Itsnotfair!

Whyaresomedoctorspaidmore
thanothers?
JULY15,2013
tags:Anaesthetist,Anaesthetistsalary,Anesthetist,cardiologistsalary,doctorsincome,Emergency
Medicine,EmergencyPhysician,GeneralPractitionerSalary,mergencyPhysiciansalary,orthopaedic
surgeonsalary,paediatriciansalary,radiologistsalary
Fromamileawayalldoctorslookmuchthesame,butgetupcloseanditturnsoutthattheycomeinmany
shapes,sizesanddisciplines.Thedifferencesarenevermorestarklyrevealedthanbyaquickglanceat
theirtaxreturnsattheendoftheyear.
Thenyouwillfindconsiderablevariationbased,notonhowsmart,hardworkingordedicatedtheyarebut
onwheretheyarelocatedintheworldandwhichparticularmedicalcareerpaththeyhappenedtohave
stumbleddown.
ArecentarticleintheSydneyMorningHerald(http://www.smh.com.au/datapoint/roadtoriches
pavedwithgoodincisions201305032iyi0.html)highlightedacoupleofthings.Firstly,comparedtothe
typicalAustralianwageearner(withanaveragetaxableincomeof$51,342)doctorsarepaidprettywell
atleastthreetimesaswelltobeprecise.
ButwithintheAustralianmedicalprofessionitselfitturnsoutthatsurgeonsearnanaverageof$350,000
comparedtotheaveragemedicalpractitionerat$155,000perannumbetween23timeshigher.
Havealookoverseasandmuchthesamepatternexistwithinmostdevelopedcountries.TheUnitedStates
(http://www.webmd.com/news/20120424/bestpaidworstpaiddoctors)forexamplewhere
radiologistsandorthopaedicsugeonsearn,onaverage,atleasttwicetheincomemadebypaediatricians.
EvenintheUnitedKingdom(http://www.nhscareers.nhs.uk/explorebycareer/doctors/payfor
doctors/),wheresocialisedmedicinewouldbeexpectedtoeventhingsoutthereisaconsiderable
differenceinthevaluethatemployersputondifferentspecialties.
Thereislittleonlinetoexplainwhythesedifferencesexistbeyondtheargumentthatsomespecialties
requiremoretrainingthanothers.Thisalonehoweverdoesnotexplainsuchawidegapopeninguponce
graduatesleavemedicalschool.
Themagicingredientseemstobeprivatemedicine.Eventhesmallestcapacitytoearnoutsideofthepublic
healthsystem,withinanygivencountry,upsetstheapplecartbyofferingdoctorsacompetitivealternative
tostaying100%onthepublicpayroll.Othermarketforcescomeintoplaythatsetrelativeincomesbased
onharsheconomicrealityratherthandeservedreward.HereareafewthatIobserve:
1. Specialistpaysbetterthangeneralist:AgoodGPknowssomethingabouteverythingwhereasa

