Does health care lower doctors wages?
Question:
Answer:
Government run healthcare always lowers physician income. Our profession is currently in crisis as socialism creeps deeper into it. It sounds Utopian to have healthcare for all, but what really happens (in every civilized country to attempt it) is the government creates a large entitlement, increases taxes by a large amount (averages 60% income tax and higher in many countries) and then spends the money on things other than healthcare. When bureaucrats need to fund a pet project, they will cut part of healthcare. The end result is decreased access to care and decreased quality.
As an example, an ENT in Canada will be paid less than $200 US for a neck dissection. This is a long and very risky surgery to remove lymph nodes from the neck while still preserving important nerves and blood vessels. It is not the work of a mechanic, yet physicians there are paid less than a mechanic. Here in the US, medicare now pays about $800 for this surgery, which is nearly half of what it was ten years ago. Less than half of practicing ENT docs will now do neck dissections. They would rather refer them to a teaching facility where income is less important.
It is easy for non-physicians to look and say, "wow, I'd like to get $800 for doing a day's work." But they cannot comprehend the amount of work it truly is, not to mention the liability should anything go wrong and the office overhead they are paying (yes, the office staff still work when you are in the OR). The fee paid for a surgery includes after care for a "global period" of time. Meaning, every time the patient calls, comes to the office, or is seen in the hospital afterward, you are not paid but you are REQUIRED to render care. Imagine such a policy applying to attorneys or accountants.
Moreover, people who have not gone through medical school and residency (and the personal debt as well as personal sacrifices) cannot possibly understand what a doctor has given up and their obligations.
The population has decided that they want socialized medicine, and it is probably going to happen during my (and your) career. They are being sold a bill of goods that will disappoint just like all other government run programs. After all, if the federal government can't take care of our wounded veterans who have paid the greatest price for this country, how do you think she will treat average citizens?
I enjoy the practice of medicine, but the profession has 1/3 of docs looking to get out NOW who are sick of it, 1/3 who are looking forward to early retirement, and 1/3 like me who are making the best they can of it for the privilege of rendering care. When the numbers of practicing docs drop enough, we will become dependent on second level providers (who just don't know the stuff because they haven't gone through the training) and foreign doctors. This is already happening on a microscopic scale, but as the numbers of US trained doctors drop, you will see a tidal wave of foreign MDs coming in to meet the needs of the baby boomers.
Most people would look at this as a distressing situation, and I do. I have already seen first-hand the poor care that results from a bureaucratic, "cost controlled" system. Medicare is currently engaged in a 5-year cut of its physician fees, which will end with fees at about 70% of their 2004 levels (this is already happening and will be deepest in 2010). Meanwhile, the cost of living, office space, wages of our employees, etc are all going UP.
It is irresponsible to say that you would not have to worry about your loans. YOU DO. They are your responsibility and usually cannot be forgiven through bankruptcy (they have special exception).
I am passionate about this because I personally see the effects every day. It will be on the doorstep of every citizen soon. I have watched patients in Medicare HMO plans get delayed in their treatment until their cancer becomes untreatable and they die in hospice. I have seen it first hand...it happens. It is cheaper to provide hospice for 6 months than expensive chemotherapy, radiation and surgery, and this phenomenon is more common in those countries with socialized medicine. After all, some elected or appointed official has to decide when a life is not worth saving.
I hope those of you reading this understand that I went into medicine thinking that healthcare for all (universal healthcare) was a great idea. I have learned from my experience that it would do NO GOOD for Americans, my profession aside. If you really want to get an earful, talk to a retired physician in their 70's or older. Many have practiced before, during and after the institution of Medicare, which now dictates how medicine is run and paid.
You should make your decision based on all factors, not just income. But, realize that we are not far from a time when physicians are civil servants and paid as such. I, for one, will avoid participating in completely government-run medicine if I can. Best of luck, whatever you decide.
If you make a formula of cost of school Vs. expected pay, then becoming a doctor is a real loosing proposition unless you are brilliant enough to be able to specialize. I also, frankly, know of only a few doctors who are glad that they are doctors. Most wish that they had become advanced nurses. There was a time when doctors made a lot of money and had a lot of prestige. That is well faded now.
I should ad: I am an NP. At the clinic where I work, I do almost the same things as the doctors. The doc's have the honor of being called "doctor", they get paid about 12 grand a year more than me, but they have SO much more responsibility. Plus I am in the nurse's union, and I get overtime pay, where as a doc does not. My sister and dad are both doctors, and my dad retired at age 55, and my sister hates her work, and looks 10 years older than she is. Talk to lots of people and choose carefully.
universal healthcare is a way to save drastically on the admin / profit side of the hc equation. of every $100 spent in the private system close to $30 goes to overhead / profit, using medicare as an example only $2-3 goes to overhead. There may be pressure on wages because of the new system but if you make it I don't think you will need to worry about your loans.
More Questions & Answers...