How much money doctors actually make | Hacker News Reader

How much money doctors actually make

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49 pointsatrudeau61 comments

I'm a graduating medical student with a master's in computer science. In a lot of ways CS is the polar opposite of medicine; one values derivation and automation while the other emphasizes memorization and one-on-one interactions.

Surprisingly, teamwork is one area where CS wins out. I've found that despite the professed importance of the healthcare team, healthcare often doesn't function like a team at all. Doctors, nurses, PAs, patient care assistants, administrative staff, can make or break your life by providing support or creating obstacles. I think it's a result of a inherently tiered system with a single person (e.g. the attending) on top who decides the treatment plan. In CS you almost never have a single person who is overly-trained relative to peers. Maybe you'll have a better developer, UI designer or manager, but none of these attributes makes that person the sole decider. The pay structure in medicine reflects its hierarchical system: software managers don't earn 10x what software developer make, whereas attendings easily make 10x a nurse's salary.

You would be surprised how this doesn't apply to many software companies out there and how the hospital environment is exactly the kind of culture existing. There is no one thing fits all fact.

> I'm a graduating medical student with a master's in computer science.

That's... actually really neat. What made you go for a graduate degree then on to med school, if you don't mind me asking?

I would guess that doctors have better career stability.

I actually got my master's in the middle of medical school (I took a leave of absence). My undergrad degree is in computer science as well. It's my long-term goal to start a radiology informatics company.

Thanks for answering! How do you feel among your peers? Performance-wise and general understanding of topics? Is there no noticeable difference or do you find that you're learning things from a different form of understanding?

Sorry for all the questions, I think it's fascinating when people wind up in a very different field from one they've more formally studied in.

Computer-science wise: I'm a rather good developer, according to my supervisors. I'm quite comfortable with Java, Python and a bit of Swift. I love writing code, starting with BASIC when I was 11 years old.

Medicine-wise: I'm in the bottom quartile of my class. I'm terrible at sitting there and studying. It's a completely different mind set. I did really poorly on UMSLE Step 2 in particular; most med students do +20 points higher relative to Step 1...I did 40 points lower. That test is entirely memorization, we're talking memorizing immunization schedules for children, the screening guidelines for low-dose CT, the warning signs of an acute abdomen, and so on...

In terms of benefits, I'm much faster at research data analysis. I'm doing imaging work and I can take a DICOM, convert it to NIfTI, run an algorithm in Python or MATLAB, and dump the results in under and hour. That kind of stuff is second-nature to me, but takes my fellow lab mates an indeterminate amount of time. I've written a number of 20-line scripts for my classmates that do basic stuff like vertical lookups in Excel and searching for files on the filesystem. Really simple stuff that would take a person a long time by hand.

One more thing, the MCAT was a blast for me. It was a wonderful test. It emphasizes integration and application of what you've learned on novel problems, very much like computer science. The USMLEs were hell. I got 98th percentile on the MCAT; 40th percentile on the USMLE.

>In CS you almost never have a single person who is overly-trained relative to peers.

You have no idea. Skill and knowledge differentials are VAST. I cannot find capital letters large enough to emphasise this enough. You get everything from the 'not invented here' guy reinventing a triangular 'wheel' that doesn't roll, all the way to the superstar who develops generic APIs and algorithms that generate value for literally decades.

Skill != training. Medical care is spit from 2 years of training to nearly 20 years. With arguably the most important group first responders getting weeks of training.

That's a puzzling analysis. Of course job skill correlates with training. Usually the better programmers have spent far more time training (usually on their own, auto-didact style) than the poor ones. I'm sure it's the same for top surgeons.

I have often noticed a strong negative correlation with degrees held. Someone without a degree must be really good to get and stay on the team. People with PHD's tend to have a lot of really bad habbits from years of school related development with long matenance cycles or production exposure.

Though I have also noticed people with a few years of professional exprence between collage and starting a masters program tend to be vastly better so YMMV.

I wish IT was more like this. The agile (communist) manifesto that seems to treat all programmers as replaceable cogs (related buzz words: bus factor, knowledge transfer, pair programming), leads inevitably to really poor teams that can't engineer anything but the most dumbed down web application, where the best performers are artificially restricted. Fred Brooks' description of a surgical like team always seemed to me like a good approach, but I've yet to see it applied, at least not ad-hoc.

I was probably a bit harsh here in retrospect comparing agile to communism ;-). I do feel agile culture though, or XP in particular, tends to to encourage a lowest-common denominator approach where individuals can't really shine.

