Good doctors are hard to find.  Everyone has heard horror stories about the surgeon that leaves a sponge behind or amputates the wrong limb or gives you forty grams of a drug instead of forty milligrams.  There’s a very steep premium on perceived quality.

That’s probably one of the most damning indictments against American medicine.  Sure, we have some of the best doctors in the world.  But we’ve also got some of the (assumed) worst.  No one knows how to separate the wheat from the chafe without a butt-load of dollar signs.

As for student loans - well, that’s something of a chicken and egg dilemma.  Are doctor’s salaries extremely high to pay off those first few years of crushing student fees.  Or do we have vastly inflated education costs because those sky-high salaries are just assumed to pay them off?  I know quite a few would-be doctors that became pharmaceutical reps instead specifically because of that cost-benefit analysis.  Plenty of people are happy to make $80k+ / year hocking pills rather than take on a quarter million in debt just for the opportunity to go through med school.

At least, that’s the conclusion I draw from this article by Ezra, which shows that we pay American doctors way too fucking much

Whereas the conclusion I drew was that I should have listened to my mom andgone to med school.

In the UK where I currently reside (and in every other EU country I’ve spent enough time in to ask someone) Med school is free or nearly free - in the UK, doctors are required to work only or primarily for the NHS (and not for private hospitals) in order to ‘pay back’ their tuition. The ‘loans’ for their education are paid back in practice hours.

David Brooks covers this subject very elegantly in his book “The Trap”.

The main theme is that the restructuring of our financial culture has driven up the cost of education, and forced graduates into indentured corporate servitude for several years to repay student loans. This makes non-profit work career-prohibitive, and drives the best legal minds into the corporate world where people might make enough to get out of debt by their 40’s.

However, the breadth of Reagan’s cuts sting at all levels. Yes, med school costs are one result of Reaganomics. Tax cuts and cheap loans have poured free money into the Real Estate market, for example, and have falsely driven the RE values in some school districts so out of whack, that they become unaffordable for normal people. Education cuts across the board defund all schools, yet richer parents can fund their particular school, thus equal schools in the same district become unequal.

Very interesting read, and Auguste, great extrapolation on the health care debate.

Zinfab @ 1:

As for student loans - well, that’s something of a chicken and egg dilemma.

As laid out in Brooks’ book, it’s not really chicken and egg at all. Cause and affect. Educational funds were cut, and tuition was raised to make up the shortfall. The prostituting of universities to the sports departments isn’t exactly the cash boon that was sold to academia. Sports departments pay for sports departments. When Michigan or Notre Dame has to cut women’s fencing to make a budget, the system does not work.

I’m rambling and off-subject. Sorry.

This actually ties into the thread on tipping that we had last week.  We have this belief system that paying more automatically means we’ll get better service.  We’ve been led to believe that bad doctors would lose patients, so they have to reduce their price in order to keep business, and therefore, any doctor who is making tons of money must truly deserve that much because the market is perfectly rational.  Of course student loans and med school costs are a problem.  But the bigger problem that invades every aspect of our society is the incorrect belief that cost is proportional to quality.  Are doctors in other countries really only one tenth as good as our doctors?  If we don’t pay doctors ridiculous prices, will nobody decide to become a doctor?  I doubt either of those things.

@ JohnGor0 - I think the author is Daniel Brook, not David Brooks.

Erica @ 7 - Boy, am I a dope. David Brooks on the brain. Thanks.

It’s not only the cost of medical education but the structure of that education that has to change. The hazing and initiation rites (humiliation by teachers, 100+ hour work weeks) that most medical students go through on the way to becoming practicing physicians can give them the same kind of us-vs-them mentality that you see in police departments or military units. And part of the way to prove superiority to “them” (the non-doctors, not the doctors and medical educators who inflicted the pain) is to charge whatever you can get away with.

Until medical education stops being premised on making doctors a special, privlieged few, many of them are going to act as if they are.

My hope is that the public option really will drive all of the for-profit insurance companies out of business, leaving us with a de facto single payer system.

I’m saddened that I have to point this out, but price per office visit != what doctors are actually paid.

First, there’s the “range” of costs for office visits.  Wonder why a Medicare visit costs $72 and a regular office visit “ranges” from $59 to $150?  Because private insurance doesn’t pay the full amount.  Doctors love to whine about how little Medicare pays, but the dirty little secret is that Medicare is guaranteed to pay 80 percent.  Private insurance will pay anywhere from 50 percent to 90 percent.  So, no, doctors never get paid $150 for an office visit unless the patient is paying out of pocket or if the patient has unusually good health insurance (like what our Congressional representatives get), and if the patient is self-pay, there’s a very good chance the doctor will never get paid or will have to sell the debt to a bill collector.  Doctors often have to charge so much up front to get anything out of the insurance companies.

Second, there’s the cost of overhead.  Thanks to our incredibly inefficient system, doctors have to pay through the nose for billing staff and for extra medical staff who take care of the onerous medical records requests required by insurance companies.  That overhead is extremely expensive.  Just imposing lower prices isn’t going to solve anything unless those requirements are relaxed or eliminated.  Of course, under a single payer system, those requirements would largely go away.

This issue is a hell of a lot more complicated.

SapphireCate: UK doctors are still paid a lot of money though. An ordinary family GP earns getting on for twice as much as an Oxford senior professor (that’s professor in the UK rather than USA sense). In this case, I assume it has something to do with the foundation of the NHs when Nye Bevin had to “stuff their mouths with gold” to get doctors to sign up. That and that the media persists in treating the BMA as a neutral or patient-interest group, rather than the trade union it actually is.

I hate to see you saddened, keshmeshi, because you didn’t really need to point that out. I figured most people would realize that I wasn’t claiming doctors are pulling in $900,000 a year take-home.

The problem, Nineveh, is that, much like the teachers’ unions, it is both.

Until medical education stops being premised on making doctors a special, privlieged few, many of them are going to act as if they are.

this is what we do with lawyers—give anyone with a 3rd rate education and ability to pass the bar exam the right to practice law. The thing is with your comparison to police and military units is that the police and the military are paid middle-of-the road salaries. 

In any case, the problem with Ezra’s numbers is not that primary care docs are being paid $80 for a visit. It’s that _specialists_ are being paid massive amounts of money. My mechanic charges $50 just to
look at my car. That is not the charge I am worried about. I am concerned with the high prices of specialized tests and procedures.

keshmeshi:

and it gets even more complicated, because doctors are (to a first approximation) in charge of how many office visits, tests, procedures etc each patient has done. So if you squeeze them on price they can make it up on volume, or just shift their mix. (Which is one reason it’s important to fix the no-compensation-for-thinking-about-patients’-problems rule.)

There was a great study I saw once showing how c-sections and maternal ultrasounds tracked inversely with birthrates…

Quite a few of our problems in the US can be traced back to this ‘free market’ absolutism.  It would be utter bullshit even if we actually had a free market, but all of the Econ 101 level theory that so-called conservatives hawk is based on a market with equality of information and equality of power.  To suggest that either of those conditions applies to any market in the US is just laughable.

About 70 years ago, my grandfather was on an admissions board for a medical school. He took great pride in explaining to me how he asked questions of the candidates, questions which were designed to discover if the candidate was (primarily) “in it for the money” or because they wanted to help people. Those who were obviously into becoming doctors so that they could become wealthy were quickly shown the door ...

Then too, it’s my understanding there’s a shortage of primary care physicians here, and too many specialists because that’s where the money is.

That does appear to be a factor.  For most people, if they have the choice of becoming a specialist and paying off their loans within 10 years or becoming a general practitioner and not paying off their loans for 20 years, most people will become specialists.

Nineveh @ #12,  one of the reasons that GP’s are currently being paid an awful lot is that the system of paying them changed in the last round of contract negotiations.  The government wanted to pay them, effectively, per visit/procedure/whatever - the GP’s said fine, this is what we do and how much of it we do.  The government didn’t believe that they did as much as they said they did, so accepted in negotiations a fairly high amount per visit/procedure/whatever. 

It turns out that the GP’s did in fact work as hard as they said they could, are now raking it in because the government didn’t believe them and thus, for example, don’t have to do night visits to make their salary (hence all the jobbing doctors doing that now).

Of course, that is all a vast simplification, but that’s mostly it.

Specialists also tend to benefit from the filtering that GPs and such do. If a patient gets to them, they have a pretty good idea that the patient is sick, has an ailment they actually know about, might plausibly be able to pay their bill and so forth. Specialists (with some exceptions) can also schedule their work better than generalists.

Of course the dearth of GPs, family practitioners and so forth also makes it harder for the ones who continue to practice, because they tend to be lone practitioners or in smaller groups with less backup…

“Are American doctors so personable that they’re worth ten times as much as doctors in Spain?”

“I figured most people would realize that I wasn’t claiming doctors are pulling in $900,000 a year take-home.”

But you did seem to equate the two in your post in a confusing manner.  Anyway, I doubt that Spanish doctors are receiving a flat sum of $15 for each routine visit they perform.  Seems more like this is the fee charged through the public health service to the patient.  So the cost of these visits in Spain is actually higher than that listed on the chart in the article.

I wonder what effect the cost of medical school has on what doctors are paid vs. the demands of the job (and of the extremely stressful period of residency) and vs. the cost of malpractice insurance.

paul, to a large degree, professionals like doctors and dentists who are paid by the procedure inevitably have a monetary “goal” in mind for the year and will take on more work in order to meet that goal and then slow down once they get to it. That provides an unconcious incentive to drum up more business or sell consumers/patients/hospitals on additonal procedures in order to meet their goals. We tendtp forget that doctors are businesspeople as much as anything else. Some doctors are willing to grab a larger part of the health care pie by working more and more hours. Others are interested in making the pie larger by pitching the importance of new procedures and new tests.

That said, the family practice docs I have seen tend to be the ones who are part of large practices formed to take advantage of econmies of scale, given their relatively low per-patient compensation. It is the dermatologist with the one-man office who can still take home a big salary on top of his office overhead.

Are American doctors so personable that they’re worth ten times as much as doctors in Spain?

To be fair, I don’t think most American doctors are actually pocketing ten times as much as Spanish doctors are.

Ezra’s chart showed a range of fees for American doctors, which maxed out at $151 for an office visit… but that range started at $59.  It didn’t say that the average office visit was $151, it said that the top end was $151, which presumably means that most office visits lie somewhere less than that, but more than $59.

Then take into account the fact that American doctors aren’t actually pocketing all of that fee… the insurance companies NEVER pay out what the office bills them.  My physician costs me $20 out of pocket for co-pay.  They then bill United Healthcare $95.  UHC then deducts my $20 co-pay, and then further adjusts the rate down so that they only wind up paying my doc $40.  So my doctor winds up getting $60 for my entire visit… and then he has to pay a staff which includes two medical billing specialists whose only job is dealing with insurance companies - jobs he wouldn’t have to retain in a single-payer system.

