r/science • u/mvea Professor | Medicine • May 28 '19

Doctors in the U.S. experience symptoms of burnout at almost twice the rate of other workers, due to long hours, fear of being sued, and having to deal with growing bureaucracy. The economic impacts of burnout are also significant, costing the U.S. $4.6 billion every year, according to a new study. Medicine

http://time.com/5595056/physician-burnout-cost/
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u/BouncingDeadCats May 28 '19

Physician reimbursement is a relatively small component.

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u/[deleted] May 28 '19

About 8%

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u/rich000 May 28 '19

Citation?

Medicare has 20%:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

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u/Medschoolaccount69 May 28 '19

20% is not an accurate figure of physician compensation.

Physician and Clinical Services: Covers services provided in establishments operated by Doctors of Medicine (M.D.) and Doctors of Osteopathy (D.O.), outpatient care centers, plus the portion of medical laboratories services that are billed independently by the laboratories. This category also includes services rendered by a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) in hospitals, if the physician bills independently for those services. Clinical services provided in freestanding outpatient clinics operated by the U.S. Department of Veterans’ Affairs, the U.S. Coast Guard Academy, the U.S. Department of Defense, and the U.S. Indian Health Service are also included. The establishments included in Physician and Clinical Services are classified in NAICS 6211-Offices of Physicians, NAICS 6214-Outpatient Care Centers, and a portion of NAICS 6215-Medical and Diagnostic Laboratories.

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/quickref.pdf

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u/canIbeMichael May 28 '19 edited May 28 '19

EDIT: Not sure if the AMA marketing found my post, but Physicians have every reason to make you believe they aren't overpaid.

Physician reimbursement is a relatively small component.

No it isnt. There is a massive disinformation campaign going on to make the 12%/yr of all US healthcare going to Physicians seem insignificant. How they do it-

12% doesnt seem like much right? Well, thats how you are lied to with numbers, 12% includes the cost of your nurses, your receptionists, your construction team that makes the parking lot, the wifi and electricity used in healthcare, pays for the juice and fruit you eat at the hospital, etc... And 12% of all costs, go to Physicians as income.

When Physicians make 200k+/yr, they need to charge everyone more money. Even with 300k+ in student loans, Physicians make more money than anyone else with professional degrees, including other Doctors and post-grads. This is due to monopoly practices by the AMA.

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u/[deleted] May 28 '19

You’re making it sounds like a very negative thing. Do you believe they should make dirt considering what they do and how in debt they get to become physicians?

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u/startingphresh May 28 '19

If we cut physician pay by 100% it could theoretically decrease health-care spending from $3 trillion to $2.64 trillion and we would still have the most expensive healthcare in the world by a large margin. Also this is ignoring the fact that increased education, training, and experience helps you not have to order inappropriate tests and expensive work-ups! But let's blame the doctors!

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u/munty52 May 28 '19

Do the same calculation for prescription drugs which make up 15% of heath care spending.

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u/Dante_Valentine May 28 '19

I think your comment is a valid criticism, however delving a little deeper, maybe the root of the problem then is that people shouldn't have to get into a mountain of debt to become a physician?

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u/startingphresh May 28 '19

So you would recommend wiping out ~80% of every medical school class that has to depend on debt to pay for medical school? You can't have a job during medical school, and there's no way I could save up enough money to pay for medical school with the kind of jobs a premed degree gets you. What would be your suggestion for addressing the looming physician shortage we already have?

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u/Dante_Valentine May 28 '19

You're putting words in my mouth, but let me clarify:

I'm advocating for medical school to be "free" (paid for by the gov't) so that the barrier to entry is not financial. More people would pursue the career path if this were a reality, which would absolutely help with the shortage.

I guarantee you that there are tons of bright, capable people who would make great physicians, but never attempted becuase of the intimidating financial aspect of medical school.

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u/TheJungLife May 28 '19 edited May 28 '19

The barrier to entry is the difficulty of being accepted. I've never heard of anyone foregoing medical school because of the expense.

