Friday, June 30, 2006


Orac has responded to my comments on doctor salaries. He adds some bits of information I'll admit that I didn't know, which I appreciate. Before I get into a more detailed response, let me clarify one thing. Of course doctors should be paid for what they do, and given that they (especially surgeons) do some amazing things, they should be paid well. Believe me, I don't want my doctor worrying about where her next meal is coming from when she is operating on me.

However, I have two responses to Orac:

1) Orac commented that I had underestimated a physician's debt, as interest accumulates on medical school debt while new doctors are going through low-paying residencies and fellowships. Thus, a $100,000 debt rises (due to interest) before a doctor is actually earning enough money to start paying it off. A $100,000 loan at 5% interest will accumulate about $62,000 worth of interest in 10 years; at 7% it gains about $100,000 worth of interest. Thus, the debt of the average starting doctor is likely to be about $160,000 to $200,000. I will kindly direct Orac to my prior post, and point out that even with this interest, this is still much less than two year's income worth of debt (and, at $160,000, is still less than one year's salary for the average physician). The median income earner trying to buy a median priced house must still take on a far greater debt load.

Orac also points out that $100,000 is only the mean debt for newly minted doctors, and there is variation around that mean He is, most certainly, correct. However, I'll also point out that the $213,900 median home price also has variation around it. For instance, at least six counties in the Southern California region have a median home price of more than $350,000; some are nearly triple the national average (Orange County's median house price is $635,000; data from here). I can easily confirm that salaries in Southern California are not double or triple that of the national average. Ever tried buying a $600,000 fixer-upper house while earning less than $50,000 a year?

2) Orac also commented that students are not going into specific medical disciplines as a result (potentially) of the salaries. Commenters on his posts have also said that lowering salaries might scare the "best and brightest" students away from medical school. While I can't argue with these statements (though I would like to see the data, especially regarding medical school applications), I can share my own perspective as a community college biology instructor.

Many of the students who walk through my lab door want to go to medical school (though pharmacy is a close second; precious few are actually interested in biology for its own sake). The "best and brightest" almost always end up trying to go to medical school (though dental school gives medical school a run for its money among a few of the best of the best). These premeds jump through dozens of hoops and work insanely hard to try to make themselves the best candidates they can be, even knowing what awaits them in medical school and afterwards. Many will, however, fail to get into medical school (though some of those are, admittedly, not the best of the best). This makes me wonder if Orac's supply problem might not be dealt with better by letting more students into medical schools and training more doctors. At least from my side of things, there's no shortage of potential doctors out there.

If there is a shortage of doctors choosing to go into specific disciplines, then that is something we need to seriously examine. I am troubled by Orac's statements that surgical residencies are ending up with unfilled positions. However, I question whether salary is the only factor that matters; after all, Orac himself has said that few doctors go into medicine for the money. If this is the case, will worrying about salaries really help? Might doing things like training more doctors, reducing the workload on doctors (both during training and during their careers), and adding more perks to their jobs be a more fruitful method of approaching the problem?

No comments: