Monday, May 30, 2011

Do American Medical Specialists Make Too Much Money?

It depends on whom you ask.

Policy Experts

If you ask policy experts, most of whom are progressives, they will say “Yes,” of course, specialists make too much money. Too many specialists making too much money spoil the national health care broth.

Just look at any other country, especially countries with government –run systems.

Specialists there make one-half of what our specialists bring home. Look at their total health costs, one-half of what other countries pay, even with universal coverage. The answer, therefore, lies in more progressive government policies that encourage more lower-paid primary care doctors and discourage more highly-paid specialists.


If you ask specialists, who comprise 2/3 of American physicians,they are likely to say “Get real.” Other countries generally offer virtually free or low-cost medical educations and do not have punitive malpractice systems. Nor do they offer widely available effective high tech life saving and life style restoring high tech care for which the public demands and clamors.

As Kevin Pho, MD, in pointed out last week in an excellent blog, “Tension between Physicians and Health Policy Experts,“ the cost of a 4 year medical education in the U.S. is $250,000 vs. $75,000 in Canada and less than $10,000 in France.

Who to Trust

Whose judgment to trust? Policy experts, specialists, or the public at large.

Kevin cites a June 13-14, 2010 Gallup poll asking the public who it trusted to do the right thing about the health system.
The results were:

• Doctors, 73%

• Health experts and academics, 62%

• Hospitals, 61%

• President Obama, 58%

• Democratic leaders in Congress, 42%

• Drug companies, 40%

• Health Plans, 35%

• Republican leaders in Congress, 34%

Lack of Clarity

These results offer little clarity on what direction the health system is likely to take. The November 2010 elections, an overwhelming Republican victory, and the recent Democratic upset of a Republican in district 46 in New York State, said to be a revolt against Ryan’s Medicare proposal, add to the confusion.

Now that we’ve had a year of Obamacare under our belts, public resistance to the health reform law and calls for its repeal show no signs of abating.

Reform Changes Everything

Only one thing is for sure: the reform law and other economic pressures have forever changed the future for doctors and contributed to pervasive physician angst. This angst, based on extensive national physician surveys, is beautifully outlined and articulated in a white paper A Roadmap for Physicians to Health Reform sponsored by The Physicians Foundation, a physician advocacy group. The Foundation will release the paper to the media, policy makers, the profession, and major players in the medical industrial complex on June 1. 2011.

A "Free" Medical School Education

Meanwhile, progressive policy experts continue in their efforts to transform the health system from the top-down. In a May 29 New York Times Op-Ed, “Why Medical School Should Be Free,” Peter Bach, senior adviser at CMS from 2005 to 2006, and Robert Kocher, a special assistant to President Obama on health care and economic policy from 2009 to 2010, say the answer is straightforward: free medical school tuition, subsidizing primary care training, and withdrawing training stipends for specialists. In short, to meet the shortage of primary care doctors, charge to specialize.

Cost and Results

The cost? A mere $2.5 billion.

The results?


• Eliminating the impact of the average medical school tuition of $38,000 on specialty and primary care career selection.

• Ending the average medical school debt burden of $155,000.

• Shift of workforce from specialists to primary care practitioners, with narrowing of the gap between the average income of $325,000 for specialists and $190,000 for primary care doctors.

As cliché-mongers like to say, beware of what you wish for, there’s no free lunch, if it’s free it may be too good to be true, and when it's free, the Piper will call the Tune. For, although Bach and Kocher do not explicitly say so, a "free" medical school education with more primary care goodies and specialty baddies could be a giant step forward towards complete centralized control.

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