The ACP Advocate Blog
by Bob Doherty
Friday, April 25, 2014
Yes, times are tough. But don’t compare doctors to janitors.
“Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections” writes internist Daniela Drake. She asserts that being a doctor “has become a miserable and humiliating undertaking” and that many believe that, “America has declared war on physicians.” And this: “It’s hard for anyone outside the profession to understand just how rotten the job has become.”
Some of her complaints (rants) may have some merit—physicians, especially primary care physicians—are undervalued, relative to other specialists, and they are drowning in paperwork that saps their professional satisfaction and takes time away from their patients. But let’s get real: doctors are still among the most highly respected and highly paid occupations in the United States. By comparing primary care to being a janitor, Dr. Drake demeans both her own chosen field and the hard-working people who work nights mopping her practice’s floors and cleaning its toilets.
Here are the facts. According to a new Medscape salary survey, internists who specialize in primary care earned an average of $188,000, and family physicians, $176,000 in 2013. Yes, that’s near the bottom of all specialties’ earnings, but still more than 90% of Americans earned. And if you are a primary care physician in a household with an income of $232,000 or more, which is the case for many whose spouses also work, you are in the top 5 percent! To put this in perspective, “If you're in a family of four, and your family's income surpasses $66,000 a year, you're doing better than the typical American family. If you're making six figures, then you're doing much better than the typical American family. If you're making $200,000 or more, you're in truly rarified territory” reports the Washington Post. The Bureau of Labor Statistics reports that the mean annual wage for janitors was $25,140. The Census Bureau reports that median household income, all occupations, was $51,000 (2012 data).
And, perhaps surprisingly, primary care physicians overall aren’t that much more dissatisfied with their pay than other physician specialists, a new study finds. “Primary care physicians were only slightly more negative [about their compensation] with 52% saying they did not feel fairly compensated while 48% did with their pay,” reports Medscape. “Considering the ongoing income disparities between primary care physicians and specialists, their having the same perception is somewhat interesting. There has been very little change in the responses to this question over the past 3 years.”
Lack of social status? Actually, physicians rank third, behind members of the military and teachers, as the most respected professions. “Roughly six-in-ten or more adults also say that medical doctors (66%), scientists (65%) and engineers (63%) contribute a lot to society. As with the military and teachers, negative perceptions of these occupations are comparatively rare.” Lawyers are at the bottom of the public’s respect ranking, say the researchers at Pew. The Gallup organization finds that 69% of the public rank physicians highly on ethics and honesty; nurses score the highest at 82%, followed by pharmacists (70%), grade school teachers (70%), and then physicians. Lawyers, again, were near the bottom, with only 20% of the public saying they were honest and ethical.
So, Dr. Drake may not respect her own profession, but the public clearly does. And by any standard, physicians—even primary care physicians—are in the top ranks of compensation.
This is not to say that there isn’t real heartache on the front lines of medicine. According to Medscape, Internal medicine physicians are the most likely (68%) to say they would choose medicine as a career if they had to do it all over again, but internists are last (27%) in saying they would choose the same specialty. One likely reason is the amount of time that internists and other primary care physicians have to spend on paperwork. “According to this year's compensation survey, 35% of employed physicians spend at least 10 hours a week on paperwork compared with 26% of the self-employed” reports Medscape.
Yet most physicians still like being physicians. “Despite the frustrations, most physicians find their careers deeply rewarding” says Medscape. “Being good at their jobs (34%) and relationships with patients (33%) were cited most among those who responded. Twelve percent chose "making the world a better place." Simply being proud to be a doctor (6%) and making good money (10%) were less compelling factors.”
So no, Dr. Drake, most of your colleagues aren’t miserable. Most are not leaving the field. Only 3 percent are in concierge practices, Medscape found.
Fortunately, there are physicians who are willing to directly rebut Dr. Drake’s views. Dr. Aaron Carroll, a professor of pediatrics, penned this:
“Monday night, at the Seder we were attending, we all discussed things for which we were thankful. I acknowledged my thanks for my family and friends, and then said that I was very, very grateful to have a job which I found so utterly rewarding and fulfilling. Evidently, Daniela Drake disagrees with me . . .
I’ve written about this again and again, and I don’t want to repeat myself more than I have to. I think physicians complain far more, and far more publicly, than their situations warrant. For all their complaints, they still do incredibly well financially. They have more professional freedom than most working people. And they’re beloved.
Moreover, tons and tons of people want to be them. Applications remain at an all time high for medical school.
. . . I’ve been around physicians for all my life, and for the entirety of it, I can remember many of them complaining. I can remember many of them complaining even while they made fortunes, lived fantastic lives, and had fulfilling careers. I remember many of them threatening to quit. None did.
I imagine that a fairly large number of Americans work just to get a paycheck. They find their jobs to be dull and unfulfilling, should they be lucky enough to have them. Being a doctor is a great gig, and I don’t really know any who would give it up to punch a clock or go do something else. I know some who’d threaten to do so, and some who wish things were better, but the number of them who follow through and abandon the field is near zero. At some point, people are going to ignore the cries of ‘wolf’. Other than bankers, is there any profession doing so well overall that complains so much in the media?”
Like Dr. Carroll, I also have been around physicians almost all of my life, although I am not one. I have spent my entire career, over 35 years now, advocating for the medical profession, and specifically, for internists, first with the American Society of Internal Medicine and since 1998, with ACP. Every day, my colleagues and I on the ACP staff work to address the aspects of their jobs that are professionally unrewarding, especially excessive administrative burdens and a payment system that undervalues them compared to others. So I sympathize with some of Dr. Drake’s complaints.
But I also know that engaging in public expressions of self-pity isn’t going to help physicians, nor is hyperbole. Comparing a highly compensated and respected profession, doctors, with one of America’s most marginalized and least respected, janitors, isn’t going to make any friends for physicians.
Today’s questions? What do you think of Dr. Drake’s comparing being a primary care physician to a janitor “without the social status?” And Dr. Carroll’s rejoinder that being a doctor is still a great gig?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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