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Who makes more: U.S. or foreign docs?

Doctor with money in pocket

TEXT OF INTERVIEW

Bill Radke: After a long wait, the Senate Finance Committee could actually vote this week
on a health-care bill. Yesterday, the Congressional Budget Office said the latest bill is not only budget-neutral, it would actually reduce the federal deficit. The cost of health care is the subject of today's Marketplace Globalist Quiz, with our quizmaster Stephan Richter of TheGlobalist.com. Good morning, Stephan.

Stephan Richter: Good morning Bill. Are you ready?

Radke: Let's do it!

Richter: All right, you know that Congress is having to wrangle a lot over the details of health-care reform, which is a key priority for this fall and it's all about lowering costs, or so one would hope.

Radke: Yes.

Richter: So I'm going to ask you this: How much do American doctors earn in comparison to other doctors in rich countries? Is it about the same? Are American doctors earning twice as much as those in other countries? Four times as much? Or let's say, 10 percent less, which would of course be good news.

Radke: That's not good news for doctors.

Richter: But for all of us consumers -- and there are a few more of those -- and ultimately we spend so much on health care that something's got to give, one would hope.

Radke: Let's see, we hear so much about the cost of medical care, all the high-tech testing we do. I say American doctors earn four times as much as anyone else.

Richter: Actually it's twice as much. And that is compared to countries like Switzerland and France, other sort of very rich countries. There the specialists make, on average, $130,000-150,000 a year. In the U.S., the average specialist gets $230,000. That's quite a lot of dough.

Radke: And for some perspective here, Stephan, do you know how much American doctors make compared to their patients?

Richter: Yes, and there your original guess of four times is almost on target. U.S. doctors make about five times more than their patients -- that is their specialists, of course, which are the ones that really put us out of whack with regards to our health-care costs across the nation. General practitioners, which are in short supply according to many people, are quite underpaid are in line with global averages so there's not much of a need for reform on that particular front.

Radke: OK Stephan, thank you. Can I put my shirt on now?

Richter: Please do.

Radke: Stephan Richter is publisher and editor-in-chief of TheGlobalist.com -- the daily online magazine on the global economy, politics and culture. Thanks.

Richter: Always a pleasure to be with you.

About the author

Stephan Richter is the publisher and editor-in-chief of The Globalist, a daily online magazine on the global economy, politics and culture.
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I am a physician just out of residency and fellowship. As mentioned above, the debt load from medical training is enormous, and it grows during residency. Mine is about 150K in med school loans. My sister who is about to graduate from a state medical school will have 250K, and she had no undergraduate debt. In addition, at the end of the 15+ years of training, a physician typically has no retirement savings, no money set aside for kids' college, and no emergency funds. I saw many of my colleagues running out of funds, and maxing out the credit cards toward the end of fellowship, and borrowing from family, barely hanging on until their first paychecks as a practicing physician, at which time, they could begin to pay down the enormous debt load.

I am well-paid now, but the vast majority of each pay check is going to servicing debt. I have compared notes with some colleagues who trained in the U.K. They finished their residency training with no debt. The government contributed to their retirement funds while they were in medical school and residency and they were paid double what I was paid in residency and fellowship. Their work hours were also shorter.

If physician salaries were reduced in the United States without providing us with all the benefits and the work hours provided by our colleagues in Europe, many of us would find a less stressful job to go with the paycut.

Is it worth the sacrifice of 6 years of near constant studying followed by 8 years of 80 hour work weeks + countless additional hours studying, being absent for the first 10 years of my daughters' lives, and the constant fear of making a mistake that results in harm or death to someone worth it?

If you want physicians to go into medicine and to make the sacrifices necessary to provide you with excellent health care, you have to give them an incentive. It's that simple.