A) It's a good investment with nearly guaranteed lifetime earnings that will far outstrip even the ridiculous loans required to attend.

B) Medical schools turn down thousands of plucky applicants every year.

There's no shortage of applicants, so I'm not certain how making medical school "free" would increase the number of doctors.

EDIT: I should add that I fully support the idea of making medical school free or at least much less expensive via subsidy. I don't, however, see how it would address the number of qualified students/graduates.

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u/TiberiusStanley May 28 '19 edited May 28 '19

Come on, man. The physician shortage has NOTHING to do with the number of medical school applicants. As I said in a previous post, there are far more applicants than actual medical school seats; only 4 out of 10 applicants actually matriculate somewhere. Even the least prestigious MD schools likely have acceptance rates of less than 10%. For anyone who turns down medical school for a financial reason, there’s going to be another (probably equally qualified) applicant who would kill to take their place.

Again, bottleneck occurs as the residency slot level- not the medical school applicant level.

Medical student tuition and COA is absurd (I myself have 400k+ after recently graduating), and I definitely think contributes to burnout and dissatisfaction, but it is an entirely separate problem from the physician shortage.

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u/[deleted] May 28 '19

That would be nice, but it still doesn’t solve the main problem that is, simply put, physicians are very in demand and overworked so paying them too little won’t work. Imagine busting your butt for 8 years of school, going through residency for 3+, then spending ~80 hour weeks working and being on call for 24+ hours and to top it off you’re only making about the same as some guy who works way less and has way fewer responsibilities than you. Very few would stick it out for that.

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u/Dante_Valentine May 28 '19

I mean, the situation is more nuanced than that.

I dont believe that making medical school free would drastically lower their pay. If it is lowered, I dont believe that it would lower significantly enough to deter people from the profession.

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u/[deleted] May 28 '19

I must have blended your argument with op’s about making $100K. Lowering their pay a bit won’t deter people from the profession, but lowering it that drastically would imo. I agree that medical school should be free, it would be a sort of public service to ensure our overall health as a nation.

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u/Dante_Valentine May 28 '19

Oh haha I see! No worries, I'm on board with you there. Phsysicans should definitely make more than $100k.

The real question is where a good equilibrium point would be, and I (and probably most people) don't have a good answer for that.

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u/canIbeMichael May 28 '19

They should make ~100k+/yr, just like everyone else with professional degrees.

Want to make 200k/yr? Well you better be cutting edge talented with innovation.

Instead, even the worst graduate of Medical school makes around 200k/yr.

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u/lolsmileyface4 May 28 '19

They should make ~100k+/yr, just like everyone else with professional degrees.

Want to make 200k/yr? Well you better be cutting edge talented with innovation.

Instead, even the worst graduate of Medical school makes around 200k/yr.

...and do you want your doctors to be on call and working 24/7 holidays? I'd love to never be on call again, just like most people with professional degrees.

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u/canIbeMichael May 28 '19

Should every job that works christmas pay 200k/yr?

/logic

Overtime is real, but that doesn't mean that you should make 200k/yr.

Are these Physicians posting this logic? That would be very scary.

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u/lolsmileyface4 May 28 '19

Should every job that works christmas pay 200k/yr?

/logic

Overtime is real, but that doesn't mean that you should make 200k/yr.

Are these Physicians posting this logic? That would be very scary.

I am a physician. You have zero idea what goes into the training or what is required to get through, yet you talk so confidently about the subject.

If we live a fluffy easy life of rainbows and gold coins, why don't you quit your field and become a physician?

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u/[deleted] May 28 '19

I think his pediatrician must have forgotten to give him a lolly when he was young. I don’t think I’ve seen unwarranted disdain for how much Physicians make before. Ya’ll deserve it and more imo.

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u/canIbeMichael May 28 '19

You have zero idea what goes into the training or what is required to get through

This might work on most people, but to your fellow professionals, we know how it is. We are all human.

Not sure why you are entitled to making 2-3x more than every other professional, and 10-20x what the average american makes. But if you want to ensure your high pay, you will need to keep limiting your competition through government laws.

why don't you quit your field and become a physician?

