The American Spectator : The Spectacle Blog : Imagine You Are a Doctor

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Much of the discussion regarding the government health care proposals has been directed toward the prudence of the ideas. But what about doctors and their moral rights in the process? I took that on in the latest Acton Commentary. Here's an excerpt:

Imagine that you are a physician. You have made it through four years of college on a steady diet of biology, chemistry, and calculus, four years of medical school so demanding that you have no life outside of school, and at least three years of residency in which you have regularly worked 100 hours a week for a very low salary. You have been the first to get up and the last to go home. And somewhere in there your third decade of life, commonly known as your "twenties" (normally a fun time), has disappeared. Along the way, you have probably racked up an astronomical personal debt because there is no time to work a second job to help pay it off. The first professional hurdle you set out to clear will be six figures accumulating interest. Forget family. If you have a spouse at this point, he or she is probably full of resentment at never seeing you.

After all this, have you made your way to an easy job? No. You are likely spending four days a week seeing patients, another day in surgery, taking a 24 hour call every four days, and working one weekend out of every four. The only time you are ever off is when another doctor can be found to cover your responsibilities while you are out. The job itself is rewarding, but incredibly difficult. You see patients and listen to them explain their symptoms. Using your knowledge, you have to figure out what is wrong with them and which of the many options for treatment you should choose. If you are a specialist who performs surgeries, you have to cut into another human being with a blade and try to correct what is wrong inside the body. It's stressful work.

Bad things happen in the cold rooms of the hospital. Patients in surgery might begin to bleed so fast you have maybe five minutes to figure out how to stop it and prevent their death. Sometimes, you open up a patient and see that things are so bad you can do nothing other than close them back up and give them the awful news. And don't ever make a mistake or even appear to have made a mistake. American medicine has been so successful that patients have unrealistic expectations for their own safety in the midst of inherently risky activities like cutting a body open and manipulating vital organs. Trial lawyers feed on those expectations to create an entire industry designed to capitalize on apparent errors. The industry works because jurors, who typically have no life experience or training to help them understand the practice of medicine, can be convinced to award giant sums to plaintiffs for errors made in some of the most difficult work imaginable. The existence of the malpractice bar has changed the way you practice medicine. You have to raise prices to pay for expensive malpractice insurance. You're induced to order excessive tests to defend against the accusations of a litigator. You will stay up late many nights updating patient charts and trying to make sure every piece of documentation is complete.

Now imagine how you would feel if the rest of us got together and proposed that the government should become the primary client for medical services. As part of the deal, the government will determine how much you will be paid. Lawyers, business executives, electricians, and plumbers (to name but a few) will all be allowed to command what the market will pay for their services-but not you. Simply because it is possible that a majority may be found who think this scheme is a good idea, you may lose all the benefits of offering your services in a free economy.

Is this situation really fair? Have your fellow citizens honored your inherent rights and freedoms? They have not, and this why a public option is so offensive. It represents a move by a majority of citizens to control the economic well-being of a person who has endured extraordinary hardship and trials in order to become a much-needed provider of medical services.

View all comments (27) | Leave a comment

Pete| 8.19.09 @ 8:19PM

This is my biggest fear...why would anyone invest the kind of time and money necessary to become a doctor just to have some "czar" or bureaucratic committee tell them what to do? The best of the best who remain will move off shore or find a way to provide their services only to the rich.

Heather| 8.19.09 @ 10:00PM

Years ago a good surgeon saved my life when my appendix ruptured. I was only 30 years old and I had a nursing infant dependent upon me. It was a nightmare that I barely survived: But because of one good doctor I did survive and will be forever grateful to him.

How dare these wretched politicians insert themselves between the American people and their doctors.

Aric Giddens| 8.19.09 @ 10:06PM

I am a doctor and I'm mad as hell. I hate dealing with insurance companies but I'll take that pain over dealing with government bureaucrats any day. The President's idea is not about healthcare reform or insurance reform, it is about more government control. We must stop this power grab. And lets all stop referring to the "public option" and call it its real name, "government plan."