It is really interesting how people think physicians make too much money. Do you people actually realize what a Cardiothoracic surgeon is doing when he cracks open your chest, or when a neurosurgeon is clipping an aneurysm in your brain? Do you realize the skill and years of training it takes to perform these skills? A CT surgeon is paid about $1200 for performing a bypass operation. That includes all preop and postop care. Malpractice insurance for a CT surgeon is about 100k per year. Therefore, a CT surgeon has to perform about 100 surgeries/year just to cover malpractice insurance. That doesn't include the cost of paying their staff and running an office. Do you people realize the years of fun these individuals give up in order to become a physician? Lets take an interventional cardiologist as an example: 4 years of college, 4 years of medical school, 3 years of medicine residency, probably 1 year of research or chief residency in order to get a cardiology fellowship, 3 years of general cardiology fellowship, and 2 years of interventional cardiology fellowship. That totals up to 17 years of schooling from college on. During residency and fellowship, you can bet that these young physicians are putting in 100 hour weeks. I will guarantee you one thing; if medicare continues to drastically cut physician reimbursement, and if congress doesn't get serious about malpractice reform, we will have a huge shortage of physicians 10 years from now. Who will do 17 years of training when there is no reward at the end of tunnel? We already know that applications in fields such as CT surgery are dramatically declining. For all you people badmouthing physicians and saying they make too much money, I just hope you don't need life saving surgery in the next 10 to 20 years. There will be no one left to help you.

In addition to the above noted differences in costs in time and $ incurred by mds in US and abroad; the author should have made note of the study published in NEJM several years ago, comparing return on investment between medicice/law/business school. Medicine came in a distant third.

Bill Radke's interview yesterday with Stephan Richter was interesting but very misleading. You should do a similar story on insurance company executive and medical director salaries. The CEO of BC/BS of NC makes over three million dollars an year (and he only has a masters degree in psychology.) Their medical director makes over $900,000 a year (and he just shuffles papers, goes to meetings, and figures out ways to deny people coverage, pay doctors less and save the company money, for which they reward themselves.) This is four to five times as much as the dreaded specialists you referred to. Why don't you do a similar "expose" on insurance company executive salaries with special reference to years of training vs income and also compare the income of the executives to their subscribers income. Now there's a story that will make your listeners sick and not merely lose their shirts as did Mr. Radke.

As a physician, donor, and daily listener, I was dismayed by this piece during my daily commute. I arrived at work and tried to help a tearful young lady understand that her cancer had been removed with inadequate margins a few years before. Her previous doctor was a plastic surgeon at an HMO, paid much less than counterparts doing lucrative cosmetic work. We need physicians who have the dedication to do their best regardless of how well a particular patient can pay. But we also need to pay physicians well to attract the best and brightest. Especially when surgeons hold our lives in their hands, or when specialists are consulted for problems too rare for a generalist to master.
Physicians in the United States are better paid than their European counterparts. They also have much higher debts upon graduation and longer training programs. They work longer hours and take fewer vacations. An careful multinational comparison reported in the New York Times economix.blogs.nytimes.com from 07.15.2009 reveals that specialists in the US make about 50k per year more than expected given the US GDP, and generalists make about 30k more per year than expected. These amounts don't consider the higher cost of a medical education here, or the higher malpractice costs and fears of litigation, or the longer work hours here. In comparison, the statistics chosen in your report were particularly inflammatory.
Hopefully, you will consider mentioning these justifying factors during commentary or a future report. I'll look forward to continuing to be informed and entertained by your program.

I am so sick of hearing greedy overpaid CEOs an doctors wining when anyone dares to point out that they have gamed the system so they get filthy rich at the expense of the "little" people they supposedly provide services for in our country. The reality is that very few people in any professional course of study graduate with large student loan debt. And very few have the benefit of well healed schalarships as have been noted by other commenters. And all professional pay huge liability premiums. If you think that you have it so bad why don't ask how many similarly educated americans out there would gladly change places with you, education requirements, college loans, residencies and all. You have been more than paid back for your suffering. And before you say something stupid like we get excellant medical care for the overpriced fees we pay, independent studies (you can look them up)have shown that the US has the most expensive medical care costs of all the Industrial nations and that we are close to the bottom of the pile on quality of outcomes and personal longevity, not including cosmetic surgery and breast enhancements of course. When I hear the argument that the high cost of malpractice insurance justifies your personal wealth I have to laugh.Usually that statement is followed by a selfserving plea for tort reform to save you from excessive malpractice awards to your abused patients (i.e. mistakes). The solution is simple. Follow ancient wisdom and "do no harm" instead of enhancing your bottom line by overbooking and craming more patients than you can realistically serve into your schedules. Most of us, your patients, have no sympathy for you. We want affordable effective health care and the only way we will get it is with the government limiting your pay or at least offering the "public option" that your industry is lobbying so desperately against. We also remember the old adage that "Doctors bury their mistakes". So get off your overblown egos and realize that you aren't entitled to anything, especially being excessively overpaid.

