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  • Disparities in pay

    Is anyone else upset with the disparities in pay between different specialties? Except for a few exceptions, medical specialties are significantly underpaid compared to other less acuity fields. Seems like we are under the pressure cooker for reimbursement cuts much more frequently.

  • #2
    I see it both ways, higher acuity/risk providers probably should be compensated higher however at the same time there is a huge shortage of PCPs and I think on a whole incentivizing people to be become PCP fields is very appropriate.

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    • #3
      I will confess to (at times) feeling some guilt given how much I make versus the acuity of what I actually do.

      That being said, I do not think the solution is to redistribute reimbursement from the better paying specialties to the lesser paying ones.

      An obviously biased vantage point from where I am standing of course.

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      • #4
        There is certainly a higher procedural premium and even at times that isnt realized in the specialty. Some places a IM guy can make out and a surgeon wont, it doesnt make any kind of logical sense, but no pay really does.

        The problem doctors have always had is attacking others in their profession instead of fighting for more pay overall which of course is used over and over in a race to the bottom. Thats not a good strategy.

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        • #5
          I think it's important to realize a few things:

          # 1 This problem is so big you cannot solve it personally. So no sense in getting riled up about it. It's like the mess the health care system is in, the mess the government is in, the mess the world is in etc. You've got to figure out how to be happy in spite of it because you can't change it. Maybe it will change and maybe it won't, but you can't change it.

          # 2 In many ways, your choice of specialty is/was entirely within your control. Remember those guys busting their butt to match into derm back in med school? Well, they studied for a lot longer than I did. I was playing foosball and they were cramming in another hour or two of studying.

          # 3 As someone "in the middle" of the specialties as far as pay goes, I can say there will always be someone who makes more than you and who has more than you. Even Trump has to feel like a chump around Buffett and Gates. But if you just turn around and realize you're better off than 99.9% of the world and 97% of Americans, it'll help put things in perspective.

          # 4 I've always been impressed with how much larger the difference is between two doctors of the same specialty than between the average of any two specialties. There are family docs making $500K and family docs making $120K. Figure out what the ones making $500K are doing and do what they do and then you won't feel so bad about that GI guy making $450K.
          Helping those who wear the white coat get a fair shake on Wall Street since 2011

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          • #6
            I think it is counterproductive to argue about slicing up the pie.  The issue is that the pie needs to be bigger, in my opinion, and then it isn't an issue.  Have you checked to see how much your hospital executives make?  Now that is income disparity.

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            • #7
              Echoing the need for the focus to be growing the pie rather than splitting it.

              Agree with WCI- most high paying specialists either had to work harder to get in or work harder in the specialty they're currently in to get the income.

              not sure how reliable but medscape tried breaking down specialist pay per hour and it's remarkably similar across the board (er with highest pay per hour if I recall)

              Nearly all fields have room for someone to kill it if they figure out how.

              I do feel bad for peds as they do take it on the chin. Peds cardiology vs adult cardiology can be a 3-5x difference - but like WCI said they do know that going in.

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              • #8
                I'm in the lowest paying specialty of medicine (pediatrics) and I although I fantasize about how great it would be to make even double what I make, let alone triple or more (which some docs do), I've never really felt resentful about it.

                I picked pediatrics because I actually like pediatric patients and the people who go into pediatrics (docs and nurses). There wasn't an adult specialty that even came close to feeling like a good fit for me during medical school.

                Having said that, I will also point out that I didn't have a clue what different specialities made as a medical student. I suppose I can agree that it was certainly something I could have looked into as a medical student and there are definitely medical students who do know what different specialties make. But for me, as someone that grew up poor in a small, working class factory town, all I knew was that doctors were "rich" and I never thought much about the different levels of what being "rich" could look like until much later in the game.

                So, although I really doubt that I'd have chosen differently if I had known I'd make so much less than some of my med school classmates by going into peds, I don't know that it's an accurate statement to say that all medical students know going in about doctor pay disparities.