Henry | 8.20.09 @ 7:18AM

I too, an m a Physician and Obama and "his" plans scare me to death. However, I recognize that the Government already controls my fees through Medicare rates, which are used by other insurance plans as a benchmark to set rates.
Any one who is pursuing the practice of Medicine to become "wealthy" is in for a deep dissapointment if Obama is successful.
I for one would take even a reduction in my fees if it would come as part of a simple, market-based solution with significant reductions in government mandates, paperwork, and risk of being sued.

Bob| 8.20.09 @ 8:35AM

As usual, we talk about rhetoric, not fact. Here is a chart that shows the median salary for physicians by years of experience:

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_/_Doctors/Salary/by_Years_Experience

Is there anyone out there that believes an AVERAGE salary of $130K per year for a doctor does not reimburse him/her for their school expenses?

All doctors are not stars. Being a physician is a business. Just because you have a degree, does not mean you are automatically ENTITLED to high salaries. Those who have great talents AND, JUST LIKE THE REST OF US, CAN MAKE THAT INTO A BUSINESS THAT ATTRACTS CLIENTS, should make a lot more money.

Many of us have advanced degrees from expensive schools, but we are not ENTITLED to a salary -- we must EARN it.

Interestingly enough, doctors in the U.K., where they have socialized medicine, earn an average of $115K per year. That is not a significant difference, and may even be slightly better given malpractice insurance rates in the U.S. vs. the U.K.

Thus, there is no factual basis for the argument that doctors will be worse off with a single payer system -- only rhetoric and ideology.

When Republicans start using factual analysis rather than scare tactics, we may regain the high ground.

Tim| 8.20.09 @ 10:10AM

No wonder they want to cut out our tonsils...

Eric Cartman| 8.20.09 @ 10:21AM

ALL BOW DOWN! THE MIGHT "BOB THE EDUCATED" HAS SPOKEN AND SUPPLIED YET ANOTHER LINK TO SUPPORT HIS CLAIMS! YOU MUST OBAY THE LINK! YOU UNEDUCATED DOCTORS WHO DON'T LIKE BEING TOLD THE LIMITS OF YOUR PAY AND DESTINY OF YOUR CAREER SHOULD BE HAPPY WITH YOUR MEDIAN INCOME! BOB THE EDUCATED HAS SPOKEN! HE OF THE OBAMA LACKEYS AND "RESONED" REPUBLICAN DEBATE DEEM THAT YOU UNEDUCATED DOCTORS MUST OBAY! ALL BOW BEFORE HIS RAYS OF KNOWLEDGE, OR "BOB THE EDUCATED" WILL WHIP OUT ANOTHER CHART/GRAPH AND/OR WEB LINK! GO NOW, YOU UNWASHED PEASENTS!

Bob| 8.20.09 @ 11:00AM

Well, Eric, facts are stubborn things and are the only way we can get resolution. And yes, if you are educated you should be able to utilize factual information. I find it humorous that a "conservative" like you doesn't believe that someone should EARN an income -- even if you are a doctor and that those who have a better business model should earn more. I think they call that capitalism.