I do agree that American doctors could live comfortably on less than what they make, but it’s disingenuous to imply that they typically make ten times as much as their Spanish counterparts.  Sure, certain specialists like neurologists, orthopedic surgeons, and plastic surgeons can make a king’s ransom, but your average general practitioner isn’t taking home millions of dollars.  My best friend from childhood is a GP, 4 years removed from his residency.  During his residency, he was making $39,000/year, working 60 hours per week on average - a little less than $13 per hour.  He’s been making “real money” since 2005 when he joined another doctor’s practice, but he’s still probably 10-15 years or so away from paying off the $200K+ he borrowed to get his MD - he’ll be in debt on school until his mid to late 40s.

I think the best approach in fighting for true universal healthcare is to keep the focus on the genuine villains in the whole thing - the private health insurance industry.  Spending a lot of time demonizing physicians - most of whom don’t go into the field just to get rich, since there are far easier and less time-consuming ways to attain that end - isn’t a winning proposition.

Besides…. the AMA has come around and basically flipped their position from the start of this debate, and they now support the public option.  The wingnuts were all rallying around the AMA in the beginning when it appeared that they were going to be an ally, but now that most doctors have come forward saying that they do believe that serious reform is necessary, you rarely hear about the opinion of the AMA anymore on the Fucked Noise Channel.

So, no, doctors never get paid $150 for an office visit unless the patient is paying out of pocket

Yeah, I’ve always had a problem with this ever since I was a teenager and learned that it happens this way.  If an uninsured person has an office visit and says, “Hey, why don’t I just pay you half the price you’re asking and we’ll call it even?”, the receptionist would just laugh at them.  But when insurance companies suggest the exact the same thing, then they’re willing to accept less.  It seems like the exact opposite of how it should be.

One of my best friends graduated pre-med from the UC system.  He tested in the top percentile of candidates.

No American medical school would admit him.

I think the artificial limits on how many schools and placements we have in the country are far more impinging than the debts incurred by medical students right now.  We have tens to hundreds of qualified applicants per student picked to be trained to be a doctor in the US.

...Personally, I’ve never had trouble finding an independent doctor who would take me on a sliding scale, and never paid more than $75 for an office visit of a doctor I chose (and that included ‘office materials’)

catgirl:

Because the uninsured person can’t say, “OK then, I’ll take you off the preferred-provider list, and 50% of your patients will have to go somewhere else”?

And some physicians do give uninsured people a break, but if the insurance company finds out they just cut their reimbursement to half of what patients actually pay. And that’s before the whole reject-every-claim-first-time crap that some insurance companies pull.

One place where sane single-payer would win incredibly would be eliminating the deadweight loss of resubmitting claims, which is something that no one even gets to bill for.

If an uninsured person has an office visit and says, “Hey, why don’t I just pay you half the price you’re asking and we’ll call it even?”, the receptionist would just laugh at them.

Not universally true.

It depends entirely on the doctor.  I was uninsured for about a year, and my primary care physician knew my financial situation wasn’t great, so he told his medical billing person to only charge me $50 for office visits, which was $10 less than the total amount he was getting when I did have insurance.  Obviously, my experience is anecdotal and I’m sure there are plenty of doctor’s offices who will insist on the full fee, but some of them are more pragmatic about it.  His choice was either get $50 right then and there, or send me home with a huge bill which I might never pay and he would have to just write it off.  For him, $50 was certainly better than nothing at all.

I had a similar experience when I was hospitalized a few years ago without insurance… it was a gigantic hassle to deal with, and I had to provide tax returns, bank account statements, and paycheck stubs to prove that I really didn’t have much money, but basically they took an initial $9,000 bill and dropped it down to $900 (and allowed me to pay it over 6 months), because they knew there was no way they would ever get $9,000 out of me (I would have just filed for bankruptcy if they pushed it, which I told them).

Like I said, I don’t think the providers are the real enemy in this system… it’s the health insurance industry, which has the most power (and the mosst at stake) in this whole debate.

I’ve been charged as much as $300 for a 15 minute office visit.  (15 minutes is considered “long” apparently).  But of course the insurance company ended up paying nowhere near that amount.  It’s just a game they play so insurance can feel like they’re negotiating the doctor down.  But if you see an out of network provider you’re responsible for the difference.  And if you’re uninsured or insurance does not cover the procedure in question - good luck.  Some doctors are compassionate, but their billing departments can be pretty rude and uncompassionate.

My great grandfather was a country doctor in the early 20th Century. My Dad told me how back then it was a service profession, like teaching or social work, or nursing today, and that nobody did it to get rich. If the son of a rich person back then said they wanted to be a doctor, their parents would be horrified.

How times have changed, huh?

Whereas the conclusion I drew was that I should have listened to my mom andgone to med school.

Tyro,

Although I had a few older relatives who tried to push me toward the pre-med track…all I needed to do was to tell them that I’ll do that provided they not only paid for my medical training, but also the millions from the inevitable malpractice suits that would result.

Moreover, my decision to not pursue a medical career was confirmed after having 3 medical interns/residents as roommates for 5 years.  When I saw the insane hours they were pulling and the schedules they had to put up with…..it made working 50-90 hrs/week in IT/paralegaling look like part-time work in comparison. 

Then again, this also made them some of the best roommates I’ve ever had as they always paid their share of the bills on time and were rarely home when I arrived home from work/hanging out with friends into the late midnight hours. 

About 70 years ago, my grandfather was on an admissions board for a medical school. He took great pride in explaining to me how he asked questions of the candidates, questions which were designed to discover if the candidate was (primarily) “in it for the money” or because they wanted to help people. Those who were obviously into becoming doctors so that they could become wealthy were quickly shown the door ...

Oddly enough, the criteria your grandfather used to admit/reject medical students would not have filtered out many medical doctors I’ve met in the Boston area as their less noble motivations were not necessarily mercenary….but the ability to have power and the prestigious title which comes with becoming a medical doctor in many societies.  In short the “I did it for the exalted status/prestige points factor”.

A similar dynamic I’ve also seen in many people who attended/graduated from MBA and/or Law school for that matter…..though many others were just as…if not more motivated by the “money” factor. 

IME…it is the MBA/Law students or graduates who tend to epitomize the “doing it for the money” mentality.  In one career journal I came across, this factor was cited as a key reason why the legal profession had a 70% career dissatisfaction rate.

Some doctors are compassionate, but their billing departments can be pretty rude and uncompassionate.

I don’t know that it’s so much about compassion as it is about basic pragmatism.  When my doctor told me that he was only going to charge me $50 for office visits while I was uninsured, I thanked him profusely.  He said, “No need to thank me.  It’s in both of our best interests here… I could charge you the full amount, knowing you can’t really pay it, and I probably wind up with nothing in the end, and you get a ding on your credit score if I refer it to a collection agency.  Or I could charge you an amount you can actually afford to pay, I get paid only a little less than what I would if you were insured, and you don’t have to worry about collection agencies calling you.  It’s simply the better option for both of us this way.”

I used that exact reasoning when dealing with the hospital who was trying to get $9,000 from me when I was uninsured.  I told them, “Look, it isn’t that I’m unwilling to pay you anything, but I simply can’t pay you the amount you are seeking, and I know you wouldn’t get that amount anyway if I had insurance.  What can we do here?”  At first, they wouldn’t yield, and told me that they would continue to pursue the full bill.  Finally, I said, “Look, you are either going to get some money from me - though far less than what you are billing - or you are going to get no money from me at all.  I don’t care if you threaten to turn this over to a collection agency, I’ll just file for bankruptcy if you do.  Sure, it will screw up my credit, but at the end of the day, you won’t get a penny from me and you’ll have to eat the entire bill.  We both lose.  Or, we could negotiate this to a reasonable figure, you don’t take a total loss, and my credit isn’t destroyed.”

And in the end, they relented.  Because while $900 isn’t anywhere near as much money as $9,000 (which they never would have gotten anyway had my hopsital stay been insured), it’s still a hell of a lot more than $0, which is precisely what they would have gotten if they refused to work with me.

Not compassion so much as pragmatism.  “Less money collected” is still a lot better than “no money collected” from a purely unemotional accounting perspective.

Doctors in America aspire to be entrepreneurs, not healers, and the medical schools select for that important characteristic.

Spending a lot of time demonizing physicians - most of whom don’t go into the field just to get rich, since there are far easier and less time-consuming ways to attain that end - isn’t a winning proposition.

Cosign this. Most up-and-coming young doctor types are plenty smart enough to make money lots of other ways, ways that don’t involve staying in school until you’re 30, having a nervous breakdown every few months, and acruing hundreds of thousands in debt.

Oddly enough, the criteria your grandfather used to admit/reject medical students would not have filtered out many medical doctors I’ve met in the Boston area as their less noble motivations were not necessarily mercenary….but the ability to have power and the prestigious title which comes with becoming a medical doctor in many societies.  In short the “I did it for the exalted status/prestige points factor”.

Maybe I’m weird… but I don’t really see a problem with this? I wouldn’t want them to go so far as to sacrifice the well-being of their patients to boost their ego/fame, but after putting in a *ton* of hard work and cramming a ridiculous amount of stuff into your brain and then spending the rest of your life working your ass off helping people in a highly skilled profession… don’t doctors deserve to have a pretty good opinion of themselves, and for other people to have a good opinion of them?

Ben, the thing is that the town doctor was probably the person held in highest esteem in the town. Higher compensation for doctors reflects a sort of middle-class-ification of what we regard as “valuable.” one reason we pay doctors more is that rank-and-file citizens regard being a doctor as prestigious and thus do not blink at the prospect of paying them lots of money.

Being a doctor is still the middle class path to social and economic success. The wealthy go into finance—medicine being considered a bit too proletarian for them.

I do not really begrudge the primary care doc for making 150k to 250k/yr and “goes the extra mile” for his customers (patients). It is the dermatologist* benefiting from highly restricted residency spits making 500k/yr while working relatively easy hours and the surgeon constantly pitching risky experimental procedures to his patients that are keeping costs high.

In any case, anyone talented in biology or chemistry generally compares the future as a doctor with the future of the biology lab’s 40 year old postdoc and decides that his or her talents are better spent on a career in medicine or pharmacy rather than getting a Ph.D.

*my dermatologist solved a problem that was causing me chronic pain, so I have nothing against them. They can be awesome

IME…it is the MBA/Law students or graduates who tend to epitomize the “doing it for the money” mentality.  In one career journal I came across, this factor was cited as a key reason why the legal profession had a 70% career dissatisfaction rate.

I think the reason you’ll see that level of dissatisfaction among JDs but not so much for the MBAs is that while the legal field frequently has the ancillary benefit of being very lucrative (though not always - public defenders aren’t what most would consider “wealthy” by any stretch), it isn’t really designed for the primary purpose of “getting rich” as a whole.  When people think of stereotypically rich lawyers, they often think primarily of trial lawyers, who only represent one segment of the massive legal community which encompasses much, much more than just that.

Someone who pursues an MBA is likely doing it mainly for the purpose of “getting rich”, which is what the primary function of a capitalist business structure is all about.  At the end of the day, some companies can sometimes do some good and benevolent things, but the single most important characteristic in defining whether or not a business is “successful” is whether or not it is making a profit.  And even the good and benevolent things that some companies do through foundations and such are all geared to improve corporate image, which is designed to attract more consumers to spend money with them, which is designed to increase profits.  EVERYTHING a company does is ultimately about the bottom line.

