Career decisions shed light on health care crisis solutions
One way to understand the possibilities for solving the US health care crisis is to take a better look at how people make career decisions.
I have a lot of doctors in my family and lots of friends who are doctors, so I'm reasonably familiar with the careers of doctors, and I'm astounded that we're not talking about paying less for health care.
Why do doctors need to make so much money? The non-financial rewards for being a doctor are larger than almost any other profession. Except teaching.
There's a reason we pay an almost non-living wage to teachers: It's rewarding and meaningful and you do not need tons of schooling to do it.
So okay, there's a shortage of teachers, but not by a lot. Because the trend today is to do meaningful work and work with civic duty. Teach for America is one of the most popular choices for college grads. So the salaries can't be that out of whack for the job.
Also, the Institute for the Study of Labor says, “When teachers were offered cash rewards for good performance (measured by factors like grades and parental feedback) student scores on national exams significantly declined.” So I don't think paying more to people with meaningful work actually gets a more meaningful performance from them.
Which means that it makes sense that we pay people for what the market demands. And we could fill medical schools twice over with all the candidates who didn't get in. Don't tell me they're not smart enough. They passed organic chemistry. That's fine for me.
So we should pay doctors a lot less. Those doctors who are motivated by helping people and doing good things for the world will stay. And those who want a lot more money can go to finance.
Oh. Wait. They can't do that. Because the days of finance guys making tons of money for doing something that is really long hours and not helping anyone are over. So we should certainly also be done with guaranteeing people loads of money WHILE they do good things.
So doctors who were in it for the money will need to go to professions like VP of Intellectual Property at a Fortune 500 company where they can sue small entrepreneurs and ruin their lives in the name of corporate profits. A job like that is pretty certain to be a good living and the price you pay is that you don't get to save the world.
It is all adult life. It is a trade-off. You get to do good things or you get paid a lot. It's why moms don't get paid. It's why garbage men earn more than teachers. Why should doctors be any different?
The doctors who complain about this will talk about insurance (premiums will be lower if no one can pay: Duh). And they'll complain about school loans (outrageously high, yes).
The cost of medical school is the obvious objection to paying doctors less. Actually, the cost is a joke. Research scientists are happier, on balance, than almost any other type of career. Teaching at med school is a great job. You solve interesting problems, and teach people to save lives, and you have great hours.
Those med school professors are totally overpaid. So make med school cheaper by paying the professors less. Then we can pay doctors less. You'll lose the surplus of applicants each year, but who needs that big a surplus? This is a good step to starting a universal health care system.
Sure, health care probably won't be as good as what we have now. For the insured, that is. But fifty million people will be able to go to a doctor who couldn't under the current system.
And yes, I know, there will be a two-tier healthcare system where many of the top-notch specialists will only work for cash. But, newsflash: This already is happening in NYC. As the mom of two special needs kids, I saw all the best doctors in NYC, for a wide range of issues, and most did not take insurance. So we already have that system. Cutting pay to doctors across the board won't create it. The only thing it will create is a way for poor people to get health care.
I think what’s really interesting are the salaries paid to pharmaceutical sales reps.
Did you see this great article in the New Yorker about health care costs? One of the most illuminating pieces I’ve ever read:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
The differences between the cost of healthcare in McAllen and El Paso in Texas are illustrated in this article—and it’s a lot more complicated than PT writes (“Why do doctors need to make so much money?”).
Well, as an adult nurse practitioner who did her residency with an internist, I learned first-hand the economic realities…and I also learned that not sleeping well at night goes with the territory as you worry if you’re doing the right thing or the best thing for your patient. I hoped to establish a practice for the working poor (my roots), but Obama’s/Democrats’ push for various requirements for delivering healthcare may make that an impossibility. It’s certainly not because I’m not willing to work for subsistence wages, either.
Death of the Solo Practice: http://healthcare-informatics.com/ME2/dirmod.asp?sid=9B6FFC446FF7486981EA3C0C3CCE4943&nm=Articles%2FNews&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=4C2420A8DC544C159AEF68ED496622DD
As the child of a doctor, I had a parent who spent the majority of my waking hours out of my life for the first ten years or so…and when he was home, he was pretty sleep deprived, so my memories of pops the doctor are a little sparse. However, I was always provided for, especially, as has been pointed out here, after he reached the threshold of experience and started pulling in some serious money (and yes, it was probably excessive). It’s all well and good to speak about how doctors are overpaid, but they seem to be in a system that insists they go through a few years of hell before they obtain that “over”compensation. And yeah, medical care as we know it is very expensive. When you get ill, do you want a new needle, with a new IV bag, with last year’s EKG beeping along while your doctor uses a scalpel that’s never been in another body? Or should we start reusing some of that stuff? We use airplanes from the 70’s, why not ultrasounds? Just do our best to sanitize needles and scalpels and hope for the best? Because that would sure be cheaper. And yes, doctors usually have to pay for all or part of that equipment.
