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(October 21, 2006)
During teaching rounds with medical students a few weeks ago, one of our patients asked the students why they had chosen to become doctors. Before anyone could answer, the patient's mother spoke up. "The reason is to make money." Over the years I have heard this many times and was not surprised with her response. The problem, however, is that she was wrong. Money is actually one of the last reasons young men and women choose medicine as their career. How do I know this? First of all, money was never a consideration when I chose to become a doctor and over the past 40 years I have heard this from thousands of medical students and doctors I have taught and worked with. The main reason given for choosing to become a doctor is a love of science and a desire to help others. Doctors, as a general rule, are not interested in the business world but are motivated by a thirst for knowledge of how the human body works and how to maintain and improve the health of patients. It is not that we do not care about making a nice financial living it is that we do not spend much time thinking about it as we go about our daily chores. Surveys have shown that many doctors have no problem in being placed on a salary or even being paid by the hour. Keep in mind that the average debt of graduating medical students in this country is $120,000. Most new doctors take on even more debt as they continue their medical education as residents and fellows. It takes about 10 years to fully train a doctor in the United States and, therefore, it is not unusual for doctors leaving training and entering private practice to owe over $200,000. Once in private practice, young doctors find that expenses to run an office and to pay medical malpractice fees seriously reduce their annual income. In addition, much of that annual income is dependant on what specialty the doctor practices. Doctors who practice primary care medicine such as Family Practice, Pediatrics or Internal Medicine make considerably less money than those physicians practicing a surgical sub-specialty or Cardiology and Gastroenterology. The average net income for a primary care doctor in 2003 was $146,000 while Surgeons who specialize in areas such as orthopedics had an average net income of $271,000. Payment to doctors reward physicians who become Surgeons, Cardiologists or Gastroenterologists who perform procedures or tests, in contrast to doctors who spend their time evaluating and diagnosing without being able to perform procedures. As a result, the median income of a doctor who is a General Practitioner in 2004 was $120,000; a Pediatrician, $145,000; a Family Physician, $146,000; an Internist, $150,000; an Ob/Gyn, $215,000; a general Surgeon $230,000 and a Cardiologist $250,000. It should be noted that these figures are averages and many doctors make considerably less as well as more. These numbers illustrate that while doctors overall make a very comfortable living, considering the long educational and training process which results in huge debts, coupled with incredible responsibilities of the job, as well as long working hours and the need for continuing education and recertification on a regular basis, the amount of remuneration is not outrageous as it seems in some arenas such as the corporate world. It was recently reported that the average income of physicians decreased by 7% from 1995 to 2003 after adjusting for inflation. (This is in contrast to lawyers whose income during this time rose 7%). Currently Medicare plans to cut physician payments by 5.1% next year and as a result many doctors in primary care specialties are wondering if they can maintain their practices. It is a good thing that young men and women interested in becoming doctors do not put money as their top priority for making their choice. |