Eric Cartman| 8.20.09 @ 12:14PM

ALL HAIL “BOB THE EDUCATED”! HE OF A HIGHER KNOWLEDGE PLAIN THAN THEE! ALL YOU KNAVES WHO BELIEVE THAT “FACTS” CAN BE TWISTED TO FIT AN ARGUMENT ARE KNUCKLE DRAGGING TEABAGGERS! OR THE “FACTS” “BOB THE EDUCATED” USES MAY HAVE NO BEARING ON THE ARGUMENT AT HAND ARE PIFFLE PUSHING NEO-CONS! ALL YOU UNEDUCATED DOCTORS HAVE NEVER HEARD OF THAT MYSTERIOUS THING CALLED A “BUSINESS MODLE”, AND THERE ARE NO WORTHWHILE COMPANIES THAT CREATE BUSINESS MODELS FOR PHYSICIANS AND HOSPITALS, ALL BUT FOR “BOB THE EDUCATED”! HE OF THE “BUSINESS MODEL” MT. OLYMPUS! AND YOU SHALL ONLY USE THE “FACTUAL INFORMATION” “BOB THE EDUCATED” DEEMS WORTHY, NOT YOUR QUASI FACTS FROM SARHA PALIN, ALTHOUH SHE HAS NOTHING TO DO WITH THIS ARGUMENT I FELT I SHOULD THROUGH HER IN FOR GOOD MEASURE! ALL YOU UNEDUCATED DOCTORS NEED “BOB THE EDUCATED” AND OBAMA’S RX FOR A BETTER HEALTH CARE SYSTEM! (LIKE HOW I THREW THAT RX IN THERE HEE HEE HEE – I KILL ME!) GENUFLECT BEFORE OUR “BUSINESS MODEL”! WORSHIP OUR “BUSINESS MODEL”! HUG OUR “BUSINESS MODEL”! NOW BE GONE WITH YOU, YOU UNEDUCATED DOCTOR RABBLE ROUSERS OR I SHALL WHIP OUT A CHART THAT SHOWS YOU DESERVE NOTHING FOR YOUR UNEDUCATED DOCTOR STUFF!

L. Ross| 8.20.09 @ 12:32PM

Bob:

I gotta say, I think you missed the boat on this one. But then, I don't know what your relevant life experience is.

I'm not a doctor (nor do I play on on TV), but I am a pilot, and there are some similarities. Both doctors and pilots (and I mean multi-engine jet types, not bugsmasher dudes) are highly motivated, intelligent individuals who make life and death decisions in real time on a daily basis. There is no reset button, no ability stop a jet in flight or stop the progress of a disease while you go home and figure out what to do. The vast majority of people want their pilots and their doctors to be the absolute best of the best, not some B student who just muddled through. Historically, both positions have paid well, and because of that, and because the qualifications required were so high, we did get the best of the best to take those jobs.

Maybe they weren't Wall Street's "masters of the universe", but these people are incredibly sharp. Heck, I even have a friend who is an Air Force Reserve pilot and a dermatologist. Freaking genius.

In addition to attracting sharp people, both professions are filled with continual education, testing, retesting, and study. You not only have to be great to get there, you have to more than maintain that standard. But, as noted in the article, the payoff for doctors doesn't start until you are in your 30's. For pilots, it usually doesn't start until you are in your 40's. Keep in mind, when you hear of the outrageous salaries of pilots on "60 minutes" or some other show trying whip up envy, pilots only make money when the plane is in motion, and are limited to 1000 hours of plane in motion time/year. Your typical day is easily twice as long as your flight time, so often over half the time you are at work, you aren't getting paid. Annual salaries for airline captains are now about in line with what I saw for experienced doctors, but only at a few majors. Commuter pilots make less than what a kindergarten teacher makes.

I guess the point I'm trying to make is that both pilots and doctors love their jobs, but they need large salaries to make up for all the time they were making peanuts. Flight time is over $120/hour in anything, and you need thousands of hours to be competetive. Medical school is equally expensive.

So, no, Bob, I don't think that the salaries I saw for doctors are all that high at all. Let's put it another way. Call up a plumber, and check his hourly rate. Bet it's close to $90/hour. I pay my aircraft mechanic $70/hour. Those figures are in line with what a doctor makes.

Bob| 8.20.09 @ 12:57PM

L. Ross -- you get into dangerous territory when you try to value one occupation versus another. Teachers make $50K per year -- is that right? Garbage collectors in San Francisco make $80K per year -- is that right? A Wall Street trader who happens to get into the right division may make $10 million per year -- is he/she worth it?

