The Taboo of $$$

[Guest ioncannon97]

Here's some food for thought for all of you pre-meds out there. A friend of mine and I recently got into a heated discussion about the reasons for which one should become a doctor. He was of the opinion that if money was even a TINY factor in one's decision to become a doctor, than one should not become a doctor. I, on the other hand, said that although the science of the human body and the thought of healing people both intrigue me, I would be lying if I said that the financial security and stability provided by medicine were not factors in me having decided that I wanted to become a doctor. My friend, however, could not understand my position and basically told me that I should not be going into medicine.

 

I would like to open this topic up for discussion. Why is money in medicine such a taboo topic? I'm sure we as pre-meds have all been told that the worst thing you can say to a "Why do you want to be a doctor?" question is "because of the money".

 

I completely agree that someone who goes into medicine for JUST the money is heading for a miserable life indeed. But I also think that someone who says that money should not be a CONSIDERATION in your decision, is not being realistic. Why shouldn't money be a consideration? This is going to be our livelihood. The quality of life of our families is going to depend on this money.

 

Therefore, I say that money IS a factor in the decision of most to become a doctor. If you want to help people, become a priest or a World Vison Volunteer. If you're fascinated by the workings of the human body, do a Phd in physiology. But become a doctor, if you want to help people, are interested in the science behind medicie, and WANT to have a financially stable and secure career.

 

So, what do you guys think? Should money be a factor in one's decision to become a doctor?

[Guest MayFlower1]

ioncannon,

 

I think this is a great question for debate in this forum.

 

I have no problem with money being a factor influencing someone to pursue a career in medicine...after all, everybody (or most people I know at least) would like to be gainfully employed at some point in their lives.

 

That being said, if money is the primary or only reason someone wants to go into medicine, then there could be a serious problem. Money shouldn't be the primary reason you get into any career. Can you imagine being in a career that you hate? Believe me, I've had jobs that I hate and no amount of money could have kept me at them. This is the crux of the problem, in my opinion...a career can be a lifelong endeavour...it takes significant investment of time, money, work, etc., to get there. When you start working...you better like what you're doing or you'll likely do a crappy job, be hard to get along with, and worst of all...you'll be miserable.

 

I personally want to wake up looking forward to my days' work...

 

Peter

[Guest macdaddyeh]

I concurr entirely with Mayflower:

 

Definitely $$$$ is an issue in pursuing ANY career; let's net lie to ourselves. It's just that it should not be the primary motivation. And although docs are typically handsomely paid, it is by NO means the BEST paid career in Canada b/c it is regulated and capped. What about dentistry or law or bay street financial careers?--Now those careers can easily make the salary of a doctor mere pittance.

 

In fact, I have a friend who is an OT, hired from Canada to California making $70K annually (pretty nice, and not near the same stress level, work load or litigation worries). Also have another friend who graduated from "Radio College of Canada," a private technical college known for spurning out grads for mega paying jobs in the tech industry (one friend is now in charge of a department at GE--makes nearly $500,000 Cdn per year no lies--plus an unlimited expense account).

 

As per the above, going into medicine JUST for the money is a really silly concept...

 

I worked at a job for 7 years and I LOVED it (currently on leave from said job), but I look at it and know that it is static; no pay increase, no movement, but ALOT of flexibility and that is what I wanted. Nonetheless, I am ready to move on because it is NOT challenging (Can anyone guess I'm talking about a dead-end union job?).

 

Anyways, anyone who says they are not minutely in it for the money is lying. Sure I want to "help" people, but the money interests me as well. And also let's not kid ourselves; it's hard work to get that money and doctors, as overworked as they are, deserve every penny they get (as do nurses for that matter).

 

PS...Great discussion...I've heard of such questions coming up at interviews...ie. Do you think doctors are paid fairly?

[Guest PDSP]

Another point regarding the money in medicine.

 

There are some occupations out there that will start off a new grad (having only an undergraduate degree) at $75K. This might be in investment banking, management consulting, product management, electrical network engineering, etc. I have friends making over $100K having graduated no more than 3 years ago! Furthermore, obtaining a one-year MBA at INSEAD will nearly double this salary. So, one year of graduate school, $200K salary. Not bad.

