Doctors’ pay: Tell me something I didn’t already know

A new study suggests that, adjusted for inflation, physicians’ incomes are, by and large, falling:

Doctors may be well off compared with the bulk oftheir patients, but a new study says fees physicians get from the government and private insurers aren’t keeping up with inflation.
Last week, the Center for Studying Health System Change said net incomes for physicians fell from an average of $180,930 in 1995 to $168,122 in 2003, a decline of about 7 percent, when adjusted for inflation.

Medicalspecialists fared better, the study said. Their in comes slip ped an average of 2.1 percent, from $178,840 to $175,011 over the period.

The news is even worse if you happen to be in primary care:

But primary-care physicians — the doctors most people see most often — saw their incomes drop an average of 10.2 percent, from $135,036 to $121,262 a year.

The reason, of course, is obvious: Declining reimbursements from third party payors, with Medicare leading the way. Unlike most businesses, the majority of medical practices can’t raise their rates when expenses climb because they are locked into contracts with managed care providers, and these contracts, once signed, are notoriously difficult to get out of. Expenses, employee salaries, and malpractice insurance keep going up, up, up, but reimbursement remains flat or even goes down, down, down. To some extent, it’s possible to make it up by working longer hours, seeing more patients, doing more procedures. But sooner or later, something has to give.

Yes, I know that doctors make more than the vast majority of their patients, but these days rare is the newly minted doctor who doesn’t finish with a six-figure debt. Academics also accept lower pay in return for not having to deal with the business side of things and for the freedom to pursue our research. Even we are starting to feel the pinch. I’m sure a lot of folks out there will say: So what? It’s just a bunch of greedy doctors. So what if they make less money? The problem is that more and more of our best and brightest are looking at medicine and deciding it’s not as attractive a profession as it once was. True, virtually none of us went into medicine to make a lot of money. (A famous saying among doctors is, “If you want to make a lot of money, go to business school.”) But if I were finishing college right around now and saw declining income and increasing hours to make the same income, I don’t know if I’d have gone through the years of pain and toil necessary to become a surgeon.