Most doctors in private practices make between $250-500K and some into the millions. They make that because they not only have the education, but have also set up a business model. Doctors are in the top 10% of wage earners in this country with half of them in the top 3%.

We all make investments in ourselves. We are only worth what we can make. Sometimes, people don't make enough to pay back their education investment. In a capitalistic economy, that's OK. Why should doctors -- or pilots -- be any different? If you are a capitalist and believe in the market, then what you are paid is what you are worth.

I have a problem with conservatives, who believe in markets, saying that people are paid too much or too little.

By the way, I don't think doctors salaries are either too high or too low -- they are what they are and they are what they are worth. We can all overestimate our importance -- and usually do. So, I think it hypocritical that conservatives should believe that someone is worth more than the market is willing to pay.

Now, as an aside, I'll take one of your comments and apply it in a different manner:

"The vast majority of people want their pilots and their doctors to be the absolute best of the best, not some B student who just muddled through."

So why would we want a President who was some B (or lower) student who just muddled through? For example, Bush, McCain, or Palin. Isn't the Presidency a more important position? Furthermore, why would we even listen to a Limbaugh or a Hannity who don't even have that level of education?

Think about your argument from an ideological point of view, L. Ross.

Daisy| 8.20.09 @ 2:22PM

I believe that physicians are unique because they often are the difference between life and death: And they should be compensated accordingly. If you truly value your life how could you NOT feel this way?

I don't want some moron politician or attorney trying to determine my doctor's earnings. It's none of anyone's damn business but my doctor's.

I want my doctor to be successful and happy; don't you? Envy is ugly, envy destroys.

Bob| 8.20.09 @ 2:27PM

Then, perhaps, Daisy, you wouldn't mind paying twice as much for health care so doctors can be paid even more. After all, you don't have to believe in markets, right? If nothing is done, then in 7 years that is what it will be.

Nobama| 8.20.09 @ 2:29PM

We don't know Obama's grades because he's never released his transcripts (suspicious); but judging from his bumbling, incompetent performance so far, he's not so smart. In fact, the Joker looks more and more the idiot every day.

Harvard? I'm not impressed.

Daisy| 8.20.09 @ 2:32PM

Get the government OUT of the insurance industry and the free market will prevail. I trust the individual not the collective.

You are ugly, Bob, and you don't wear envy well.

Bob| 8.20.09 @ 2:40PM

Daisy, you don't seem to know much about the insurance industry. It is the most regulated industry on the planet. Rates are regulated. Coverages are regulated. Redlining is regulated. And currently, it is done on a state by state basis.

Thanks for the laugh....

Nobama -- you need an "A" average to graduate from Harvard Law with honors -- he graduated magna cum laude (which usually requires a 3.6 or 3.7 minimum. When we know the average, we don't have to see the entire transcript.

So who was the last "competent" President? According to economics, it was Clinton who governed over greater economic growth than even Reagan.

Pete| 8.20.09 @ 2:45PM

Bob was an executive in at least 15 different industries, so he knows everything. I wonder if he thought his compensation was too high? I am positive it was, given the crap he spews on these pages. Note the arrogance with which he writes - is it any wonder he enjoys the Mocha Messiah's condescending ways? How did you keep an executive job for 8 decades being a horse's ass, Bob? You must be one cunning fella.

And Clinton was just the beneficiary of Bush I's policies if Osama has nothing to do with our current shit storm. Can't have it both ways, Ace.

Bob| 8.20.09 @ 2:53PM

Pete asked:

"How did you keep an executive job for 8 decades being a horse's ass, Bob? You must be one cunning fella."

Exactly! Just like everyone else on Wall Street.

