Would anyone be in surgery if you were paid nothing or below minimum wage?
Give me the honest truth.
Give me the honest truth.
What is your price?
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Sure, people would still be interested in it...but no one would do it for a job. What job would anyone do for less than minimum wage - very few things. Even pro athletes, who are basically doing for a job what they always loved to do in their free time as a child, demand what they consider fair wages.
Now, if you were to change your proposal to surgery paying somewhere like $30-$50K, somewhere in the range of what Americans consider a potential for middle-class lifestyle...still i personally would have to say no given the current cost of medical school - I'd never be able to pay it back. But if med school were free, yes, I'd probably be willing to do surery for that salary range (we already do during residency)
Now, if you were to change your proposal to surgery paying somewhere like $30-$50K, somewhere in the range of what Americans consider a potential for middle-class lifestyle...still i personally would have to say no given the current cost of medical school - I'd never be able to pay it back. But if med school were free, yes, I'd probably be willing to do surery for that salary range (we already do during residency)
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BA-AR said:
Missionary surgeons do just that.
Sure, there are people who would be surgeons for a subsistence wage. Just not many.
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I still would. I don't like any other area of medicine as much as I love surgery, so if I were in another specialty, I probably wouldn't have the same feeling, but insofar as surgery is concerned, I can honestly say that I would do it for free. I'd just live with my parents or try and marry a rich woman. 
As am finishing surgical residency, the job market for surgeons and all of health care is getting worse and worse.
I am being told its because insurance reimbursement is going down (i.e. hernia repair = $200.00, appe=$175.00 -$225.00 ). For all of the training and the hard work away from family and friends, its not worth it.
I looked up the top paid CEO in the country, 3rd highest paid is CEO of United Health with 124.8 million.
Is there something wrong with this picture?!
William W McGuire
Total Compensation: $124.8 million (#3)
5-Year Compensation Total: $342,284,000.00
William W McGuire has been CEO of UnitedHealth Group (UNH) for 14 years. Dr. McGuire has been with the company for 17 years.
Education
College: University of Texas Austin BA ' 70
Graduate School: University of Texas Medical Branch Galveston MD ' 74
I am being told its because insurance reimbursement is going down (i.e. hernia repair = $200.00, appe=$175.00 -$225.00 ). For all of the training and the hard work away from family and friends, its not worth it.
I looked up the top paid CEO in the country, 3rd highest paid is CEO of United Health with 124.8 million.
Is there something wrong with this picture?!
William W McGuire
Total Compensation: $124.8 million (#3)
5-Year Compensation Total: $342,284,000.00
William W McGuire has been CEO of UnitedHealth Group (UNH) for 14 years. Dr. McGuire has been with the company for 17 years.
Education
College: University of Texas Austin BA ' 70
Graduate School: University of Texas Medical Branch Galveston MD ' 74
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BA-AR said:
Interesting. Can you tell us why more specifically why is not worth it? Are you finding that surgery is not exactly a love but just a job now? Because, I'm having second thoughts and am not sure if it's worth it either. The compensation just isn't there. How about doing a fellowship?
bigtimesmally said:
Thats a good point. I love to operate now but I do not know how long I can continue to enjoy it in this environment.
Maybe trauma/critical care fellowship --> where as critical care/trauma attending you get base salary with overhead and malpractice insurance is paid for by the hospitals.
How long can you practice if after a long and difficult case you have to argue with the insurance company for 150 to 200 dollars, and then toss and turn all night in fear that the patient is going to sue you?
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bigtimesmally said:
I hear from others all the time that you should pick something you enjoy so that even if the money disappears, you'll still enjoy going to work every day.
I think it's nice advice but unrealistic. I think I would be much happier having picked my 2nd choice specialty and maintaining a level of pay that I am comfortable with and aware of rather then picking my 1st choice specialty and having to deal with an uncertain pay cut later on.
It is nice to be idealistic and to pick something because you truly love it, but ultimately, everything boils down to a job. There are bills to pay, children to feed, etc... etc... and if your desired field cannot provide for those things, it might be better not to enter it.