 

Compare this to becoming a doctor - 3-4 years of medical school, 2-6 years or residency, and then the doctor just starts to make anywhere from $100K to $300K. I believe a family physician would have to work very, very hard to make $200K (after expenses, before taxes). Therefore, a specialist will have spent typically 9 years of post-undergraduate study to make a similar salary as the individual with the one-year MBA! Furthermore, the doctor will now be behind the MBA for almost 8 years worth of earnings (around $1.4 million!). This said, not everyone could get those high paying business jobs. But for the most part, those capable of gaining acceptance to medical school generally have the capability to succeed in business as well.

 

So, I really don't think medicine is the career of choice for those interested in making the big money. In fact, it is hardly worth the time investment for the final salary. One has to do it because they want to really help others and are willing to give up a decade of their lifetime earnings (generally 25% of the earning years) to achieve it.

 

PD

[Guest sally2001]

pdsp,

i think the difference b/wn your point and that of the first poster is that you are emphasizing money should not be the ONLY reason anyone chooses to pursue medicine. i don't think very many people would disagree with you. the first poster asked if money should play a role AT ALL in the choice, even if a very small role. again, i'm sure that most people would agree that the financial incentive does attract people to the career, however it's not the only reason, otherwise people would opt for some of the careers you have highlighted instead.

[Guest PDSP]

sally2001:

 

My concluding paragraph wasn't worded properly to convey my thoughts about these posts. I agree with everything posted above. I was just adding my thoughts to the discussion. Thanks for providing me with your interpretation.

 

PD

 

I've edited the first line of my last paragraph to properly reflect my views.

[Guest Biochem10]

I agree that money has to play some kind of role, though a minor one. I don't think I would consider going into medicine if I knew that I would have problems making ends meet each month and I couldn't afford to have a family, unless of course I was married to someone rich and then my career choice would be completely independent of money. I feel that I'm fortunate to want to go into a career that is financially stable. I think I will love the challenge, satisfaction and interacting with people that accompanies the role of being a physician, I can, in no way, see myself getting these same things out of a career in business, no matter how much I would be earning. I would rather be a teacher any day then a business woman.

[Guest GDL]

Very nice dicussion we have here,

 

I agree on what most has been posted so far, money should definitly not play the most important role in one's decision to become a physician but that is is normal that it is taken into account. However I would like to continue on this subject by asking a question, now keep in mind that this is somewhat just for the sake of discussion

Lets say doctors did not make as much money as they do, what if they made just as much as a local pharmacist, would this affect that little part of you that takes into account the $$ and would you still pursue medicine? I do realize that this is a bit idle thinking, but I feel that this thought puts on balance $$ and our desire to go forth and heal.

Any thoughts on this?

[Guest scalar]

Local Pharmacists actually do quite well.In the States Pharmacists are now starting at 100K with stock options, benefits and according to an new grads on the student doctor network, many pharmacies are giving BMW's and/or full tuition reimbursements due to the shortage down there,

 

In Canada the perks may not be that extreme but I know at Walmart, there is the idea to pay Canadian pharmacists in US dollars with starting salaries at 80-90,000US per year with raises each year. Even Shopper's starts its Pharmacists at 85-90K Cdn per year!

 

So much less schooling, much less debt and much better hours with roughly the same pay without the gov't interfering makes pharmacy a pretty decent career.

 

So don't pitty your local pharmacist chances are he's making more than the local family doc and perhaps even more than some of the specialists once they pay their overhead.

[Guest Kirsteen]

Hi there,

 

This is a great topic and one that's really important to reflect on prior to hitting the interview circuit.

 

To add a few cents here, I recently had the opportunity to be part of a small group question and answer session with Canada's first female cardiac surgeon (an amazing and inspirational woman, by the way). The question arose: "Do you feel that heart surgeons are paid too much?". Her response was an emphatic, "Absolutely not! Yes, we get paid a lot, but we're worth it!" To paraphrase, she said that given all the years that surgeons spend in school and in training, and given the large amount of responsibility and hours that they accrue over the course of their career the large take-home pays are more than warranted.