                 

                I also think that some people feel uncomfortable even talking about the money making side of medicine because it's supposed to be a calling that we go into selflessly looking only to help people without thought to our compensation. It's a silly idea but I think it does prevent more frank med school discussions of exactly how much doctors make.

                 

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                • #9
                  I agree with HLM. I chose pediatrics because I loved it and it made me happy when it was time to choose a specialty back in medical school. At the time (only ~10 years ago) we were being told that pediatricians would only make ~90k per year. Eventual salary alone was not enough to sway my choice and the student loans I had accrued seemed like "funny money" anyway (although I would be quite bitter now if the 90k part had come true).

                  As WCI mentioned, I do feel very fortunate compared to the vast majority of world citizens. I think one reason that pay disparities within medicine can be so frustrating is that you look around at other physicians and realize that they are not working any harder than you and may have even done less training than you yet they may still make multiples of what you do.

                  I of course support PCPs being better reimbursed and hope that we can all support each other rather than saying, "You made a poor decision as a medical student so now you should never complain for the rest of your life." To be fair I love my job, so the only thing that I sometimes wonder about is whether there is something else out there that I would have loved just as much.

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                  • #10




                    I agree with HLM. I chose pediatrics because I loved it and it made me happy when it was time to choose a specialty back in medical school. At the time (only ~10 years ago) we were being told that pediatricians would only make ~90k per year. Eventual salary alone was not enough to sway my choice and the student loans I had accrued seemed like “funny money” anyway (although I would be quite bitter now if the 90k part had come true).

                    As WCI mentioned, I do feel very fortunate compared to the vast majority of world citizens. I think one reason that pay disparities within medicine can be so frustrating is that you look around at other physicians and realize that they are not working any harder than you and may have even done less training than you yet they may still make multiples of what you do.

                    I of course support PCPs being better reimbursed and hope that we can all support each other rather than saying, “You made a poor decision as a medical student so now you should never complain for the rest of your life.” To be fair I love my job, so the only thing that I sometimes wonder about is whether there is something else out there that I would have loved just as much.
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                    There's also the option to earn your money doing something else and do medicine as a calling/hobby. As docs we often assume that there's nothing we can do that will pay us more than practicing medicine, but I keep seeing more and more examples where that isn't true.
                    Helping those who wear the white coat get a fair shake on Wall Street since 2011

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                    • #11




                       

                      Having said that, I will also point out that I didn’t have a clue what different specialities made as a medical student. I suppose I can agree that it was certainly something I could have looked into as a medical student and there are definitely medical students who do know what different specialties make. But for me, as someone that grew up poor in a small, working class factory town, all I knew was that doctors were “rich” and I never thought much about the different levels of what being “rich” could look like until much later in the game.

                       
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                      I could not agree with this more. I also grew up poor so the salaries for all specialties seemed quite high.  I could not imagine spending $125,000/year as a medical student.  Honestly, until I was a third year resident and had my "WCI Awakening" I had no concept of how much people actually save for retirement, because my parents have not saved any money at all.  I had no idea of how much per year would be spent to pay back loans.  I completely acknowledge my lack of foresight, but I am not alone.  Now I have chosen a geographic area where I make much more then I would in a large city, but many people are either unwilling or unable to do this.

                      I had the board scores and nationally recognized research fellowship to be competitive for dermatology, but I truly believed that any field within medicine would make "enough".

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                      • #12
                        Thanks everyone for the comments.  Don't get me wrong, I am very thankful and feel privileged to be able to do what I do on a daily basis.  At times though, I do feel disparaged that some specialties are making close to 7 figures without much additional training or acuity or coming out of fellowship with offers of 350K. There is something wrong with our health care system when a pain management physician is making more than 10x the salary of a PCP.   I'm not trying to solve the problem, just initiating a discussion.

                         

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                        • #13
                          The something thats wrong is the incentive structure. Cant fault smart people for figuring it out. Believe me, I sometimes cant believe what specialities that took half of the training mine did can make regularly as a standard employee. Agree its a mess of a problem that is difficult to fix, especially since getting docs together is like herding cats in a field of catnip.