I see nothing wrong with comparing teachers to doctors; if doctors’ hours and risks were moderated to be more in keeping with those of teachers, I’d be all for a pay cut. Teachers are exposed to a lot of crazy diseases, no bones, but how many of them routinely handle their sick students’ blood and tissue while holding sharps?
But maybe the system can be made more humane all around. Take doctors off the 48-hour shifts, allow them schedules that let them see their kids between the hours of 7AM and 8PM most days of the week, and then we’ll talk. Having more doctors may be one way to go, but that’s a very small part in a massive overhaul that needs to occur.
I used to think the same thing — before my husband went through all his training and gave up his entire youth for medicine. I was all of about 18 when I thought this.
I’ve since wisened up. The costs are so immense that I actively discourage anyone from going into medicine unless they are certain they are called to be a doctor. Because you can’t know the incredible non-monetary cost unless you live it. And by the time you discover that, it’s too late — you’re trapped.
You are seriously out of whack about the non-monetary rewards being greater than for nearly any other profession. That’s because the stresses nearly outweigh the rewards.
The bureaucracy that has now come into medicine over the past decades, driven primarily by Medicare and documentation demands with insurances following suit, have robbed medicine of much of the joy of serving patients. The red tape, documentation, and micro-managing of physician care through rules on rationing will drive many physicians out of American medicine.
We will have a huge exodus of exhausted physicians who are already just barely hanging on.
And if doctors make so dang much, why do we have virtually no one training in primary care?
Why did a couple dozen physicians give up shop in our community to become employees of the hospital system?
Why did our civically involved primary care physician not have a vacation for five years before he gave up shop?
Why do primary care physicians make so little that there’s no way they could hire the same childcare and household help you do?
And why are even specialists willing to leave the stressful bureaucracy of medicine to finally have a real personal life with time for themselves and their families? And go practice medicine for free, where the real “non-monetary” benefits shine through from grateful patients without bureaucracy, political pressures, paperwork, constant threat of fines or lawsuits from absolutely ridiculous requirements that have nothing to do with patient care?
Don’t get me wrong. Medicine is a deeply rewarding calling, and my husband is excellent at it. But it chews you up and spits you out, and you have to work very hard to keep it from consuming your entire life with its demands. Add any more pressure to this situation, like reducing salaries, and you will have a mass exodus of current physicians.
You’ll replace them just fine. All you have to do is pay for their education and make training and professional life much more relaxed, like it is in England. And accept the long waits and substandard care that comes with that. Which is fine for primary care — but deadly when you have a real problem.
You’re out to lunch on this one.
Yes.
“There's a reason we pay an almost non-living wage to teachers: It's rewarding and meaningful and you do not need tons of schooling to do it.”
And because we’ve been able to get away with it.
Pay does give some indication of societal value. We expect to pay doctors a lot. We expect teachers to settle for job satisfaction.
So doctors are overpaid and teachers work for job satisfaction. Let’s move on and talk about REALLY obscene compensation, that received by pro athletes and movie stars. No value added there.
If there were no value there, then people would simply stop paying $200 for a seat at a basketball game and would stop paying $15 for a ticket to a crappy movie. However, that has not yet happened. Pro athletes get paid what they get paid because their performances bring in fans willing to pay obscene amounts of money for tickets.
The fact that people pay these prices out of their own pockets speaks to the value that they add.
Penelope…(sigh) I don’t know what your degree is in, but it’s pretty obvious what it’s not in.
“There's a reason we pay an almost non-living wage to teachers: It's rewarding and meaningful and you do not need tons of schooling to do it.”
$50k is a quite livable wage where I live.
The places you so admire with their gov’t health systems have fewer doctors, less qualified doctors, longer wait times, and less medical research than we do. Our system isn’t perfect by any means, but trying out the failed systems of UK and Canada isn’t the way to go.
Amen.
I live in Montana. I have a Ph.D. I am three years from retirement, and just last year I broke the $60,000 ceiling.
I’m not bitching. I’m saying that $50,000 isn’t the poverty line up here in the Great White North, nor in most other rural areas.
You have great insights into some things. I don’t understand how you can be so ridiculously out of touch with economics.
Very few people (maybe 50,000 in the US) are good enough to be top level doctors. Tens (if not hundreds) millions of people demand services from top level doctors and can pay almost any price (with insurance). Top level doctors make a lot of money.
If you want to change it, make a push for doctor robots or something.
My biggest disagreement with this post is that you are only referring to urban docs here. No rural doctor will make over $80k and if you have $200k in student loans & a family, cutting physicians’ salaries 35% will make it pretty damn impossible for every non-urban community to have access to health care. I’m speaking from experience her: my father has been a physician for 30 years and has worked three jobs that entire time – my mother has always been fully employed. I also work at an FQHC (federally qualified health center) where the PAs and MDs make practically pennies given they’re saving lives.
I say, before we cut the physicians’ pay, let’s look at the problems with medicaid (way too many people over using this!) and low insurance payments to family practice versus high insurance premiums.
I really enjoy all your posts, Penelope, but this one just seems mean and un-researched.