I think that is it both sad and ridiculous that surgeons have to go to college for 4 years, med school for another 4 (while paying chunks and chunks of tuition), residency for another 5 (while working for paltry pay at 80 hours a week) and still have to be afraid that all their hard work might not provide for a livable salary.
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In one word my answer to the original post is : NO. I don't think this should be surprising. Many of us could make more money in other fields (when adjusted for the level of education, work hours, and life commitment) but we have chosen to pursue something we find personally rewarding and honorable. Having said that, I for one am no martyr.
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cdql said:
I won't mind the long training, the less than desirable lifestyle, and the late night calls if the compensation was there. Otherwise, it seems life is too short to put yourself through such nonsense.
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bigtimesmally said:
Nonsense? I don't understand. Why even engage the discussion?
Speaking as someone who is starting a career in surgery, I can't comment on the difficulties encountered in training. But ALL medical students know the sacrifice required to enter the field of surgery or medicine in general.
But if its nonsense, why even enter clinical medicine? Why not business or big pharma?
drpectin said:
You can never actually KNOW something until youve actually done it, and not just for your required and sub i's. Theres a totally different level of personal responsibility, maturity with aging, then you get to add years of hard work with possible poor treatment, and little respect and crappy pay. You can anticipate what it will likely be like but will never know until youve done it for real. There is a point where it isnt worth it for every endeavor, not just medicine.
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When I first started residency I would have said "yes" I would still do surgery.
Now that I'm about to enter my 5th year, I would say no. It's only partially about the money but it's really the lifestyle. While reading this thread, I've gotten 2 pages (crap, make that 3) and I'm sure I'll get 3-5 more before I wake up at 5 am. You may only work 80 hours in the hospital but at my program, you're on all the time, at least for floor calls. That's just like the real world. So you never get to fully relax and when you're at the hospital, it can often times be very stressful.
Before medical school I worked at a warehouse lifting and packing boxes. I clocked in and I clocked out. Made $10/hour. No stress, no worries, noone died, noone sued me, noone got a post-op complication that I lost sleep over for 5 days, noone gave me $200,000 debt, noone called me at 3 am and woke up my family, noone pimped me, noone worried about looking good in front of the attending/boss. I just showed up, did my job, and went home.
Medicine is much more than the money. I love to operate, I love to take care of my patients. I don't love all the crap surrounding it all. I guess we think the compensation will somehow make up for the crap when we're not at the hospital. Hopefully that's right.
For minimum wage I would not:
go into $200,000 debt
be on 24 hours/day
be open to lawsuits
do 4 years of college
take the MCAT
apply to medical school
pray i got in
attend four years of medical school
take 3 steps of the USMLE
interview at a bunch of places
do 5 years of painful residency
prepare and take the ABSITE every year
take written and oral boards
be constantly available
do surgery again
don't mean to be a downer. just being honest
Now that I'm about to enter my 5th year, I would say no. It's only partially about the money but it's really the lifestyle. While reading this thread, I've gotten 2 pages (crap, make that 3) and I'm sure I'll get 3-5 more before I wake up at 5 am. You may only work 80 hours in the hospital but at my program, you're on all the time, at least for floor calls. That's just like the real world. So you never get to fully relax and when you're at the hospital, it can often times be very stressful.
Before medical school I worked at a warehouse lifting and packing boxes. I clocked in and I clocked out. Made $10/hour. No stress, no worries, noone died, noone sued me, noone got a post-op complication that I lost sleep over for 5 days, noone gave me $200,000 debt, noone called me at 3 am and woke up my family, noone pimped me, noone worried about looking good in front of the attending/boss. I just showed up, did my job, and went home.
Medicine is much more than the money. I love to operate, I love to take care of my patients. I don't love all the crap surrounding it all. I guess we think the compensation will somehow make up for the crap when we're not at the hospital. Hopefully that's right.