These data would be more informative, were they also paired with vocational costs MDs also incur, usually unavoidably. Malpractice insurance, prep for board exams, for example. Note that the latter can include having to travel to conferences, or similar events, to stay current in the field, and there may not always be an employer to reimburse such costs. Likewise, insurance rates will vary between disciplines, eg. higher for radiology vs psychiatry.

Also, it's probably helpful to factor in how much debt they're in starting out.

My fiancee is in (we're in) >400000 of debt. And as a resident she's effectively making ~-2 dollars/hour [0], because of the interest rate on that loan, location, and hours.

I can't find it immediately, but in a recent MedScape report, some ~5% of physicians are still paying off their med school debt at 60 years old.

[0] http://dotphra.se/

Don't forget malpractice insurance. As high as $200k/yr for high risk doctors like obstetricians. That significantly reduces your take home pay.

When I read this 25 years ago (insane malpractice insurance for obstetricians) my thought was a good national health insurance program would probably fix that. If the US took better care of families with sick/special needs children they wouldn't have to go after the doctors when stuff goes wrong.

I think it's a more complex issue than either medicine, insurance, or the legal system can address alone.

The US which relies on free markets, insurance, and the legal system has worse outcomes than countries that do not.

"some ~5% of physicians are still paying off their med school debt at 60 years old"

I bet that for a lot of these physicians it's because the debt has favorable terms, not because it's onerous.

I expect to be paying off educational debt well into my fifties. I could pay it off right now, but the rate is below 2 percent, so it's advantageous to carry the debt. In particular, if I die the debt is wiped clean...but if I have already paid it back, my heirs won't get that money back. No reason at all to pay off this debt until I have to.

Agreed. It would also put say, the Infectious Disease specialty in its proper context, as that involves even more extensive training than say, internal medicine.

Geography and type of employment also play huge roles. A clinical professor at UCLA earns far less than a private practice doctor in Ft. Worth.

I don't really understand this. I'm a small business owner and all the insurance, training costs, etc. are not money I make. Those are business expenses. If you work for a big hospital or group, the employer pays for all that. If you open a private practice, your business still pays for it. The doctor and their practice are separate legal entities for a reason. The doctor's salary comes AFTER all that stuff is paid for by the business. So you don't subtract the cost of insurance from their salary.

Lots of doctors operate their businesses as sole proprietors, and not all firms that employ doctors provide malpractice. (Granted, that's a shitty policy, but it happens, and it's even a bit theoretically justified since it might cut down on moral hazard.)

Sole proprietors still have business expenses that are separate from their income, which comes after. Additionally, anyone making Doctor money who runs their business as a sole proprietorship is a fool for not protecting their personal assets from their business dealings.

Even if all the physicians were to decide to do their accounting the way you recommend, one would still need to make adjustments for the costs of doing business, when considering reporting of income like that found in TFA, which certainly does not include such adjustments.

It's not a matter of "decide to do their accounting." Business expenses are business expenses, even if you're a sole proprietor. It is a business expense, therefore it comes before your salary. Just like any other business expense, you could technically not choose to claim that business expense, but then you'd be paying income tax on that money. But you could also choose not to claim your office space rent, the salaries you pay your administrative staff, etc. Those things are all in the same category.

Private practices would indeed have their expenses arranged in the fashion you describe, i.e. with those qualifying expenditures counted as business expenses before pass-through. The caveat is that titling the private practice as the malpractice policy holder, so that the insurance costs become business expenses, exposes the corporation to lability, not just the individual physician. For practices involving multiple physicians, or which own/rent property to operate a clinic, this liability exposure can be undesired. Relating from a relative who is a physician, who has been a contractor and an employee, I have to stress the general point that professional expense accounting for doctors is quite unique, due to substantial involvement of insurance and regulatory concerns. It's not easily relatable to other professions. Likewise, doctors, despite making very generous compensation, are often still frequently struggling with their employers/contractees, or with 3rd parties like insurance providers, pushing costs onto them. Since telemedicine doesn't really exist in significant form, doctors don't always have the option of quitting and finding better work in the same city/state.

While this might be the case in many businesses, physicians generally pay their own malpractice insurance (which can easily be more than $10k a year) out of pocket. The litigious nature of the medical system as a whole in America drives these costs way up and it makes a noticeable impact in not only how much doctors take home but how they act to cover their asses from a lawsuit.

Conference expenses and the like are still often covered by the group though so that's at least something.

$10k doesn't seem so bad if you are billing at a rate of $2 million a year.

(Of course utilization isn't 100% and primary care doctors aren't billing at that rate, but that's often the rate for a not particularly expensive specialist visit)

http://www.aafp.org/news/practice-professional-issues/201505...

