In a post titled Ice Bergs and Ice Cubes last week I expressed my opinion that healthcare is at the core of America’s financial crisis, and that the profession of doctor is being corrupted by the medical industrial complex through the auspices of medical societies. Subsequently there has been discussion among Globe Community bloggers about physicians’ salaries, including speculation that, despite complaints about low Medicare reimbursement rates, medical specialists command such high incomes that they live in mansions. To that observation I commented:
Makes quite a contrast with the historical images of doctors, doesn’t it? Images like Doc Adams on Gunsmoke, Marcus Welby, M.D., or my great grandfather who made rural rounds in Berryville, AR, sometimes for free. Ah, those were the days.
What in fact is the financial picture for medicine these days? An article in Time Magazine sums it up well.
Under the present system, if you can call it that, physicians are generally graduating the educational pipeline with massive debt and are confronted with a Hobson’s choice on specialization:
In 2009, primary-care doctors earned a median salary of $191,401, according to the Medical Group Management Association’s 2010 physician-compensation report. Cardiologists earned a median of $457,310 and dermatologists made $385,088 — doctors who owned their practices earned much more, on average.
What are the motivations of students to become doctors? One would like to think that high on the list would be humanitarian compassion, and of all the types of practice it is the generalist that most closely relates to the humanity of the patient. However, if one tried to design a medical education system that would discourage generalists, it is the one we have:
In these tough economic times, most Americans would say that any of those (specialists) incomes seem high. In fact, the primary-care doctor’s gross is often far short of what they need to make ends meet. The average medical-school student graduates with $200,000 in loans, according to the American Academy of Family Physicians (AAFP). This doesn’t include their debt related to four years of undergraduate study. For some students the total debt burden can reach nearly $500,000 — a daunting sum that puts many of them off family medicine. “Money is a bigger influence on these decisions than most students will admit,” Luk says. Plus, specialties offer lifestyle advantages, like more time with family in the long run.
The Time article ends with this:
The recent passage of health care reform legislation offers some improvement to primary-care doctors, but doctors see it as insufficient. “The new legislation adds a 10% bonus to primary-care physicians’ Medicare reimbursement salaries. But this is nowhere near enough. We need to see a 30% to 50% increase in salaries overall to make any real change in the system,” says Dr. Lori Heim, president of the AAFP.
I submit that our medical system is broken. Medical costs are at the core of the financial crisis and are poised to spiral out of control, and at the core of the medical cost problem is a medical education system that is fundamentally flawed, both financially and morally. I frankly don’t know how it’s going to get fixed. The two political parties have an attention span of two years at the moment, and that discourages any fundamental fix. We need reform of medical education.
Government should, I submit, fund education for doctors just like they do for professional military officers at the service academies. That would remove the crushing debt and free up physicians to be motivated by service, not money. What leader will take up this cause?