First off, welcome to all the new readers who stopped by today.  The website had more pageviews today than it did in the first 3 or 4 months of its existence.  I hope you find something of value here and even consider signing up for the RSS feed (also available by email) and the new monthly newsletter.  (Scroll to the bottom of page to sign up for either or both of these).

I was interviewed by a CNN reporter last week and she wrote an article that was published today on CNN’s front page that included a link to the website.

I had sent Parija Kavilanz an email about her article, Doctors Going Broke, suggesting that although this is mostly due to increasing regulatory costs and decreasing reimbursement (particularly from Medicare/Medicaid), part of the reason docs are going broke is that they don’t have the skills to either run a small business or manage their personal finances.

She had previously done an article called Medicare Doctors Fed Up With Washington about the paycut we traditionally face down every December.  She subsequently published a series called Doctors:Why we can’t stay afloat, about 6 doctors who have either already closed their private practice or are about to.

The comments on these articles, like many on CNN or any other major news source, were long, varied, and often quite bizarre.  For example, one comment on the article I was quoted in suggested the article was a “paid advertisement of the financial services industry” or even of this website. The commenter apparently hasn’t spent much time on this site to see what I tend to say about the financial services industry.  Publicity like this website is getting from the article can’t be bought anyway, at least not with the tiny profit this website has made in the last 8 months.

A concerning trend is noted in the comments on the four articles that “doctors make too much money.”  I think this comes from four different lines of thought.

1) Nobody should make a lot more than anyone else, therefore doctors make too much money. 

This is simply a socialist view on society.  The idea that hard work, intelligence, and even a little luck can pay off with a higher income is capitalism at it’s finest.  Thinking like this leads to a society like North Korea, where everyone is poor.

2) My health care costs are too high, therefore doctors make too much money. 

There is a vast misunderstanding that doctors are somehow are at the top of the health care food chain.  The truth is that doctors’ salaries make up less than 10% of this country’s health care costs.  Doctors are part of the solution to runaway health care costs, not part of the problem.

3) I pay a ton of money for 10 minutes of time with the doc.

Many patients don’t realize that what they pay for 10 minutes with the doc also covers 10 more minutes he spends on documentation, evaluating tests, consulting with other docs, writing orders, prescriptions, and work notes, and other “out-of-room stuff”.  It also covers the cost of electricity, medical equipment, nurse/tech/receptionist salaries and benefits, and coding/billing/collecting costs.  It is gross income for the business, not net income for the doc.  There are also a lot of “charges” that are very different from what is actually collected.  For example, a typical emergency doc may bill $500 an hour, collect $225 an hour, and take home $150 an hour after business expenses (not his personal taxes).  Now, $150 is a great salary, but it isn’t the $500/hour that a careless observer might think he is making.  This isn’t particularly different from what other professionals like attorneys charge per hour.  Try retaining a good attorney sometime.  You’d better believe they’re going to for every minute they spend thinking about or even talking on the phone to you about the case.  The doc only gets to bill for the time he actually spends with you.

4) I’m a professional and I don’t make $200K like a doc.

There are a number of unique sacrifices that doctors make.  First is the years of training.  4 years of college, 4 years of medical school (assuming you got right in), 3-5 years of residency, and maybe even another 1-3 years of fellowship.  Although you get paid in residency and fellowship, it works out to less than $10 per hour while your student loans (averaging over $150K and rising rapidly) continue to grow at 6.8%.  Essentially, rather than starting his career at 22 or 25 like most professionals, most doctors don’t really start until 30, 35 or even later.  Some of the high pay for doctors is compensation for starting late.

Second, doctors work long hours and take call for which they are poorly paid.  Although my specialty rarely works more than 50 hours a week (due to high-intensity rotating shifts), most doctors work more than that, and some specialists in some areas don’t work less as attendings than they did as residents.  $200K for 40 hours a week is very different from $200K for 80 hours a week.  In addition, these doctors may be woken up several times a night to answer questions from patients, the emergency department, or the hospital wards.  Often they are called in to work for several hours in the middle of night, but still have to spend the whole next day working.  People don’t do work like this without a high salary, no matter how altruistic they are.

Third, a doctor’s job is very stressful.  Errors are simply not tolerated, by the doctors, those they work with, their patients, and especially the patients’ attorneys.  It isn’t so much that docs constantly worry about getting sued (although they do.)  The real stress is that doctors worry they’re going to miss something that will hurt their patient.  I spent a few summers mowing lawns.  If I screwed up, I had to go back and cut the lawn again, or, worst case scenario, the customer fired us and hired someone else.  There was just about nothing I could do wrong that couldn’t easily be fixed.  Not so in medicine.  One missed medication interaction, overlooked symptom, misinterpreted test, slip of the hand and WHAM!  Someone dies and you spend the next 5 years lying awake at night thinking about it.  That kind of stress deserves to be compensated.

Now, don’t get me wrong.  There are a lot of problems with physician pay.  The whole system is pretty screwed up.  Cognitive work pays too little compared to procedures.  Uninsured patients are charged too much, and Medicaid patients are charged too little.  But the idea that doctors shouldn’t make any more than the average American is insane.  If I’d spent 11 years of 80 hour weeks building websites instead of learning how to practice medicine, I’d be making just as much money, for a lot less stress.  Never mind if I’d decided to go to Wall Street instead.

I hope that wasn’t too much of a rant, but it was something that needed to be injected into the national conversation.  If we don’t pay doctors well, there won’t be enough doctors, and the ones we get won’t be the ones we want.  Nevertheless, doctors still have the responsibility to run their businesses efficiently and manage their own personal finances, and hopefully this website can help with that.