 

Cheers,

Kirsteen

[Guest strider2004]

Imagine you have this terrible abdominal pain in your lower right quadrant. It's so bad that you've been vomiting for the past 2 hours. In the emergency department at 3am, the surgeon is called and he thinks it's appendicitis. You have to do to the OR right away.

 

Your surgeon has been in the hospital since 6am the previous day. That's 21 hours so far and just about to start your surgery. Would you want him worrying about how he's gonna pay this month's utility bills? Does he have a mortgage on his $75k house? Does he stay up at night worrying about how he's gonna feed his 3 kids? Would you want your surgeon, who you are about to entrust your life, to be making $30k a year and worried about how he's gonna make ends meet?

 

Part of the financial reimbursement that physicians receive is due to the amount of responsibility put on their shoulders. Obstetricians pay $70,000 in liability INSURANCE. That just shows how much responsibility they have.

 

I think it's funny that somebody should think that med wannabes shouldn't ever think about money. Sure, noone thinks about money...until they don't have any. I was just in a car accident and I'll have to pay $5000 out of pocket because my insurance is so high already. I'm lucky that my parents can help me out. Money brings peace of mind. When I'm in the hospital 12h a day, maybe working 60-80h a week, I don't need that crap. I wanna pay it and get it over with. The reason doctors are paid well is so they don't have to worry about money. Isn't that what's it's all about? Financial security? How can you possibly be confident in treating other people when your own life is in shambles; you're going to be evicted from your apartment? If your doctor is financially secure, then he/she can worry about the other things...like you.

[Guest ioncannon97]

I'm really glad that my my original post got such a great response. Now, in response to some of what has been posted:

 

Firstly, to Scalar who believes that Pharmacists with starting salaries at 85-90k make as much as specialists: your numbers are wrong. I know some specialists and believe me, they make at least two to three times that figure easily after overhead.

 

Second, a lot of you have commented on how financial security is needed for doctors to cope with their stressful lives. I completely agree. If doctors were constantly worrying about finances, some may take up extra jobs or cut corners to save overhead. Any such measures would hurt patient care so I think that society as a whole benefits if doctors have financial security.

 

Most of us seem to have agreed on the fundamentals of the money in medicine question: i.e. we seem to agree that doctors deserve and need financial security. To continue the discussion then, I ask the following question:

Where should the line be drawn? Should any specialist be making 400k or more as some do. I mean, one has sufficient finanicial security at the 150-200k level. Wouldn't the health care system be better served if that extra 200k that is paid to some specialists was cut and added to something else, like nurses salaries? Doctors would still hav sufficient financial security. They just wouldn't be able to buy as many Jags.

[Guest MayFlower1]

A very interesting can of worms...

 

Although it is a noble (and perhaps novel) idea...I'm not sure if I know too many professions which demand employees to work for free. Why should docs who see lots of patients and work hard hours...who have poured tons of personal time...money...and effort into their training...be asked to work for free once a "cap" has been hit? I think if capping is going to be implemented, docs should also have the choice of not working once they reach their caps.

 

Why should doctors be treated any differently than any other profession? It's a fact of life that some professions/functions are valued by people more than others...the more valuable and/or rare skills are remunerated at higher levels...the less valuable/or common skills are remunerated at lower levels...this is just a fact of life as we know it. Doctors perform a very valuable function...the ability to be a good doctors doesn't come cheap either...from a personal investment perspective...from an intelligence perspective...from a sacrifice perspective...from a monetary perspective...sorry...docs should be well compensated.

 

If you think about it...guys in charge of companies designing telephones, fibre optic equipment, etc., are compensated at far higher levels...is this as important work? Would they accept a "cap" on income after their company sells a certain amount of their product? I don't think so.

 

My 200 cents.

 

Peter

[Guest monksters]

First off, I like the honesty with which everyone has responded on the board. I myself also am glad that medicine is a financailly secure profession... Aside from the fairness factor (number of hours invested plus worked plus opportunitiy cost), it is a highly demanding job with high responsibility which should in fairness be treated as other professions are.

 

However, because of the public health care system, there is only so much we can pay health care staff etc... Unless we are willing to pay more for our health care or we are willing to let some services become privitized. I guess as economists say.. there is no free lunch

[Guest macdaddyeh]

Hi everyone; great discussion!

