Why do some physicians rake in the cash, while others take home more modest incomes? A recent article on Medscape dived into this question and prompted earnest discussion among healthcare professionals. (Comments may have been edited for clarity or length.) More than a few physicians saw a high salary as largely the product of business acumen. A neurologist wrote: Formal entrepreneurial and business training should be included in med school curriculum. Ability to think outside the box will equip docs to increase their earning abilities. Although ethics, patient care, and job satisfaction should be the focus, there should be an appropriate reward for doctors in terms of remuneration. An obstetrician agreed, suggesting that "with digital methodology, business can easily be taught to medical students today, especially when almost every student has been primed in technology and computers." Several physicians, however, saw common sense as more important than formal business training. A retired doctor offered this view: You don't have to get an MBA to understand business. There are plenty of practical books out there on business principles. If you see patients in an efficient manner and minimize waste and keep overhead costs low, you can make a living without working 60 hours per week. But a primary care colleague had concerns about this approach, asking, "If the key is seeing more patients, the question is, what corners are being cut? Are patients being billed honestly; is the billing appropriate to what is being done?" And a radiologist suggested that business smarts frequently amounted to a kind of moral ambiguity: Most physicians I know who are more financially successful than others in their fields have somehow figured a way to milk the system. Thirty years ago, studies showed that a physician with x-ray machine in the office was twice as likely or more to order chest x-ray for chest symptoms. A pediatrician was baffled by peculiarities of the market: Academic versus nonacademic is a big driver for nonrainmakers. It has never made sense to me that in academics, some surgeons are making well above the average, whereas nonsurgeon academic physicians are often making only one third or two thirds of what nonacademic physicians earn. An anesthesiologist also saw problems with how money is often allocated: I trained as an anesthesiologist in pediatric cardiology but soon discovered that there is very much more money and very low risk in doing garden-variety D&Cs, hernias, and gallbladder operations for insured, healthy, young patients rather than uninsured open heart surgeries in sick crack babies with AIDS who are on Medicaid. It should be the other way around. But quite a few physicians, particularly those in primary care, bristled at the idea that money should be so central to the thinking of those in healthcare. One primary care physician wrote: We should be valued on the number of life-years saved (or improved). The family doctor who gets three people to stop smoking in 1 day ultimately saves more life-years and more money than the neurosurgeon who drained a subdural hematoma. Both are definitely needed, but to only value the deployment of technology at the end of the pipeline misses the entire point of the value of medicine to society. A colleague agreed: If making money is someone's goal, they should go into business or the financial sector. Medicine should be a profession of service, not of gathering wealth. The pursuit of wealth adulterates priorities and taints medical judgment. However, another primary care physician saw some room for self-interest in medicine, saying, "When your education costs $400,000 and you didn't come from a wealthy family, your check matters. The banks don't care about ethics." Yet another physician in primary care saw an upcoming crisis in the imbalance of compensation: As docs burn out on clinical practice and go into administrative positions, our shortage only deepens. It's disconcerting to hear that paper-pushers make more than skilled physicians. As such, there is even more incentive to leave active practice. A physician's assistant (PA) pitched a solution to weary doctors: Want to earn more money? Take more vacations? Want a life? Hire a PA, and train him or her appropriately. Treat your PA like gold, and your quality of life will improve dramatically. As the sole PA in a private practice, I am proud to say that my contribution allowed the MD/owner to triple his number of offices and hire three more MDs. Life is what you make of it. The final word goes to yet another primary care physician, who had this advice for those in his field, and beyond. "The greatest wealth is a joyful life—love what you do. Marry no more than once and avoid getting heavily leveraged, and any of our salaries, including those in primary care, can be adequate." Source