For minimum wage I would not:
go into $200,000 debt
be on 24 hours/day
be open to lawsuits
do 4 years of college
take the MCAT
apply to medical school
pray i got in
attend four years of medical school
take 3 steps of the USMLE
interview at a bunch of places
do 5 years of painful residency
prepare and take the ABSITE every year
take written and oral boards
be constantly available
do surgery again
don't mean to be a downer. just being honest
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BA-AR said:
wow. pulmonologist with residency at UTHSC. it's sickening that CEOs make this, only because i'm not there yet :x
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You not being a downer. I mean you've honestly arrived at this opinion. The good part seems to be that you still find some good in the field. No one likes the crap one has to deal with, but then all professions have to deal with some crap. Right now the pendulum is swinging to one side for medicine.
Not everyone can be a CEO. Not everyone can be a physician. Residents may work at a minimum wage rate, but its still better in my opinion than working in a warehouse (you obviously disagree).
And its not like you have to keep doing surgery if you don't want to. I know of two people who have left surgery residencies to go into corporate america and are quite successful. The point is do what you like - why suffer in a field you resent? How can you do that for 20+ years?
drpectin said:
I think some of the points we as future surgeons have to remember is that we do not have to walk away from our love and passion of surgery. We should fight back for our profession, against the malpractice lawyers and health care insurance companies; they are making unbelievable amount profit on our hard work and passion for surgery
Drpectin: Average compensation is $220,000 to $280,000, depending where you practice.
These numbers are right, but you have to remember that the surgeon has to do large volume of surgery to get to this level and most surgeons who have large volume of cases have malpractice insurance in the range of $60,000.00 to over $100,000.00.
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Not entirely true. Big city compensation is certainly lower than smaller communities. So if you would have to have higher volume in a large city to get the same level of compensation. And malpractice is typically higher in those large communities as well. Those compensation numbers are usually figured AFTER overhead like malpractice.BA-AR said:
As a general surgeon leaving the Air Force for the private sector, I can attest to the existence of a fairly robust market for general surgeons. In my case, I had multiple offers in communities with populations ranging from over 1 million to less than 10,000. Starting salaries were 160-400k with a usual 1 year guarantee. In my chosen practice, after overhead, I will make over 200k the first year. The other general surgeons in the practice make between 450k and 750k depending on how busy they are. In a large midwestern city, my malpractice will be $11k per year which includes bariatrics. That is on the extremely low side. The highest malpractice rates in the country are in Miami (Dade County) Florida. The average general surgeon there pays $150k per year.
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Wow! Now that kind of compensation is worth toiling for!
I think the original question is a bit unrealistic in that, would anyone do anything for nothing or for minimum wage? (I mean...does anyone actually want to flip burgers for minimum wage?)
I think the original question is a bit unrealistic in that, would anyone do anything for nothing or for minimum wage? (I mean...does anyone actually want to flip burgers for minimum wage?)
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FliteSurgn said:
Wow. That's definitely reassuring. I think all we ask as future physicians is that we get compensated accordingly for our hardwork. That's all. It's not greed or selfishness, it's simply being rewarded for all the hardwork and sacrifice that majority of people wouldn't and couldn't undertake.
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bigtimesmally said:
Agree, agree, and agree!
It's not like we're asking for multimillion dollar salaries like those that athletes command!
Heck, I'd be more than thrilled with half a million!
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I'm currently a 3rd year resident and my answer would be "hells no" would I do it again
do the math
compensation for a lap chole $250-500
one complication lawsuit - $100k-$5mil
that means doing 200-2000 lap choles to make up for one mistake
of course most if not all have malpractice insurance but it still sucks thinking about it
but then again, i'm a jaded resident who is currently doing 6 months of trauma so take my advice with a grain of salt.
that's why i'm shooting for plastics now. The lawsuits are there, but the compensation is high enough to decrease the benefit to liability gap.
do the math
compensation for a lap chole $250-500
one complication lawsuit - $100k-$5mil
that means doing 200-2000 lap choles to make up for one mistake
of course most if not all have malpractice insurance but it still sucks thinking about it
but then again, i'm a jaded resident who is currently doing 6 months of trauma so take my advice with a grain of salt.
that's why i'm shooting for plastics now. The lawsuits are there, but the compensation is high enough to decrease the benefit to liability gap.