It could be argued that someone pursuing an MBA mainly because they want to get rich is actually pursuing that particular degree for all the right reasons, in the sense that wealth creation is the principle function of business.  Someone pursuing an MD or JD mainly because because they want to get rich will often struggle more with career dissatisfaction, because the fields weren’t conceived with the purpose of wealth creation as a primary focus.

Doctors in America aspire to be entrepreneurs, not healers, and the medical schools select for that important characteristic.

Wow… generalize much about a section of society which is made up of several million people?

OK, my last figure was off (I was thinking of all healthcare professionals, not just specifically doctors)... I should have said:

Wow… generalize much about a section of society which is made up of nearly a million people?

Tyro I don’t begrudge them for getting higher salaries than they used to, it’s just interesting how it’s changed in the last 100 years.

And it was middle class back then, too, just on the lower end of it—like high school teachers are today.

In this case, I assume it has something to do with the foundation of the NHs when Nye Bevin had to “stuff their mouths with gold” to get doctors to sign up.

Stuffing mouths with gold referred to the consultants/surgeons/specialists, and the deal made by Nye at the beginning was to allow them their private hours alongside their NHS hours

British doctors are pretty well paid—even the hospital doctors at the beginning of their careers. It helps that they don’t carry a mortgage’s worth of debt with them when they qualify. Specialists may not get the 4,000-sq.ft. mansion and pool that their American peers may afford, but the payoff is in terms of peace of mind and not having to deal with the shitpile of paperwork and the basic unfairness of the American non-system.

As Atul Gawande said, though, the question of how to make money is there from the moment an American med student signs his/her loan agreement. It shapes who goes into primary care and who goes into lucrative specialisations, it shapes the tacit segregation of healthcare in the US between “rich clinics” and “poor clinics”, it pushes doctors with an eye on easy money towards becoming property speculators with stakes in testing facilities; it corrupts and pollutes the system.

If the son of a rich person back then said they wanted to be a doctor, their parents would be horrified.

How times have changed, huh?

Not as much as you’d think.  Howard Dean tells a great story about how he had to take his dad out to a three-martini lunch in order to break the news to him that he was going to medical school and not continuing to work in finance.  And it was because, to his (extremely wealthy and well-connected) family, being a doctor was exactly like working the counter at McDonald’s—a service job.

My bigger point was this… a quick way to completely run off all popular support for healthcare reform is to try to make doctors out to be bad guys.

It’s not a popular position to hold, and if most of the Democrats in Congress espoused a similar belief as some here, it would guarantee that we would get no healthcare reform at all, because the American public wouldn’t support it.

Valid criticisms can be made about the profit motive of some practitioners in the field… saying that all American doctors are greedy fucks who only want to get rich only makes the person making that claim sound like a bitter asshole.

If there’s one thing progressives are often good at, it’s making the good the enemy of the perfect.

It’s why I can’t stand hearing claims that unless we get universal healthcare this second, we’ve accomplished nothing.  Bullshit.  One can reasonably say that the public option is the inferior alternative to universal healthcare.  But having a public option is still better than having no public option, and it still gets us closer to the goal of true universal healthcare than doing nothing at all.  That some would argue that we should approach the debate as a matter of “universal healthcare or nothing at all” boggles the mind.

I think the Democrats screwed themselves by not using universal healthcare as their launching point, but not because I think that was an immediately attainable goal.  Rather, it is my opinion that by starting there, it would have allowed them to negotiate to a better public option than what we’ll likely get.  I never expected to go from what we have today to universal healthcare tomorrow, because the necessary public support isn’t there yet.

Most people favor a public option today; but most do not yet favor a full government universal healthcare system - yet.  The key word being “yet”.  Those of us who advocate for full, government-run universal coverage are not in the overall majority in the American public at this point.  I think that public support could eventually rally behind such an idea, but before people are willing to put their full faith into the benefits of such a program, they’ll want to see it tested on a smaller scale.  The public option IS the test drive to get to universal healthcare.  But it has to be built to succeed, and assuming it is established properly, eventually people WILL want a full universal system in place.  But we aren’t there yet, and demanding that everybody get on board with a position that isn’t shared by the vast majority of the country is a futile effort.

Maybe I’m weird… but I don’t really see a problem with this? I wouldn’t want them to go so far as to sacrifice the well-being of their patients to boost their ego/fame, but after putting in a *ton* of hard work and cramming a ridiculous amount of stuff into your brain and then spending the rest of your life working your ass off helping people in a highly skilled profession… don’t doctors deserve to have a pretty good opinion of themselves, and for other people to have a good opinion of them?

Bagelsan,

Upon rereading that sentence, I realized that I did not express the excess degree of the egoism/elitism/desire to power that I meant to express which can be summed up as the “desire to play God over others”....not merely a desire to have respectable status. 

I think the reason you’ll see that level of dissatisfaction among JDs but not so much for the MBAs is that while the legal field frequently has the ancillary benefit of being very lucrative (though not always - public defenders aren’t what most would consider “wealthy” by any stretch), it isn’t really designed for the primary purpose of “getting rich” as a whole.  When people think of stereotypically rich lawyers, they often think primarily of trial lawyers, who only represent one segment of the massive legal community which encompasses much, much more than just that.

True though corporate lawyers working in BigLaw firms can also become quite wealthy on their high salaries/bonuses so long as they are able to quickly pay off their law school/undergrad loans, don’t immediately attempt to emulate the lifestyles of the firm partners, and better yet continue to live like budget constrained scholarship students they were as undergrads until the debts are paid off and they’ve accumulated a sizable chunk of savings.

As for the most poorly paid sections of the legal profession, you can add lawyers working for non-profit NGOs like Legal Aid where the salaries are so low($20k/year or less) that one practically has to have a trust fund to be able to afford to work for them while paying back massive law school/undergrad debt.

DTG and others:

I realize that my comment might have come off in a way that I didn’t intend.  My point wasn’t that doctors are all heartless and greedy.  The problem is that insurance companies have the bargaining power to pay only a fraction of the doctor’s fees, so they have to raise the fees to get a fair price.  Individuals without insurance don’t have the bargaining power, and they often end up paying the inflated, unfair price.  So we end up with this weird system where the people who can least afford it are paying too much, simply to make insurance companies feel good about their bargaining power.  The problem is not with the doctors, and I think most doctors support some kind of health care reform.

Actually catgirl, my comments were mainly directed mnsr, who claimed (without a shred of empirical evidence to back up the assertion) that most American doctors cared more about being entrepreneurs than being healers.

And it was middle class back then, too, just on the lower end of it—like high school teachers are today.

Ben D.,

I’m not sure high school teachers are still considered part of the middle class on the basis of income and social status if the attitudes towards K-12 teachers I’ve observed among most upper/upper-middle class parents, parents aspiring to that strata, and most Ivy/Ivy-level undergrads. 

From what I gathered from their attitudes, K-12 teaching is already disdained as it is considered by them to be a working-class/blue collar level service job and with the exception of a minority of bright but excessively ideal college graduates* considered a dumping ground for undergrads whose mediocre academic performance precludes them from pursuing more prestigious/remunerative occupations.  One illustration of this is the level of disdain I’ve observed on many campuses of grad students from other grad schools towards grad students from their campuses ed schools as they were not considered “of the same caliber” as themselves. 

As for the income part, I’ve lost count of how many friends and classmates who ended up leaving the teaching field because the pay was far too low for them to remain and be able to make a sustainable living and/or they were burned out, especially considering all the crap they had to put up with from the educational bureaucracy, parents, and students.  After a while, they felt it was too much of a sacrifice to remain when they had other options which not only offered much higher pay, but also better working conditions and higher social status. 

* Many classmates and friends who attended Grad schools of education and became teachers have never tired of expressing their frustration and anger at how upon expressing their desire to teach K-12 were urged to reconsider as that would be “a serious waste of their high intellects/potential”.

If you look at the number of hours doctors work, and the loans they have to take out and pay, and the years of cut-rate salaries they receive while “training”  ... and then add in the responsibility level ... I don’t think it is excessive.  Not when compared to CEO types who contribute very little to society.

The pay rates in the early going could drop if there were no student loans to deal with ... but housing is a still a huge cost because many internship and training programs are in major cities.

If anything we should have more doctors being paid less and working shorter workweeks.

Ah, you’re right in calling me on the intended-hyperbolic “10 times a Spanish doctor” although I imagine Spanish overhead is higher than we might think. Additionally, I was using numbers at the very top end of Ezra’s range, and I happen to know that a low-level emergency visit (similar to urgent care) is charged to non-insureds at $160, at least in Portland, indicating that an office visit rarely rises to the full $150.

it’s just interesting how it’s changed in the last 100 years.

Care to examine how that’s tracked with the change in medicine over the past hundred years?

A hundred years ago, there wasn’t a hell of a lot a doctor could do for you except set broken bones or offer minor surgeries or palliative care.  It was easy to forgo medical care if you didn’t have the money.  If anything was seriously wrong with you, you would die quickly anyway.  Hell, penicillin was invented a mere 81 years ago.

Some doctors and dentists, perhaps many, sell their patients to other doctors and dentists when they want to retire, as if their ‘practices’ were fast food franchises. New doctors pay handsomely for the patients of retiring doctors, incurring huge debts. Doctors build up practices in order to sell them. Doctors in these types of ‘practices’ spend too much time hiring/firing, accounting for revenues/costs and managing finances/investments and not enough time seeing patients. These types of doctors want to be entrepreneurs, and they helped make medicine into a medical industry for great profit. If you listen carefully, some doctors complain about all of the paperwork they have to fill out in order to be paid. If doctors worked in clinics, they could be full time healers, but many doctors desire to be clinic owners, preferring to be rich. Dr. Frist was one of those types of doctors.

Some doctors spend very little time with their patients because a telemarketer is on the phone asking about their past Club Med vacations. This happened to me when working as a telemarketer. The receptionist actually broke into the line and told the doctor the patient was waiting. He told me to call back in five minutes, which I did, and he finished the 30 minute survey.

after putting in a *ton* of hard work and cramming a ridiculous amount of stuff into your brain and then spending the rest of your life working your ass off helping people in a highly skilled profession… don’t doctors deserve to have a pretty good opinion of themselves, and for other people to have a good opinion of them?

This describes doctors, and it also describes teachers, and it also describes engineers, and CPAs, and social workers, and….

So no, not really. Sure, a better rep than fast-food managers or grocery baggers or telemarketers or investment bankers, but there are lots of professions (and not-officially-professions) where people work their asses off helping other people that don’t get the pay or prestige doctors do.

mnsr wrote:

Some doctors and dentists, perhaps many, sell their patients to other doctors and dentists when they want to retire, as if their ‘practices’ were fast food franchises. New doctors pay handsomely for the patients of retiring doctors, incurring huge debts. Doctors build up practices in order to sell them. Doctors in these types of ‘practices’ spend too much time hiring/firing, accounting for revenues/costs and managing finances/investments and not enough time seeing patients.

My dentist sold his practice, and the people who work there now are the same people working there seven years ago—except for the absolutely gorgeous redheaded dental technician.  :(  But I never saw any evidence that either the old or new dentist himself was spending an inordinate amount of time on non-patient things.

Actually, since the new dentist is Indian, the best thing he’s done is keeping the old staff, and the old staff learning how to translate his English into English the patients can understand!

