room with a patient doing what I enjoy--listening, teaching, responding, answering, comforting and learning--my salary seems very generous. But when I'm changing a medication for the fourth time in four years to satisfy some insurance company's whim, explaining to the same insurance company that my diabetic patient IS on an ace-inhibitor even if their claim's made data doesn't show it, explaining to my staff that I will NOT make the referral for that highly paid specialist's patient because he's too busy to do it or refusing to see someone who showed up 30 minutes late for her physical for the third time in three years; then I can't be paid enough.

A million dollars a year is a lot of money... certainly not underpaid. $314,000 is NOT a lot of money in the big cities and on the coasts for what heart surgeons and electrophysiologists do. OK, my wife and I both work to make that much money on the East coast... but we are not surgeons and we certainly don't feel rich.

I once asked a doctor who made about $300-$400K+ what it was like to make that much. His answer? He said he wished he could live the lifestyle his wife and kids are living... that he is always working and never home. He was looking forward to retiring and was pretty exhausted. My guess is that he thrives on the stress and overextending himself. I think there's some ego and need for power going on also. How can you go through so much training, hold so many people's lives in your hands, realize your high status, and maybe see others as not as smart... and then slow it all down...make less... spend more time with the family while in your prime and lead the simple life?

And if you want to stay on the cutting edge, you need to have all the latest technology, all the "toys" that boost up the practice. More money made. More expenses. More stress. More to lose. More insurance.

How many surgeons will trade their white coats for coveralls in their prime? Not many.  I was in the Navy. I hated/loved it. I was told that a complaining sailor is a happy sailor. I think the same is true here.

Maybe these surgeons and electrophysiologists need to slow things down, choose their toys wisely, and take time out to be a father, a husband and a what? ... a human being. We all need to do that. But surgeons and electrophysiologists are working from dizzying heights... the lure of money and power is great... and it probably looks scary to look down. 

 

 

 

Nice insightful post.

QUESTION: How much is that 3rd-string baseball player in the Major Leagues worth? ( - pick your major league sport ... - ).

How much is that entertainer worth?

How much is that CEO worth? (and while he/she is clearly worth a large amount - is he/she worth thousands of times as much as a regular worker in the company ... ? )

 How much is your child's grade school teacher worth? (you know, the one who has to buy their own supplies if they want to try anything innovative and educational ... ).

THANKS AGAIN John for your soul-searching post!

Dear John,

Thank you for your opinion on this most recent article by Medscape. This Medscape article is yet another example of the vast collection of printed material that continues to depict our profession in a not so flattering tones.

I would like to touch on some of your points, because I am confused as to your sentiment on this issue.

1.) It seems in the beginning, that you chastise the responders ("Whoa. What’s up with heart docs being such downers?") for not appreciating the average 314K salary.

Perhaps you can gain some perspective as to the response in 2012 by these "downers". Looking back just a few years back, you may recall a survey by the AMA ( http://www.theheart.org/article/1018537.do) that was eventually used as an excuse by CMS to bundle more codes in order to save Medicare money. Back then we were also apparently the biggest earners of all physicians, averaging 400K, if you believe the few that answered the AMA survey. So yes, I would feel "down" for working harder and making 25% less 2-3 years later.

2.) "Who is forcing them to buy so much stuff?": Are you referring to our own purchasing power  (i.e. personal assets, etc) or just the basic business expenditures to run a veritable outpatient cardiology practice (i.e. echocardiogram, EKG machine, an office space and staff to start). I am not even including Medicare's and private insurance #1 nemesis...the SPECT Camera.

As an EP, I don't suppose you have to spend money of your own for a Carto navigation system or whatever the latest equipment is used today. I am assuming that your overhead expenditure, being primarily a hospital-based cardiologist, is different than for the office-based Cardiologist. Are you part of a group that has a dedicated CEO to worry about overhead or are you a solo-cardiologist like some of us, who do have to worry a little more about it?

Yes, I will agree that if you have personal expenses that exceed your means, then that is not society's issue, but office overheads don't decrease with the years, and your revenues do. Yes, you can "see/do" more to compensate, but at some point you would be sacrificing quality. One thing we are, is skillful. What we are not, robots.

3.) "What of saying they wouldn’t become a cardiologist again? Why not? Is it because of administrative demands and hyper-regulation? Come on fellas (and ladies). What would be better? Primary care? Pediatrics? Do you think the keepers of the front line have less non-medical burden?": is it then justifiable to"accept" a systematic flaw to healthcare delivery because others have it worse? This is not a simple "the grass is always greener on the other side". This is more like there is no grass in either side, but who has it more barren. We ought to be getting involved making the process better instead of settling because our other colleagues have it worse. That my friend, IS a "downer" mentality which I don't share with you.

Later in your blog, you seem more supportive of your fellow Electrophysiologists' salaries, and bringing the main issue at hand,how much is our skills worth? Well, like in anything in business, somethng is worth whatever someone will pay for it. In this case OSU knew of their current and future worth and compensated them accordingly. No different than Facebook paying a billion dollars for Instagram. Another business transaction based on tried and proven principles of economics. Let's be clear; however that not everyone if acquired by a large hospital systems. 

The problem is that patients don't pay for our skills. Private insurances and the government insurance do, and they determine what we are worth based on an arbitrary process noone seems to understand or is even privy to it.

Even the basic micro-economic principles of supply and demand do not apply to us because our worth is pre-determined by this arbitrary process that we have no say in it. Private insurances just follow CMS' beat and at least here in South Florida, it comes with an additional 20-25% discount from CMS fees.