I am a cardiologist. I make loads of money. Piles of it. I drive an expensive sports car to work. I graduated from medical school debt free because I received scholarships and worked part time jobs while attending state schools with relatively low tuition rates before completing my fellowship at an Ivy League university which paid me a stipend. I absolutely love my job. But...

I am sick of hearing complaints about how much American medical specialists make. I am almost as sick of hearing this as I am of telling people to quit smoking, start exercising, and stop eating so much poisonous fattening food.

I make so much money not because I charge huge amounts for my services. Insurance companies and the government won't allow me to do that. I make so much money because I never rest. I work or am on call an average of 26 days a month. I go days without seeing my kids awake. I cannot go an hour without being paged. I don't advertise. I don't cruise the streets in a panel van and snatch people to force them to do stress tests. They seek me out.

Americans are voracious consumers of health care. Around 40% of medical problems in our country are a consequence of poor lifestyle choices. In my specialty, its about ninety percent. This very program, when not airing Michael-Moorish propaganda such as Mr. Richter's asinine tripe, has interviewed economists that have logically explained the cost of health care in this country is a function of volume, not of service price.

So, if you wish to ask my Swiss counterpart how many hours he works in a week, be warned: he may be on part of his 2 months of paid vacation.

And if you are truly concerned that I am paid too much, then put down your cigarette and your honey bun, and go take a lap.

You can't look at doctor's pay without looking at other apects as well. How much do doctor's in other countries pay for their education compared to doctor's in the US? How much do they pay for malpractice insurance? How many years do they spend in residencies getting paid less than people with bachelor's degrees, not enought to start paying medical school loans and yet the loans still acquire interest in those times (That's called a Residency Deferment). I found todays show extremely uninformed. I'm not a doctor myself, but I know many. Most are 300,000 in debt after residency. Some pay 100,000 year in malpractice insurance alone. The reason Primary Care is not a popular specialty choice is that those who go into it cannot afford to pay back their loans. Doctor's salaries are not the place to make cuts. Start with educational cost reform, lawsuit reforms, and student loan reform first.

You can't look at doctor's pay without looking at other apects as well. How much do doctor's in other countries pay for their education compared to doctor's in the US? How much do they pay for malpractice insurance? How many years do they spend in residencies getting paid less than people with bachelor's degrees, not enought to start paying medical school loans and yet the loans still acquire interest in those times (That's called a Residency Deferment). I found todays show extremely uninformed. I'm not a doctor myself, but I know many. Most are 300,000 in debt after residency. Some pay 100,000 year in malpractice insurance alone. The reason Primary Care is not a popular specialty choice is that those who go into it cannot afford to pay back their loans. Doctor's salaries are not the place to make cuts. Start with educational cost reform, lawsuit reforms, and student loan reform first.

If you go to the Globalist website, you will realize which direction this report is biased.

Examining the ratio of patient's salaries to doctor's salaries is pointless. Why not report the ratio of the doctor's salary who is volunteering at a homeless shelter to those he/she is serving at the shelter - oh, I forgot, you can't divide by zero. While Richter's at it, why not compare the ratio of the salary of the baseball player at bat to the average spectator watching him (I guarantee it'll be much greater than 5:1).

Money is not evil, it's the love of money.

This was a totally irrelevant, poorly researched piece of reporting.

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