Oh, I don’t know. I’m willing to listen to doctors point out that all that student-loan debt means that they have no incentive at all to go into lower-paying areas of medicine, like taking a position in a rural area as a GP, even though we need a lot more GPs in rural areas than we need plastic surgeons. But guess which pays more? And you can’t take noble intentions to the bank.

Lawyer dissatisfaction is also partly the result of people going to law school because they can’t think of anything better to do with a BA, and then finding out too late how much most people hate lawyers.

Some doctors and dentists, perhaps many, sell their patients to other doctors and dentists when they want to retire, as if their ‘practices’ were fast food franchises.

That’s how I found my dentist:  G. was going to his predecessor and she sold the practice to him.  I actually didn’t mind at all, though, because the previous dentist did a search and interviews so she could find someone who would fit in well with her client base.  I didn’t have to go to an all-new dentist out of the blue—he was someone fully vetted that the previous dentist liked and thought would fit in well with her patients.  Since you are going to a doctor or dentist for very personal service, it’s good to have that recommendation.

Fascinating, always, to see how people who wouldn’t put their name on rank prejudices about anyone else will plaster their name all over rank prejudices about doctors.  Because you can, you know…why not?  Always fun to blame a group you perceive as elite.

I graduated from med school just over two years ago with $300,000 in loans from a public school in the US.  Since then, those loans have accrued $15,000 in interest alone.  I’ll start out with a salary around $130,000 at max in the state I live in; if I’m lucky, I’ll top that with a little loan repayment from the feds or the state.  Throw that into any loan calculator you like, and make a conservative guess that I’ll be paying that back at 5% over 30 years.  And then try to tell me I’ll be making too much.  We won’t even get into every broken marriage, thirty-hour shift, car wreck from exhaustion, and a litany I won’t even begin to describe I’ve seen along the way.  This is a profession that is still arguing whether we should be scrubbing into surgery after 30 or a mere 24 hours on our feet.  You cannot pay us enough, because there isn’t enough money to make up for this.  You can argue all you want, but until you’ve lived through it - with a mortgage-sized debt on your shoulders to show for it - you don’t have a leg to stand on.

P.S. That doesn’t mean I argue for more money: it means I argue for more humane treatment, less loans, and a cap on physician payment in return.  But, I’m a socialist at heart, so I digress.

Some doctors and dentists, perhaps many, sell their patients to other doctors and dentists when they want to retire, as if their ‘practices’ were fast food franchises.

That’s how I found my dentist:  G. was going to his predecessor and she sold the practice to him.  I actually didn’t mind at all, though, because the previous dentist did a search and interviews so she could find someone who would fit in well with her client base.  I didn’t have to go to an all-new dentist out of the blue—he was someone fully vetted that the previous dentist liked and thought would fit in well with her patients.  Since you are going to a doctor or dentist for very personal service, it’s good to have that recommendation.

Above and beyond that point, the notion that retiring doctors can just “sell” their patients to another doctor is a pretty ludicrous claim.

Sure, in remote rural areas with only one practice this is somewhat the case, but in any decent-sized city or suburban area, you do generally have the option of changing doctors if you aren’t happy with the physician who takes over the practice you had been going to.  As crappy as the current healthcare system is, you aren’t usually restricted to having only one practice to choose from for basic healthcare needs.  Whenever my physician retires, if he sells his pratice to a new doctor that I don’t like, I’ll just go find a different doctor.

Lawyer dissatisfaction is also partly the result of people going to law school because they can’t think of anything better to do with a BA, and then finding out too late how much most people hate lawyers.

I’m not sure that’s as big of a factor as our popular culture has made it well known how much lawyers are hated by most people.  Even Shakespeare had something to say about them….

I’m wondering if a bigger motivator which piggybacks on the factor above is that many fresh BA holders without strong math skills* and/or acumen/desire to go into some sort of corporate business/commerce field do it because it seems the “default” seemingly lucrative profession for those fitting their descriptions?

Anyone who does something solely for the money and not some level of love for the given profession/career tend to become highly dissatisfied with their careers when they actually have to do the less glamorous aspects of their jobs. 

Saw it before among IT/CS people, lawyers, banking analysts, and medical doctors. 

* Several lawyers at a firm I worked at used paralegals including myself to do simple arithmetic for them because their math skills were practically nonexistent.  Am talking first-fourth grade stuff here…..not stats or calculus….

We won’t even get into every broken marriage, thirty-hour shift, car wreck from exhaustion, and a litany I won’t even begin to describe I’ve seen along the way.  This is a profession that is still arguing whether we should be scrubbing into surgery after 30 or a mere 24 hours on our feet.  You cannot pay us enough, because there isn’t enough money to make up for this.  You can argue all you want, but until you’ve lived through it - with a mortgage-sized debt on your shoulders to show for it - you don’t have a leg to stand on.

While I do sympathize somewhat with the high debtload medical students must assume as I lived with 3 MDs for 5 years and had several high school classmates who went into medicine, I’ve also known many others who ended up with similar or higher debtloads who ended up going into far less renumerative professions such as social work, teaching, or academia*. 

As for working crazy hours and horrid working conditions without many breaks, I can give you that…..though a stint in the military can far exceed that with crappy pay to boot….especially if one happened to be drafted during high tensions/wartime as was the case with my father in Taiwan in the 1950’s and Americans before 1973. 

Also…..lawyers and tenure-track academics* can give medical doctors a run for their money in the long hours/horrid conditions with mortgage sized debt department….

In short…..join the club…..

* Had a prof who ended up in deep debt to his eyeballs because his state university graduate institution had its funding severely curtailed while they jacked up his tuition, fees, and effectively forced him to pay for research expenses that would ordinarily be reimbursable at a decently funded school/department.

has anyone here looked at a statement from a doctor’s visit lately? if you have insurance, you’ll see a confusing list of fees, “allowed” fees, and actual fees. the insurance business is in the business of paying doctors as little as they can.

when an insurance company writes the checks, there are always little deductions, write-offs, etc. adjusters are paid lots of money to save the insurer money. after a while, every single charge or fee gets knocked down. and this happens regardless of how much it actually costs to perform the service, whether you are a doctor or anyone else.

the natural response of doctors (or anyone else) is to increase your charged fees so that, after the insurance company knocks them down to “allowed” fees, the doctor is being paid what they should have been paid in the first place. and then some doctors’ billing departments take the game further, coming up with excuses to dissuade patients from seeking needed care, charging directly for covered care when the insurer doesn’t pay well and exploiting ambiguities in coverage, etc…

While I do sympathize somewhat with the high debtload medical students must assume as I lived with 3 MDs for 5 years and had several high school classmates who went into medicine, I’ve also known many others who ended up with similar or higher debtloads who ended up going into far less renumerative professions such as social work, teaching, or academia*.

I know of no social worker who has completed their educational studies with a $300,000 student loan debt.  The highest-rated graduate program for social work in the United States is less than a mile away from me (Washington University in St. Louis), and I know for CERTAIN that it isn’t as expensive as Washington University’s medical school (#3 in the country, behind only Harvard and Johns Hopkins).

Medical school isn’t “sometimes” more expensive than other graduate and post-graduate programs, it is almost ALWAYS more expensive.  Go look at any school in the country… the cost of tuition alone for their PhD, EdD, JD, MBA and other post-baccalaureate programs is almost universally less expensive than is the case for medical schools.  Not to mention the cost difference for medical textbooks and cadavers and whatnot.

I’m not knocking social workers, teachers, or academics… what they do is extremely valuable to society, and I think the vast majority are very underpaid.  I also concede that a lot of specialists do make too much money.

That said, no, I don’t agree with the proposition that the workload and debt incurred by social workers and teachers fresh out of school is equivalent to the workload and debt incurred by doctors fresh out of school.

K-12 teachers don’t have 30 hour shifts.  Ever.  My mother was one, my brother is one, and one of my closest friends is one.  It can be very stressful work for certain, and definitely those who go in the field deserve higher compensation than what most of them currently get.  But it is simply untrue to allege that the average K-12 teacher enters the workforce with as much student loan debt as a resident physician, or is expected to dedicate as much time or commit to as inconvenient a schedule as a resident physician.

Sorry, we can agree that the compensation differential between the two fields shouldn’t be as great, but I’m not buying the thesis that being a teacher requires the same initial time and money investment as being a doctor.  Because as a general rule with very few exceptions, it just isn’t true.

I don’t think tht doctors’ unions are unions or associations; UI believe that the correct term is guild.

That said, no, I don’t agree with the proposition that the workload and debt incurred by social workers and teachers fresh out of school is equivalent to the workload and debt incurred by doctors fresh out of school.

Is the workload-to-income ratio comparable? How about over time - is a social worker with ten years’ experience likely to see the same income growth as a doctor with ten years’ experience?

I’d like to think that we can all agree that crushing student-loan debt is appalling, particularly when there’s little alternative and when it drives students into high-paid specialties or jobs because they have very little choice. I’d also like to think we can all agree it helps nobody, and is nothing more than hazing, to force young doctors to work ridiculous shifts and hours. But c’mon. “Initial time and money investment” ignores what you get out of that investment, especially over the course of a career and not simply when you’re fresh out of the gate.

chareth - certainly the negative opinion of lawyers isn’t the only, or even the primary, thing that makes people dissatisfied, but it doesn’t help; you don’t get a fancy, respected title like “Doctor” and people don’t look up to you.

K-12 teachers don’t have 30 hour shifts.  Ever.  My mother was one, my brother is one, and one of my closest friends is one.  It can be very stressful work for certain, and definitely those who go in the field deserve higher compensation than what most of them currently get.  But it is simply untrue to allege that the average K-12 teacher enters the workforce with as much student loan debt as a resident physician, or is expected to dedicate as much time or commit to as inconvenient a schedule as a resident physician.

If we’re strictly talking about debts from school tuition and fees, then you’re correct.  On the other hand, teaching K-12 is one profession where it demands individuals complete a BA and a Masters with associated debts while the larger society, especially those in the upper/upper-middle class looks down upon/treats them with the same disdain one sees reserved for those in blue-collar service jobs.  To add insult to injury, the salary is extremely low for the requirements/expectations demanded by the demanding and disdainful public…especially when student teachers/teachers often must dip deeply into their meager incomes to pay for basic school supplies that school systems/taxpayers should be paying for as a part of educational funding.  You’re also leaving out the hours outside of the school day such as lesson planning/lecturer preparation, grading of student work/tests, dealing with parents after school hours, etc. 

  And the socio-economically privileged wonder why so many topflight undergrads see the reality of how teaching is so devalued by them even as they pay lip service about how important the profession is to society and as a result…vote with their feet by pursuing better paid and more highly esteemed careers such as medicine, finance…or yes…even law. 

I’m sorry, but skylanda’s griping I read above is reminiscent of the sort I’d often hear from wealthy Republicans and trust fund kiddies from school, work, and within my own family about feeling put upon because they must pay more in taxes off of their “hard earned money” to maintain a semblance of social equity and fairness…especially when they benefit the most from the society which created the environment which allowed them/their families to become wealthy/inherit wealth in the first place. 