As you'd know if you had an ounce of comprehension, I don't believe that government affects economic growth. Tax cuts are not stimulative and neither is spending. Economic growth is the purview of private enterprise. Why else would you see continuous growth in GDP no matter who was President?

http://www.data360.org/dsg.aspx?Data_Set_Group_Id=230

L. Ross| 8.20.09 @ 2:56PM

Bob,
To start, I didn't say that doctors are underpaid, but I was responding to your line which implied to me that they are overpaid.

"Is there anyone out there that believes an AVERAGE salary of $130K per year for a doctor does not reimburse him/her for their school expenses?"

The point I was making is that for doctors, there is a lot of ground lost towards making a living, just like for lawyers, because their education continues when their peers are out earning a living. They need to make good money to make up for the fact that their earnings were so low (or non existent) for so long.

I appreciate what you are saying about education, but education and accomplishment outside academia are two different things. I for one, hated school, but brought home the grades I needed to get into the Academy. It wasn't until I was in flight school that I ever felt I was learning much worth while.

You rip on GWB for having middling grades in college, but no one goes to college to learn to be president. They don't offer that course of study. I would argue that life experience trumps grades handed out in an artificial environment like school.

Successful businessman, successful govenor, two term president. Kept America safe after 9/11. Those are not small accomplishments. I know you don't like him much, frankly, I found him a disappointment on everything but killing muslims, but I would take him over BHO in a heartbeat. I find BHO's smirk far more offensive than GWB's smirk.

I don't know much about the education background of Ronald Regan, but I don't this it was exceptional. He did seem to do a good job as president, however. Jimmy Carter, with his Naval Academy education, not so much.

As far as Limbaugh and Hannity go, I find Hannity to be shrill with limited range. Limbaugh I find to be very impressive on a number of issues, but often very weak on science. His politcal insight is, however, very sharp.

Daisy| 8.20.09 @ 3:09PM

The joke's on you, Bob--I said to get government OUT of the Insurance Industry, so obviously I'm aware that it's regulated. Moron.

Pete| 8.20.09 @ 3:14PM

Stay on topic, Bob. Remember, you tried your "mini-graph" diversion last time and it got you nowhere.

Why, oh why, do you begrudge a doctor a decent/high salary? Even you, Bob, are worth what someone is willing to pay you in a capitalist system. Getting the gubmint involved will put downward pressure on their compensation artificially, and many folks will just chose not to become doctors. I don't want to get treated by a doctor who has to consult a federal handbook before making a recommendation. As I said to start this string, getting the government involved will cause a shortage of doctors overall, and cause the best ones to move off-shore or figure out a way to provide their services to those willing to pay what they are worth.

Bob| 8.20.09 @ 3:18PM

L. Ross -- grades are indicative of a learning personality. People who work hard in school are more likely to work hard in their occupation. Obviously, there are exceptions, but they are not common. Besides, school shows affinity for certain subject matter. Palin, for example, received a "D" in macro-economics by her own admission. If she doesn't have an affinity for economics, how is she going to make good economic decisions. She didn't study much in school and she has shown that she doesn't study much now. Do you really want a President who is not intellectually curious?

Bush was NOT successful in any business venture he tried with the exception of baseball. There his job was fundamentally partying -- which he had done well all of his life. He would not have even gotten that job without his father. All of his other business ventures failed.

For President, I would have preferred Romney over either Bush or Obama. In the primary I voted for Ron Paul. But I could not bring myself to vote for a ticket that had Palin on it.

I admired Reagan for taking the years and time to study the issues. He always had an excellent work ethic and, growing up in Hollywood, he actually governed quite moderately. It has been 9 months since the election and Palin has studied nothing.

Carter's problem was that he was a micro-manager. He didn't know how to be an executive. But he was also a successful Governor as was Clinton.

We actually agree on Limbaugh -- he is most often wrong on many of the financial and scientific issues but he has keen political insights if put in perspective.

Bob| 8.20.09 @ 3:23PM

Pete, I guess you didn't read my post. I said a person is worth what he/she is paid -- no more, no less. That is what a market is all about. So where do we differ on that issue. Furthermore, markets will adjust as they did in the U.K. even if the government gets involved. It is called supply and demand.