Wha? Normally you are right on track, Penelope, but this post went completely off the rails. Pay doctors less? The country has a critical shortage of primary care physicians as it is because the pay is so crappy, they have to fight insurance companies constantly, and they get to spend so little time with their patients in order to break even that they can’t get that “helping people” satisfaction you write of. Emergency physicians do more charity care than any other doctors – something like 50% of their work is unreimbursed. School teachers are paid like crap and look at our public education system – crap. Washington DC is experimenting with paying teachers more, and the NYTimes today reports that NYC is experimenting with doing the same. Not sure why garbage collectors are paid so well – maybe because people don’t care if their kids can’t read but they really mind a lot if there’s trash on the lawn?
The real waste and high costs associated with health care are in the INSURANCE industry. That’s where the majority of money goes and none of pays for actual health care. To quote Paul Krugman today, there are two rules for health care reform:
1. Don’t trust the insurance industry.
2. Don’t trust the insurance industry.
Further to above — a substantial reason we have a nursing shortage in this country is because we have a critical shortage of people who teach others how to become nurses. So before you go hacking up the salaries of the people who teach our health care professionals, take your knife to the income of insurance executives and trial attorneys who are really driving up the cost of medicine.
“the days of finance guys making tons of money for doing something that has really long hours and not helping anyone are over. ” so..when Warren Buffet, a finance guy, pledged $40 billion to charity. that didn’t help “anyone”. and the billions of dollars Hedge Fund managers, aka “finance guys”, have given to charity over the last decade prob didn’t help “anyone” either.
also. is the “adult life” really that you either “do good things or you get paid a lot”. Who has done more for society Bill Gates or your average Teach for America teacher? Nothing against Teach for America, but Wal-Mart has done more for the average American than Teach for America ever will.
I agree we need to do something differently with our health care system but I’m not sure that cutting the pay to doctors is really going to make a dent. Aside from that, I get really tired of helping professions getting the shaft in the pay department. Teachers, social workers, nurses, foster parents, etc. are all very helpful people doing meaningful work and those jobs can be very fulfilling. They’re also often very demanding yet helping professionals are supposed to do the jobs for crap wages because they should just be grateful they get to do meaningful work??
We had to have a nursing crisis before nurses began to be paid decently and positions for advancement were made available to them. Social workers, who provide case management to children who need STABILITY more than anything else, burn out and leave their jobs because no one is willing to pay for enough of them to make the job even do-able.
So, yeah, I work in a helping profession. It doesn’t mean I don’t want a decent car and to keep my utilities turned on. Should everyone who enjoys their work take a pay cut?
In general, the jobs that make the most money are the ones that effectively make rich people richer (financial analysts [until last year], really good salespeople, wealth managers, lawyers, upper management in for-profit companies). After that, it’s jobs that take the most investment to get into, like doctors. If doctors didn’t get paid as well as they did, they wouldn’t be able to afford to become doctors, and the same thing that happened to nursing would happen to doctors as a group.
In general, people should be paid commensurately with the value they create, and that cost should be borne by those who benefit most from that value. As a taxpayer, I have no problem with paying (for instance) police officers or transportation workers a decent wage; I benefit immeasurably from personal safety, protection of property, and decent roads. Teachers (and case workers, whom I generally lump into the same category) get paid crap because the value they create is so hard to pin down and measure. I think the taxpayer needs to bear more of that cost. Compare the benefit to society of a gainfully employed citizen who received decent early intervention, case work and education against the cost of caring for that same person who never got the necessary treatment to even partially compensate for or work around a speech delay or learning disability.
“In general, people should be paid commensurately with the value they create, and that cost should be borne by those who benefit most from that value.”
But who determines the “value”? You? Me? In a free market–and I wouldn’t want to live in any other kind–people ARE paid according to how they’re valued. At this time in history, our society values doctors, movie stars, and basketball players more than we value teachers. I think that’s stupid, but allowing the government to come in and determine what people should be paid is ever MORE stupid. Those who would set the “values” and salaries of professions always have their own agendas–and, by the way, always seem to benefit from thir own decisions. You’d soon see huge raises for Congress because, after all, they’re responsible for setting everyone else’s salary…. Allowing the market to reach its own level is the only thing that makes sense.
I am surprised, you wrote something with which I completely disagree. I think you are way off on this one. I am a doctor’s daughter and have lots of friends who are doctors. Good teachers are critical to our society and I wish they were paid better. Policeman too. They do a great service. But they don’t spend nearly as much time training. Medical school may not cost much, but there is certainly some opportunity cost during residency. If they had just spent three years in law school, they would be making a lot more money during those years they do their training. Being a doctor requires a high level of training and skill; it carries a greater responsibilty and a different level risk. Its more analogous to engineering where specialized training gets rewarded with higher pay. If we pay the doctors less, we’ll just end up with more lawyers and more real estate developers. But you already know that, you’re Jewish :-).