While becoming a medical doctor may not always guarantee a champagne filled life, it usually provides a pathway to a comfortable middle/upper-middle class existence for the practicing doctor and his/her family and high social status within the larger society.  And with few exceptions and some isolated misdirected anger and frustration towards doctors seen here and other places…doctors are on the whole still highly respected and esteemed compared to those in other professionals requiring similar levels of grad training and debt levels….just ask Shakespeare and most people what they think of lawyers….

they’re dissatisfied because the work is hard and they really don’t like the work to begin with or (far more common) the debt load to job prospect ratio is hugely out of balance, and due to the ABA’s complete complicity with con artist lower-tiered law schools, many people don’t figure this out until they’re too far into law school to quit or until they begin their careers.  a tier 4 law school can cost as much as a top 20 and the average starting salaries aren’t nearly enough to pay off that debt level.

Hard, tedious, and boring due to lack of genuine intellectual stimulation was the way one senior associate I worked with describe her vocation. 

As for the ABA complicity with lower tiered law school….this was probably a reason why nearly every lawyer i talked with about what the legal career entailed/required emphasized that if I want to maximize my chances of a viable and lucrative legal career to try to get into at least one Top-25 law school and attend/graduate from the highest ranking one assuming I was admitted to multiple schools within that category…..or consider other careers as the competition from Tier 1 grads, workload/rigor, debtload, and aggravation is such that putting up with it from a lower-ranking law school is a losing proposition from a cost-benefit perspective. 

There’s also the danger of being so ill-prepared that the probability of failing the bar exam in a state like NY is high as happened with one lower-tiered law school where over 50% of their graduates failed the NY bar one year….a serious embarrassment when many lower tiered law schools boast NY bar pass rates of 80% or above. 

chareth - certainly the negative opinion of lawyers isn’t the only, or even the primary, thing that makes people dissatisfied, but it doesn’t help; you don’t get a fancy, respected title like “Doctor” and people don’t look up to you.

That may be true, but lawyers are still considered members in good standing of the middle/upper-middle class financially and/or socially by most in US society.  That’s one thing going for that field that K-12 teachers don’t have from my observations of attitudes from others and the society at large. 

Also, aren’t attorneys entitled to use the Esq. after their names…..however meaningless it may be in the greater scheme of things?

**** If an uninsured person has an office visit and says, “Hey, why don’t I just pay you half the price you’re asking and we’ll call it even?”, the receptionist would just laugh at them.****

****Not universally true.

It depends entirely on the doctor.  I was uninsured for about a year, and my primary care physician knew my financial situation wasn’t great, so he told his medical billing person to only charge me $50 for office visits, which was $10 less than the total amount he was getting when I did have insurance. ******

I have to back up DTG on this. I lost my insurance this year, and found out that my doctor has a separate fee schedule for uninsured (At least, if you ask her about it) that is basically 30% cheaper than what she bills to the insurance companies.

teaching K-12 is one profession where it demands individuals complete a BA and a Masters with associated debts while the larger society,

In my experience, teachers generally get their Master’s degree paid for as part of their “continuing education”. While it’s a profession that requires a graduate degree, it’s generally acquired while working and paid for by the employer… but as a municipal “service job” it’s more analogous to police, firefighters, and social workers.

Here’s the thing about doctors: while many of them have to put up with bone-crushing hours and other assorted problems, I’ve never heard of one doctor who faced the prospect of never being able to pay off his loans. There are plenty of other people who acquired a debt load that they will never be able to pay off. Of course, if compensation drops drastically, then this may change, but I don’t think anyone is planning to cut compensation on primary care physicians when it comes to bending the cost curve.

The flip side is this: plenty of people claim that one way to get more doctors to go into primary care is to forgive their loans in exchange for spending time in primary care instead of a subspecialty. However, most doctors are reasonably competent at math and realize that it’s not worth it to dispense with $200k worth of loans to take a $150k-$200k job in primary care when you could accept the loans and take a $400k-$500k+ job in orthopedic surgery (minus the opportunity cost of spending the extra years in residency).  What’s going to have to happen is a move to lower tuition across the board, lower compensation for subspecialities, and put more money into primary care.

I also think that exholt understands the social dynamics of lawyers better that DTG: lawyer jokes aside, people only hate lawyers in the abstract. Among the upper middle class who actually socializes with lawyers, it’s considered a profession part and parcel of the “professional class” alongside the doctors and finance people that show up for parents’ day at the local private school. People report poor job satisfaction with law because the work isn’t that great and lots of people in the profession went into it because it’s perceived as a “good profession,” not because they have some passion for the law and the actual work isn’t that great.

The great thing about plastic surgery is that you are not limited by the number of people who are sick. Just convince people that their bodies are somehow “wrong” and you’ve got it made. I do bot mean to disparage those surgeons who repair real disfigurment and alleviate real suffering by saying this.

As for teachers getting MAs in education: Let’s stop paying for it. The abuse other graduate departments heap on MEd’s is well-deserved. If these people were so great they could get degrees in the subjects they teach.

Remember, those cool professors you had in college most likely had no formal education in “education” at all.

That said, no, I don’t agree with the proposition that the workload and debt incurred by social workers and teachers fresh out of school is equivalent to the workload and debt incurred by doctors fresh out of school.

Is the workload-to-income ratio comparable? How about over time - is a social worker with ten years’ experience likely to see the same income growth as a doctor with ten years’ experience?

I’d like to think that we can all agree that crushing student-loan debt is appalling, particularly when there’s little alternative and when it drives students into high-paid specialties or jobs because they have very little choice. I’d also like to think we can all agree it helps nobody, and is nothing more than hazing, to force young doctors to work ridiculous shifts and hours. But c’mon. “Initial time and money investment” ignores what you get out of that investment, especially over the course of a career and not simply when you’re fresh out of the gate.

I essentially agree with all of what you just said.  My response was to exholt’s comment about knowing “many others” who ended up with a similar or higher debtload than that incurred by the average medical student.

While I am sure some scattered examples exist of some social workers/teachers etc. that complete school with a bigger debt load than some medical students (mainly trustafarians), as a whole, it really isn’t particularly comparable.  The average debt load carried by most medical students far exceeds the average debt load carried by most social work/education students.

As for the workload-to-income ratio, it really depends on what point in someone’s career we’re talking about.  My friend’s residency paid him $39,000/year, and he was averaging 60 hour workweeks when he was doing it.  My little brother’s first full-time teaching position paid him $35,000/year, and he typically committed about 50 hours per week doing it (including work at home), with a fully paid 2.5 month summer vacation and a two week winter break (his contract was structured to spread his annual salary throughout the whole calender year, not just the school year).  Both of them were working these jobs at the same time, both in the same market, St. Louis.  Including his hours worked at home, my brother averaged a little more than $22 per hour for the time he committed to his job.  My friend the physician averaged about $13 per hour at the same time.

Now, that said, once my friend finished his residency, his salary went up quite significantly when he went into private practice ($120,000 per year), whereas my brother’s only went up marginally in the same timeframe ($39,000 per year).  And while my brother’s workload didn’t change much, my friend’s decreased pretty substantially.  But, my brother was able to get all of his Perkins Loans completely forgiven after a short time working as a teacher.  I’m unaware of my friend being able to get any loan debt forgiven.

So obviously in the long-term, a doctor’s debt-to-workload ratio and debt-to-salary ratio is going to be much better than that of a teacher or a social worker.  But almost never is that the case in the first several years out of school.

It can typically be 5-8 extra years before the doctor surpasses the teacher in income/work ratio, because the teacher can start teaching while the doctor still has at least 2 years of med school left, and many teachers can start teaching before completing their Master’s degrees.  An MA, MS, or MFA definitely improves a K-12 teacher’s resume and salary potential, but it’s not mandated across the board in every or even most school districts.  Certainly some K-12 positions require it, but not all of them.  My brother only had a BA, a state teaching certification, and one year working as a substitue at the time he got hired full-time as a fifth grade teacher, and he was hired by one of the better school districts in the STL suburbs.

teaching K-12 is one profession where it demands individuals complete a BA and a Masters

Highly encouraged, but not universally mandated by any means.  My brother started teaching in a nationally recognized school district in the St. Louis suburbs with just a Bachelor’s degree.  A friend of mine who teaches high school English for the Los Angeles Unified School District only has her Bachelor’s degree.  Another friend got a teaching position straight out of undergrad in the northern Chicago suburbs a few years earlier.  All three of them got these jobs in the last six years.

The expectation of a Master’s Degree for K-12 educators is certainly increasing and I believe will eventually be pretty universally mandated, and I believe there are far more Master’s level K-12 educators today than there were even 10-20 years ago, but it is not an absolute requirement across the board in all school districts yet.  Many teachers today get their Master’s Degree while they are already actively teaching.

Also, regarding lawyers and the title “Doctor”, though no one ever refers to them as that and I’ve never met one who referred to themselves that way, they are in fact “Doctors”... JD stands for “Juris Doctor” - Doctor of Law.

I don’t think primary care doctors are overpaid—obviously, since I am one.   But I agree that it’s tiring to hear doctors whining about it, since I’m thrilled to be able to make the good living that I make.  I routinely hear colleagues who make more than twice what I do bitching about not making enough money, and it takes everything I have not to roll my eyes.

The problem, as others have pointed out, is that pay for doctors is dependent on how many patients they see, so it’s more about making patients happy than providing good care. The trick to making a patient happy is to create the impression that you’ve really done something for him. For instance, if you come to my clinic (a university-based Community Health Center) with a cold we give you some decongestants and tell you to get plenty of rest and fluids.  If you go to the private clinic down the street you get a steroid shot and $200 worth of antibiotics. So they’ve made you no more healthy in the short term, probably less healthy in the long term, and cost the health care system a lot more money, but you’d probably be happier with the care you got there because we “didn’t do anything for you”.

I’ve always insisted on a strict salary arrangement with no incentive bonuses, because I want to limit my incentive to provide bad care. But that just means I have an employer breathing down my neck about more billing and better patient satisfaction, and of course I still want to make my patients happy. It’s still always in my interest to do more if I can possibly do more.

So if some physicians’ salaries are out of control, it’s a symptom of a medical culture that breeds more and more expensive care, not better care.  Fixing that is going to require a much more extensive overhaul than anyone in power has the political will to even suggest right now.

Some comparative figures:
There are 199 accredited law schools in the USA, meaning that there is one law school for every 1,547,010 Americans.  There are 14 common law schools in Canada, and 5 civil law schools (for Quebec’s European-style legal system.  The numbers are thus:
@ 14: one law school for every 2,416,500 Canadians; and
@ 19: one law school for every 1,780,579 Canadians.

Even with two totally separate systems of law and two different official languages the Americans still have way more law schools per citizen. 

BTW, there really isn’t a “tier” system in Canuckistan.  This leads on the one hand to some complaints that there are no so-called “centres of excellence” in the field (though there are centres of specialization ... if I had known I was going to practice business law I might have gone to UofT or UWO rather than Oz) but it also means that there are no `Law School and Storm Door Repair’-type schools*, either.

* - Shamelessless stolen from Bob Newhart.

Also, aren’t attorneys entitled to use the Esq. after their names…..however meaningless it may be in the greater scheme of things?

Doesn’t “Esq.” just mean that you are of gentle birth and thus armigerous?  How can that apply in a country like the USA where there is no heraldic system?

