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Who makes more: U.S. or foreign docs?
Doctor with money in pocket
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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.
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I'm a little perturbed at how the comparison between incomes was portioned off as a separate issue from the cost of education in the United States. I am 26, graduated with a B.S. in Biology and currently make $29,000 a year as a Research Assistant. I am returning to school for nursing, where there is luckily a lot of financial assistance available but I have a number of colleagues applying to medical school or currently in medical school. Just the application process can create a hefty amount of debt for someone who may already be facing large loan payments from their undergraduate education. Taking the MCAT costs about $200, not including the cost for preparation classes, practice tests and retaking the exam if you don't do well enough the first time. Application fees for the first round can climb into the hundreds of dollars or more, depending on how many schools you apply to. Most schools charge ANOTHER fee to submit your secondary application. If you are granted an interview, you have to consider travel expenses to the school. Fee Assistance programs exist through the AAMC but the requirements mean a lot of independent 20-somethings make too much money to be considered...but not enough money to afford the application process without a credit card. This is just to APPLY to medical school. My point is, we make it very difficult for doctors to afford their education- is it so wrong that we pay them twice as much to compensate for it? Perhaps a health care overhaul and an education overhaul are more intricately linked than we are willing to admit.
I agree with most of the comments made above. Your analysis ojn doctors salaries in the US was more propaganda than responsible journalism. US doctors incure a lot of costs that were not taken into account in the analysis, including paying 50,000 plus dollars a year for four years duiring medical school for medical school and then making about 36,000 a year for 3 to 7 or 10 years during residency and fellowship training. In particular, specialists train for three to eight or so more years than primary care docs and so incur a lot of lost wages during that time when they are making a nominal salary. Additionally, specialists in the US work 12 plus hour days during the week, in addition to taking overnight call and then work all day many weekends. I do not know how this workload compared to Europeans but I am guessing it is a lot more. Finally, you did not discuss the rate of malpractice lawsuits in the US versus Europe nor the cost of malpractice in the US versus Europe. There is a lot of burden on US doctors that you did not discuss.
I agree with the above comments regarding U.S. medical school costs. An additional factor to consider when comparing physicians' salaries to those of their patients is that of work hours. Many physicians routinely put in 10 to 12 hour work days to be followed by overnight call, and often full days of work on the weekend. Mr. Radke offers facts and desires change without any analysis. Most physicians would agree that tort reform would change the way medicine in the U.S. is practiced, and decrease the cost of healthcare drastically. Anna Holbrook, MD
Radke and Richter did not acknowledge the costs and economics of medical education in the United States as compared to other countries ... that adds another layer, which any journalist would be remiss to ignore. Not the best sound bite analysis, Marketplace.
I'm not a doctor so I can only base my comment on what I read in 'The Healing of America' by T.R. Reid. According to Mr. Reid, doctors do make more, but also pay much (up to 100 times) more in malpractice insurance. So when you compare take home pay they make about the same amount. Also you have to take into account that doctors here pay for their own educations while in Europe their education is subsidized heavily. I think your story was unfair to doctors.
I noticed that the commentator did not remark on the disparity between the debt incurred by US medical grads compared to their Swiss and French colleagues. This does not justify outrageous pay, but many medical students are forced to choose specialties with higher pay (vs primary care or pediatrics with much lower salaries) so that they can ensure they will be able to pay off the enormous debt they piled up while going to school.
Your story this morning about discrepancies between US and foreign physician salaries appeared skewed because some particular facts were not mentioned. As a practicing pediatrician, well known as one of the lowest, if not THE lowest paid specialties, I can assure you that the average salary of $230,000 is something I will never see in my lifetime. I suppose if I renounce the reasons I went into medicine in the first place, and left the rural, underserved community I serve, moved to LA and began stamping out ear infection in the children of the rich and famous, I might not be able to assert such a claim. But leaving pediatrics and other primary care specialties aside, a glaring omission is that the majority of practicing physicians in this country graduate from medical school with an enormous debt burden, unlike graduates in other industrialized countries with government run health insurance. As graduate in 1996, I am fairly lucky to have only accrued $125,000 in debt, which I am paying on the 30 year plan in order to make my payments reasonable. This is the equivalent of a second mortgage. More recent graduates are facing up to two times the debt burden I have, and subsequently are expecting a salary sufficient to make those payments. I have long argued that government sponsored medical education would greatly reduce physician salaries on this fact alone. I would gladly have preferred to have my education paid for by the government in return for committing myself to repayment in the type of community I am already working in anyway. And like many of my colleagues, the commitment to treating the underserved is independent of National Health Service Corp scholarships and loan repayment, which, by the way, is not guaranteed to every applicant. Thus, it is not an accurate comparison to say American doctors make more money for the work they do. That comparison should account for the cost of medical education that most industrialized countries subsidize. Sincerely, Joann Kaplan, MD
When comparing global physician incomes, should we not consider how the education is paid for (i.e. investment in human capital, which should receive some fair rate of return)? In the US, medical students pay for their undergrad and med school education, often taking out loans which currently averages $120k-130k, but can surpass $200,000, presently. In many other countries (?all; do not know), medical education is paid by the country, so students do not graduate with ?as much/any debt. If we consider those costs, maybe the US general practitioners are underpaid and in need of reform, and US specialists' comp would warrant further review? It is not always a simple analysis.
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