Your perspective is a bit off base. First, the cost of education, esp. for attending a medical school is huge. And as you pointed out, the time spent in internship and residency add to the time, hence the expense, devoted to education. The preparation physicians devote in terms of time and money is balanced by significant incomes in most areas of medicine. But when you consider the amount of time spent in education before a physician is able to practice, along with the expense of education and the short life span many physicians enjoy, the return is not as significant as it may appear. Unfortunately, public perception plays an important role in determining incomes, often not valid. Your perception is that an attorney makes a larger income than a physician because of the less time spent in education. That is not true either because the majority of lawyers are not making that much income. What Americans need to do is study what really is happening in America rather than basing their opinions on past assumptions. We would all be better off.
You don’t go far enough, but you are absolutely right. The biggest problem with US health care system is that way too many people think they have a God-given right to make 300 or 400 or 500 k per year because they went to med school. Nonsense. And we don’t have anything remotely resembling a real market economy for health care services. Add in the obscene profits made by the drug industry, aided by a GOP leadership they bought and paid for, and an insurance industry that takes a huge slice off the top for doing absolutely nothing as far as health care goes, and it’s no wonder we pay double what anyone else pays in the world for a system that actually gives us lousy overall results.
I think you’re being silly. Firstly, doctors spend years in college even just to be a GP. It’s not just about the money they invest in a degree, it’s also about the time.
For example, my friend is 32, started university at age 18, has passed everything as soon as possible, and she has still not completed her training to be fully qualified as anaesthetist. Of course she should earn a lot of money once she does. By the way, that’s in Australia, which has universal health care.
Secondly, until they get to specialist consultant level, doctors work obscenely long hours. If they didn’t get paid well for what they do, they would burn out and quit. They might go into the profession for meaningful work and start off with high ideals but that won’t last without financial rewards to compensate for the time they put in.
The problems with the American health care system have nothing to do with doctors’ salaries, and everything to do with lack of public funding and the profit motive of health insurers.
As for the whole idea that if work is meaningful it should be badly paid, that really makes no sense either. Why? By the same argument you could also say that if work is fun that you shouldn’t get paid well either – so all Hollywood film stars and NBL players have to take a huge pay cut! Don’t let envy cloud your judgement. It might not feel fair that someone enjoys their job and gets paid well for it, but then life isn’t fair.
You say that teachers are paid about right because that’s the market rate. Yet you are also saying that the market has it wrong for doctors. So which is it? Is the market right or wrong?
@ Deb:
I am pretty certain that the parts of Asia where Europeans and Americans go for “medical tourism” health care are not the parts of Asia where Britain is getting its doctors. No one in his or her right mind would go to Pakistan for an operation!
When someone in England says “Asian,” he means South Asian — Pakistani, Indian, Nepali, etc. When Americans say “Asian,” they usually mean Oriental (East Asian) — Chinese, Japanese, Korean, etc.
I also stand by what I said about the inadequate sanitation in British hospitals. “Insensitive” be damned.
India has become the center of a large medical tourism industry. You can absolutely get top notch care there.
Many in the NHS believe that the unacceptable levels of poor hygiene and cleanliness only came about when hospitals started to outsource cleaning to private contractors, to cut costs.
@Jim C.
Thanks for the englightenment on an American ‘Asia’ and a British ‘Asia’. Even given that, your ‘certainty’ seems based on incomplete facts. The England ‘Asia’ or South Asia, at least India, seems to be quite a rage when it comes to medical tourism – see http://www.medicaltourismmag.com/issue-detail.php?item=150&issue=7 and http://www.healthtourisminasia.com/indiat.html for details. And India DOES happen to be one of the countries from where Britain gets its doctors.
My comment on the ‘insensitivity’ in your earlier post was related not to inadequate sanitation (anyone could be insensitive on that) but reg. your comment on planting of bombs.
One way to lower the cost of healthcare is to change the laws that force hospitals to give free goldplated medical care to people who are not in the country legally. In fact, the state of California could solve most of its budget problems if it simply stopped providing free healthcare, education, food stamps, housing assistance and unemployment checks. Ditto for the whole rest of the country. But pointing out the obvious is illegal-alien-a-phobic, and practically hate speech… So, yeah, I think obama should cut everybody’s pay because they make too much. Oh wait, he’s going to… by raising taxes… But not on you and me, just the fat cats who make way too much. Oh, we might all have to “sacrifice” a little (that means pay higher taxes) because the rich folks might not have enough to solve all the peoblems we have, but don’t worry, all that money will go to really, really good use!
While what you are talking about is definitely a factor their are two factors you left off. The more the state is involved the more employee’s are required to work on legal issues and paper work. The oversight is very very expensive. The training to become a doctor is also labor intensive, and takes a good deal longer than it does to become a teacher. I do absolutely agree that Doctors need to become Doctors for a will to help people, and not for a will for money, they become better doctors that way.
A story you might want to check would be the Doctor that Ron Paul talks about in his book “Revolution: A Manifesto” who because he refuses to accept any form of insurance cuts his costs down to about $35 a visit, and still makes a decent profit.
My point is, while it definitely hasn’t helped. The healthcare industry is not all Doctor’s faults.