 

I believe that doctors should be well remunerated, but let us remember a few things. First, *MOST* doctors' are paid via FFS (typically but not always) which is negotiated between the provincial medical associations and the province (for this reason some doctors don't even trust the medical associations as a bargaining unit).

 

Nonetheless, keep in mind that because doctors are indirectly considered public servants, there *MUST* be a cap or maximum on their fees because they are paid out of the public purse. If you think about it, the prime minister has an important job, but there would be an outrage if he got paid way too much (and he doesn't) as with any other "public" position. For example, someone recently posted the public servant 100K+ list in which every position in Canada in which ANYONE making over 100K has their name published (except physicians working in clinics; only notes those associated with universities and hospitals--as well as publishing salaries of other public officials).

 

As long as medicine in Canada remains publicly funded we will always see maximums and caps etc, and I do not necessarily disagree with this because we are not living with a private system in which people pay BUT that said I am not saying that doctors should not be well paid--it is just this notion of "well paid" that must be defined...

 

Perhaps it is time to get rid of FFS?! This would prevent those ridiculously long hours that some doctors work (including Peter's wife;) and prevent doctors for accepting more and more patients simply to get that ridiculous $55 per visit fee minimum (or whatever it is).

 

PS. I don't EVER see Canada moving to a private system because under the Canada Health Act such a move would be considered illegal and unequal and cause huge social inequality and upheaval!

[Guest RAK2005]

If you were to get rid of FFS, you would do two major things:

 

1) Decrease the amount of time a MD will work (i.e. what's the point, after you've put in your 37.5 hr/week -exaggeration, but you get my drift)

 

2) Make the actually service suffer, increase waiting lists, decrease numbers of operating surgeons, +++ increase ER waits/line-ups etc.

 

My other point is, if you think Canada will NEVER go to a private system, try getting Physiotherapy and dentistry paid fully by the government. It just won't happen. BC also has delisted Chiro, massage, PT in their province.

 

I think the time-bomb is ticking, unless the government does something a lot more drastic than what Romanow is suggesting. It's a start, but not a cure (which I wish I had!!).

[Guest statementofclaim]

I'm not aware of any federal legislation regarding public sector salary disclosures, but in Ontario, there is such a piece of legislation for all public sector employers.

 

www.e-laws.gov.on.ca/DBLa...p01a_e.htm

 

You can have a look at the hospital employees in various Ontario areas at:

 

www.gov.on.ca/FIN/english...spit02.pdf

 

You'll mostly see pathologists, psychiatrists, medical officers of health and a few Rads. Interestingly, I thinks the highest paid public sector worker is a Rad at Sick Kids. I thinks he's paid someting over $500K.

 

When you do a google search of such other ontario organizations, you'll see cops, librarians, school board administrators, etc. doing as well or better than many docs.

 

Interesting piece of legislation.

 

Later...Mark

 

Oh, Macdaddyeh... congrats on the interview. Good luck.

[Guest macdaddyeh]

Statementofclaim: It's good to see you on the boards again. Where have you been?

 

As to the previous post, I disagree somewhat, but not entirely that FFS is *THE* way to go and as for medicine going private this WILL NEVER happen.

 

It is such a well-entrenched right (and privilege) in Canadian society that we have FREE (read tax paid, absolutely no direct costs to pay) health care. I would not want to be in the position that during a serious illness or accident I might lose my job, or lose my house or lose my life just because I could not afford medical care, or that I lose all medical privileges attached to my employer if I move voluntarily or quit or retire (which happens automatically in the States). Canada in fact attracts investment for the simple reason that employers don't need to pay for health insurance because of our publicly funded scheme (not including supplemental benefits) and this is yet another social benefit of free health care.

 

For more info on the principles of The Health Act, I refer you to:

 

www.hc-sc.gc.ca/medicare/home.htm

 

Although this is a policy and an act, it is not a statute and there may be some legalities in how it is interpreted (statementofclaim might be some help here), but esentially to introduce a private system is outrageous and would also cause unnecessary duplication, increased admin costs and besides with the system we have in place, despite its problems, Canada is still ranked consistently as being one of the best in the world according to UN and WHO etc. So a public system does not make for worse health outcomes.

