I edited this post to fix a couple of quote format issues
I disagree with this line of thinking.
this is what I WOULD argue.
1. Doctors in America NEED to be among the highest paid to attract those with enough talent to make a difference. Our friendly psychologist here jon snow might argue that being a doctor doesnt need much intellect but he is wrong. He is also wrong to argue that 1% pay is equal to 1% intellect. This is plain and simple wrong. The people who get paid 1% are not your brightest. If they were the physicists, the pure mathematicians, the logicians, the theoreticians in research would be the highest paid. Most are not. This is simply a reality- intellect does not equal actual productivity. The people who ARE the 1% are your bankers, your lawyers, your Big 4 accountants and accountants elsewhere, your ad executives, your marketing executives, your sales executives. These are your 1% in income. Your professionals with the expertise and ability to generate revenue for business. Doctors are in the 1% not to generate revenue but to allow others to go back to work so they can generate revenue.
I take issue with this rationale because
1. Doctors in countries where the profession is less remunerated are not necessarily less competent—health outcomes, though certainly the sum of a multitude of factors, aren't worse in countries where, even if assuming a sharp difference in work hours, the gap between identical specialties' pay is in the hundreds of thousands of dollars.
2. We may have a shortage of doctors depending on who you ask, but we most certainly don't have a shortage of competent people who
want to be doctors. Every year the slope to enter the medical profession gets steeper in terms of grades, GPA, and interpersonal competence. I struggle to believe that at a lower payscale a quarter or half the applicants would give up their vocation to the profession, and have seen no data to suggest this.
2 I want to show what an extreme example of underpaid doctors does to society-
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- basically saying that 78% of families preferred children NOT to go into medicine due to poor status/remuneration. That the most prestigious medical schools struggle to recruit even competent students. And that they have to reduce standards to fill their needs despite china having one of the LOWEST per capita physicians in the world.:
"Even Chinese doctors overwhelmingly prefer their children not to follow them into the profession: according to a 2011 survey by the Chinese Medical Doctor Association, 78 per cent of respondents said they hoped their child would not don a white coat. Many of China’s less prestigious medical schools find it hard to recruit students to train as doctors and others find that students with lower scores on the national university entrance exam, or gaokao, will use the lower requirements of some medical schools to gain entry to university, only to transfer later to faculties with higher earning potential."
This article shows that many many families have their children choose other careers like engineering instead of medicine. In fact doctors who go to med school are the lowest performers in general and as a result fall into being a doctor because they lack choices. Medical care is substandard in middle class china as a result. and wealthy patients instead travel to the USA for appropriate care. Is this what you want?
I have spent some time looking into the effects of pay and career choice and I know its a very important one.
While obviously no one is saying doctors should get paid so little- such cuts where doctors are not in the 1% will lead many to choose careers in business that are not the best use of their ability. If most doctors instead today chose fields like accounting and ad agencies I can assure you that except for the research minded folks- the ones at IVY league universities, the vast majority of physicians would be substandard.
The article describes an average salary of just under $400 a month. It
is an extreme example, because barely meeting paychecks at the end of the month is not what is at question. Again, given the sheer volume of competent applicants makes me question whether half
would drop should the pay be 80%, or 60% of what it is today. To give some context to my point according to
the newest publication on
matriculant MCAT and GPA a few days ago, average MCAT went up to 511 (AAMC considers that anyone scoring over 500, the 50th percentile mark, can handle a medical school curriculum, and this is the 86th percentile mark, meaning the average person entering a US MD school was in the top 14% of test takers) and the average GPA crept up to 3.71
from 3.65 in 2008. Any estimates of the number of potential future doctors who would be dissuaded by a lower compensation rate are necessarily ballpark, but I'd venture that more than a third would have to be so vocationally inclined toward the highest paying of the 1% professions before we see schools worry about filling up their classes with competent applicants. Granted, as
@VA Hopeful Dr pointed out, any reduction in physician payscale would have to consider
existing physicians, which is an altogether greater issue.