With all due respect, what you are completely missing here (and perhaps noted above in earlier comments, I don’t want to read them all) is that teaching is primarily a female occupation and medicine male. Hence the salary differential. Sheesh, woman!
The idea in this blog could really be extended to the media. It's in trouble, and some salary correction might help. Lots of local news reporters (such as, uh, me) make approximately teacher wage. The big ones make Bill O’Reilly or Anderson Cooper wage. Like teachers, we don't need a ton of schooling. It’s an amazing fun job. While we’re not saving the world like doctors, we do get to make our mark. Scale back the salaries of the big guys and it'll help bring the companies back to solvency, plus only journalists who are passionate about telling good and important stories will be attracted to the industry in the first place, which is good for readers and viewers.
In the case of both physicians and journalists, the world is a bit dazzled by their respective industries. “People” (read: doctors and journalists) get upset when you suggest they aren’t somehow special. But both the medical and media systems are broken, it’s time to look for solutions that may take them off their pedestal a bit.
O’Reilly & Cooper make the big bucks because they bring in the big audiences, which in turn bring in the big advertising dollars, which allow their TV networks to hire reporter and writer peons to produce more shows. If Fox and CNN didn’t pay them big bucks, somebody else would and then get the benefits that would surely follow.
There is NOT a health care “crisis” in the U.S. Here is where people from all over the world want to come when they need top-notch health care without waiting a lifetime for it. The two hospitals in my city turn away NO ONE. Yes, there is a small percentage of people who need help with health care (and I’m the first to agree that we should take care of all children), but our system needs tweaking, not destruction and then rebuilding, or we WILL end up like Canada and England.
And speaking of England: my friend’s English father (living in England) needed a heart bypass, and he needed it NOW. He was told that he’d have to wait 9 months. If he hadn’t had private health insurance, he’d be dead. So much for socialized medicine.
And, frankly, how does someone who makes $200 grand a year doing what PT does get off saying that doctors need to earn less?
As a 30-something MD with a 6 week baby at home working my ass off for ~40k/y, I sure say amen to this…!
In Canada, teachers are paid very, very well. It’s a sought-after job. Only A+ university students get to become teachers, which means super teachers in the classroom, which means a super school system. The same applies for most European countries.
Only in the US are teachers paid so dreadfully. And you have the public education system to show for it. I dislike reading motherhood statements about how teachers love to teach and don’t care what they’re being paid. This is just rationalizing stupidity.
However, it’s certainly true that doctors will still practice even if their income is lower. In Denmark, doctors earn only somewhat more than welders. In Japan, doctors earn so little they have to have vending machines in their waiting rooms to make up the shortfall. Note that Japan has the highest life expectancy and lowest infant mortality rates in the western world (the two indicators of quality of healthcare). But keep in mind that these are all universal healthcare systems, not private systems.
I’ve read some of the comments about socialized medicine, and I shake my head at the fears and confusion in some of them. There is not a country in the world with socialized medicine that has ever discussed going back to private medicine. Healthcare is a right of citizenship, just like education, fair trials, voting, and freedom of expression.
Certainly the ultra-rich may come to the US seeking medical care, but ordinary citizens do not. Besides, do they actually get better? Or do they die anyway? Is this just a case of excellent international marketing on the part of US doctors, rather than a case of excelling healthcare?
If a medical procedure actually worked, other countries would already be doing it.
Don’t be afraid of universal healthcare. It’s good. It takes care of people. And it turns your country into a community.
“There is not a country in the world with socialized medicine that has ever discussed going back to private medicine. Healthcare is a right of citizenship, just like education, fair trials, voting, and freedom of expression.”
This is spot on. Despite the failings of the NHS, I don’t think anyone in the UK would actually want to scrap it. We’re just too used to the idea that health care should be free.
The same attitude goes for everywhere else in Europe I’ve lived where there’s an equivalent system. There are some abuses of doctor / hospital time, some hospitals are considered better than others, and waiting times can fluctuate wildly from one place to the other, for one procedure or another. But nobody seriously thinks that getting rid of universal health care is the best way of fixing the problems.
Woah. I didn’t expect you to turn into communism or something. You begin to scare me, P’ !
Especially you, you are an entrepreneur, you know the meaning of the word “Responsabilities”.
There’s my point of view :
I find perfectly normal that an entrepreneur OR a doctor win a lot of money, because both are under pressure, both have great responsabilities, both have to fullfil a lot of duties and both can go to court if they screw up, even a little bit.
You always says that an entrepreneur CANNOT be perfect all the time. Well, a doctor MUST be perfect all the time. If he’s not, his customer can suffer (or die) and turns himself (or his family) against the doctor to court.
That’s why doctor are greatly paied in America.
I beg of you P’, don’t go that way. Don’t go to or near the communism. ;)
In the U.K we do indeed get free medical care on the N.H.S however, there are often very long waiting lists for essential life saving operations such as bipasses and health can deteriorate quickly when having to wait “your turn”. There are, however, options to better healthcare by paying for it privately. So it all depends on your luck and the waiting time for your particular ill-heath.