>On average, primary care physicians overall -- and family physicians, specifically -- earn $195,000 annually, compared with $284,000 for physicians in other specialties

Quite surprised Dermatology and Plastic Surgery aren't the top two. Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear.

If you go to an oncology conference you see a lot of paper presentations and poster sessions. If you go to the annual Derm conference there's a whole "scene" in the corridors and the trade show floor is really little different from the trade show floor of, say, a car show, or the AVN awards. Maybe GDC, or maybe that's a bit over the top. If you aren't an unabashed fan of capitalism (which I am), you'd likely call it crass.

One year I was walking the show floor and stopped to look at a display of liposuction tubes -- it was beautifully laid out, like a cross between a bunch of Cala Lilies and an pipe organ rank. The salesdroid came over and said only two things: - "Hello, Doctor! Do you do liposuction in your clinic?" (I shook my head) - "Well you can easily get an additional $3000/day from these babies."

I'm also surprised radiologists score so high because a lot of the analysis has been farmed out to India. And since that entailed a fully digital stack, those Indian MDs are about to be the first physicians to be replaced with DL. Perhaps the large number reflects a small residual 'n', or perhaps the radiologists have been able to hang on even though part of the job is outsourced -- presumably by them.

>Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear.

I think you've hit upon the reason. Turns out when the customer is paying directly and feels the pinch directly the market will not bear as much.

Plastics is likely dragged down by a significant number of academic surgeons. Anyone doing a high volume of elective cosmetic procedures would laugh at these numbers.

Derm likely reflects the number of hours worked, which is lower than other specialties. If you looked at a chart of earnings per hour, derm and ortho would be much closer together. NSG isn't mentioned but it should be the same or higher than ortho (with vascular and CT maybe a bit lower).

Overall these numbers are low and represent a lot of physicians who are optimizing for lifestyle rather than income. There is still a lot of money in medicine if you know where to look.

It's funny that list almost seems like the pay scale should be inverted.

The most important doctors get paid the least and the least important doctors get paid the most.

That logic also seems to be true in most major corporations...

"important" might be one adjective, but typically less specialized, less competitive, and more common

Well a lot of it is supply and demand plus a little for elective procedures. Orthopedics is so high because there aren't enough doctors. These days all elderly get hip and knee replacements. In the past, they would have just used a wheelchair. Add to that all the sports injuries when chronic over training has 12 year olds getting MCL and rotator cuff surgeries.

Also, if you look at Pediatrics and Family Medicine, one could argue that 99% of what they do should be done by CPRN or other highly trained nurses. We don't need MDs to look in a kids ear for three seconds to diagnose an ear infection and prescribe an anti-biotic. This is also one of the things we should be doing to help remove cost from our health care system. MDs in this setting should be at a 10x1 ratio and be there for difficult cases and to oversee.

This article is extremely misleading. Even though these salaries might be high, they aren't adjusting for number of hours worked.

When we think of a typical "salaried" job, we think 40 hours/week. This is almost certainly not the case, even for the cushiest physician specialties.

My girlfriend is a critical care physician about to enter attending-hood working at a university hospital. She will be working a minimum of 50 hours/week and with all the administrative tasks she's being asked to do, it'll probably be more like 60+.

Really we need to see hourly rates to get a better idea of what physicians actually make.

The doctors who live on my street drive Porsches, Mercedes-Benz and Audis. Two docs on our street own multiple Porsches each (summer, winter, racing).

Maybe it's family money.

Then again maybe it's taxpayers paying their salaries.

(location: mid-sized city in Canada)

German doctors have nice sports cars too. Same in the US.

I've wondered why everyone and their moms are pushing people to study computer science and STEM, but you don't see the same push for physicians.

I consider health professions as STEM, under Science specifically.

US ICE has a list of degrees that includes a number of health related degrees: https://www.ice.gov/sites/default/files/documents/Document/2...

Because it takes 0-4 years of schooling to get your foot in the STEM door, but 8-12 years of schooling for medicine. That pretty much bars access for anyone interested in having money in their 20s/30s, and those without a strong support system.

There is a reason why only those from affluent/foreign backgrounds go into medicine. They're the only ones who can "afford" to not make money right out of college.

Realistically, it takes 4 years to attempt to get your foot in the door at a medical school unless you have pre-admittance or you're looking at a special case like UMKC's 6-year program. Getting into an MD or a DO program isn't a guaranteed thing. It's a substantial downside risk.

Also, you can have a STEM-based undergraduate education as your pre-med, even math and computer science can count if you take the right additional electives. The two aren't mutually exclusive. It's a good fallback if you bomb out of getting into med school (or decide 3 years into ugrad that you don't want to apply).