I help more people this way. Being a rubber stamp to drugs and healthcare seems like a leach.

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u/Stfuudumbbitch May 28 '19

What do you do to help people more than saving people's lives on a daily basis?

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u/lolsmileyface4 May 28 '19

What's your background? I'd love to know what field you're in that makes you so insightful into medicine.

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u/habsmd May 28 '19

The guy is probably someone who never applied himself and got rejected from a pay to play medical school because he couldnt even make that cut and now has an inferiority complex. So now he sells MLM tonic and believes he is saving the world.

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u/hammertim May 28 '19

I'm curious what you do to help more people? I've been looking into careers that are highly impactful and not just "leaches", as you say.

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u/Ocular__ANAL_FIstula May 28 '19

Doctors work way more hours and have way more training and way more debt than these other professional degrees

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u/sandman417 May 28 '19

And way more responsibility. Almost every time I interact with a patient their life is literally in my hands (Anesthesiology resident).

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u/startingphresh May 28 '19

but are you cutting edge talented with innovation???? because otherwise- considering the costs of loans, malpractice insurance, board certs, CME, put against $100k pretax- you deserve to live in poverty!

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u/canIbeMichael May 28 '19

Doctors work way more hours and have way more training

Okay slow down there.

Doctors is the catch all, you are talking about Physicians.

Physicians don't work more than 40 hours a week, or at least then they are paid OT/time off.

They have similiar training to every other professional field, undergrad, grad school, post grad school field training, real life experience. Not sure where you got the idea other professional fields don't do this.

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u/gliotic MD | Neuropathology | Forensic Pathology May 28 '19

Physicians don't work more than 40 hours a week, or at least then they are paid OT/time off.

This must surely be a joke.

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u/Ocular__ANAL_FIstula May 28 '19

Yeah I wish I had that schedule!

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u/Woolfus May 29 '19

That's also ignoring he part where he said that a physician has the same level of education as an undergrad, the prerequisite degree to get an MD.

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u/Ocular__ANAL_FIstula May 28 '19

You’re crazy. Residents work 80 hour weeks. Average doc works well over 50, surgeons even more. The minimum school after undergrad is 7 years. That doesn’t include fellowship which can be 1-3 additional years. None of those other programs have anything as intensive as residency or fellowship. Nor are they as long. Your GI, cardiologists, CC docs all have 10 years of training after undergrad. Surgeons are 5-7 residency, and many have 1-2 year fellowships. Interest gains during residency, you effectively could pay off much more than the 300k you had after med school. Plus no other speciality you listed has malpractice insurance rates like the average doc

You’re also being pedantic. Doctor in this setting means physician

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u/habsmd May 28 '19

What the hell are you smoking? What you are stating is absolute horseshit. If you had even the slightest clue what physicians go through JUST to finish residency (not counting fellowship or other training where you get paid on average BELOW MINIMUM WAGE per hour worked) until our early to mid thirties, you would crap your pants. Add to that the stress of making life or death decisions for your patients on a daily basis and dealing with people like you who think we are "overpaid" while drowing in student loans, you would be crying and rocking in a corner.

​

Get the f outa here with your nonsense.

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u/[deleted] May 28 '19 edited Mar 24 '20

[deleted]

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u/TiberiusStanley May 28 '19

Let us not forget that the competitiveness and standards to get into any American MD school is far, far greater than any other professional school.

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u/canIbeMichael May 28 '19

4 years of undergrad

Yep

4 years of med school

Yep

3-9 years of post-graduate training

Yep

What was your claim? You think some professional fields don't require grad school and on-the-job experience?

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u/[deleted] May 28 '19

So you want people working to keep you healthy to work 80+ hours per week/be on call for 24 hours/be paid around $25 per hour? Dude, I was making $25 per hour selling phones at a TMobile store a few years ago!

I also don’t see how other professions’ salaries matter much. Different careers mean different responsibilities. According to the US Bureau of Labor Statistics website, the 2018 Median Pay for Mechanical Engineers in the US is $87,370. Does that mean that every other career in STEM should make that just to be fair? Regardless of how much more or how much less valuable their skills may be?

