Reader Mailbag: Doctors and Patients Fight Over What Doctors Get Paid

(MoneyWatch)  Do doctors earn too much money? The question is hugely important, particularly since government policymakers, employers and health insurers are busily trying to rein in runaway health costs that threaten corporate competitiveness and the average person's access to care. The answer--to judge by the many responses to my recent BNET post on the growing threats to doctors' income -- depends on whether you're a doctor or a patient.

One insurance professional, bonadventure, writes:

I view medicine in its current form as a type of extortion. If the life guard refused to save anyone drowning without receiving let's say $10,000 claiming that he/she is making life and death decisions and is actually putting his/her life in danger we wouldn't stand for it. We would be outraged. Now, when doctors do it we make excuses.

When a doctor with the handle section34 observes that a lifeguard gets only one day of training compared with a physician's many years of education, bonadventure responds that he's just pointing out there's "a group of people who make the same [life and death] decision, are paid less than doctors and actually risk their own lives."

What really outrages the doctors in the BNET thread are people who say that they shouldn't care about earning a bit less than they do now, since their outcomes are so far above average. Some of the physicians retort that they don't make high outcomes. One geriatrician in his 30s -- detroitlove -- points out that he and his doctor wife have a combined medical school debt of $300,000 and that he earns under $100,000 a year. Other higher-earning physicians argue that their skills and their ability to save lives justify their incomes.

Reacting to a self-described "knowledgeable patient" who questions doctors' right to earn several times more than someone with a master's degree, Vascular Surgeon responds that Medicare pays too little for procedures, that his expenses are climbing 8-10 percent a year, and that he worked hard to get to where he is. He also points out that a holder of a master's degree does not graduate from school $200,000 in debt, does not have the level of responsibility that a doctor has "in terms of risk," and does not stand to be sued if he makes a mistake.

This sets off an exchange of comments regarding whether doctors think they deserve high incomes because they're better than other people. Vascular Surgeon says that's not it, but he deserves something for saving people's lives. Comparisons are made to attorneys (whom physicians believe are filthy rich) and sports stars, who everyone agrees are paid way too much. Some physicians are leaving health care or private practice, it's said, because their incomes are falling.

But patients aren't terribly sympathetic to doctors' complaints about their financial difficulties. Knowledgeable Patient says:

The [BNET] article states cardiologists would see a drop in income from $483k to $450k [if all payers paid Medicare rates]. It's hard for me to view that as financial hardship. If I had a drop of 20%, from $50k to $40k, that would be tough and it would hit me harder than it would hit a surgeon because we are talking about so much less income, but I would deal with it. And many people in our country have had to deal with loss of jobs in this difficult economic time.

It's easy to understand this individual's point of view, considering that many U.S. physicians do make far more the average person, and also far more than doctors in other advanced countries. Yet it's also understandable that in a nation where athletes rake in millions and Wall Street bankers and attorneys have country homes and yachts, physicians should feel they deserve to make a very good living.

Image supplied courtesy of Wikimedia Commons. Related Stories:

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• If Healthcare Reform Fails: Fewer Well-Insured Patients Will Leave Doctors Hurting
• Healthcare Spending Hits 17 Percent of GDP In Largest Annual Jump
• The Downside of Healthcare Reform: Doctor Shortages, Deadly Nursing Strikes