Why is discussing compensation a taboo amongst physicians?

[Medstud21]

Hello all,

why is there such a taboo associated with discussing compensation amongst physicians? I feel like my peers get very uncomfortable discussing compensation related issues. Some thing as little as discussing call pay an agonising experience. I feel like this is a huge problem, especially in employed positions where your employer has all the leverage in contract negotiations. They refuse to pay you more because “we pay everyone the same in X specialty” but you cannot negotiate together as a group because “these are individual contracts”. If physicians discussed comp openly, it would be much more advantageous for everyone. What are your thoughts?

[CordMcNally]

There are many, many reasons. Many reasons are for the employer benefit. You said if physicians discussed compensation openly then it would be much more advantageous for everyone. That's not necessarily true.

[jfoxcpacfp]

First of all, are you a med stud or a med student? Just need to clarify the individual perspective of the poster with whom I’m communicating. Petty, but it matters to me.

Regarding compensation, sharing this information can be cultural and may also be familial, depending upon the background of the person with whom you are attempting to develop a relationship. I have been fortunate to learn this through many discussions with physicians, many of whom are 1st generation Americans (and I so appreciate their patience and willingness to teach me).

I d/n believe discussing call pay with other physicians is universally taboo. It also could depend on how you approach the convo, such as asking directly “what do you get paid?” as opposed to “I’ve been offered $xxx/hr and expected $xxx/hr”, making yourself vulnerable, which tends to soften the recipient, then inquiring (if appropo) “what do you get?” or “do you mind my asking what you make?”, which opens the door to them declining gracefully, if that is their preference. Of course, always pay attention to body language - you can learn so much if you are attentive and receptive, Jmpo.

[Medstud21]

There are many, many reasons. Many reasons are for the employer benefit. You said if physicians discussed compensation openly then it would be much more advantageous for everyone. That's not necessarily true.

By everyone, I meant other physicians. Especially in employed situations.

[wideopenspaces]

I don't think it's really taboo, I am very open about my compensation with residents who are job searching as well as my friends- we all know how much each place in town pays for inpatient/outpatient/call, etc. I don't think it's a big deal to discuss.

[CordMcNally]

By everyone, I meant other physicians. Especially in employed situations.

Yes and no. If an otherwise happy employed physician finds out they are being paid less than a colleague (or colleagues) then that breeds resentment. That bit of information would take an otherwise happy physician (who agreed to that particular contract) and pretty much ruin that job for them.

Look at sports. It doesn't always benefit the athlete to have everything public.

[Jack_Sparrow]

I’ll post my salary on say this website, I wouldn’t dream of telling a co-worker my salary ever. Never ever ever. If your paid a dollar more, they will never look at you the same. They will resent you for life. Sure the admin clerk knows your a doc and probably make a lot of money. Never let it get back how much though. Let them just think “a lot”. I had someone come along in the practice a few months after me ask about salary. I made the mistake of openly talking about my salary. They got 5 grand more sign on bonus. It’s a nothing burger but it hurts to hear your paid less.

[StarTrekDoc]

UC salary all public domain; if you don't talk about compensation among employees, you simply give the upper hand to the employer. Divide and conquer. Admin does it well.

[uptoolate]

Probably many reasons. In a fee for service environment income is directly proportional to how much work one does and can vary quite a bit even from year to year for an individual so actual individual numbers may not be as useful as averages and medians. As more docs became employees I could see how it could be useful at the negotiation stage but as pointed out, there is no surer way to make someone making 800k a year unhappy than to tell them that their colleague is making 850k. And how useful is the information when so many MDs are doings so many different things even within the same specialty.

When I started in an academic job many, many years ago there were many 'secret' sweetheart deals and busy clinicians supporting researchers and senior faculty which caused a great deal of resentment. Knowledge of everyone's salary definitely sorted this out in a positive way for the busy clinicians when they demanded to be paid fairly.