Re: negotiating with professionals.
Sometimes we are easier to deal with than other goods and service providers, to a ludicrous degree.  For a funny take on it please go here:
http://www.youtube.com/watch?v=R2a8TRSgzZY

Seeker: 199 accredited law schools, divided by 50 states, with an area of 3,794,101 square miles comes out to about 19,000 square miles per law school.  Comparing colleges by population is unfair due to the fact that people can’t necessarily move to an area to pursue their career.

The biggest problem we have now is that all degrees in social areas (i.e. Doctors, professors, teachers, lawyers) should be offered two routes.  One where they pay their own way and may enter the private industry immediately.  The other route is free but you have to give up X amount of years to public service.  To make the free route more enticing though limiting the amount of financial aid available for such graduate programs would make it easier. 

Doctors aren’t overpaid so much as insurance companies, hospitals, and doctors have been working towards gaining more profit for their efforts because they have a monopoly on the system.  When we have no state-run hospitals except for the infirm and mentally ill we leave a gaping hole in the system.

Xeranar:
You might want to check your Atlas.

USA area: 9,826,675 km2
USA population density: 31/km2
49,380 km2 per law school

Canada area: 9,984,670 km2
Canada population density: 3.2/km2
525,508 km2 per law school (@19)

Your density of law schools to area is over ten times ours.  In Canada if one wants to go to a law school one must move to a major (or middle) metropolitan area.  We have many flaws in our system but we at least chose not to address the geography problem by breeding low-quality law schools.

i’ll also disagree that people don’t look up to lawyers

Oh, of course it’s a “profession” and has social status and prestige - I wasn’t suggesting that people sneer at lawyers the way they do at, say, laborers.  “Esq.” isn’t really the same as “Doctor”; nobody addresses me as “Esquire Mythago,” although if I’m writing to another attorney I probably would address them as “Parsleigh McEvilclient, Esq.”, and on formal pleadings and documents you also tag on the Esq. None of this is a plea for sympathy; it’s just an observation, and I get the strong sense from a lot of my colleagues that they had no idea people would be this mean to them. (That famous Shakespeare quote, by the way, was not anti-lawyer at all. It was put in the mouth of a villain.)

And what J Train and Tyro said about doctors. Yes, medical school is hell, as are medical-school student loans. But doctors are well-paid, and they have a very good earning curve. To complain that they have it sooo much harder than social workers or kindergarten teachers besmacks of exactly that kind of arrogance and cluelessness that makes my job easier.

And seeker, apologies for both the double-post and the digression, but a) law schools to area is kind of a silly metric, and b) don’t know about Canada, but in the US we have a “quality” circle-jerk that has nothing much to do with law schools’ quality and a lot to do with privilege feeding on itself. As has been pointed out by smarter people than me, there are two legal job markets in the US - “BigLaw,” the industry of large, prestigious law firms whose business is primarily serving large corporations, and everything else. Law schools are ranked by US News and World Report, of all things, and BigLaw hires from them primarily so they can say they have top-ranked grads. So the top-ranked schools charge the sort of tuition you’d charge to people who expect to be making $150K+ right out of the gate, and the grads then go to work for the highest-paid firm they can find (or, if possible, they make an intervening stop at a clerkship to rack up a bonus for the following year).

no one EVER uses “doctor.” that’s straight-up orly taitz territory

One JD who used this was “Dr.” Farris, the founder and first president of everyone’s favorite college for homeschooled evangelicals, Patrick Henry College. He didn’t last in part because he liked to assume the trappings of being an academic without accepting the mindset.

But look, whatever the flaws of the training of new physicians, we should be thankful that they exert more quality control than is used for admission to the bar.

A doctor or dentist will tell their clients, some call them patients, that they thoroughly ‘vetted’ the doctor they are selling their business to, but that is ludicrous. They sell their business to the highest bidder, and it always turns out they think the buyers are great health care providers, too.

mythago:

The whole circle jerk thing came in for some vigorous debate on the threads about SCOTUS judges, remember?  There were some posts here that pretty much said (whilst vigorously denying that they were saying any such thing, oh my) that only Hahvad, Yale and maybe some other Ivys were there to produce SCOTUS judges and every other law school was there to produce folks with a peeling shingle who accept payment in chickens.

I’d agree with you that law schools to area is a ludicrous metric.  It was Xeranar ‘s example and I only used it to point out that even by his own measurement he was wrong.

One never sees Esq on pleadings here.  The only initials that one might see on court documents and the like is “QC”, standing for Queen’s Counsel, (a “silk” in English parlance).  They are rarer on the ground now, at least in Ontario.  They tend to be split between lawyers who get silk for being great lawyers, and lawyers who get silk because they are politically well-connected.  That is why Ontario stopped awarding QCs in the 1980s (the feds still award them) after the Liberals took over after 42 years of Tory rule.  When one dealt with a QC one never knew whether one was dealing with a brilliant lawyer or some barely literate moron who had been rewarded for being the best fundraising bagman that Riding X ever had.

I think that Tyro is wrong when (s)he says that “people only hate lawyers in the abstract”.  No, they hate them ideologically and directly, too.  Directly: No decent person will look your new black boyfriend in the face and ask if he likes watermelon but they will look at the lawyer and joke to his/her face about thievery and lack of principles.  Ideologically: they will resist anything that lawyers – as a group – suggest.  It took decades to regulate paralegals in Ontario because every time the Law Society tried to bring in something, anything to protect the public it would be smacked away as “lawyers protecting their turf”.

Fees and doctors, that amuses me, too.  I’ve heard doctors here in Ontario bitch about how much lawyers earn.  I made myself persona non grata at a party about fifteen years back by snapping at a doctor over just this issue.  The MD had kvetched about us, and the heads swivelled to me expecting a funny response.  I just shrugged and said, “every single one of your bills, every single one, will be guaranteed to be paid for the rest of your life, and no patient will ever get an automatic discount if they have your bill assessed,  andyour profession is admired no how badly you perform, and your insurer and governing body protects you even if you leave a toaster in a patient and there is no competition among doctors because the prices-taxes are all the same and you get to artificially restrict the number of competitors you have and thus there’s so few of you so you get to hold the government to ransom on your fees.  Lawyers get none of that at all.  So when you have all of your advantages taken away then you can bitch to me about how tough you have it, but until then (cough!) off, okay?”

The hostess never spoke to me again.

Doesn’t “Esq.” just mean that you are of gentle birth and thus armigerous?  How can that apply in a country like the USA where there is no heraldic system?

It is originally a British term denoting social status, but in America, it is commonly associated with lawyers.  I don’t see it a ton, but I have seen a decent number of lawyers’ business cards that have Esq. appended to their names.

no one EVER uses “doctor.” that’s straight-up orly taitz territory.

Completely unhinged nutbar that she is, I think Oily Taint refers to herself as a “doctor” because of her DDS, not her JD.  In addition to being a joke of a lawyer, she’s also a practicing dentist.

In addition to being a joke of a lawyer, she’s also a practicing dentist.

Jill of all trades, master of ....

You might want to check your Atlas.

USA area: 9,826,675 km2
USA population density: 31/km2
49,380 km2 per law school

Canada area: 9,984,670 km2
Canada population density: 3.2/km2
525,508 km2 per law school (@19)

I used miles, so my atlas is still absolutely correct.  You’re population density is also 10th of ours.  Comparing Canada which has 90% of it’s population along it’s border and has about a 50% share of area that is unlivable tundra is rather unfair to compare.

It isn’t ludicrous to ask somebody who has to fight for a profession to not move 1500 miles back east to attend a prestigious law school.  Also I would say most of our law schools are far from sub-standard.  Another poster pointed out though that the Ivy League system has created a stranglehold on our law profession by creating a double standard.  A law degree from a state college is about the same in quality as one from Yale but just as getting a PhD is a bit of a name game, so is a JD.  So is an MD for that matter.  Americans love class-ism, it’s our division.

BTW, many Canadian law schools are switching to JD from LL.B., in part to ensure compatibility with the American market (hello, pressure from Bay Street anyone?) and in part because the law degree is fairly universally a postgraduate achievement now, and so ill-fits a “Bachelor” designation.

It isn’t ludicrous to ask somebody who has to fight for a profession to not move 1500 miles back east to attend a prestigious law school.

It is far less ludicrous than the creation of third- and fourth-tier law schools where half your graduates can’t even pass a bar exam (as noted by another poster, above).  Law is a complex and demanding craft and it is not unreasonable to ask people to move to a major urban centre to learn it from a school that is well qualified to teach it.  Determining how many law schools one has per mile/kilometre/acre/arshin/whatever is a rather silly metric best left to determine whether or not one places a Wendy’s franchise.

As for America it isn’t a binary game with “only the Ivies count” on the one hand and “all law schools are equally good” on the other as the only two choices.  The Ivies do have a disgustingly strong lock on things that matter in the USA, but it doesn’t necessarily follow that some eighty-person law school in Whereeverthehellitis AlaTexassippi is comparable in quality to Stanford, say.  (Regent’s is a joke, but got huge numbers of its people placed due to ideological purity rather than competence so that’s a separate issue.)  There’s a ton of great law schools in the USA and they can’t be left out of the dynamic because people don’t want to discuss anything other than the perceived extremes.

As for the strung along the border metaphor you’ll find that to be an enduring myth.  For the most part Canadians reside in urban and linked suburban nodes which were sited thanks to the best available local climate and the original water and later rail transportation systems, and/or their related military utility and defensibility.  Some of the most important cities (Calgary, Edmonton, Québec and Halifax spring immediately to mind) are nowhere near the border;  hell, our national capital was chosen in part because of its placement well back from the border, given your national pastime of invasions to liberate people who’d prefer to be left the hell alone.

Thanks, skylanda (#59).

I agree that many professions have _some_ of the negative aspects of medicine that, to me, justify higher salaries, but I can’t really think of any other professions that have _all_ aspects.

Law - in big cities, big firms can force you to work ridiculous hours.  However, they also compensate at ~ $160K (NYC) during the grueling associate period, whereas residency compensates at ~$40K.  Many attorneys have huge law school debt, but they (1) could work during summers, (2) make 4x as much right out of law school, and (3) had three rather than four years of school. 

Education - show me a teacher with >$200K of necessary debt (i.e., not debt due to Harvard undergrad.)  Furthermore, though hours can be long, they do not require 30hr shifts, and the job itself offers summers off (yes, I realize that most teachers have another job during that time.) 

Tenure-track faculty - I’ve done the Ph.D. thing.  Hours, stress, and poor job security are definite negatives.  Again, though, it is generally possible to work largely when and how you want.  For science Ph.D.s, it is easy to graduate with _no_ grad school debt, as tuition is paid by the program and a stipend is provided by an advisor, grant, or program.  Furthermore, at least in my experience, the classes/training aren’t anywhere near as hard as the classes/training in med school.  Not even close.

I think the military is nearest to medicine in overall negatives.  In both fields, abuse during training is simply expected.  (for those who don’t know, med students and residents will regularly be screamed at, be unable to eat, be unable to sit down for many, many hours at a time, etc.)  I don’t really know about the military, but I assume that soldiers endure the equivalent of frequent 30-hr shifts.  Both careers involve lives on the line.  Bottom line, I think soldiers deserve much higher salaries, despite their benefits.