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tripod said:
Though I agree the life of a resident is no fun ... I think you're being unduly pessimistic.
Medicare pays around $700 for a lap chole (code 47562). Approximately 1 in 200 lap choles will have a CBD injury, of which 25% will sue. So 1 suit per 800 lap choles = $560,000. The average CBD injury judgement is about $500K, but not every suit is successful - figure 50% for a $250K loss on $560,000 of LC revenue. So even if you had no malpractice insurance, lap choles would still pay nearly $400 ($310K/800).
(sources for above data available if anyone cares.)
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Well, if I would be shooting for a fellowship anyways. Particulary, Hand is very attractive to me as is CT surgery, Head and Neck, and Cosmetic. There is a lot of variety there, so, specialization will give better compensation and better hours.
Pilot Doc, based on your years in practice, are you aware of the compensation for the surgeons who have completed various fellowships such as above?
Pilot Doc, based on your years in practice, are you aware of the compensation for the surgeons who have completed various fellowships such as above?
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not to be crass, but i don't know what some people are talking about or what kind of surgeons they know. but every single surgical attending i know makes more than enough money to live very comfortably. enough to pay back their loans, buy a nice home, buy nice cars, send their children to private schools if that's what the want, etc. and these are attendings a few years out of residency. i hope people weren't expecting to live a Donald Trump lifestyle once they became surgeons and this is what they're comparing it to.
I am a long time lurker with infrequent posts. In fact, I started looking in on this forum when Dr. Cox was a medical student.
That aside, I could not let this topic go without input. I am 2 years out from a Surgical Critical Care fellowship and I work at an academic institution. I have friends in various parts of the country in different practice styles. The compensation ranges from $150k to over $500k per year. Most of my friends are in private practice general surgery and they make a very comfortable living. Call averages q4-6 and none of them have been sued (yet).
For me, I am very happy with my job. I love what I do. But, if someone had asked me when I was a third year resident I would have told them the same thing that some of the people responding to this post are saying. I was not sure I wanted to go on with residency at that point. By the time I was a chief resident, my perspective had started to change. In fact, I would repeat my chief year without pay. That is how much I enjoyed it. (I would only want to repeat it once, though!)
Having said that, we all know that surgery is hard. Learning to take care of patients and to operate on them is hard. The 80-hour work week will not change this basic fact. For me, the post training period has been awesome. I work with interesting people. I look forward to going to work. I do not despise call. In fact, I enjoy the challenges I face when I am on call. I make a great living. Sometimes I can not believe that I get paid for doing this. Would I do this for free or minimum wage, maybe, but only for a short time. I have family responsibilities and I need to be able to provide for them. A better question might be: "would you be willing to do this if you won $30 Billion in a lottery?" Again, my answer would be yes, with no reservations.
That aside, I could not let this topic go without input. I am 2 years out from a Surgical Critical Care fellowship and I work at an academic institution. I have friends in various parts of the country in different practice styles. The compensation ranges from $150k to over $500k per year. Most of my friends are in private practice general surgery and they make a very comfortable living. Call averages q4-6 and none of them have been sued (yet).
For me, I am very happy with my job. I love what I do. But, if someone had asked me when I was a third year resident I would have told them the same thing that some of the people responding to this post are saying. I was not sure I wanted to go on with residency at that point. By the time I was a chief resident, my perspective had started to change. In fact, I would repeat my chief year without pay. That is how much I enjoyed it. (I would only want to repeat it once, though!)
Having said that, we all know that surgery is hard. Learning to take care of patients and to operate on them is hard. The 80-hour work week will not change this basic fact. For me, the post training period has been awesome. I work with interesting people. I look forward to going to work. I do not despise call. In fact, I enjoy the challenges I face when I am on call. I make a great living. Sometimes I can not believe that I get paid for doing this. Would I do this for free or minimum wage, maybe, but only for a short time. I have family responsibilities and I need to be able to provide for them. A better question might be: "would you be willing to do this if you won $30 Billion in a lottery?" Again, my answer would be yes, with no reservations.
zambo said:
You dont get it; I am talking to general surgeons and some sub-specialist who after malpractice and overhead, are taking home $70,000.00 to $125,000.00 before income tax. I do not see where it is adding-up, after 4 years of college, 4 years of medical school, 5 to- 7 years of surgical training. For what!!
