‘Doctors are not saints’: Physicians are tired of being blamed for their paychecks

Alexis Kayser (Email) – Wednesday, August 9th, 2023

Physicians make a lot of money, according to an Aug. 4 article in The Washington Post. Physicians know this, according to social media — and they believe the scrutiny of their paychecks is misguided.

The controversial article, titled, “The average doctor in the U.S. makes $350,000 a year. Why?” explores the reasons behind physicians’ high pay. The titular figure comes from a working paper — first published by the National Bureau of Economic Research in 2020, last updated in July — that analyzed more than 10 million tax records from 965,000 physicians over 13 years.

One reason given for high physician pay is the hefty student loans accrued during medical school, compounded by years of residency worked for low pay. These circumstances during peak earning years cap physicians’ lifetime earning potential, according to the Post.

There is also an element of supply and demand, as the U.S. has a massive physician shortage — significantly more notable than most other developed countries’ — which could explain why pay is so much higher here than in other nations.

But the publication also suggested physicians are strategic about earning more, “behaving in ways that drive up their income.” When Medicare payment rates increase 10 percent for a certain procedure, billing for that procedure rises 4.4 percent; the Post alleges physicians will work to find additional patients who could benefit from the intervention as it becomes more profitable. And the report found that graduates from top medical schools tend to choose better-paying, lucrative specialties.

Atul Grover, MD, PhD, an internal medicine physician and instructor at George Washington University in Washington, D.C., suggested that the highly paid specialists drive the pay gap between U.S. physicians and those in other countries. The emphasis on procedures with clear outcomes takes away from disease prevention, Dr. Grover argued in the article.

“American physicians seem to be quite talented at caring about economics,” wrote Andrew Van Dam, the article’s author.

Two of the economists who worked on the report shared their insights with Mr. Van Dam. Many physicians go into medicine to help people, and feel that conversations about pay misrepresent their motives, Maria Polyakova, PhD, of Stanford (Calif.) University told the Post. Joshua Gottlieb, PhD, of the University of Chicago suggested they could have the best of both worlds.

“You can want to help people and you can simultaneously want to earn money and have a nicer lifestyle and demand compensation for long hours and long training,” Dr. Gottlieb said. “That’s totally normal behavior in the labor market.”

The Post article blew up on social media, receiving more than 6,000 comments and hundreds of reposts across various platforms. Many physicians alleged the publication misrepresented their motives and questioned why they were the target of pay disputes.

“Is @washingtonpost going to complain about UPS driver pay of 170K as they complain about US Physician pay?” tweeted Shariq Shamim, MD, a St. Louis-based interventional cardiologist.

“I have no problem with the average doctor making less than half as much as a rookie in the NFL,” wrote one top commenter on the article.

Others, including emergency physician Leon Adelman, MD, felt there was some truth to the article.

“[The article] is snarky, insulting, and partly correct,” Dr. Adelman wrote in a LinkedIn post. He believes the U.S. should pay physicians more for primary care and preventive medicine, writing that financial incentives for proceduralists “distort the physician job market and harm Americans’ health.”

“Doctors are not saints,” Dr. Adelman wrote. “They follow financial incentives.”