Lots of people write about how “doctors work so hard.” But let’s look at it from an economics and value-creation perspective. I’m a neurosurgeon, so you know I do pretty well financially, but how much value am I adding to society? Here are a few examples: 1. A mail carrier couldn’t work because of a herniated lumbar disc. We’ll figure he makes $50,000/year. I operated on him; he goes back to work. That’s about $1,200 for taking out herniated disc. He has about 10 years until retirement. Do you think society and the patient are getting good value for my service? 2. A UPS guy falls in the sorting area and bonks his head. He probably makes $40,000/year. He comes to the ER lethargic with a subdural hematoma. I took out the subdural in the middle of the night. He went to rehab and was back to work three months later. If I don’t operate, then he dies or ends up in a nursing home. I operated, he went back to work. My work earns about $2,000 for operating, rounding on him every day for 10 days and then getting him back to work. He’ll work another seven years until he retires. Did I create value for this patient and society? 3. A nurse makes $80,000/year. She can’t take care of patients because she has terrible back and leg pain after walking 100 feet. I did a lumbar fusion for her mobile spondylolisthesis. That’s about $5,000 worth of surgery. She went back to work a month after I operated on her, and she’ll work without restriction for 10-20 years. Am I delivering value to society? 4. An accountant with Parkinson’s disease can’t work because she has so little functional time on medication during the day. She makes $100,000/year and probably saves her clients $1 million/year in taxes and expenses. I did deep brain stimulation for her, and now she can work all day for the next 5- 10 years. $5,000 worth of surgery. Is that good value creation for the patient and society? 5. A 40-year-old roofer owns his own business with employees, has a wife and two kids, develops a sudden, severe headache after a love sesh with his honey. CT and a subsequent arteriogram shows a ruptured aneurysm. We fix the aneurysm, take care of him for two weeks, and he goes back to work three months later. Craniotomy for an aneurysm pays about $3,500. What do you think? See the common thread here? If I do 250–300 cases/year, then what is the annual economic value of my service to society? What’s a fair salary for me considering that? $50,000? $500,000? $5,000,000? You can do the same thought experiment for any physician. What proportion of the value that I create should I extract? 5 percent? 10 percent? 75 percent? 103 percent? I’ll tell you that is quite a bit less than 10 percent. And I didn’t even have to talk about 15 years of postsecondary education and training. Source