[MPMD]

When I started in an academic job many, many years ago there were many 'secret' sweetheart deals and busy clinicians supporting researchers and senior faculty which caused a great deal of resentment. Knowledge of everyone's salary definitely sorted this out in a positive way for the busy clinicians when they demanded to be paid fairly.

I think there's something to this however to play devil's advocate: some of these deals are very much in line with the overall mission for the dept and med center and those who criticize them are sometimes not bringing a whole lot to the table other than clinical productivity.

If you have a million dollar NIH grant and you work at a big academic center you are a commodity and you have negotiating power. If you are just a good doc who shows up on time and gets your work done but doesn't do much else -- you are pretty replaceable and probably replaceable with a younger doc who might even work for less. I think understanding this is pretty key to a long happy career in academics. I don't know of any place that is even close to this ruthless in their approach but it's good to be aware of the lay of the land.

[bean1970]

Because pay disparity exists. For multiple reasons. 1) actual pay disparity. Paying genders or races less. It's real. Our university always talks about doing a pay study/gather the data and release it. But it is always shot down. They know it is real. The issue is who is going to pay for it. I heard it would be something like the university would need to come up with over 30million dollars to fill in the pay gaps for people in similar roles/longevity for a year. Who has the money for that? no one so it's kept hush.
2) Pay disparity due to time. This is real. this is why people move jobs. While some salaries may have minor cost of living adjustments/inflation adjustments annually or every so often, often these increases don't line up with market forces. So I hire someone in 2019. If I hire someone this year with basically the exact same contract/RVU expectation/work hours, the salary might be 50K more if that is what is happening in the community. University regulations would prevent a raise for that reason. Best option really is for 2019 employee to quit and get rehired. The new employee is going to make more. 3) cultural/societal norms
In the military everything is transparent. Based on rank and time in service. Some people will have access to bonuses, but those are published as well (not by name but the types of bonuses). Public state universities will publish state base pay, but this is not how physicians are generating their income..that is either coming from the hospital or physician practice which is not public data. We all know what an associate professor in whatever college makes (college of arts, college of medicine, college of nursing), but that is not the entire picture.

[Panscan]

I think there's something to this however to play devil's advocate: some of these deals are very much in line with the overall mission for the dept and med center and those who criticize them are sometimes not bringing a whole lot to the table other than clinical productivity.

If you have a million dollar NIH grant and you work at a big academic center you are a commodity and you have negotiating power. If you are just a good doc who shows up on time and gets your work done but doesn't do much else -- you are pretty replaceable and probably replaceable with a younger doc who might even work for less. I think understanding this is pretty key to a long happy career in academics. I don't know of any place that is even close to this ruthless in their approach but it's good to be aware of the lay of the land.

yet the good doc taking care of people compared to their average peer is doing way more good for society relative to their replacement than the fancy grant person(obviously you know my cynicism/opinion of academics and research in general).

If your 2nd paragraph is true then I think the academic places have swung too far in favor of research instead of balancing it with clinical teaching/being good doctors(the real point of being a tertiary or quaternary center IMO). If all you value is people who write papers and get grants you're going to have a crappy hospital with crappy teachers who produce more crappy docs and it doesn't matter how much research you do (besides being ranked highly on some lists), people won't go there. It's like we have flipped 180 from the past where before if you were a good doc you could throw a scalpel or openly abuse people and that was fine, now you can do essentially 0 clinical work/ have 0 clinical interest but produce some grants and you're golden. Personally I don't really know why these people become physicians and not just PhDs. The increasing focus on research in residency in general to me is alarming with more and more residencies requiring research or having separate research tracks. Is the goal to train doctors or scientists? There's a difference.

Unrelated, but I think the stuff about "medicine being a calling" is perpetuated by academics to a) justify their lower earnings relative to their peers b) enable them to lowball future grads. Our outlooks are very self-fulfilling so if you enter a low paying job (relatively) you're probably going to gravitate towards concepts that justify why its ok to make less. As I mentioned in another thread, I have begun to hear about residencies and fellowships requiring their trainees to sign non-competes. What exactly is the purpose of that if not to low-ball them once they graduate? I think this is wildly inappropriate.

