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Causes of high medical expenses part two: Doctors

2011-09-19

Causes of Excess Cost in Medicine Part Two—Doctors

Doctors go through a long period of training before beginning full clinical practice.  After college, the training begins with medical school.  Unlike college, however, attendance at medical schools is usually not supported by scholarships.  Most students at medical schools are required to pay in full for their tuition and living costs.  Those who do not have sufficient funds usually take out student loans, guaranteed by the federal government, to pay for this.  The costs always exceed a hundred thousand dollars for four years of medical school.

After medical school, doctors go through residency training for three to five years.  During residency, they are not required to repay their student loans, but they receive only modest salaries during residency, perhaps forty thousand dollars a year.  They frequently supplement these salaries by moonlighting.

Once residency is complete, a doctor can go into full clinical practice and usually expects to earn more than a hundred thousand dollars a year in compensation.  Today, most doctors work for larger entities—clinics, hospitals, or corporations.  From their salaries, doctors are required to begin repaying their student loans, which are usually very large.

There is a great incentive for doctors achieve larger compensation, and presently salaries at large clinics begin at over one hundred fifty thousand dollars a year for nonspecialists.  Specialists can expect to receive more than two hundred thousand dollars a year.

In addition to salaries, specialists can supplement their incomes with payments from pharmaceutical companies for doing clinical research and giving speeches to other doctors.  These payments often exceed fifty thousand dollars a year.

The high salaries of doctors are largely a function of their financial obligations incurred during training and the expectations of society related to their status.  As a result, they are divorced from the concerns of the average person about costs.  They do not see any conflicts in charging three hundred dollars for a first office visit to patients who make less money.

If it were not for the excessive financial obligations of medical training, doctor’s salaries would not have to be so large.  The federal government has a small program known as National Health Service, in which a few doctors are supported by scholarships during medical school in exchange for agreeing to work in underserved areas for four years.  If this program were greatly expanded, there would be far more doctors not pressured by large student debts.  These doctors would have less incentive to make large salaries and would be more likely to treat patients at reasonable fees.

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3 Comments leave one →
  1. 2011-12-09 01:33

    How about all doctors required to work in under-served areas or specialties for at least 5 years in return for 80 per cent of medical school costs.

    Medicine has become just another money-making machine for those lucky enough to get into medical school. And that 10 percent of applicants who make it to medical school are not the ONLY qualified applicants. The process is criminal at a time when millions of boomers are going to be looking for care never mind those areas without physicians.

    Alternative, send physicians to Canada which seems to have shortage. Same deal as above would apply although extra 10 percent forgiveness for leaving country.

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  2. 2011-12-09 02:43

    Thank you for your comment.
    I agree with an “underserved service” type of proposal and this can most simply be implemented by expanding the current National Health Service Corps program, which pays all four years of medical school in return for four years service after residency.
    Medical school has become a part of the greater loan crisis of higher education in which students can start out over a hundred thousand dollars in debt with a degree which no longer guarantees a job. At least, after medical school you are not likely to remain unemployed.

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    • 2011-12-10 02:21

      I suppose I am idealistic and naive to think that one coming out of medical school should have a smattering of concern for the common good. It seems now that such schooling is viewed by some (many, most) as a way to guarantee a life of high income and its perks gained upon the miseries of his/her fellow man.

      I do think there can be an accommodation between income and service. Seems that income will come based upon that service.

      Perhaps the family doctors of old were no more dedicated than today’s physicians, we just have created that myth.

      No doubt, if my experience in Canada as a visitor can attest, physicians are needed in lots of locales wherein they are currently absent.

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