Working Conditions for American Doctors

Fewer than half of American doctors, survey data show, feel that they are paid enough. The least satisfaction with pay is found among the doctors who are paid the most, orthopedists and general surgeons.

It seems hard to make a case, however, even when the cost of medical school is a couple hundred thousand dollars, that doctors in the United States are unfairly compensated or unable to achieve a high standard of living. Many people, after all, somehow find ways to make ends meet when they are taking home over $100 per hour. However, maybe the vicissitudes of American medicine are felt in other ways. The Medscape survey of nearly 20,000 doctors looked at this possibility, too.

• Some specialties are more "open" to women practicing medicine than others. Only eight percent of US proctologists, for example, are women. Women are greatly underrepresented in cardiology, orthopedics, radiology, and general surgery. On the other hand, 50 percent of American gynecologists and pediatricians are women, and women make up about a third of psychiatrists, dermatologists, and primary care physicians.
• Very few primary care providers spend more than 20 minutes per patient. However, only three percent of primary care providers spent less than 10 minutes per patient.
• Some specialties are especially prone to dissatisfaction with the profession of medicine. Only 50 percent of orthopedists (who earn on average $421,000 per year before additional fees averaging $29,000 per year) and 51 percent of plastic surgeons (who earn on average $354,000 per year before additional fees averaging $26,000 per year) said they would choose medicine as their profession if they could repeat their life choices. One has to wonder what jobs they would choose instead of medicine, perhaps hedge fund manager or cocaine kingpin? Of the lower-paid specialists, only 25 percent of primary care providers said they would choose the same specialty again.
• Ten times as many doctors in 2014 as in 2011 practiced in "accountable care organizations," or ACOs. About 30 percent of American doctors were involved in ACOs at the end of 2014. An ACO is a group of healthcare providers who agree to take responsibility for a defined group of patients, controlling costs while achieving good health outcomes. A doctor in an ACO may be paid more if a diabetic patient maintains good blood sugar levels by having lower HbA1C readings, and less if the patient is diagnosed as uncontrolled. A doctor in an ACO may get more money if patients are not admitted to hospital, and less if they are. When patients can only get insurance that covers them for ACOs, then doctors have to join ACOs. This usually means they have to sell their practices to hospitals, and start taking a salary rather than earning a (usually higher) solo practice income.

See Also: Doctor Suicides: A Growing Epidemic

Money issues seem only to drive dissatisfaction. Most doctors want more and more. However, doctors are happy when their patients get well and express gratitude for their care. In an extraordinarily greedy culture in which individuals almost never can afford this basic human right from their own labor, perhaps all patients can offer is their appreciation.