I'm not in derm but I was pretty pissed off after reading such a sensationalized and misleading article by NY Times.
The reporter conveniently ignores the amount of education, high level of academic performance, sacrifice, time and money that it takes to become a doctor (pre-med (4 years) --> medical school (4 years) --> residency (3-7 years) --> fellowship (1-3 years) and this doesn't include if you take a gap year which is becoming increasingly required due to the competitive nature of medical school admission and some professions like radiology and pathology are requiring multiple fellowships before one is able to find a job). Plus the insane amount of debt that is accrued over our training (quarter of million for tuition alone assuming you got some scholarships plus interest, not including living expenses). The amount of income potential that is lost within that decade of training is conveniently ignored. No other profession requires this much education, training, time, money or sacrifice. We live in a capitalist society and when every other profession is out there making money (lawyers, bankers, dentists, pharmacists, nurse practitioners, CRNAs, etc) it's pretty naive to think doctors should or will take a pay cut for doing a "noble cause." I don't blame doctors for trying to increase their income as long as they are not hurting their patients or making them undergo unnecessary procedures. And yes it is not fair that primary care doctors make so little. There should be talk about increasing their pay instead of decreasing the specialists pay.
The reporter also compares incomes in Europe vs. incomes in US--training in Europe is also relatively easier than here in the US. Their work hours are typically restricted to 50 hours a week during residency, they do not have 4 years of pre-med (a money-making scheme) because they go to medical school straight from high school (which is why medical school is traditionally called undergraduate medical education and the MBBS degree is an undergraduate degree that is equal to the MD degree) and their education is ridiculously cheap compared to the US. She also didn't mention the insane malpractice premium physicians/surgeons have to pay here in such a highly litigious culture.
There is absolutely no discussion of why hospitals have to charge so much. They're trying to cover for all the lost revenue from patients who do not pay and from insurance companies/government when they fail to reimburse. Thus, the costs gets directed on to other patients who have insurance or who can pay leading to insane bills. They're not doing it out of greed, they're doing it for sustainability. The government and insurance companies have too much power in the health care industry which ultimately drive up costs. A doctor's salary is a small cause of the increasing health care costs even though thats what is being targeted by the government and media. When the government and insurance industry make decisions they are not taking into account the best interests of the patient. The government is inherently inefficient and has bankrupted the post office, social security, medicare/medicaid and play politics with important issues and people still want them to take over health care? On the other side you have the insurance industry, which is for-profit and their goal is to minimize costs while maximizing profits at the expense of what is best for the patient and now with Obamacare they just received a blank check to maximize profits. Tort reform is never discussed because the government is run by lawyers and the person that currently determines physician reimbursement and operates Obamacare and medicare/medicaid is Kathleen Sebelius, a former lobbyist for the Kansas Trial Lawyers Association. Despite these real issues that are conveniently ignored, the political leaders and media are obsessed with selling the story that doctor's salaries is a major cause of health care costs.
Just like any other profession, not all doctors are equal. The reporter did not even attempt to differentiate between the quality of doctors (academics vs. non-profit hospitals/clinics vs. for-profit centers vs. for-profit solo private practice). The main issue that the article discusses is confined to doctors in for-profit practice who joined medicine primarily to make money but the article fails to make that distinction. This is seen in every field and it's not at all specific to medicine. Think of the shady lawyers and dentists that you've seen or heard about. Yes there are some shady and unethical primary care doctors, specialists and surgeons--it's these people that need to be exposed instead of painting an entire field of medicine as "evil." NYT has published several articles criticizing different fields of medicine and blaming them for the cause of high health care costs. It's not black vs. white. It's extremely irresponsible for them to write such sensationalized articles without giving the full story or presenting the alternate side to the story.
Unfortunately, it's the system that has failed our patients (the money hungry malpractice lawyers and all the misleading advertisements that they air on TV to take advantage of people who are already suffering, the stingy for-profit insurance companies that currently enjoy a monopoly by being able to restrict patients to a certain geographical location even though we live in an increasingly globalized society, the failure of Obamacare from preventing insurance companies from increasing the premiums/deductibles on the already struggling middle class, the government bankrupting medicare/medicaid)---doctors income is not the major issue despite what they want you to believe. We're easy targets because we are so divided. They're trying to paint a picture of the doctors being evil because we're the politically safest target, the average person is not going to have sympathy for us. Doctors need to go on the offense to take on the political leaders and media and to educate the public on what doctors have to go through, unfortunately that will not happen because we're so divided.
Sub specialty and location.