kneesurgeonknowseverythingthereistoknowaboutaverysmallnumberofthings.Specialization
attractsbetterratesofpayinallprofessionsandmedicineisnodifferent.
2. Interventionpaysbetterthanintellect:Everyradiologistandcardiologistknowsthattheycanadda
heftypercentagetotheirsalaryiftheyaddthewordinterventionalinfrontoftheirtitle.Whichleads
tomynextpoint
3. Proceduralpaysbetterthanhourlyrates:Anymanagementconsultantwilltellyouthat,ifyouwant
tomakemoneyyoumustchargeperserviceandnotonanhourlyrate.Inmedicinethisplaysoutinthe
differencebetweenwhatagastroenterologistcanchargeapatientforahalfhourprocedureversusa
onehourconsult(theformerbeinggenerallymuchmorethanthelatter).
4. Richpatientspaybetterthanpoor:Sadly,muchofmedicalscience,pharmaceuticalresearchand
clinicalpracticeisfocussedonconditionssufferedbypatientsthatcanpayhenceerectiledysfunction
researchisbetterfundedthanmalariaresearch.Similarly,cardiacsurgerypaysbetterthanpaediatric
surgery,giventhedemographicofthepatients.
5. Diagnosticspaysbetterthantreatment:Borrowingfrompointthree,diagnosticspecialtiescan
executealotoftransactions,chargingperitemratherthanontime,andsocangenerateincomefaster
thanmoreinvolvedtherapeuticspecialties.Alsolessfacetimewithpatientsfreesuptimeforbillable
activities.
6. Acutepaysbetterthanchronic:Anacuteeventlikeabrokenboneoramyocardialinfarctwilltend
tocostmoretotreatthanachroniccondition.Patientswithachronicordegenerativediseaseareoften
financiallyvulnerableandhavelimitedcapacitytopayforprivatehealth.
7. Electivepaysbetterthanemergency:Anyspecialtywherepatientscanbepredictablylinedupin
advanceforsequentialtreatment,suchaswithacolonoscopylist,canaffordtopayitspractitioners
morethankstoinherentefficiency,plusalittlebitofpointthreeagain.Comparethattoemergency
medicinewhich,byitsverynatureisunpredictableandalsocannottakeadvantageofthenatural
filteringaffordedbypointfour.
8. Talentrestrictedpaysbetterthantalentoversupplied:Touchingonpointone,specialtytraining
numbersaregenerallycontrolledbyaregulatingbody(collegeorboard)thatareoftenkeentomake
surethatthereisnotanoversupplyofdoctorsinthatspecialtyinthemarketplace.Anythingthat
artificiallylimitssupplyputsupwardpressureonprice,andsoitisforspecialistmedicalskills.
ManywillfindtheabovetobeunfairIhavespokentomanyanaggrievedemergencymedicinespecialist
orpaediatricianovertheyearsabouttheoutrageousinequityinpaytheyexperiencecomparedtotheir
surgeonandanaesthetistcolleagues.
Butthentherewerelikelymanynonfinancialreasonswhytheychosethatspecialtyinthefirstplace.Itis
nosecretatmedicalschoolthatyouwillmakemoremoneyreadingMRIscansalldaycomparedtocaring
forGPpatientsinthecommunity.
Sopayinmedicineseemstobeinherentlyunequal,atleastinanycountrywherethereisatleastsome
componentofprivatemedicinetoinvokethepowerofthemarket.
Ihavenottouchedonthegeographicalaspectsofpaydifferential
(http://economix.blogs.nytimes.com/2009/07/15/howmuchdodoctorsinothercountriesmake/?
_r=0http://)inthisblog,butifitmakesyoufeelbetteraboutpayinequityspareathoughtforCuban
doctorswho,byallaccounts,areamongstthebesttrainedintheworld,andmostequitablypaidwithin
theirowncountrycardiologistsandpediatriciansdogetpaidmuchthesame.Theyallearnabout$600
(http://www.nytimes.com/2009/08/04/health/04cuba.html?pagewanted=all&_r=0)(yessixhundred
USdollars!)perannum.
Foodforthought.