                          Find it shocking that people had no idea that peds made terrible money in medical school. I may not have known the intricacies of doctor pay but everyone seemed to know how bad peds got paid, I mean they never stopped talking about it on rotations. Maybe its because we were in a HCOLA for school, it was more obvious the difficulty and thus discussed more.

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                          • #14
                            RenalDoc, I am assuming you are a nephrologist.  I seriously considered going into nephrology because I loved the kidneys. I thought it was intellectually stimulating and was quite committed to going into nephrology. However while in residency the nephrology fellows  appeared to be the most miserable and they worked harder then the residents.  As I was exploring the speciality I went to the American Society of Nephrology meeting where there was one break out session about how to recruit more residents into nephrology.  When I asked the question, "Why should someone do a nephrology fellowship where they work harder than a resident for $55,000, when they could be a hospitalist for those two years and make $240,000 and have a better schedule?", everyone looked at me like I was crazy.  I was honestly asking because perhaps there was something I was missing.  People talked to me about the academic pursuit and caring for the people in need, and made me feel guilty for talking about the money.  Later, when people would ask me why I changed my mind about nephrology fellowship, I would mention the lack of higher income for the increased workload, and people would get offended.  So I started to tell people I just simply changed my mind and that was easier.

                            I wonder if the leadership in nephrology demanded more, especially in multi specialty practices and large hospitals, wouldn't they have to pay more?  As long as people are still willing to do the work for less then they will continue to pay the lesser amount.   I ultimately decided that I can still care for those in need in my relatively low paying speciality in rural outpatient internal medicine.  However, I know I am making more then the academic nephrologists where I did my residency training.  I also have a much more forgiving schedule then those nephrologists.

                            Zaphod, in my medical school no one talked about pediatrician pay to me.  The only people in my medical school that complained about primary care pay to me as a student were the family medicine physicians.  I ultimately decided I was not interested in peds, but I did not learn of the pay disparity between peds and other specialities until residency.

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                            • #15




                              RenalDoc, I am assuming you are a nephrologist.  I seriously considered going into nephrology because I loved the kidneys. I thought it was intellectually stimulating and was quite committed to going into nephrology. However while in residency the nephrology fellows  appeared to be the most miserable and they worked harder then the residents.  As I was exploring the speciality I went to the American Society of Nephrology meeting where there was one break out session about how to recruit more residents into nephrology.  When I asked the question, “Why should someone do a nephrology fellowship where they work harder than a resident for $55,000, when they could be a hospitalist for those two years and make $240,000 and have a better schedule?”, everyone looked at me like I was crazy.  I was honestly asking because perhaps there was something I was missing.  People talked to me about the academic pursuit and caring for the people in need, and made me feel guilty for talking about the money.  Later, when people would ask me why I changed my mind about nephrology fellowship, I would mention the lack of higher income for the increased workload, and people would get offended.  So I started to tell people I just simply changed my mind and that was easier.

                              I wonder if the leadership in nephrology demanded more, especially in multi specialty practices and large hospitals, wouldn’t they have to pay more?  As long as people are still willing to do the work for less then they will continue to pay the lesser amount.   I ultimately decided that I can still care for those in need in my relatively low paying speciality in rural outpatient internal medicine.  However, I know I am making more then the academic nephrologists where I did my residency training.  I also have a much more forgiving schedule then those nephrologists.

                              Zaphod, in my medical school no one talked about pediatrician pay to me.  The only people in my medical school that complained about primary care pay to me as a student were the family medicine physicians.  I ultimately decided I was not interested in peds, but I did not learn of the pay disparity between peds and other specialities until residency.
                              Click to expand...


                              I learned pretty quick to not talk to much about money in med school. It was seen exactly how you described, taboo and offense at the very mention of it. This is very detrimental to the profession and is one of the major reasons sites like this have such a void to fill. I dont know why I looked at pay, it just made sense to me as something you should do. The workloads are crazy different between fields, as are some of the liabilities, etc...and the pay does not follow those things. Only seemed prudent to investigate further.

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