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As a biology major with a passion for learning about diseases and diagnosis (and no interest in staying in a lab all my life), applying what I learn to medicine would be a logical step. Pre-med requirements also include physics, chemistry and a wealth of other courses. Then, there’s the grueling, five-hour MCAT which has sections assessing knowledge of the physical sciences, verbal reasoning, writing and biology. After undergraduate come medical school and residency, meaning that doctors don’t actually begin practicing until their late twenties to early thirties. A stable salary comes even later, and despite the fact that the medical profession is held in high regard and the general belief is that doctors make hefty salaries, the returns are quite slim in relation to investments in education. Also, there’s a discrepancy between the salaries that people like Wall Street professionals, who contribute fairly little to society, make and what doctors earn. Doctors face massive stress and their compensation is highly variable and subject to regulation. All of these factors combined have made me slightly wary of going into the field, though I have no doubts that I’m capable of preparing academically for it.
Studies have shown that almost fifty percent of doctors believe they are undercompensated. Salaries range from around $150,000 to $315,000 for physicians, and on average, they carry around $150,000 worth of academic debt when they begin practicing. Anthony Youn, M.D., writes for CNN: “The average base pay for managing directors at Morgan Stanley is $400,000. At Goldman Sachs, it’s $600,000. The average salary of an NFL player is $1.9 million… When you consider these numbers, the thought of pediatricians making $156,000 a year doesn’t seem unreasonable. They often see 50 patients per day, answer our calls at all hours, and keep our kids healthy. What about critical care physicians? They average $240,000 a year, but are responsible for keeping the sickest of us alive. One-quarter of critical care physicians spend more than 65 hours per week with their patients, not including time doing paperwork.” Youn also notes that the government and insurance companies regulate physician compensation, creating salary ceilings and sometimes forcing them to work for free.
Doctors could earn even less after the Obamacare provisions take effect in 2014. Back in 2009, speculators said that doctors would stop treating Medicare and Medicaid patients, instead only giving care to the privately insured so they’d be compensated more. Primary care physicians generally approve of Obamacare while highly specialized doctors like radiologists and cardiologists do not. The former receive a bonus under the legislation. They also get to see more patients, who receive better coverage so that prescription drugs and surgeries are cheaper. But Uwe E. Reinhardt, an economics professor at Princeton who writes for The New York Times worries that this wouldn’t last for long. He writes, “For reasons that elude me, United States policy makers and the medical establishment have for decades preferred to deny thousands of eager and qualified American youngsters the opportunity to study medicine and have then met the resulting shortage of physicians by importing foreign-trained physicians from other countries. But while there is no overall shortage of qualified young Americans eager to study medicine, there is now a nationwide lament over a shortage of American medical school graduates willing to enter the primary care specialties. For that reason Medicare may soon substantially increase the fees for primary care physicians, assuming private insurers will swiftly follow suit, as usual. The only question then is whether such fee increases will come at the expense of taxpayers or from other parts of the health care sector, perhaps even the more highly paid medical specialties, including radiology and cardiology. That is a political call.”
In addition, doctors are highly susceptible to burnout on the job, according to a Mayo Clinic and American Medical Association survey of 7,288 physicians. Around 50% of them report at least one symptom of burnout, which could open the door to alcohol abuse, poorer patient care and mistakes on the job. Alexandra Sifferlin of TIME writes that there were 22 questions to determine where the doctors were on the Maslack Burnout Inventory, which “asked participating physicians… about their feelings of burnout — including ‘emotional exhaustion’ or losing enthusiasm for their work; feelings of cynicism or ‘depersonalization’; and a low sense of personal accomplishment.” Sifferlin adds, “When each symptom was considered separately, 37.9% of the physicians had high emotional exhaustion, 29.4% had high depersonalization and 12.4% had a low sense of personal accomplishment.” A huge concern is that nearly 60% of primary care physicians said that they were feeling burnout while “doctors practicing pathology, dermatology, general pediatrics and preventive medicine (including occupational health and environmental medicine) had the lowest rates of burnout… The authors found also that physicians worked about 10 hours more per week than other people on average (50 hours a week versus 40), and were much more likely to work extra long weeks of 60 hours or more: 37.9% of doctors worked at least 60-hour weeks, compared with only 10.6% of the general population. More than 40% of doctors reported dissatisfaction with their work-life balance, saying their jobs didn’t leave enough time for a personal life or family, compared with 23.1% of non-doctors.”
Pauline W. Chen, M.D. discusses the same issue for The New York Times:“The study casts a grim light on what it is like to practice medicine in the current health care system. A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer… [Doctors] are also more likely to quit practicing altogether, a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.”
While all of these aspects of the medical field are menacing, they’re not enough to convince me that it’s the wrong way to go. Salary fluctuations are nothing to look forward to but the benefit that doctors provide society is highly attractive to me, a student who could choose to go into the financial sector and make more money with less schooling and better hours.
Sources:
http://thechart.blogs.cnn.com/2012/05/01/seriously-doctors-say-theyre-underpaid/
http://economix.blogs.nytimes.com/2009/07/10/rationing-what-doctors-make/
http://www.buzzfeed.com/buzzfeedshift/doctors-react-to-the-survival-of-obamacare
http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html?hpt=he_c1
http://well.blogs.nytimes.com/2012/08/23/the-widespread-problem-of-doctor-burnout/?ref=health