4 years of undergrad and 4 years of med school at least. And I agree that a tech related bachelor's is a good idea for a med school backup.

True, though many of the initiatives for more STEM workers (through visa programs) focus more on graduate students, especially at the PhD level. There are various exemptions to visa caps for people with grad degrees, and there was a proposal (that died along with general immigration reform) to provide a green card to anyone with a PhD in certain STEM fields, with a possibility for people with MS degrees should there not be enough PhDs.

It's not 100%, but I'd say there is definitely a push toward graduate education in the "STEM worker shortage" conversation.

Interestingly, a RAND study found that the reason people with choice don't get PhDs in STEM fields is because they aren't competitive with the "professions", or even para-professions in health related areas.

https://www.rand.org/content/dam/rand/pubs/issue_papers/2005...

The education pipeline for doctors is completely full. With medical schools turning away large numbers of applicants.

People on this site frequently gripe about medical school and residency slots.

Aren't medicine and law the classic things demanding parents push their kids to study?

These pay scales are insane for the fact that doctors essentially just have to show up. This doesn't even include management of others (aka Director roles, etc). Just literally showing up.

if you think all doctors do is "just show up", i'd be curious to know what you think programmers do. Do they just "type stuff"?

I meant ... normally for a pay scale above $200k in the non-coastal areas, someone has to manage staff, lead a team, run a business unit, and make strategic decisions. Literally, doctors "do their specialty" - no teams, no 'winning clients' and closing deals to bring in business. They don't have to have any other skills but their specialty at those ranges.

...I know a number of doctors who manage staff, lead teams, provide cost justifications to their hospital's C-suite, and make strategic decisions.

An employee at a company is likely responsible for a small piece of a product that will affect the lives of some number of people by a very small amount. A doctor will affect the lives of some number of people by an enormous amount. The responsibility is much higher in the medical profession, so doctors may "just show up" but when they don't, people suffer dramatically; when a regular employee doesn't "show up", nobody bats and eyelash.

> Despite having the same training and experience as their white peers, physicians who identified as Asian, Latino, or black received significantly less

What does this mean? The averaged all doctors by race? They averaged by profession and race then combined to form some sort of weighted average by race?

It looks like a lot of this is variance by specialty:

http://www.medscape.com/viewarticle/878129_5

>And white doctors take home significantly more than their equally qualified peers of color, regardless of specialty.

"We found that African American, Latino, and Pacific Islanders were more likely to work in medically underserved areas than were white physicians (adjusted odds ratio, 1.22-2.25; p < .05)." [1]

Though I'm sure bias has a part in the income disparity, I suspect it is less so, relative to other professions, as the fees paid to doctors for each procedure are broadly standardized. Individual doctors' choices of where to practice and what kind of patients to serve may play a larger role. (IMHO, this is a much better justification for affirmative-action programs than other oft-cited justifications.)

[1] https://www.ncbi.nlm.nih.gov/pubmed/22708247

On a similar note, a 2016 study in JAMA[1] found gender disparities in faculty pay at US medical schools, which persisted even when correcting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue.

It seems like the medical profession would actually have an easier path to pay fairness than other industries, because clinical revenue is so easy to measure. (As opposed to other fields where the financial value of an employee's work is more difficult to measure.)

[1] https://jamanetwork.com/journals/jamainternalmedicine/articl...

Thanks for asking this. I often read articles saying such things but do not provide any data or how they came to the conclusion. It makes absolutely no sense to say this without the data to back it up.

From the source:

"White/Caucasian physicians earn the most ($303,000), followed by those who are Asian ($283,000), Hispanic ($271,000), and black/African American ($262,000).

The gap can be partly explained by participation in primary care, which pays less. Of the four groups, black/African American doctors are most likely (30%) and white doctors least likely (20%) to be PCPs, the survey found."

They continue:

"A 2016 studyin BMJ[12] found an even wider gap than the new Medscape report in payment levels for black doctors. White male physicians in the United States earned as much as 35% more than black physicians, even after accounting for specialty, experience, number of hours worked, number of Medicaid patients, and whether the physician is a PCP, the study found."

I can't find the BJM report. The phrase "earned as much as 35% more" is odd. Is this some maximum out of all the professions considered? a single doctor who earned more? The maximum seems like an odd number to report without reporting the average. Is there some reason they want to exaggerate the difference? It irks me.

edit: I suspect another large factor they did not consider is location of practice. We should only compare doctors that practice in the same location. Location plays a big influence on the wealth of your customers, and therefore how much you are paid.

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