why doctor salaries unequal

8/9/2019 Why Doctor Salaries Unequal

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‘It’s not fair!’ Why are some doctors paid more

than others?

JULY 15, 2013

tags: Anaesthetist, Anaesthetist salary, Anesthetist, cardiologist salary, doctors income, Emergency

Medicine, Emergency Physician, General Practitioner Salary, mergency Physician salary, orthopaedic

surgeon salary, paediatrician salary, radiologist salaryFrom a mile away all doctors look much the same, but get up close and it turns out that they come in many

shapes, sizes and disciplines. The differences are never more starkly revealed than by a quick glance at

their tax returns at the end of the year.

Then you will find considerable variation based, not on how smart, hard-working or dedicated they are but

on where they are located in the world and which particular medical career path they happened to have

stumbled down.

A recent article in the Sydney Morning Herald (http://www.smh.com.au/data-point/road-to-riches-

paved-with-good-incisions-20130503-2iyi0.html) highlighted a couple of things. Firstly, compared to thetypical Australian wage earner (with an average taxable income of $51,342) doctors are paid pretty well –

at least three times as well to be precise.

But within the Australian medical profession itself it turns out that surgeons earn an average of $350,000

compared to the average medical practitioner at $155,000 per annum – between 2-3 times higher.

Have a look overseas and much the same pattern exist within most developed countries. The United States

(http://www.webmd.com/news/20120424/best-paid-worst-paid-doctors) for example where

radiologists and orthopaedic sugeons earn, on average, at least twice the income made by paediatricians.

Even in the United Kingdom (http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-

doctors/), where socialised medicine would be expected to even things out there is a considerable

difference in the value that employers put on different specialties.

There is little online to explain why these differences exist beyond the argument that some specialties

require more training than others. This alone however does not explain such a wide gap opening up once

graduates leave medical school.

The magic ingredient seems to be private medicine. Even the smallest capacity to earn outside of the public

health system, within any given country, upsets the applecart by offering doctors a competitive alternativeto staying 100% on the public payroll. Other market forces come into play that set relative incomes based

on harsh economic reality rather than deserved reward. Here are a few that I observe :

1. Specialist pays better than generalist: A good GP knows something about everything whereas a

http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/http://www.webmd.com/news/20120424/best-paid-worst-paid-doctorshttp://www.smh.com.au/data-point/road-to-riches-paved-with-good-incisions-20130503-2iyi0.htmlhttp://offthescript.com.au/tag/orthopaedic-surgeon-salary/http://offthescript.com.au/tag/paediatrician-salary/http://offthescript.com.au/tag/orthopaedic-surgeon-salary/http://offthescript.com.au/tag/radiologist-salary/http://offthescript.com.au/tag/emergency-medicine/http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/http://www.webmd.com/news/20120424/best-paid-worst-paid-doctorshttp://www.smh.com.au/data-point/road-to-riches-paved-with-good-incisions-20130503-2iyi0.htmlhttp://offthescript.com.au/tag/radiologist-salary/http://offthescript.com.au/tag/paediatrician-salary/http://offthescript.com.au/tag/orthopaedic-surgeon-salary/http://offthescript.com.au/tag/mergency-physician-salary/http://offthescript.com.au/tag/general-practitioner-salary/http://offthescript.com.au/tag/emergency-physician/http://offthescript.com.au/tag/emergency-medicine/http://offthescript.com.au/tag/doctors-income/http://offthescript.com.au/tag/cardiologist-salary/http://offthescript.com.au/tag/anesthetist/http://offthescript.com.au/tag/anaesthetist-salary/http://offthescript.com.au/tag/anaesthetist/


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knee surgeon knows everything there is to know about a very small number of things. Specialization

attracts better rates of pay in all professions and medicine is no different.

2. Intervention pays better than intellect: Every radiologist and cardiologist knows that they can add a

hefty percentage to their salary if they add the word ‘interventional’ in front of their title. Which leads

to my next point…

3. Procedural pays better than hourly rates: Any management consultant will tell you that, if you want

to make money you must charge per service and not on an hourly rate. In medicine this plays out in the

difference between what a gastroenterologist can charge a patient for a half hour procedure versus aone hour consult (the former being generally much more than the latter).