3. Next I want to point out the glaring issue with comparing American and European pay. This is the essential issue and the main problem why comparing USA with Europe is an enormous problem that people like Jon Snow Don't get. Do you know what the average engineer salary in the US in software is? Its >80k. This is even in places like the midwest. In Europe? Its closer to 30k. Lawyers? Same 30k. The list goes on. Professionals in general are not just less compensated in europe. They are SUBSTANTIALLY less compensated. So while in Germany your doctor may 'only' earn 130 to 150k in primary care but guess what. He's happy because he is EXTRAORDINARILY well compensated. In fact, his only choice would be to work as an engineer and get paid 100k less .
This is a fair criticism in terms of getting people to go into the profession. Again we'd be relying on the vocational choice of potential premeds giving primacy to the size of our salary.
Below are the average salaries of doctors (left,) lawyers (center) and software engineers (right or bottom.) While it's hard to find a pattern here because other idiosyncrasies of each country and industry appear to be stronger determinants of the levels of compensation, the U.S. figures in the top 5 of all select-country comparisons, suggesting indeed the United States does compensate some of its professionals better. The extent to which this suggests that a compensation closer to that of, say, Germany, which compensates lawyers better (and doesn't for that reason struggle getting competent medical students to matriculate) is debatable.
(Pardon the size of these graphs, I tried shrinking the latter two to not make this post too big)
4. Europe also offers many of its citizens excellent benefits. Through higher taxes- and I mean MUCH higher taxes- most citizens can tap into a system that takes care of them all of their lives. No doctor has to worry about retirement. No doctor has to worry about healthcare coverage. Doctors can expect to receive 80% of their pay in retirement in most continental developed western societies. So instead of making 200k and saving 50k of it they basically need to spend the 150 they have on whatever they want. Not even healthcare costs them much.
You said it, through much higher taxes (and more progressively steep, i.e. affecting higher income earners like doctors more) doctors don't have to worry about their healthcare and retirement.
It's also worth putting into context what these savings mean in money and proportion. By retirement age, 65% of physicians have a net worth of >1M, and that number increases for those working past their retirement age. Compare to household net worths at 30th, 50th, and 70th percentile (below). While the basic needs of retired physicians in European countries are typically met with a combination of pensions and private savings, seldom do those pensions or those savings enter these categories. Yes, I understand that net worth does not equate to retirement savings, but the data on the latter is difficult to find and I think we can agree that there is some correspondence between the two.
However, I would never argue...
1. I would never argue that doctors pay should be largely based on all those years of training. I think that as a society we are less and less forgiving with all these years of hard work. Yes its an enormous challenge for doctors with the years of no pay along with debt and the long hours. I get that- but this challenge is not unique to doctors- whether its the legal field, or other fields or dangerous jobs like policing and the military. Also we all know what we are getting into before we even start. Its not a good way to argue we should get paid more.
I'd argue that this does have some relation to how much is paid. Indeed, lawyers also endure many years of training, but they are also reimbursed in relation to it. If we spoke to those financially inclined pre-meds, I would imagine time investment is something they would think about when looking at the paychecks of physicians vs, as you said before, lawyers or software engineers.
2. Nor would I agree that our college education debt is a reason for higher pay- again this is a challenge for many fields across the board. This is an extraordinary problem in the US because they colleges caught onto the fact that students can take on more and more government backed debt and as a result can charge whatever they want.
I'd say it's a reason relative to the size of the problem for the average graduating medical student vs, say, someone graduating with an undergraduate engineering degree. It's more difficult, if not much more daunting, to consider the prospect of paying off a $190k debt with a smaller salary. Of course, the moment that this debt is paid it stops being a consideration but the salary does not change, which brings the question of whether that debt was the causative element behind the salaries. It's just a structural burden we couldn't think of reducing salaries without considering.