To ran to hospital for lap appe. At 2a.m., and find out the patient has no insurance, and if he/she is UN-happy with your care. There are hundreds of lawyers, which had a good night sleep, ready to take his/her case.
Then the Joke does not end there, even if you do not loss the lawsuit, your malpractice goes up!
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Nice post!
It reminded me of an old classic movie!
Peter Gibbons: Our high school guidance counselor used to ask us what you'd do if you had a million dollars and you didn't have to work. And invariably what you'd say was supposed to be your career. So, if you wanted to fix old cars you're supposed to be an auto mechanic.
Samir: So what did you say?
Peter Gibbons: I never had an answer. I guess that's why I'm working at Initech.
Michael Bolton: No, you're working at Initech because that question is bull**** to begin with. If everyone listened to her, there'd be no janitors, because no one would clean **** up if they had a million dollars.
Like Thinkfast said, a great way to gauge if you really love your job is to see what you would do if you no longed needed your job for financial reasons.
I would like to think most doctors would still say yes!
It reminded me of an old classic movie!
Peter Gibbons: Our high school guidance counselor used to ask us what you'd do if you had a million dollars and you didn't have to work. And invariably what you'd say was supposed to be your career. So, if you wanted to fix old cars you're supposed to be an auto mechanic.
Samir: So what did you say?
Peter Gibbons: I never had an answer. I guess that's why I'm working at Initech.
Michael Bolton: No, you're working at Initech because that question is bull**** to begin with. If everyone listened to her, there'd be no janitors, because no one would clean **** up if they had a million dollars.
Like Thinkfast said, a great way to gauge if you really love your job is to see what you would do if you no longed needed your job for financial reasons.
I would like to think most doctors would still say yes!
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Dr. Z said:
That's a great post. Much appreciated. I have done the surgery rotations that were killing me and I was swearing to myself not to continue. Yet, I still have a deep interest in surgery and truly see myself as a future surgeon. Would I feel the same after training or mid-training, I don't know. Would I rather take a lifestyle career instead as I have the opportunity to do that now, don't know. I'm so torn. I hate to go the lifestyle route and 10 years down the line find that I am bored and truly missed out on a career in surgery based on misconceptions about the field and all the negative comments that are out there and on this site. But, I have to say, that I have yet to hear a surgeon tell me they wish they had done something else. I really see them enjoy their work. Regardless of their personalities, they are impressive people and deserve better compensation than they get.
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bigtimesmally said:
I can't tell if you're being facetious. (I'm still a resident) Compensation is hard to pin down. There are surveys out there, but for a number reasons docs - especially successful docs - are unlikely to fully disclose their income. So the surveys probably underplay the difference between high and average earners. I've attached one example.
I'm guessing you're a pre-med or med student. The fields you list are far flung and are best approached from four separate residencies. (CT- gen surg, H&N - ENT, Hand - ortho or plastics, Cosmetic - plastics) They're also not all particularly lifestyle friendly - CT has notoriously long and unpredictable hours, and hand has it's share of emergencies.
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Pilot Doc said:
I'm a med student. I'm just trying to be as informed as possible. I'm familiar with the surveys but wanted to get the perspective of someone already in practice who has more real wold knowlege Thank you, by the way.
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bigtimesmally said:
A couple places to look for jobs
www.practicelink.com
ACS
You'll find plenty of jobs paying far more than $70-120K/yr. Any surgeon working for that needs to move. They're in an area with too much competition or too little insurance.
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BA-AR said:
believe me I get it. i don't know what surgeons you're "talking to" who only make $70K before tax.
well don't you think you should have known these were the risks and sacrifices that came along with being a surgeon? didn't you realize it when you were doing your 3rd year surgery rotation? did you expect them to just pay you $500K per year, let you be home by 5pm every night, and never have to bother answering to patients and their lawyers? is that what you thought being a surgeon was? it seems like it's you who still doesn't get it: the golden age of medicine is long over.