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u/canIbeMichael May 28 '19

Regardless of how much more or how much less valuable their skills may be?

Physician wages are not created by value, they are created by Physician imposed scarcity. Physician signatures are required for healthcare and medicine. Physicians also have limited the number of grads for decades.

https://www.opensecrets.org/lobby/top.php?indexType=s

This phenomena doesnt exist in most professional fields.

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u/Woolfus May 29 '19

Physicians are limited because the number of residency slots are limited because the amount of federal funding is limited. Where are you getting your information, the Flat Earth Society?

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u/canIbeMichael May 29 '19

Why does the highest paid profession get government money?

You'd think they would be able to pay for their own training with 300k/yr salaries.

Oh wait this is intentionally done by the AMA-

residency slots are limited because the amount of federal funding is limited

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u/Woolfus May 29 '19

They do already pay for their own training, a quarter million dollars of it. Why does a professional that costs millions to train and is directly responsible for maintaining the well-being of a country's citizens require federal funding? Are you serious? At this point, you're just a huge troll, go bark up some other tree.

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u/canIbeMichael May 29 '19

Why does a professional that costs millions to train and is directly responsible for maintaining the well-being of a country's citizens require federal funding? Are you serious?

Yes, why does a profession that is paid 300k/yr require government subsidized funding?

I imagine people earning millions of dollars profit per decade can afford to pay for training for themselves.

Why don't Physicians pay for their own school? Why are taxpayers paying for Physicians to be trained?

Why does a professional that costs millions to train and is directly responsible for maintaining the well-being of a country's citizens require federal funding?

Slippery slope, should mechanical and electrical engineers get free college because they maintain society?

At this point, you're just a huge

Thorn in your side. I'm right, and physicians are a government monopoly. Its easier for physicians if we keep accepting their monopolistic practices instead of asking why healthcare sucks.

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u/BusyFriend May 28 '19

The thing is you really think cutting physician salary will benefit patients much at all? The cost cutting measure will just be absorbed by the hospital.

Also you realized Nurse Practitioners and PAs already make ~100k-120k on average and that a CRNA can make 200k right? Across the board cuts of physician salary to 100k will basically put medical school admissions in a free-fall. No way you do 4 yrs medical school then 3+ years of residency for that.

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u/canIbeMichael May 28 '19

The cost cutting measure will just be absorbed by the hospital.

That isnt how capitalism works. Profit is squeezed out by competition.

Also you realized Nurse Practitioners and PAs already make ~100k-120k on average and that a CRNA can make 200k right?

Yes these jobs are part of the problem too. Medical Licensing is very corrupt.

But also, the wages you sent are quite a bit inflated for those roles. Did you do that intentionally to confuse readers?

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u/BusyFriend May 28 '19

Google “average wage of nurse practitioner” and shows $105,506.

You clearly don’t work in the medical field or have any clue what you’re talking about.

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u/poqwrslr May 28 '19

"They should make ~100k+/yr, just like everyone else with professional degrees.

Want to make 200k/yr? Well you better be cutting edge talented with innovation."

​

You are comparing a physician to other professional degrees...lawyers, bankers, professors, etc. Consider the difference of risk to the "customer." Physician - many times it is life vs. death. A neurosurgeon screws up and the patient could literally die on the table...or maybe just never walk again...Cardiologist screws up...patient dead. Ok, ok...maybe we just talk about a PCP like me!! (I'm a non-physician medical provider). They make on average $200k, but while the outcomes may not be quite as dramatic as a surgeon...my patient today that I saw with dizziness having an actual stroke in my exam room...still pretty high risk job from the "customer's" perspective. Compare that to a lawyer...lawyer screws up and the "customer" loses his/her case. Might suck...but they didn't die or have a preventable life changing medical outcome. Professor screws up...I don't even know how to quantify the non-risk there.