Daisy, do you really want an insurance company who doesn't carry reserves? Without regulation, there wouldn't be any. Do you really want an insurance company that can pay whatever claims they like with no recourse? Without regulation, that would occur. You really don't know what you're talking about.

Daisy| 8.20.09 @ 3:33PM

Are you blind or just stupid, Bob? I told you that I trust my fellow individual American citizen more than a faceless, heartless government bureaucracy.

Let competition of the free market decide! Competition is the only way to keep business accountable. That's why I detest HUGE government--there's no way to hold the clowns accountable.

ObamaCare would be an absolute disaster for our country; surely we can do better than that Obomination.

Pete| 8.20.09 @ 5:11PM

You are correct, for once, Bob. I did not read your entire post...just the first paragraph and figured I could guess the rest. But you can forgive that oversight given your statement in an earlier post: "Thus, there is no factual basis for the argument that doctors will be worse off with a single payer system -- only rhetoric and ideology." You tell me, oh fountain of endless knowledge, how doctors will get paid more or even the same in a system where they are told what to do, where their specialties melt away in favor of government statistical analysis, and where the government is under pressure to cut costs? I'd say there is plenty more reason to believe my statement than your prophecy to Daisy of paying twice as much for healthcare in 7 years. Come clean, are you arguing FOR or AGAINST something here or just trying to annoy folks or perhaps get some superiority kicks you miss from your executive days?

Daisy| 8.20.09 @ 7:29PM

Pete, Bob the clown has been blogging here for almost a year and his goal has always been to annoy.

That's why I either ignore him or insult him--but never seriously engage him. He's an @ss.

Eric Cartman| 8.20.09 @ 8:06PM

SILENCE, YOU NATTERING NINCOMPOOPS OF NEGATISM! “BOB THE ALMIGHTY”, “BOB THE MERCIFUL!” “BOB THE EDUCATED” HAS SPOKEN! HE WILL THRILL THEE WITH HIS KNOWLEDGE OF ECON 101 AND BOGGLE YOUR MIND WITH COMPARING TEACHER AND GARBAGE MAN SALARIES, WHICH REALLY HAVE NOTHING TO DO WITH THE DEBATE AT HAND! WATCH IN AWE AS PEARLS OF WISDOM EMANATE FROM HIS BLOW HOLE! SUCH WISDOM AS “I DON’T BELIEVE THAT GOVERNMENT AFFECTS ECONOMIC GROWTH!” AND DON’T GIVE “BOB THE EDUCATED” ANY GUFF ABOUT THE SOVIET UNION, CUBA, OR THE PARADISE OF NORTH KOREA! GOVERNMENT HAD NO AFFECT ON THOSE PEOPLE OR THE ECONOMICS OF THE PERSPECTIVE CONTRIES! JUST KNOW THAT “BOB THE ALL KNOWING. CEO OF 142 FORTUNE 142 COMPANIES, INVENTOR OF AIR, RAP STAR, MAN ABOUT TOWN AND BON VIVANT” HAS BLESSED YOU WITH A SMALL GLIMPSE AT HIS WONDERMENT! YOU UNEDUCATED DOCTORS AND PILOTS CAN NEVER SEE THE NUANCE OF HIS WISDOM! YOU KNOW NOTHING UNTIL YOU GAZE UPON HIS GHARTS AND GRAPHS! FOR SHAME! HOW WE BOBOPHILES CLUCK AT YOU AND TUT – TUT YOUR FEEBLE MINDS! NOW LEAVE IN THE SHAME KNOWING THAT YOUR STATE UNIVERSITY DIPLOMA IS BUT TOILET PAPER COMPARED TO “BOB THE SUPER EDUCATED, MIND OF A SUPERIOR BEING” DIPLOMA! WE SPIT IN YOUR GENERAL DIRECTION!