Dr John Mandrola practices cardiac electrophysiology in Louisville, KY. He finished training at Indiana University in 1996. His practice encompasses catheter ablation, including an eight-year experience with AF ablation, device implantation, and consultative EP. Outside of the EP lab, Dr Mandrola's two hobbies include competitive cycling and writing. He has maintained a medical, fitness, and cycling blog, Dr John M, for the past two years.
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When doctors make big salaries . . .Apr 29, 2012 09:34 EDT
The top story on theheart.org this week bumped a nerve. Discussing cardiologists' salaries are bound to draw interest, but most striking were the doctors' gloomy attitudes about their pay and job satisfaction.
Surely this prickly topic is worthy of comment.
Let's go (carefully).
We can start by considering this well-read story about five heart rhythm doctors in Ohio who were paid two million dollars in 2011. I know of these guys, having visited their practice almost 10 years ago when I began learning the AF-ablation thing. They had built a highly successful EP private practice that was recently bought by Ohio State University. Shockingly, OSU dared to suggest that these heart doctors were more valuable than their basketball coach. Say what you will about doctors making millions, but who can argue with the logic of paying the person burning aberrant pathways in a beating heart more than a coach?
More illuminating than this right-place-right-time story is this Medscape survey of US physicians. The cardiology compensation part of the report notes that the average US cardiologist earns $314 000 dollars per year. More notable however are these details:
- 54% of heart doctors felt underpaid.
- 50% said that although their income put them in the 1%, they did not consider themselves rich. They said high expenses and debt offset the salary.
- Only 13% of heart doctors even considered themselves "wealthy."
Most depressing were the answers to the if you had it to do over question:
- Only 48% would choose medicine as a career.
- Just 50% would do cardiology again.
- A paltry 18% would stay in the same practice setting. (The other 82% must see greener pastures elsewhere in cardiology.)
Whoa. What's up with heart docs being such downers?
"Not rich because of expenses?" That's a ridiculous statement. Who is forcing them to buy so much stuff?
What of saying they wouldn't become a cardiologist again? Why not? Is it because of administrative demands and hyperregulation? Come on fellas (and ladies). What would be better? Primary care? Pediatrics? Do you think the keepers of the front line have less nonmedical burden? And don't even say you would be a radiologist, for those docs rarely get to do what we love so much: proudly puffing out our chests when we win. We heart doctors love our apex-predator role. We cherish being the quarterback.
And don't tell me you are serious about not being a doctor again. I'll chalk that up as sampling error or a typo.
What is a fair wage for doctors?
Clearly, what one considers fair compensation depends largely on the vantage point of the observer. Policy wonks and think-tankers that have yet to need the fury of medicine may feel differently than real patients.
Let's consider some examples: There's this pediatrician who once felt a baby's belly during a "well-child" visit. Although the baby was hollering, something felt off. The ultrasound showed an early-stage malignant tumor that was excised before it could spread. Ten years later, the kid is perfect. What was that pediatrician's skill worth?
And another. The furrowed brow and tears quantified the severe pain. The damn CT showed tumor all over the place. The oncologist hedged—a terrible sign. While the specialists addressed their particular specifics, the patient remained fearful, anxious, underinformed and in pain. Yes, she was suffering. In comes the palliative-care doctor who can both see and be comfortable with the obvious. Soon the patient's pain was eased, the family comforted, and the dying process proceeded with dignity and grace and compassion. How much was that expertise worth?
And one more: When a heart specialist falls off a bike and looks down at his right thumb pointing in the wrong direction, he sees his career flash before him. How much should the hand surgeon be paid to restore a career? Is it more than a BB coach?
I could go on. You get the picture.
It took me a very long time and tons of effort to learn how to care for just the heart rhythm. And I'm still learning. I'm not complaining; I love the effort. Most doctors that I roll with feel the same way. Heck yes, I would do it all over again.
But really, how much is it worth to have skilled, dedicated, and compassionate people to care for you or your loved one when needed? How much is society willing to pay for these skills? How do the years of training, the inflammation of night call, and the juggling of increasing administrative burdens get valued? Is it bad to think that it is worth more than a basketball coach?
That's a tough one. Isn't it part of our job as physicians to speak up on the matter?
Two final comments
I have no idea how much doctors should make. Whenever I think about the thorny topic, I can't help but remember a pearl of wisdom given to me by a gentlemanly senior partner. Many years ago, having only worked a year, I was stewing about the spreadsheets that listed our salaries. The wise and seasoned doctor told me something that sticks in my mind today. "We are all happy with what we make. What upsets us most is seeing what others make." Since then, I try not to dwell on what others make.
Second, don't tell too many people this: If freed from the farcical intrusions of hyperregulation 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?
What doctors want most is not more money. Mostly, we just want to doctor.