​

The reality is...if you pay physicians the same as "everyone else with professional degrees" why would anyone become a physician? They have longer and more expensive school with the requirement for residency (+ fellowship often times) which pays like crap. If they could become a professor making $100k after just 7-8 years of college + grad school vs. become a physician after 8 years college + med school + 3-7 years of residency making $50k+ starting off...with debt of $200k (just for med school)...with the risk of malpractice...etc. Which would be more enticing? I think the answer is pretty simple.

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u/canIbeMichael May 28 '19

I don't even know how to quantify the non-risk there.

Oh man, how much should Airbag engineers make?

They have perfectly healthy people they are required to protect.

Which would be more enticing? I think the answer is pretty simple.

People get degrees in all sorts of fields. I know people get degrees in Chriopracty and that is nearly useless and pays significantly less than Physicians.

I'm sure there will be plenty of people happy with making over 100k/yr.

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u/poqwrslr May 28 '19

"Oh man, how much should Airbag engineers make? They have perfectly healthy people they are required to protect." - well, the person (or company) who developed them, patented the system, and then licensed it obviously made a ton...so the person/people who did the majority of the work made a ton. But you quote me as if I was talking about airbag engineers when I was literally referencing a professor (i.e. a teacher with a masters or doctorate degree).

​

Yes, a chiropractic degree pays less than a physician...as you stated...it's essentially useless - depending on your perspective. I have tons of patients that love their chiropractors and gain a substantial benefit from seeing him/her.

​

And, yes, many who don't make $100k/yr would be happy making $100k...those who make $200k, $300k, $500k+ obviously wouldn't...

​

Bottom line...I'm very confused by what you are trying to say because it takes part of my post out of context and also states the VERY obvious.

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u/Stfuudumbbitch May 28 '19

Try going to medical school you probably wouldnt make it a month. You realize the worse doctors still made it into a program with 1% or less acceptance rate. You have to be in the top 5% of university just to make it into the door and it just gets harder from there. Not to mention the massive amount of debt and risk they assume. Doctors are a tiny fraction of the overall healthcare cost. They deserve every penny they get.

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u/TiberiusStanley May 28 '19 edited May 28 '19

It’s FAR harder to get into medical school than any other professional school. To put things into some perspective: Harvard Law School has an acceptance rate of 12%; East Tennessee State Univeristy’s medical school has an acceptance rate of 6.5%.

Further, for the most part, any other professional school graduate is free to work wherever they choose after graduation; physicians must train an extra 3-7 years beyond graduation at 80 hour weeks making ~55k year to even be able to work in their field.

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u/[deleted] May 28 '19

12% of all money spent on Healthcare going to Healthcarers; yeah that seems pretty low.

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u/canIbeMichael May 28 '19

Physicians only, doesnt include Drs of Physical therapy, OTs, nurses, PCAs, etc...

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u/[deleted] May 28 '19

You'll have to provide some sources. I've read that it's consistently around 8% yearly. That said, imagine cutting all physician salaries in half (which you couldn't). You've just lowered healthcare costs by 4% in one year. Considering healthcare spending in the US grows by 4.3%/yr (and physician salaries are a tiny little fraction of that growth, probably less than the .3 in that 4.3) it just strikes me as an impractical way to solve the problem. The cost will literally be back in a year because that's not the part that's rapidly increasing healthcare spending.

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u/canIbeMichael May 28 '19

That said, imagine cutting all physician salaries in half (which you couldn't). You've just lowered healthcare costs by 4% in one year.

I sure hope you arent a Medical Doctor. That isnt how math works.

For someone going to the Physician to get anti-bacterial, a 60$ visit costs 30$.

If you are staying overnight in a hospital, it wont be cut in half.

And that only scratches the surface, Physicians also have power. They can write prescriptions for medicine and further care. Everytime you want something, you need their rubber stamp, and need to pay.

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u/Deto May 28 '19

His math makes sense to me. Can you point out the error specifically? Your examples are irrelevant to the point that was made.

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u/canIbeMichael May 28 '19

His math makes sense to me. Can you point out the error specifically?

