Wednesday, June 13, 2012

Doctors Who Are In It For The Money

First of all, a little disclaimer. This is a purely personal opinion. You are free to vociferously disagree with any and all choices I've made in assembling this list. In fact, since we live in a free internet, you can go publish your own list if you so choose.

After practicing medicine for a decade, I've made some observations of why some people want to become a doctor. Sure we all told the medical school admissions committee that we want to be a physician to help people. But soon enough it becomes obvious that some people want to be doctors to enrich themselves. And there is nothing wrong with that. Who says doctors have to be altruistic all the time? No doctor ever took a vow of poverty. We certainly don't begrudge MBA's and JD's for wanting to make money so why should doctors be looked down on for doing the same thing?

But first I want to list the medical fields who are definitely NOT working for the money. They represent the purest examples of what people believe doctors should be. Not surprisingly most of them are in primary care. Unless otherwise noted, the income numbers come from Medscape's Physician Compensation Report 2012.

1. Pediatrics. These gentle souls are taking care of the next generation of humanity. They certainly deserve more recognition and income than what they are receiving now. Mean income: $156,000. Twenty-four percent make less than $100,000.

2. Family Medicine. They're busy treating every member of the family, cramming in 30-40 patients a day into their busy office schedules. They see everybody, from babies to geriatrics yet are paid a pittance. Mean: $158,000. Making less than $100,000: 23%

3. OB/GYN. Nobody goes into this for the money. The work is nerve racking. The risks are high. So many things can go wrong that is beyond your control. And lawyers are always just a phone call away. Mean: $220,000. Less than $100,000: 19%

4. Infectious Disease. This is the Dirty Jobs of medicine. They are treating contagious people all day while risking contamination to themselves or their families. You couldn't pay me enough to go into ID. Mean: $170,000. Less than $100,000: 14%

Now for my list of Dr. Moneybags. These are physicians who seem overly concerned about what kinds of cars they should possess, what type of insurance their patients carry, and how many free "educational conferences" they can wrangle out of their drug reps.

1. Cosmetic surgeons. Notice I don't lump all plastic surgeons in here. Many plastic surgeons do wonderful work on burn patients and cleft lips. But cosmetic surgeons are in the business of telling people they should be ashamed of their bodies which should be altered to fit into an idealized, homogenous world. They'll gladly accept any credit card you have to pay for the procedures. You only have Medicare? Too bad. You'll just have to stay ugly.  Mean income: $323,434.

2. LASIK surgeons. This field is all about the volume of patients. Thus there are the incessant radio commercials for the local LASIK surgery centers with their "Harvard trained" doctors and "latest" technology. They even advertise that they'll do a free insurance check and financing is available. Doesn't sound that different from a car dealer commercial. I was unable to find a reliable source for LASIK surgeons' incomes but at $1,000-$2,000 per eye, you do the math.

3. Dermatology. Such a hot field right now with medical students. Why? No calls. No emergencies. No life threatening illnesses. And like cosmetic surgeons, most of the patients are more worried about their looks than their actual health. No kid ever grows up thinking he wants to look at ugly skin lesions for the rest of his life, but once the income level is factored in, it suddenly becomes the must have residency in the country. Mean: $283,000.

4. Gastroenterology. A lot of gastroenterologists do life saving work treating severe GI hemorrhage, inflammatory bowel disease, or cholangitis. But all too many run GI sweat shops that aim to do 20-30 endoscopies in the morning, and just as many in the afternoon at a few hundred dollars or more per procedure. If that is not enough, more and more GI docs now want to own ambulatory surgery centers where they hire anesthesiologists on a salary so that they get a cut of anesthesia compensation too. Mean income: $303,000.

5. Spine surgery. Here is a field whose procedures have not been scientifically proven to be more effective than conservative management yet make some of the highest salaries in medicine. It also seems to regularly make the news in committing insurance fraud. So why are so many patients referred for all sorts of spinal fusions, laminectomies, and diskectomies? Is it to support their astronomical compensation? Mean income: $688,500.

Some people may scoff and ask where is anesthesiology in the category of money grubbers. With a mean income of $309,000 a year, our field is a ripe target for the jealous and the ill-informed. However, I submit that anesthesiologists are under compensated. It is through the advances in anesthesia over the years that make much of modern medicine possible. Sure you can excise a skin lipoma without anesthesia, but it wouldn't be pleasant. And obviously nobody would perform spine surgery without anesthesia and all the safety equipment in the operating room that makes the procedure possible. So, no, anesthesiologists aren't getting paid nearly enough for all the services we render. But then, we're not in it for the money.

7 comments:

  1. I had no idea spine surgery could be so lucrative...but I work in physical therapy and I have not heard anyone report positive results from spine surgery. That's just a personal observation of others' anecdotes, though.

    The timing of this post was interesting too, as someone on the SDN forums just asked if anesthesia was a good field to go into for the money. This person really, really wanted that $300k income.

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  2. Shocked you feel anesthesia doesent get paid enough:) The fact is the majority of anesthesia providers choose the field for the money.

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  3. Money doctors are usually the surgeons. They offer surgery which is not necessary just to earn money especially in the field of cosmetics. Inappropriate to do surgery just to look perfect, which some of them can lead to damage due to malpractice.



    Joan @ Doctor Websites

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  4. I had cervical spine surgery after the conservative treatments failed and it DID help. Spine surgery might be a big thing but in some cases it is needed.

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  5. I am one of the money grubbers listed above, my view of anesthesiology is far different than your view. You make more than many of the surgical specialists that you serve, you have less call, a more predictable day, hire CRNA's to do much of your grunt work. You might want to remember that without the general surgeons out there as well as the OB's, GI, ENT etc you would be only a pain specialist which isn't a bad gig (they make more than an anesthesiologist and have no call). Beware of the pot calling the kettle black!

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    1. Wow!!!!! I liked that comment!!!!!!!!!!

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  6. Wow great post!!!

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