Look, medicine is full of little miseries, and they add up.  In surgery, you can’t really leave to pee or even scratch an itch.  Your day is jam-packed (yes, there are exceptions for certain specialties) - it’s not like you can browse blogs for even a few minutes every few hours, because you’re not at a desk.  You frequently don’t have time to eat, or you have a sadistic attending who thinks you shouldn’t have to eat.  You have to arrive quite a bit earlier than for the vast majority of jobs.  During residency, those 30-hr shifts usually happen every 4-5 days, and for many specialties, they continue (less frequently) throughout your career.  You’re dealing with shit, vomit, pus, blood, and horrific injuries on a routine basis.  You get used to it, but you’re still human. 

Granted, this varies by specialty.  I don’t know a dermatologist who (I think) provides a service worth his salary.  All I know is that there’s no way in hell I’d go through this for less than $100-200K in eventual salary.  I really enjoy helping patients…but, let’s face it, I could get a lot of that from volunteering at a nursing home or something.

On the topic of med school costs, if you’re a Quebec resident, you’d pay maybe $20k-ish in tuition for the 4-year MD at McGill, which is why so many American students flock to our “budget Ivy”...Howard Dean’s wife, for instance.

But look, whatever the flaws of the training of new physicians, we should be thankful that they exert more quality control than is used for admission to the bar.

They have to; the medical disciplinary process is a joke. It’s not as hard to become a lawyer as to become a doctor, but once you’re in the medical profession, man, you’re in the club. Lawyers are about as loyal to one another and the profession as a bunch of angry cats.

And on the ‘hostility towards lawyers’, again, this wasn’t a bid for sympathy - just an observation that I think a lot of newish lawyers and law students are blindsided by finding out that the shiny degree and the salary doesn’t come with a lot of big hugs. (I find that the quickest way to deal with nasty comments at parties and so forth is to say “So I take it you’ll never be bothering me for free legal advice?” which always sets new land-speed records in the 500 Meter Shut The Fuck Up competition.

angry cats:  This.

mythago sez: I find that the quickest way to deal with nasty comments at parties and so forth is to say “So I take it you’ll never be bothering me for free legal advice?” which always sets new land-speed records in the 500 Meter Shut The Fuck Up competition.  I sez: I plan to steal that.

This American Life had a pretty good two-part series on the source of the insane cost of health care in this country and reached the same conclusion that single-payer is the only sane solution.  A huge part of the cost of a doctor’s visit is paying the people who have to do billing.  It doesn’t make any sense.  And there’s plenty of blame on pharmaceutical companies, etc. etc.  Treating health care like a consumer good doesn’t make much sense at all.

Kirjava—just a note.  The experience of tenure-track faculty varies widely by discipline.  In the social sciences/humanities it is pretty rare (outside of a few of the very top programs) to get by without debt and the dramatic cuts in funding have made it worse for any non grant-funded discipline..  And in my field you are then walking into a job that will earn you 50-60 thousand/year (I earn less as a tenured faculty member than high school teachers in my area.)  No one in my department pulls down six figures.

pennylane:
When dealing with fine arts tenure watch out for who is competing with whom for grants.  There is an awful lot of vicious competition elimination disguised as calm, objective committee work in uni fine arts faculties.

As for the strung along the border metaphor you’ll find that to be an enduring myth.  For the most part Canadians reside in urban and linked suburban nodes which were sited thanks to the best available local climate and the original water and later rail transportation systems, and/or their related military utility and defensibility.  Some of the most important cities (Calgary, Edmonton, Québec and Halifax spring immediately to mind) are nowhere near the border; hell, our national capital was chosen in part because of its placement well back from the border, given your national pastime of invasions to liberate people who’d prefer to be left the hell alone.

“Strung along the border” is an extreme characterization, but 97% of your population IS located in your provinces (as opposed to your territories), and within those provinces, mostly in the southern halves of those provinces.  You aren’t anywhere near as geographically spread out relative to your total land mass as Americans are.  We may have Wyoming, but you have Nunavut - our least densely populated state in the lower 48 has nearly 130 times as many people per square km as your least densely populated territory.

For the US population to be spread out in a way that is similar to Canada, we would have to have 90% of our total population living east of the Mississippi River.  Your overall national population density is far smaller than that of the US, but if you limit it to just the provinces - where almost all Canadians live - the disparity isn’t nearly as big as it is when you include the virtually people-free massive territories.  You have massive tracts of land up north where you can go more than a 100 kilometers in any direction without finding a single person.  The three territories in the NW, which make up almost 40% of Canada’s total land area, have barely more than 100,000 people between all three, spread out over 3.5MM square kilometers.

In the social sciences/humanities it is pretty rare (outside of a few of the very top programs) to get by without debt and the dramatic cuts in funding have made it worse for any non grant-funded discipline..

For various reasons, if you cannot get a Ph.D. (in any field) without going in to debt, then you are better off not getting a Ph.D. at all. And in any case, the Ph.D. situation in the humanities is similar to the situation with law schools—there are not enough tenure track faculty positions for any but the graduates from the top Ph.D. programs.

I mean, I do not mean to place all the blame on those students—22 year olds are not typically qualified to make rational job market decisions or have accurate perceptions about these sorts of things, but the truth is that the grad schools are at fault for producing more Ph.D.s than the market can support, which is the same problem going on with law schools.

Kirjava is right, though, that Ph.D. students in the biosciences don’t accumulate any loans, since they’re paid a low (mid-$20000s) stipend. That’s why a Ph.D. looks so much more attractive to me as my next educational step than an M.D.—I can’t justify all that debt to myself for a job with low (and always getting lower) job satisfaction. Bioscience Ph.D.s appear to be unique for those kinds of stipend guarantees though—is it common even in other hard sciences, like physics or chem?

I do question Kirjava’s comment about med school classes being tougher than Ph.D. classes—I mean I would think you have to know a lot more science to be a scientist than a physician, so they have to be tougher in that sense. But if you mean “tougher” as in “physically more taxing”—that I could see, what with the binge-and-purge style “learning” med school education uses.

Bioscience Ph.D.s appear to be unique for those kinds of stipend guarantees though—is it common even in other hard sciences, like physics or chem?

Yes, it is the same in all of the sciences since the student is typically supported by the professor’s grant, and it is cheap to keep a grad student to do lab research.

The job market in the biosciences has it’s pluses and minuses. The increase in biotech means that there are a decent number of good industry jobs. On the other hand, in universities you can find plenty of 40 year old postdocs making 45k/yr. Plus, there are a large number of people with Ph.D.s from abroad arriving in the USA every year.

When you normalize for quantitative skills, years of education required, and hours worked, the basic sciences compare poorly economically speaking. On the other hand, the work is really interesting, moreso than making PowerPoint presentations for your client at while working at McKinsey or selling bonds.

DTG:
True in and of itself and I did make the point myself when I noted the population density figures.  The point I thought that I’d made was that the problematic bit is the “along the border” nonsense.  It’s a pernicious little myth that suits a lot of people who want to characterize Canadian population issues as being linked to American proximity rather than the geographic, climactic, trade-travel and defense rationales that I noted earlier.  The whole “huddled up against the border” crap is just that: coincidental crap.  Canadian cities are where they are because of some mixture of east-west water and trading routes, 19th century train routes, fine harbours, defensible positions and decent (in context) climate; they’re not there because they’re close to America.  For most of the time since 1776 you have been a distinct and visible threat and humans in choosing their settlements rarely cozy up to the nearest threat.

I’d note also that I am a subscriber to Pierre Berton’s theory that American proximity has helped foster, not minimize, a separate Canadian identity.  Berton posits the notion that large parts of southern Ontario (including the coveted “golden horseshoe” stretching from T.O. to the Niagara Peninsula) might have gone American by osmosis if it hadn’t been for the 1812 invasions; a lot of American immigrants who were indifferent to politics—and passively if not actively hostile to the colonial government—swung into the Loyalist camp after seeing their farms burned to the ground by American troops and irregulars, especially the latter.  Regarding that it is interesting to note that in Canadian vernacular the phrase “Kentuck” was, for decades after that war, synonymous with “goddamn psychotic barbarian savage”.  Most of the Britons of that era found dealing with the Indians a far more civilized experience than dealing with American frontiersmen.

I mean, I do not mean to place all the blame on those students—22 year olds are not typically qualified to make rational job market decisions or have accurate perceptions about these sorts of things, but the truth is that the grad schools are at fault for producing more Ph.D.s than the market can support, which is the same problem going on with law schools.

Tyro: wouldn’t you say that this has a great deal to do with the schools deluding themselves ... and lying to their students .... that they and the market for their graduates’ skills exist in wholly unconnected universes?  The law schools generally take the position that it is the profession’s task to stop entry into the profession if there’s too many lawyers, because law schools don’t train lawyers, you see, they provide legal educations.  Completely different!  The fact that law school is merely a glorified trade school is something they can’t bear to admit for even a second.

seeker @ #109:

Yeah, that makes sense to me.  I never bought into the notion that the population centers of Canada were predominantly southern due to some special affinity for America… in the simplest terms, they are where they are because the northern side of your country is pretty fucking climatologically inhospitable to human beings.

I do get how it must be pretty freaking annoying to constantly have Americans falsely claim that you all live near the border because you just like us so darn much.

I can’t speak for America, cutestory, but up here it used to be lawyers who trained lawyers.  Osgoode Hall Law School, for example, used to be the Law Society’s school for training lawyers and is named after the building that still houses the LS and the Court of Appeal.  Eventually the LS decided to leave it up to the universities and kicked over its school to York University.  (That’s why you have the oddity of York U having a law school which is 80 years older than it is.)

In some states you can still qualify to take the bar exam through an apprenticeship with a real live lawyer, instead of law school.

I am pretty sure the LL.B. is not a new invention; it was the Canadian equivalent of the JD back when I was in law school, and that was before everyone in class had a laptop.

I am pretty sure the LL.B. is not a new invention; it was the Canadian equivalent of the JD back when I was in law school, and that was before everyone in class had a laptop.

It certainly is not.  Before the 1960’s, the degree one received from 3 years of law school was an LL.B.  If you looked at lawyers who graduated from law school before or during the 60’s, they’d tend to have LL.Bs on their resumes…including Ted Kennedy’s law degree from UVA. 

Essentially, they changed it to “JD/Juris Doctor” to make it sound more prestigious/pretentious despite the length of time and curriculum is largely the same.

“pointless hoop-jumping is actually a fairly useful skill to master in this business i think. “

Hence, chareth, the existence of the LSAT!  (And dating, but we won’t go back to THAT thread!)

Truth be told there needs to be a balance between academic training and apprentice/practical; they must be complementary and balanced, not the “ne’er the twain shall meet” method we have now.  I’d suggest two years academic followed by one year of articling.  That will drive law faculties insane, though, given that there’s an awful lot of steepled fingers and tenure riding on the notion that It’s An Education rather than just a really cool trade school.

Highly encouraged, but not universally mandated by any means.  My brother started teaching in a nationally recognized school district in the St. Louis suburbs with just a Bachelor’s degree.  A friend of mine who teaches high school English for the Los Angeles Unified School District only has her Bachelor’s degree.