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It is interesting that the myth of the poverty stricken teacher persists. The teaching work schedule is 25% less than the standard work schedule. As someone who took a 2 year leave from teaching to see what else was out there I can tell you that the difference between a 36 week work year and a 48 week work year is huge.
In my area, teachers start at $45K-$60K. The top of the salary schedule is upwards of $90K. At 32, with ten years of experience I made $80K. There are opportunities to earn additional stipends by mentoring new teachers, coordinating programs, coaching, teaching after school programs or summer school, National Board Certification etc. One of my friends made almost $100,000 last year. With only 12 years experience.
Now my friend lives in Los Angeles and I am in the San Francisco Bay Area. Still, these salaries are well above living wage.
P-You need to do a little research. In New York State, you need a Master’s Degree to teach prek-12 in a public school. That costs about 30 grand (on top of your cost for a bachelor’s degreem, which costs about 20 at a state school. Most teachers start out behind the eight ball, and need time to catch up to their own education costs. The reason merit pay doesn’t increase test scores is the same reason you can’t just increase your blogroll because some sponser tells you they’ll pay you more if you do- you work with what you are given to the best of your ability, and that’s all you can do.
I’d like to know where you can make 80-100 grand after 10 years of teaching. I hope you weren’t teaching economics.
P.S. Did you do all of the mentoring new teachers, coordinating programs, coaching, teaching after school programs or summer school, National Board Certification etc. within the 36 weeks? Not sure you know what you are talking about on this one.
I’m a huge fan of your blog, but I’m going to respectfully disagree with thoughts on med school faculty lifestyle and compensation: As the child of a medical school professor, I experienced first hand the lifestyle of academic medicine. Rigorous, anything but “flexible” in terms of scheduling hours (my dad still does rounds with students at the age of 65 and is still takes “on call”), and stringent continuing ed requirements (as could be expected). We lived a very modest lifestyle that was often dictated by hospital and teaching schedules.
The salaries of Ph.D. research scientists and M.D. residents are low, compared with other fields…In fact, bachelor and master’s degrees students who take industry positions frequently receive higher starting salaries than Ph.D.’s who choose to remain in academia. Never mind the fact the jobs of research scientists are often grant funded and dependent on getting funding. In addition to teaching, professors are often responsible for running labs. Suggest you consider having a more at-length conversation with the M.D./Ph.D. at the major research institution you quoted.
The health care industry does need to be fixed, but this isn’t the solution.
Wouldn’t things likely change if the people who make the decisions (Congress and Federal employees) experienced anything similar to what the rest of us endure to pay for our own healthcare?
I pay through the nose for catastrophic coverage with a $5000 deductible. So, basically I pay for all my routine care. I seek out significantly less care than I probably should at my age and I pay very high rates for any doctors visits or tests I get. Doctors themselves may negotiate with a cash-pay patient, but hospital systems are less inclined.
Things have got to change, but they won’t unless the lawmakers have an incentive to change them.
Normally I find your posts entertaining, and often thought-provoking. But this is sort of similar to your post about art in that it doesn’t initially make sense to me — only the content here is more confusing.
Eventually I was able to find some merit in your argument about artists, but that same process doesn’t translate here, where the categories are much broader. You seem to be setting up some sort of dichotomous relationship between doing meaningful work and getting paid, and I think you pretty much explicitly say that meaningful work warrants less competition (I could be wrong. I’m writing this on very little sleep and very much caffeine).
The obvious problem that I have with this argument is the implication that doing harm (or valueless work) warrants higher monetary compensation, even if “higher” is only in comparison (i.e., were the changes to result in lower average salaries overall). I think it’s fair to say that this was implied, but again with the sleeplessness. You are right: this would be an effective way of weeding the Scrooges from these sorts of jobs. But I don’t know that it mitigates the damage they do others (it might), and the basic idea seems to just… opposite, perverese. I know, I know, you cited teachers and higher compensation. I think, though, that at least some of that would have been due to a harmful conflict of interest, though, lacking research, I ultimately concede this point. Maybe some day I’ll stumble across more examples, one way or the other.
Hmm… I think I have to take back the way I started this comment. This post is actually very thought-provoking, now that I’ve tried to respond. Thanks.
This is the first time I have heard that there is a teacher shortage. Last I heard the only areas where there are shortages are in High School level Math and Science. But the rest of the market is pretty much oversaturated from everything I have read.
The market is the best place to set prices. If people value having porcelain chompers more than they value their 10k or whatever, then that’s what the procedure is worth. I agree with the criticisms of the doctors vs teachers analogies. One reason doctors make more money is because the market values the work they do more than the work teachers do. There are much higher barriers of entry (med school) to become a doctor. Plus, it takes a stronger work ethic to become a doctor. My wife is a doctor and I honestly believe that most people are incapable of doing the job. She can, and deserves to be compensated accordingly. There are more reasons why this post is based on an irrational premise, but I think that’s enough. P – I love your blog and am one of your biggest fans, but I disagree with you on this particular point. Hope you find your groove again soon.