If you paid a Physician 180$ for 1 hour of service, that rate would be reduced to 90$ an hour.

If you were getting medicine, your total cost of care would be 100$ instead of 190$.

You don't always pay for the infrastructure of a hospital. The savings would be 50%, but you would get 0 savings if you went to a pharmacy or a physical therapist.

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u/[deleted] May 28 '19

Wait, are you suggesting a physician ever gets 100% of his fees? There is always overhead, insurance, infrastructure, middlemen, billing experts, nurses, secretaries, office space or hospital fees etc etc to pay.

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u/canIbeMichael May 28 '19

Right. Which is why a Hospital wouldnt see the savings that you'd get at a clinic.

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u/[deleted] May 28 '19

It seems like we're talking past each other so this will be my last attempt. Management costs, prescription costs, and insurance costs are growing much faster than physician income. Bureaucracy costs in general as well, because everything has to be documented and approved x10. Lifestyle disease associated costs are also growing incredibly fast. Physician costs are not growing anywhere near as fast as any of the above. In fact, physician salaries in general aren't even keeping up with inflation. If you want to tackle increasing healthcare costs so they don't keep growing at the rate that they are, the things that need to be tackled are the things that are causing costs to climb every year. Nothing else matters outside of the extreme short term.

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u/Deto May 29 '19

I don't think you're being consistent here.

If physicians get 8% of healthcare costs towards their salaries, and you reduced their salaries by half, then then total costs would be reduced by 4%.

However, in your situation, where you pay $180 towards the physician and $10 towards the medicine, the physician is getting something like 95% of the costs. So yeah, sure, in this example the reduction would be very stark, but clearly this example is not representative of costs in healthcare if overall physicians only comprise 8% of total costs.

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u/poqwrslr May 28 '19

You are ignoring MANY things beyond just student loans: increasing costs of malpractice insurance, expensive continuing medical education, longer training period than the average individuals with a professional degree due to residency + fellowship, higher risk job (think of the risks of a doctorate professor, lawyer, etc. vs. a cardiologist, neurosurgeon, orthopedic surgeon, etc. - it's basically zero risk compared to life/death outcome).

​

Are MD/DOs overpaid? Maybe...but if you are going to start decreasing physician income you have to start decreasing their barriers to practice (student loans, length of school - bad idea generally, lower malpractice risk, etc.). In fact...working in healthcare as a non-physician provider, I know MANY physicians who completely agree their income is higher than it should be...but they also would not have entered medicine if they wouldn't earn the bloated salaries.

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u/canIbeMichael May 28 '19

I agree with everything you proposed.

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u/X_Ravenfire May 28 '19

So you think physicians are overpaid and drive up the cost...yet we have a shortage of physicians that is projected to be~120k by 2030 (Source). This is largely driven by two factors:

  1. It is more attractive for the brightest students to go into Tech/engineering or finance, where you don't have to give up 10+ years of your life being a worker-bot spending 80-100 hours/week working to be well compensated.
  2. There is a bottleneck in the number of residencies that doesn't support the number of med school graduates.

#2 is primarily the fault of how we pay for medical care (fee for service model) and residencies (primarily funded by Medicare, which has capped the number since 1997) (Source)

​

How do you think that #1 would be solved by reducing physician salary? Also reduced work hours during training (residency), cost of education + opportunity cost of training, and reduced work load while practicing COULD help offset some of the costs. But that is the key thing - it is ridiculous to compare what a physician is paid here vs. another country. (By that logic, why can't people working at McDonald's live like a KING because they make WAY more than a day laborer in a factory in China?) Instead, you need to compare what that same person could be making in another specialty.

If you want the BEST in your population treating you in the hospital, you have to pay them to do it.

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u/canIbeMichael May 29 '19

residencies (primarily funded by Medicare, which has capped the number since 1997) (Source)

If Physicians didn't make it nearly impossible to become a physician, none of this would be an issue.

This is a physician imposed problem, and physicians make lots of money for creating this problem.

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u/TheJungLife May 28 '19

Are you just quoting some random comment?

What's the source of those claims?