DrJohnBethell,Director
WavelengthInternational
CheckoutourFacebookPage(https://www.facebook.com/WavelengthInternational)foramore
lightheartedlookatmedicalissues
fromSalary
6Comments leaveone
1. YakeshKhanna PERMALINK
July16,201312:15am
Doctorswerenotsohighintheircompensationfewdecadesbackasmedicinewastreatedasaservice
tothecommunitywhichisnotthecasenow.Marketforcesdonotbringtheirratesdownasdoctorsare
virtualmonopolies.
Patientshavelittlechoicetogotoacheaperdoctorandhavenobargainingpower.Onceitisquestion
oflifeandhealth,doctors/hospitalsmakebestuseofthathelplessnessofpatientsandkeepmakingtons
ofmoney.
Inanyotherbusiness,youhavedeals,discounts,etc.,Doctorsincreasetheirpriceseveryyearwithout
caringifthecountryisinrecession.EvenInvestmentBankers(infamousfortheirgreed)inUSearned
lessinrecession.DoctorsinUSearnfivetimesmorethanaverageandthreetimesmorethanaverage
ofdoctorsinotherdevelopedcountries.
Letustakeanaccident,apersonwhosavesthepersonfromdeath(sayafireman)getspaidverylittle
ascomparedtoERdoctor.BothofthemsavedhislifebutFiremancannotaskforanycharges.Same
istrueforPoliceman,Militaryman.Theyalsosavelives,inadifferentway.Iftheybreaktheircharges
procedurewise,theycanmaketonsofmoney.
Whenyouseethewealthofdoctorsandhospitalsaroundtheworld,yourealizethatthemost
exploitativesystemisprivatemedicinewherepatienthasnocontroloncostonceheisbeingtreated.
REPLY
2. ThinusVanRensburg PERMALINK
July16,20137:22am
Yakeshthatisagrossoversimplification.Doctorshavetostudylongerandintheprivatesectorthat
resultsinhugedebts.Iftheyareinprivatemedicinetheydonotgettheovertime,shiftallowances,
leaveentitlements,etcthatthoseotherentitiesthatyoumentionedgets.Nordothosepeoplecarrythe
legalriskofbeingsuedformassiveamounts(becausepeoplelikeyouseedoctorsasundeservingfat
cats).ComeandwalkinmyshoeseverydayandseehowImakemymoneyasaGPIearnevery
centofitanddonotexploitanyone
REPLY
3. YakeshKhanna PERMALINK
July16,20131:09pm
Thinus,Youarerighttoagreatexetent.Doctorsasindividualsareverynicepeopleandhaveworked
veryhardtobecomeadoctorbutthesystemhasbeenturnedintheirfavour.Thishasbeendoneby
intermediaries.Therearetoomanyadministrators.TobecomeaGP,ifonehastostudyfor11years,it
isnotfairatall.Sincedoctorsmakemoremoney,medicalschoolsalsobecomeexpensive.AMAhas
seentoitthatthereareentrybarriers.Hopefully,someday,therewouldbeparadigmshiftintraining
doctorssothatcostofeducation,medicines,proceduresgoesdown.Thisshiftishappeninginhigher
educationwithonlineunversities.Atthistime,yourchildren(andyoutoo)payhigherhealthinsurance
premiumswhichkeepsgoingupaboveinflation.USispayingtwicethepercentageofGDPtowards

healthcareevenwhen15%populationisuncovered.Asectionofsocietyislivinginislandsofwealth
evenafterpayingmedicalschooldebt,malpracticeinsurancethoughallthisisactuallypaidbypatients.
Ireallyrespectthisprofessionbutacombinationofplayershavemadeeveryuserofmedicalcare
wonderwhereitwouldstop.
REPLY
4. DrShantaGhatak PERMALINK
July21,201310:27pm
AlthoughIcompletelyagreethatsomedoctorshavefallenbutmanytoomanysavethelivesmany
havehonedtheirskillsspenthoursweeksmonthsyearswithgritanddedicationatallcostsspent
theirlivesinbuildingtherightcapacitiesgettingthatrightamountoftensioninthesuturematerials
whentheyopenandshuttheskull/abdomen/etcittakesyearstomastertheskillsandattheendthe
doctorsreallyarelefttodiealone.whocareswhentheyareoldandcannotpracticeanymore?
Onlymoneycannotbetheonlyyardstick.doctorsdontspendtimewithfamily/children..they
essentiallymachinisethemselvesinexcellingbeyondtheirdreams..:)
REPLY
5. Raj PERMALINK
November18,20136:23am
Wellsaid!
MD,USA
REPLY
6. ExNHSsurgeon PERMALINK
March5,20143:19pm
Hear,hear!Unfortunatelywhatyousayisbecomingtruerightacrosstheworld.Thebanalcomments
ofYakeshKhannaservetoconfirmthatthevastmajorityofthepublic,maybeevenretiredmembersof
themedicalprofessionitself,simplydonotgetit.Thankgodneitherofmydaughtersexpressedeven
thevaguestwishtogointothemedicalprofession.
REPLY

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