Very informative, but I think you’re off base regarding cutting wages b/c the ones who are doing it for the fulfillment will stay. Sounds like you’re trying to justify why you’re constantly in a financial crisis at your start-up. I think I should be paid for a job well done, whether I’m personally satisfied or not.
And I’m surprised you didn’t reference oral sex in this post, Penelope…
I’m an a proud free-market-loving American who married a beautiful French girl and ended up in France. Living here will make you a believer in universal healthcare, socialist healthcare… Whatever you want to call it, it works. I’m not terrified by a trip to the doctor and I don’t worry about changing jobs or starting my own company for fear of the healthcare costs. On my last trip to the emergency room for stiches I paid 11 euros.
Some things belong in the private sector (you choose to buy Nike shoes instead of the $10 Wal-mart specials, so you should pay the full price) and some other things should be controlled by the community. (No one chooses to get sick.)
And this French system seems to work for everyone. There are plenty of smart people going into medecine, they work crazy-long hours like the doctors in the US and they make lots more money than the average French-man, so they can still have the nice house, family vacations to the ski resort, etc. And, and, and! The doctors know that their kids will have good healthcare, even if they’re not rich later on. Does an American doctor have this satisfaction? No.
Hi Dave,
As a french native and living, I can talk about this.
If you’re living in France at the moment, you should be aware about the huge crisis of french healthcare which is happen right now.
The french healthcare system created a huge money gap in our country.
Let me talk with numbers and statistics.
Between 2007 and 2008, SIX MILLIONS of sick payday has been granted by the social security. Could you imagine ? We are 65 millions in France and 6 millions of sick payday has been given.
On these 6 millions of sick payday, about 7% was abusive in order to stay at home and getting paied for that.
For an entrepreneur, this system is a problem. Because the Social Security is supposed to control the people who are under sick payday but in fact, there is too few controlers to be efficient.
Then, companies have to hire private controlers-doctors to do that.
That’s just great. Companies are spending a LOT of fees to the Social Security and have to hire a private controler ? That’s bullshit.
Let me tell you something else about Social Security. I don’t know if you are working in France, but if you do, just check out your salary paper at the end of the month and check out how much you are spending in the Social Security.
Do some maths on one year and you should resultat that for this price, you could get a private one. If you have a good salary, you can even pay less in a private one. But in France, you do not have the right to hire a private one. You know why ? The french government FORBIDS to private medical care to be here.
We haven’t the right to choose.
Something else. For the reimbursement of you medical fees by the social security. You have to send back the medical paper within 48 hours.
That’s just fine for minor illness but don’t get chirurgy or something.
Don’t get me wrong. I like the French Social Security system and I want protect it. But is far from perfect and a lot of huge efforts have to be done in order to solve a lot of problems in it.
No system is top notch and the French System is not either.
Hahaha, it seems this blog has shifted from thought-provoking career advice (which I loved and bookmarked and have even used in my interviews etc), to controversial, unsubstantiated posts on public policy issues and on oral sex.
1. The name of this blog should not be ‘Brazen Careerist’. Instead, it should be, ‘The Automated Mindless Controversy Generator’
2. Missed the oral sex in this post. Where is it hidden? In the comments maybe?
3. Why doesn’t PT bother to reply to all the comments that people write in response to her posts? Is it because she does not have any smart answers to all the questions raised?
Jack
One thing is for sure, this post pushes the outside of the health care envelope. Spend a few nights on trauma call – putting someone’s brains back together – or a few decades on your feet in the operating room saving lives – and then decide what that is worth – especially if it is your brains that they are saving.
Jessica Bond
The hospital told me they could not turn me away because I told them I as busted. But they also lied to me about the conditions of Charity Care.
I’m a non-medical professional working for a group of Stroke doctors affiliated with a large, active hospital in a major metropolitan area. To add my 2 cents:
The doctors I work with have as a minimum 3-4 years undergraduate, 3-4 years medical school, 3 years residency and 2 years fellowship before they make any money to speak of. From Residency on they work/study a minimum of 60 hours a week. Fellows and Attendings (faculty) are on call at least 1 week a month which means at least 20 phone calls and 5 trips to the hospital at odd hours. When they’re on service (again for a week a month), it takes at least 6 hours a day 7 days a week – often they work through lunch. They have to make quick decisions which are literally life & death (or worse if you know anyone with severe stroke disability) and often times all they can do is keep the patient comfortable and comfort the family. They volunteer their time for community service – holding health fairs with wellness screenings so people can avoid being our patients.
On the hosptial side, it’s a bit complicated. Most Level I trauma centers loose money. Private hospitals can do OK. As I understand it: if EMS or another hospital calls a hospital about accepting a particular patient, the hospital can refuse if they feel they can’t properly treat the patient either because they’re not qualified for the level of care or they don’t have room (on “bypass”) or room for that “service”. If someone just shows up, with a non-life threatening condition to a non charity hospital, the hospital may qualify them financially before agreeing to treat; if it’s life-threatening and the hospital has room and the capability they’re supposed to at least stabilize the patient.