Another reason I think it's taboo is because physicians get paid a lot. Period. Obviously this requires a lot of schooling/significant loan burden/effort/higher hours than general public, but laypeople don't go into this depth of analysis when they hear a number. If a layperson makes X and a physician makes 4X, there is typically immediate jealously/resentment and the dots aren't connected regarding the fact that the doc may have been in school/training for multiple times as long, with significantly more debt, etc.

[artemis]

3) cultural/societal norms.

I think this plays a larger role than the OP realizes (especially among younger doctors who are still holding onto the shreds of their former med school idealism). If medicine is a noble calling, isn't it crass and vulgar to discuss wages? Why, that implies we do the job for MONEY!!!

(Of course we do it for money. Something can be a calling and a job at the same time; most of us couldn't afford to work for free even if we wanted to. But stating that reality out loud makes some people very uncomfortable.)

[JBME]

this topic isn't taboo amongst just physicians....it's pretty much taboo for anyone. it's a cultural thing at least in America

[MPMD]

yet the good doc taking care of people compared to their average peer is doing way more good for society relative to their replacement than the fancy grant person(obviously you know my cynicism/opinion of academics and research in general).

If your 2nd paragraph is true then I think the academic places have swung too far in favor of research instead of balancing it with clinical teaching/being good doctors(the real point of being a tertiary or quaternary center IMO). If all you value is people who write papers and get grants you're going to have a crappy hospital with crappy teachers who produce more crappy docs and it doesn't matter how much research you do (besides being ranked highly on some lists), people won't go there. It's like we have flipped 180 from the past where before if you were a good doc you could throw a scalpel or openly abuse people and that was fine, now you can do essentially 0 clinical work/ have 0 clinical interest but produce some grants and you're golden. Personally I don't really know why these people become physicians and not just PhDs. The increasing focus on research in residency in general to me is alarming with more and more residencies requiring research or having separate research tracks. Is the goal to train doctors or scientists? There's a difference.

Unrelated, but I think the stuff about "medicine being a calling" is perpetuated by academics to a) justify their lower earnings relative to their peers b) enable them to lowball future grads. Our outlooks are very self-fulfilling so if you enter a low paying job (relatively) you're probably going to gravitate towards concepts that justify why its ok to make less. As I mentioned in another thread, I have begun to hear about residencies and fellowships requiring their trainees to sign non-competes. What exactly is the purpose of that if not to low-ball them once they graduate? I think this is wildly inappropriate.

Another reason I think it's taboo is because physicians get paid a lot. Period. Obviously this requires a lot of schooling/significant loan burden/effort/higher hours than general public, but laypeople don't go into this depth of analysis when they hear a number. If a layperson makes X and a physician makes 4X, there is typically immediate jealously/resentment and the dots aren't connected regarding the fact that the doc may have been in school/training for multiple times as long, with significantly more debt, etc.

meh.

the purpose of medicine was never to be high paying. i'm glad it is and not looking for a salary cut but much of the rest of the world gets along fine without having docs at the very top of their income scales. highly compensated doctors is clearly neither necessary nor sufficient for a good system that takes decent care of people.

i really don't think academics or AMCs are trending towards research at the expense of clinical care. if anything the opposite is true -- expansion of "brands," buying up smaller hospitals to create networks, none of this has anything at all to do with research. sustaining a career based on research grants is very difficult, way more than a full time job. the pressures are intense for sure.

i am aware of no doctors who do no clinical work and are "golden" except for those on research tracks. i think it's fine for someone with a primary clinical research interest to get an MD. i mean if we gathered here celebrate people who retire from clinical practice at 41 b/c they have supersaved to FI then it seems really weird to criticize someone who drops clinical work in favor of science. this is also a fairly fluid thing over many doctor's careers where they have large grants and cut back then return to clinical practice when the grants end.

also not at all sure that residencies are shifting towards research, again this is very much my world here. if anything it is becoming harder to do any meaningful research during residency training and there is an emphasis on doing specific research-oriented fellowships.