4. Rich patients pay better than poor: Sadly, much of medical science, pharmaceutical research and

clinical practice is focussed on conditions suffered by patients that can pay – hence erectile dysfunction

research is better funded than malaria research. Similarly, cardiac surgery pays better than paediatric

surgery, given the demographic of the patients.

5. Diagnostics pays better than treatment: Borrowing from point three, diagnostic specialties can

execute a lot of transactions, charging per item rather than on time, and so can generate income faster

than more involved therapeutic specialties. Also less face time with patients frees up time for billable

activities.6. Acute pays better than chronic: An acute event like a broken bone or a myocardial infarct will tend

to cost more to treat than a chronic condition. Patients with a chronic or degenerative disease are often

financially vulnerable and have limited capacity to pay for private health.

7. Elective pays better than emergency: Any specialty where patients can be predictably lined up in

advance for sequential treatment, such as with a colonoscopy list, can afford to pay it’s practitioners

more thanks to inherent efficiency, plus a little bit of point three again. Compare that to emergency

medicine which, by its very nature is unpredictable and also cannot take advantage of the natural

filtering afforded by point four.

8. Talent restricted pays better than talent oversupplied: Touching on point one, specialty training

numbers are generally controlled by a regulating body (college or board) that are often keen to make

sure that there is not an oversupply of doctors in that specialty in the marketplace. Anything that

artificially limits supply puts upward pressure on price, and so it is for specialist medical skills.

Many will find the above to be unfair – I have spoken to many an aggrieved emergency medicine specialist

or paediatrician over the years about the ‘outrageous inequity‘ in pay they experience compared to their

surgeon and anaesthetist colleagues.

But then there were likely many non-financial reasons why they chose that specialty in the first place. It is

no secret at medical school that you will make more money reading MRI scans all day compared to caringfor GP patients in the community.

So pay in medicine seems to be inherently unequal, at least in any country where there is at least some

component of private medicine to invoke the power of the market.

I have not touched on the geographical aspects of pay differential

(http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?

_r=0http://) in this blog, but if it makes you feel better about pay inequity spare a thought for Cuban

doctors who, by all accounts, are amongst the best trained in the world, and most equitably paid within

their own country – cardiologists and pediatricians do get paid much the same. They all earn about $600(http://www.nytimes.com/2009/08/04/health/04cuba.html?pagewanted=all&_r=0) (yes – six hundred

US dollars!) per annum.

Food for thought.

http://www.nytimes.com/2009/08/04/health/04cuba.html?pagewanted=all&_r=0http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0http://


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health care even when 15% population is uncovered. A section of society is living in islands of wealth

even after paying medical school debt, malpractice insurance though all this is actually paid by patients.

I really respect this profession but a combination of players have made every user of medical care

wonder where it would stop.

REPLY

4. Dr Shanta Ghatak PERMALINK

July 21, 2013 10:27 pmAlthough I completely agree that some doctors have fallen …but many too many save the lives many

have honed their skills spent hours weeks months years with grit and dedication at all costs …spent

their lives in building the right capacities getting that right amount of tension in the suture materials

when they open and shut the skull/abdomen/etc…it takes years to master the skills and at the end the

doctors really are left to die alone….who cares when they are old and cannot practice any more ?

Only money cannot be the only yardstick….doctors don’t spend time with family/children…..they

essentially machinise themselves in excelling beyond their dreams…..:)

REPLY

5. Raj PERMALINK

November 18, 2013 6:23 am

Well said!

MD, USA

REPLY

6. Ex NHS surgeon PERMALINK

March 5, 2014 3:19 pm

Hear, hear! Unfortunately what you say is becoming true right across the world. The banal comments

of Yakesh Khanna serve to confirm that the vast majority of the public, maybe even retired members ofthe medical profession itself, simply do not ‘get it’. Thank god neither of my daughters expressed even

the vaguest wish to go into the medical profession.

REPLY

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why doctor salaries unequal

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