Tuesday, November 5, 2013

Doctors Earn a Lot

The average family doctor earns $189,000 a year. My 2012 physician income did not reach two thirds of that, but I’m not complaining. When friends express wonder at its size, I happily agree. When they suggest that doctors earn a great deal, I acknowledge that America pays doctors generously. 

Editorials occasionally express disapproval. Like my colleagues, I note the errors (assuming, for example, that most of the health care dollar goes into the doctor’s pocket) then move on.  It never occurs to me to respond. Among problems of our health system that infuriate Americans, the size of our incomes is well down the list. 

Others protest, and I wish they wouldn’t. I can’t remember the last defense that didn’t sound whiny. Every doctor beats two dead horses.

The first is what I call the Ophra Winfrey defense.

“Ophra Winfrey (or Alfred Pujols or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

The media pour out a daily stream of outrage at the latest baseball contract, lawsuit settlement, or CEO salary. Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does.

Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.
 “The average American pays more for alcoholic beverages than. . .” 
“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”
“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

The best justification of our income lies in what we do:  we comfort the afflicted, relieve suffering, and save lives. I look on medicine as a noble, humanitarian calling, perhaps the noblest. Patients acknowledge this. So what’s the problem?

It’s this: humanitarians shouldn’t make a lot of money. Few laymen believe clergymen, nurses, social workers, paramedics, teachers, policemen, or firemen are overpaid. They are less certain about doctors, but it doesn’t upset them if they have good insurance and enough money.

What are we doing about those who can’t afford us? Some doctors volunteer an afternoon or two. A few genuine humanitarians work full-time with the poor at a salary unacceptable to most of us. The majority does little.

That statement produces an avalanche of disagreement. Poverty is no barrier in their practice, a chorus of doctors insists. They make allowances for anyone in financial difficulty. This is a frivolous argument. Few among us refuse a patient who pleads for charity, but it doesn’t happen often.

Why don’t the needy call? They don’t hesitate to consult clergymen, social workers et al. I believe it’s because we are so powerful and prosperous and (ironically) because no influential group objects to this. In the debate over caring for the uninsured, no one wants doctors to shoulder the burden. Repeated cuts in Medicare and Medicaid have produced enormous psychic but little material suffering. Nor has the increasing skimpiness of private health insurance. Whatever changes occur in the years ahead, Obamacare included, there’s no chance a physician’s income will come to equal that of, say, a police officer.

Doctors enjoy the best of both worlds. We care for the afflicted. For this we are widely admired and well paid. Sacrifices are expected - but only of our time and mental health. It’s hard to feel guilty because almost no one wants us to feel guilty. 

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