When I was in K-12 during the 80’s-early ‘90s, teachers were required to have MAs in education to be eligible to teach in NY public schools….and I’ve heard similar requirements in many other states…especially in the US NE.

Remember, those cool professors you had in college most likely had no formal education in “education” at all.

For every one “cool Prof” like this, there are at least dozens whose lack of training in “education” issues meant they knew their area of expertise cold…but really sucked at teaching it to us undergrads*......especially when most topflight PhD programs overwhelmingly privilege research proficiency over good teaching. 

The epitomization of this was what I found to be a disturbingly common tendency among Ivy-league/Ivy-level university Profs to literally run/avoid their undergrads and foist all their office hours/mentoring responsibilities off on the TFs/TAs.  I don’t know about you…but this behavior does not constitute “good teaching” in my book…..

* This tendency seems especially bad in the STEM fields as many Profs…especially those at the Ivy/Ivy-level universities exude the “My intellect/time is too valuable to be wasted on teaching undergrads”.

pointless hoop-jumping is actually a fairly useful skill to master in this business i think.

Ha! Or, in the words of my Civ Pro professor (who was an actual litigator on sabbatical; one of the benefits of being at a regional school instead of a T14 machine): “Even if the other side has a really good case, if you know your civil procedure inside and out, you can run rings around them.” That was probably the most important thing I learned in law school.

I like how everyone is piling on the doctors when the vast majority of primary care doctors do not make the vast salaries and, despite what Ezra Klein would have you believe, do not own private yachts and BMW 7-series. And by “like” i mean the same way I “like” cauliflower or rush hour traffic or Glenn Beck. Primary care doctors might not be poor but believe me, the vast majority are not pulling down $250k take-home either. And their take-home pay gets worse every year.

And the claim that doctors make 10x what they make in Europe is a lie that would be laughable if it weren’t so malicious. Do Klein and auguste really think your median middle-of-the-pack doctor pulls in over 600k a year? Really? Or are they knowingly lying just to incite hate?

Why all the hatred of doctors anyway? Do people actually think that doctor pay is a more significant component of healthcare costs than drugs? Or medical equipment? Or hospital administration?

Which of these people cares the most about your health: the Pfizer drug rep, the CEO of the hospital, or your physician?

Slash the compensation of a particular career and guess what—both the quality and the quantity of the people entering the career goes into the toilet. The pay of primary care doctors has already been slashed repeatedly, both directly (Medicare cuts) and indirectly (out-of-control costs the doctor must pay). As a result, nobody wants to go into primary care and our best and brightest med students pursue specialties like freakin’ dermatology. And our great thinkers of Journolist propose to fix the primary care doctor shortage by… further cuts in primary care compensation? How sad that this is the one thing the Republicans and Ezra Klein can agree on. How sad that a doctor’s chief guardian is… Harry Reid of all people. How sad that auguste wants to have medicine have all the appeal of tax accounting as a career option for our best students.

I just graduated from med school with a goal of entering primary care internal medicine. If Ezra Kline, NPR, the GOP, etc have their way and my salary is set at 60k, then I assure you I will quit medicine forever. I will quit medicine forever and get a lucrative job with a biotech firm, or maybe with hospital administration… as NOBODY seems to wants to cut the pay to either one of these groups.

Well why wouldn’t I? 60k in a US version of the NHS vs. 150k+ as a shill for Pfizer. If you have people to support with your paycheck, please tell me with a straight face you wouldn’t go for the corporate job.

TCB, if there is one thing I hate more than people who think that doctors don’t work hard, it’s doctors playing a woe-is-me whine about how hard they have it. When was the last tine a doctor got laid off and couldn’t find a job? Oh, yeah—NEVER.

Not one person has advocated paying docs 60k, nor has Ezra claimed that your typical PCP is making 600k. You are arguing against the straw men in your head, and for the most part this thread has seen only people leaping to the defense of docs and pointing out that the insurance companies are the real criminals here. But part of doctor bonding seems to be fostering the fantasy that they’re a put upon minority that the world hates or something.

From the original post: “Are American doctors so personable that they’re worth ten times as much as doctors in Spain? “

Doctors in Spain make an average of ~$67k in US dollars, and that’s a conservative estimate. Ten times 67k is 670k. So yes… people are really making that claim.

You are right that the commenters here—i.e. actual, real people living in the real world, unlike Ezra Klein—are coming to the doctors’ defense. But who do you think helps influence policy in Washington? A bunch of no-name citizens in flyover country like you and me, or major media and political players, and members of the elite JournoList, like Klein?

Now do you see why I’m worried?

No, TCB, I do not see why you are worried, to be frank.  In the real world the chances of there being a significant limit on what doctors are allowed to earn are about the same as the pope coming out in favour of gay marriage.  Your fears are of the boogieman under the bed variety and are quite fairly treated as nonsense.

From the original post: “Are American doctors so personable that they’re worth ten times as much as doctors in Spain? “

Doctors in Spain make an average of ~$67k in US dollars, and that’s a conservative estimate. Ten times 67k is 670k. So yes… people are really making that claim.

Ezra was referring to the per-visit compensation given in Spain vs. the US, not a discussion of yearly salaries. And it is an illustrative point: even if you do believe that per-visit costs in the US will be expected to be more expensive, is ten times more expensive really viable?

And in any case, anyone familiar with Ezra’s work knows that he is more interested in bending the cost curve of subspecialties rather than expressing concern about PCP salaries.

As I said, you are fighting the demons in your own head. I do find that many doctors reflect this kind of paranoia. I’m not going to waste my time trying to make sense of it—I’m not your therapist—but it is a phenomenon, and it is irrational, and your screed is just a reflection of that, rather than rational arguments to be engaged with.

TCB, there’s something else that you don’t factor into your views: in most socialized systems your income is near-as-dammit guaranteed.  The insurer doesn’t stiff you, no patient goes bankrupt owing you $77k, you don’t get sued by a patient/debtor as a slimy negotiating position to lower what is validly owed, (and so on).  You submit the bill, it’s paid, c’est fait et fini.

What’s better?  Five $3k bills where you only get paid on three and then possibly only some time later, or five $2k bills paid with reasonable promptness and no fuss?

OK, I agree with TCB on some aspects, but not on this: I am firmly and fully in favor of single-payer health care.  The vast majority of my patients right now cannot pay.  The clinic and hospital service I work at is pragmatically a charity institution, and should those charitable sources decline (any more than they already have), we are done for.  I am for fully funded payees because hospitals like the one I work out swing out in the breeze when the public gets all huffy about illegals and the like: guess what, we take care of all comers no matter what (read up on EMTALA if you have any doubt), and without full funding, neither of the institutions I currently serve at will ever be anything but as close to bankruptcy as any of their clientele. 

Medical school debt is the hook that the system uses to guarantee that no matter how much abuse trainees take, they will stick it out.  We have no other choice; bankruptcy doesn’t clear student loan debt the way it clears consumer debt.  This system is sick and broken as much as the health care delivery system is sick and broken; trainees come out already burnt out and ready to quit (believe me - I watch cohorts of friends go through this every year), but they can’t.  The result is so many doctors who are so dulled to caring any more that they do a disservice to their patients but cannot get out because of the debt.  Those that do finally clear the debt and get the hell out do a disservice by using up the training resources without paying back years of patient time, but I don’t blame them at all: there is only so much abuse a person is obligated to take - as once the abuse of training is done, one goes on to being hassled by insurance companies, pressured by employers to take more patients per hour and make more money for the corporate body, and knowing at every turn that a wrong move, a late move, and even no mistake at all can land you in court for everything you’ve ever worked for.

Listen, I know people that have it worse than me.  My entire clientele, top to bottom, has it worse than me - believe me.  People who signed onto the military at the dumb old age of 18 and shipped out to Afghanistan before they knew WTF was happening to their sorry selves?  They have it worse than me.  Firefighters: longer hours, more dangerous work.  But I gotta be honest: most people who have the time to sit in front of a blog yammering about how easy it is for people who work 30hr shifts every fourth night (really, a show of hands here please: who here has ever worked a 30hr shift where people’s lives depend on you? especially when you’re green on the block and have no idea WTF you’re doing and have no reasonable back up? really?)...I’m sorry, you walk two shifts in the shoes of any medical/surgical intern and we’ll talk about compensation and who gets paid what.

And I’m not arguing for higher pay for doctors - I said that before, I’m for capping tuition and then capping reimbursement in a commensurate fashion.  I’m just saying that you’re not going to get doctors on board with the lowering the pay until you get a generation in practice that didn’t grow up under the notion that 30-hour shifts/80-hour week was a generous limitation.

I agree that many professions have _some_ of the negative aspects of medicine that, to me, justify higher salaries, but I can’t really think of any other professions that have _all_ aspects.

Law - in big cities, big firms can force you to work ridiculous hours.  However, they also compensate at ~ $160K (NYC) during the grueling associate period, whereas residency compensates at ~$40K.  Many attorneys have huge law school debt, but they (1) could work during summers, (2) make 4x as much right out of law school, and (3) had three rather than four years of school.  ftp hosting

Education - show me a teacher with >$200K of necessary debt (i.e., not debt due to Harvard undergrad.) Furthermore, though hours can be long, they do not require 30hr shifts, and the job itself offers summers off (yes, I realize that most teachers have another job during that time.) audio hosting

Tenure-track faculty - I’ve done the Ph.D. thing.  Hours, stress, and poor job security are definite negatives.  Again, though, it is generally possible to work largely when and how you want.  For science Ph.D.s, it is easy to graduate with _no_ grad school debt, as tuition is paid by the program and a stipend is provided by an advisor, grant, or program.  Furthermore, at least in my experience, the classes/training aren’t anywhere near as hard as the classes/training in med school.  Not even close. video hosting

I think the military is nearest to medicine in overall negatives.  In both fields, abuse during training is simply expected.  (for those who don’t know, med students and residents will regularly be screamed at, be unable to eat, be unable to sit down for many, many hours at a time, etc.) I don’t really know about the military, but I assume that soldiers endure the equivalent of frequent 30-hr shifts. blog hosting Both careers involve lives on the line.  Bottom line, I think soldiers deserve much higher salaries, despite their benefits.

correct me if i’m wrong, but don’t medical schools in the US generally screen people so much starting out that most people who actually make it through a residency are actually going to be employed as doctors (and making relatively good money)?

A reason why several Pre-meds and Pre-med advisors have said that if one’s overall GPA is less than a 3.5/4.0 and any pre-med core classes are less than an -A to not bother applying to Med school.  Had several friends who had to apply 4-5 years before gaining admission to any US med schools despite graduating with 3.7+ GPAs from places like Berkeley…..

Then again, this screening may be more of a show as I’ve also met several doctors who admitted they severely screwed up…sometimes to the point of being a factor in a patient’s death. 

A reason why a friend who was a Cardiology fellow warned me and his friends to avoid getting sick in July…..that’s when nearly all the experienced doctors go on vacation and the hospitals are mostly staffed by interns fresh from Med school.  Seems like screening for 3.5+ GPAs and -A+ GPAs in pre-med classes does not preclude cases of doctors screwing up….even the experienced ones if cases like a New York hospital operating on the wrong body part twice is any indication…..

Price != Cost

They are very different animals. Prices can often bare no relation to costs.