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mysophobe said:
I don't think anyone goes into the whole process thinking, "I'm gonna be a surgeon to get rich!" (Actually, few people in their right mind would get into medicine at all to get rich. It's a much quicker and easier path to riches in the business world)
But it isn't unreasonable to ask for a salary around 300-400K after going through med school and a painful residency. And because that type of lifestyle is being threatened, that's why I think people are getting concerned.
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What I'm saying is anyone who starts up this whole shabang without researching how much time, money, and effort goes into making less than a lot of other professions after a much longer time period is a *****. No where did I say that you can't expect a good or great salary for what you do after undergrad, med school, and a long residency. Hell, it's more than reasonable.
I'm just rehashing what zambo said. If you go into surgery expecting to work a 40 hour week for half a mil. a year, you're an idiot.
I'm just rehashing what zambo said. If you go into surgery expecting to work a 40 hour week for half a mil. a year, you're an idiot.
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zambo said:
My sentiments exactly.... $70k before tax in private practice? Someone most likely needs to reassess their business model. AVERAGE compensation for a general surgeon is $220,000-$280,000 NET, this means some make more some less. But $70k?!? C'mon give me a break.
But I think there are several posts here that point to the fact that it does get better. The average surgeon works 60 hours per week and at least some surgeons enjoy their work. The strange thing is, at least in my experience, that the academics appear to enjoy their work more, even though they are usually paid less.
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drpectin said:
Why else would you take a 25-75% pay cut?
j/k
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iliacus said:
No offense, but how would she know? I was a scrub tech many moons ago, and the doctors never discussed their salaries, or anything about money. Most of them hardly talked about anything but the case.
Example:
One surgeon bills the insurance companies and Medicare/Medicaid for $780,000.00 but only collects 28% to 32% of his/her billing, which translates to $249,600.00.
Malpractice = $70,000.00/year
Overhead = @$80,000.00/year (office rent/office manager/and other office staff) sharing with other partners
$249,600.00 ($70,000.00 + $80,000.00) = $99,600.00
Income Tax @35%
Take home = $64,740.00
One surgeon bills the insurance companies and Medicare/Medicaid for $780,000.00 but only collects 28% to 32% of his/her billing, which translates to $249,600.00.
Malpractice = $70,000.00/year
Overhead = @$80,000.00/year (office rent/office manager/and other office staff) sharing with other partners
$249,600.00 ($70,000.00 + $80,000.00) = $99,600.00
Income Tax @35%
Take home = $64,740.00
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BA-AR said:
Every salary survey I've ever seen shows gen surgery median compensation in the $200-$300K range (after malpractice, overhead, and the like-- every salary survey I've ever seen reports pre-tax income after expenses). In every field, by definition, there will be people who make way below average, but you can hardly point to them as the norm. You're absolutely right that going through the four year med school, 5-7 years gen surgery residency and getting paid $99K per year would make a lot of people think about other careers, but this is just not by any stretch of the imagination the norm or expected outcome.
I'd want to know more about your example surgeon, because either he/she is a dinosaur who hasn't picked up lap techniques and is in a saturated urban market or has some other major extenuating factor screwing up their compensation picture. They're probably in the bottom couple percentile for compensation.
To give a more concrete example, the salaries of the top 1000 or so faculty in the University of California system are available at:
http://www.sfgate.com/news/special/pages/2005/ucsalary/
If you search through the faculty of gen surgery at ucsf, you'll see that the chair and chiefs of different hospital gen surgy departments are all making $350-$550K per year, and at least half the faculty (including asst professors) are making over $200K per year from their ucsf salaries. Median salary looks to be around $210K per year. This is academic medicine in a urban area, which is not exactly known as the place to go for dinero relative to private practice.
http://www.surgery.ucsf.edu/faculty/index.html
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BA-AR said:
I agree, if this was the typical salary for general surgeons, then, people would have heard through the grapevine and no freaking way would the match would have been as competitive as it was this year. Who would want to do this? And, man, with all the headache of running a private practice? Are you kidding?