There’s a vicious cycle about hospital facilities and capacity – hospitals even in metropolitan areas aren’t expanding as they need to in order to service the population because they’re not generating enough excess over expenses. Paying customers are suffering because the MRI’s, CAT Scans, OR’s etc. are being used by non-paying but seriously ill people.
There are a few other flies in the ointment – everyone is paid based on services performed, not how efficiently the patient is treated and how quickly they can be made well. I saw this first hand with my aging father when his pulmonologist wanted to examine some skin lesions that (the Dr. knew) were being appropriately treated by a dermatologist – that useless charge was billed & paid by medicare. Another problem is the indigent don’t seek medical care early and when they do they’ve gotten very sick and it’s frequently at a full-service busy ER.
If most everyone had “decent” insurance and access to appropriate medical care in a timely fashion, the medical facilities would be there. We still would need to address the results-based rewards.
The problem won’t be fixed overnight, hopefully we can move in the right direction.
Get rid of the middle man- the insurance companies. If there is a huge margin between what they take in and what is paid out, thats where your health dollar discrepency is. Why do we need a profit making institutuin between you and your doctor? If we can manage public services like police, fire, schools, roads why not health care?
I didn’t read all of the comments, just scanned them, so I apologize if my post is a repeat…do you really know any doctors? Were you being sarcastic when you suggested they get paid less? Do you know how much time and energy they spend in medical school and residency and how little money they make in residency considering the amount of time they spend at work and studying? From what I’ve seen – my fiance and most of our friends are doctors – it’s the equivalent of 9 years of boot camp. It’s physically demanding, mentally relentless, and emotionally draining. Their course of training makes them stronger, quicker and infinitely more capable. It creates doctors with whom I’d entrust my life. Not every “smart” person can cut it as a doctor. It’s not just a job, it’s a way of life, virtually all-consuming, something that they, their family and friends have to deal with every day. The doctors I know don’t necessarily do it for humanitarian reasons, and they certainly don’t do it for the money. By pushing themselves in seeking answers, they strive for perfection, which can be seen as some sort of a dysfunctional personality trait, but that’s the kind of person I’d want to cut me open if it ever needs to be done. Suggesting that they should make less money because teachers don’t make any money is absurd. Teachers should make more money, period. Doctors are compensated fairly, and shouldn’t be penalized because not everyone is paid what they should be paid.
Wow, I work in health care and if you think phsycian “pay” set mostly by the free market, is way out of whack you need your head checked out. It’s the lawyers that drive up the cost of health care. For example, my wife needed 15 (didn’t really need) weekly ultrasounds for our 100% healthy baby even though our baby is flawless, because she was on a blood thinner. Never mind there was not one sign there were any problems ever, and in spite of her being a young 32, the word C-section came up often, in spite of ZERO need for one and our refusal to have one. In the labor room, it was filled with cameras as well.
All of this was 100% due to lawsuits and the threat of them, caused for and voted for by liberals like you. Hope you enjoy your time in Taxconsin, you fit right in.
Oh, one more thing, for her “overpay,” my wife’s OB visited us at 6am in the delivery room before meeting with her patients, came back later on to check up on her twice during the day, once at night, and delivered our daughter at 11pm at night, in spite of having two children of her own, then went home to sleep to see us the next morning at 8am.
How many teachers, who vacation all summer long and whine the rest of the time, do anything close to this level of work or have anywhere near this level of skill (I attended nearby UW-WHitewater and all the academically challenged, or “dumb” students went into the College of Education).
Send your kids to private schools instead, they are worth every penny!
Whoever wrote this is an idiot. Go to medical school, finish everything you have to do to be a doctor and then tell me you don’t deserve that kind of compensation. Upon Graduation I will be working 58 hours a week on average (the national average for a Radiologist). How many do you work blogging from home? 20? 30? So to say that my 58 hours a week diagnosing what could be a deadly disease isn’t worth my compensation is absurd. Yes I chose to go into this profession I understand that, but I guess you think saving lives isn’t worth compensation when I work over 70 hours more a month than the average American
Fred, the author is a liberal. She has no idea that work, other than her own weird work, is actually quite valued by patients, at least paying one, that you and others do.
Thanks for your hard work and you deserve a raise. It’s the trial lawyers that need to stop feeding off the teet of superior US healthcare.
My previous comment was definitely anti-doctor-paycut, and I’m a liberal. You just invalidated your valid comment with your political generalization. Be careful.
I acknowledge that this is not the point of the article, but I have to say something about your reference to teaching. Teaching done right in some of our toughest districts is HARD and demands a lot of hours. You are right that teaching doesn’t require a lot of education…this is a travesty and I think we are going to pay for it as a country.
Malcolm Gladwell’s take on what teachers should be paid, and who should be accepted into med school. Teaching isn’t altruism, it’s a job we need done better.
http://www.gladwell.com/2008/2008_12_15_a_teacher.html