 

Statementofclaim, thanks for posting those salaries; as we can see indeed, some doctors are very well paid despite our "public" system.

[Guest PDSP]

I disagree with the idea of caps and clawbacks on physician billing, regardless of whether or not the physician is paid out of public money. In Ontario, like many other provinces, the waiting lists to both see specialists and receive treatment are ever-increasing in length. By restricting a physician's salary or allowed number of procedures, the government is, in essence, mandating the existence and persistence of these dreaded wait-lists. And in the case of life-threatening, time-critical illnesses, managing the cost of healthcare through these practice restrictions not only causes frustration on the part of the patient, but also contributes to increased risk and most likely increased mortality. Physicians should be allowed to work as much as they like and be paid accordingly. I've never heard of any other civil servant not being paid for over-time. In fact, CUPE strictly enforces a "no overtime without pay" policy so that its employees receive proper compensation for their work hours.

 

The government could help alleviate the current healthcare access problems, while incenting physicians away from service south of the border, by simply compensating physicians in an adequate fashion.

 

PD

[Guest monksters]

Usually products/services that are paid for are determined by market price... that is what the market will bear or what we are willing to pay for it. In the case for Health Care, this is not the case because we indirectly pay for our medical services through the "System"

 

Because of this it is the government that determines the cost of our health care rather than the market according to how much they can allot to it from the budget.

 

So actually it may not be possible for Doctors to be compensated more unless the Ministry of Health gets a healthy donation from Donald Trump or we are willing to pay more taxes.

 

Furthermore if we eliminate a cap and keep the FFS, the costs of health care will skyrocket because, physicians be pressured to work more. At the same time the quality of care will significantly decrease because in areas like Family Meds, time with the patient may go down.

 

I think the so called wait lists are caused by an increase in technology, our demand as people for better and more and more service, and the health care workers' motivation to do more for patients. This along with the fact that people are living longer and are aging causing a greater need for services.

 

Part of the so called shortage is also partially historical. Provinces were once funded 50-50 by the Feds and at some point there was a large pressure to increase the building of hospital etc. etc... when this was reduced to block funding (soon before the Canada Health Act).. the provinces had to bear the increase cost that was built up from the infrastructure that was put in place... hence the "shortage of funding"

 

I think our health care system is pretty good. And as for improvement, I think that if we siphen off some of the elective procedures and diagnostics that already exist it would free up some funding in the public system. Furthermore, I believe we should increase more accurately evaluate the evidence around certain interventions and services so that we know when we are actually doing good for the patient and hence waste less money. Finally, I think that we should better connect health care service with certain community service organizations both for better continuity of care and so that we increase the capacity of the "system"

 

Sorry if I've gone off topic... one of my weaknesses

[Guest PDSP]

monksters:

 

Many excellent points in your analysis of the Canadian Healthcare system. I do, however, have a couple of points to add to your thoughts.

 

The concern that is expressed over the possible explosion in costs due to the removal of caps and procedure limits would only be a short-term affect until the backlogs are cleared. But, as you indicated, measures must be in place to ensure that procedures are not requested when they are not medically necessary. This level of accountability must be at the physician level. The physician must be able to defend his or her decision to order a given diagnostic or therapeutic procedure. Perhaps a review panel that examines random case files would help to ensure that proper protocol is being followed by the physicians.

 

Now, since the money that pays for all these procedures (and the extra ones required to clear the backlog) come from the public, the public must be ready to accept responsibility for these costs. That is, as the public demands improved service with reduced waiting times, it must be prepared to ante-up the increased costs to pay for these services. We already see that some citizens are willing to pay drastically more to receive quicker treatment - those that pay private clinics or seek treatment south of the border. But, for those nearly 25% of Canadians who make less than $20K a year, paying more for a service they may or may not need seems rather impractical. And in this lies the the fundamental problem of any public and/or private healthcare system.