4.) "If freed from the farcical intrusions of hyper-regulation and stifling administrative burdens, almost all doctors would doctor for less. And we would clearly be less inflamed and happier. Guess whether quality would be better?": I disagree with this statement, for the same reasons I just wrote before. If free from these hyperregulations and administrative burdens, incomes would probably go up because costs would go down. Yes, we would probably be happier but because we would be allowed to doctor more, and feel satisfied with our jobs.

I am not sure if quality would change because I am not clear if there is a "quality" issue in all of this. We would need data, and I am not aware of anything out there linking current practice patterns with outcomes for the population. Perhaps the subject for another blog.

One more tidbit just to put things in perspective, all the NFL payers drafted this past weekend, if signed, will all be 1%ers by definition due to the CBA rules that allow for their minumum wage to be at $390K. We won't probably hear much about this in the press.

To conclude, this is a very senstive issue with many variables, and I guess in the end you seemed to sort of be in agreement with the sentiment of the responders, and although you make the point that you don't care what any of us make, you did seem to care at the begining.

Best,

Alan

 

 

 

 

Assume doctors are not overpaid, is it that they see non-MD's they think are overpaid?  Doctors seemingly had many choices early in life and decided on a medical career.  I am not sure the vast majority of doctors would be happy with the average salaries even if they were freed of regualtory hurdles and paperwork.  I suspect that many doctors just beleive they should be paid the most.  They hate feeling socially-poor while being labelled federally-rich.  This is especially true in urban areas.  

 The only real remedy I see is helping doctors rediscover passion for their work (priceless) and improving their own health (wellness! Gasp!).  Honestly so much dissatisfaction is intrinsic to poor health and so many doctors ignore basic needs of exercise, sleep, balanced nutrition, and passion (a mind-body benefit).

Thanks for your heart-felt post.

Steven

One of the cardiologists at my hospital drives a Ferrari.  I bet he'd do it all over again ;). Nice piece.  Could even apply that to my pharmacist profession.

My EP was hired away from a practice to take over a start-up facility in a well known heart center.   He received a signing bonus of $50k and a guarantee of $450k a year...  I can only assume he can make more if it all goes well.     Sure he is talented and learned and should be paid a good annual sum.     However I know other professionals out there that are just as talented or learned in their fields that make a quarter of his pay.   And I am not here to discuss athletes and movie stars or Lindsey Lohan showing her naked body for a cool million.   That is insane to begin with. 

 When I was in the navy and assigned to aircraft carriers with 5000 men and 120 aircraft and four engine rooms, sick bays, galleys, combat information centers, flight deck crews, ordinance, etc. etc...     Everyone was needed to keep that carrier operational and the crew fed and all hundreds of thousands of jobs performed daily.    Sure there were some jobs that seemed more important than others....   Say a cook as opposed to a fighter pilot but the carrier would have stopped dead in the water without each man doing his job.    In the navy we were all paid based on our rank or rate standing, from the bottom to the top.   A seaman was paid less than the captain but there was a limit and we all knew it.     Somehow we were all able to live with it and took pride in our work and performance.   

In the end we could all be replaced by the proverbial phone call and I think that goes for everyone...  even the President can only serve eight years.    

Something we never think about is what would happen if it is all taken away, what would you give to get it back? As a CT surgeon I was an Alfa Predator then I was diagnosed with a progressive neurologic disorder ~10 years ago. I tried to switch carriers to become an intensivist. Hard to call up my old colleagues to please see the patient in Bed 3 and harder still to have them be surprised that the diagnosis was right. But after three years this was too much an d our hospital president let me down as softly as he could when he told me that it was time to quit.. Thanks to good financial planning, my disability income is more than adequate. Do you really need $650 K? Yes I would do it all again. I would do it for half of what I made before. When the phone doesn?t ring at night it still wakes me up and I can?t get back to sleep. I might even complain less about the form and the rules. When was working 70-80 hr weeks I used to occasionally wish that things would slow down a bit. Be careful what you wish for.

We have the rare privilege of saving lives every day. Don?t tell me that there is a better job. Was I worth more than a plumber? Yes. As much as a coach? Which one, the Head coach of Duke?s Basketball program or the Ping pong coach of Peoria U? There aren?t that many Pro Entertainers at the top. A middle level physician is going to do a lot better than a second stringer on the field hockey team. (let?s be totally honest, we may be big fish in our own ponds but most of us put our pants on one leg at a time) But what about those clinics around the holidays when you have to make two trips to the car to carry out the heartfelt gifts of your patients. Economists have a different way of looking at costs. Opportunity costs are what we give up to get something. What would you give to have your job? Now what would you give to get it back? I?ll bet more than 50% would give plumbing a miss.

To quote Joni Mitchell ?? you don?t know what you?ve got ?til it?s gone?

I absolutely believe that MDs are underpaid, especially after you consider overhead costs like malpractice insurance.  Medicine is not as lucrative as people think it is.  According to this article, a doctor's average take home salary is $27.72 an hour: http://www.hcplive.com/hot-topic/doctor-average-hourly-wage-2772   That's less than what me, a SOCIAL WORKER (notoriously underpaid field) with a masters degree, takes home.

I work with a lot of physicians, and most of them do seem burnt out.  It makes me sad when I overhear them taking about being stuck at the hospital and having to miss their kids growing up.  One time, I overheard a doctor excitedly tell another that he had Christmas off for the first time in five years.  

Nurses are actually the ones that are raking in the big bucks.  At the Sutter Health Hospitals in California, nurses average $136,000 a year (http://www.sutterhealth.org/about/news/news11-committed-to-competitive-wages-and-affordable-care.html) with no malpractice insurance.  Don't forget the time and a half overtime pay on top of that.  Not exactly fair that MDs have to go to school for 8-12 years only to make less than nurses.

 

http://socialworkburnout.blogspot.com