 

When push comes to shove, the public only wants to pay for something that they know, or reasonably believe, that they are going to make use of. Those who are most capable of paying for services (the middle-agers) are relatively healthy. It is the very young and elderly that require greater care, but don't have the income to support the necessarily higher costs. This is probably the strongest argument for a publicly-funded system. Pay-in to the "pot" (healthcare tax dollars) while one is healthy and wealthy. Then, collect services as one ages and experiences a lower income. The biggest problem being that we have many "baby-boomers" entering the later years in life and there is no "pot" to fund their care. All of us, every Canadian, is going to have to pay for our elder parent's and grandparent's care. So, the next time a politician advocates a tax cut, I'll be voting for the other guy who'll be putting that money directly in to MY future healthcare.

 

PD

[Guest tantastic]

Hi there,

 

A quick couple of questions.

 

A) I looked at the salary disclosure you posted (thanks for the link by the way ) I was wondering if you knew why there was such a discrepency between the salaries of what appear to me to be identical positions. for example some radiolists are paid 120K per year and some are paid 450K per year. Are those that ar higher paid special in some way?

 

Secondly out of curiousity what were the starting salaries out of law school for grads? I would assume that they undergoe extensive training and also play a crucial role in society.

 

Good to see ya back friend

 

Tantastic

[Guest monksters]

The escalation due to removal of a cap is unlikely to be a short term effect. It is sort of a chicken and egg story.... because of the increased services that health care workers are willing to give, the more likely that

1. the public percieves themselves as more sick

2. those who are not truely sick end up entering the system

3. these same health people become sick because of the increased use services that some times do more harm than good (98,000 serious adverse affects are caused by medical errors)...we then have to subsequently pay for the surgeries, drugs, care that in fact was originated from us.

4. the diagnostic and drug companies capitalizing on the new trend of increased services in the health care system and hence increasing their production for the increase in demand...more marketing etc etc..

 

So in the end, rather than decrease the backlogs, this actually increases the backlogs...

 

The problem of increasing taxes especially for the working population is that they are also generally the biggist spenders. This poses two potential problems:

1. To be fair, those with higher income pay more tax.

Hence not only will doctors who are motivated by more lucrative salaries in US move because of lower tax ( which negates the original reason for increasing tax-ie to keep health care workers), we will be reducing spending.

Which decreases the economy, which decreases jobs etc... and those on the labor level will suffer the most.

2. Decreased business investment in BC also stiffles economy. Lower economy, more unemployment, greater poverty..

 

I think the key is working towards greater efficiency in our system, rather than increasing volume. Hence this means re-evaluating the system from inside out..making more informed decisions and making those decisions accountable... As they are trying to do with the Romanow Report (to some degree).

 

The other thing is to focus towards more home care instead of in-hospital care...many of these old folks don't need acute care facilities but live in them because there is no where else to put them. This fills up beds that could be used for acute care patients.

[Guest PerfectMoment]

money should definitely factor into one's decision when making career choices. for me, money is a very important part of why i want to get into medicine, but by no means is it my primary reason. other careers have the potential to earn more (MBAs, dentists, business owners, etc) without all of the stress, long hours, or years of education require to enter meds. as well, all the people who say that doctor's make too much should consider that many many doctors do NOT get paid pensions. Somebody with an MBA working for a company will at least get a pension on top of the RRSP when they retire... doctor's don't get that...

[Guest UWOMED2005]

Hey Tantastic, I think I can answer that one. In a fee for service system, depending on what area of a specialty a doc is interested in, what the patient population is (pediatric and geriatric patients take more time,) and how one wishes to process the clientelle, renumeration can vary greatly. Take the example of two ophthalmologists: one just does cataract surgeries (Dr. Curly,) the other does neuro-ophthalmologic consults (Dr. Moe.) Cataract surgeries are very well renumerated right now, whereas neuro-ophthalmologic consults not so much (in comparison.) Then consider the fact that you can do a lot more cataract surgeries per day (say 30 for argument's sake) than the neuro-ophthalmologic consults (say 6 per day), particularly those on geriatric and pediatric patients. So Dr. Curly is getting MORE money per procedure, and billing for MORE procedures per day. In this specific example, it wouldn't really be hard at all to see a discrepancy of $450k vs. $120k.

 

This is also the mechanism by which geriatricians and pediatricians are poorly renumerated, whereas as some other specialists due quite well. Having had some exposure to some salary figures, I must admit I was quite shocked by how different the salaries can be in medicine.