Some Doctors Worry That Pay Is Sign of Greed : Medicine: Others say the pay balances the costs of schooling, insurance and lawsuits. The debate can pit specialists against general practitioners.
One doctor stopped eating in his hospital’s dining room when he finally tired of hearing other physicians brag about their fat incomes, megabuck retirement funds and money, money, money.
Another remembers a colleague’s shock at learning her salary. How could she be happy when her pay--more than comfortable by most Americans’ standards--seemed so low?
Money, it seems, is becoming an obsession for many in medicine. Doctors long have made lucrative livings. But huge fees--especially for surgery and high-tech procedures--have turned medical pay into a subject of intense fascination, both for those who pull down sky-high incomes and those who are jealous of the doctors who do.
“Greediness is becoming more and more an issue,” said Dr. Michael V. Buenaflor of Northampton, Pa. “Guys are a lot more cynical and are turning to the American way of ‘Go for it.’ ”
But in the medical world, at least, money does not always buy happiness. Many doctors say they are fed up with their profession. They complain of second-guessing insurance companies, burdensome paper work, miserly Medicare fees, high malpractice rates and the constant fear of being sued, among other things.
Some argue that practicing medicine has become so unsatisfying that many are bent on making sure that the work is financially rewarding, even if it is no longer fun.
And rewarding it is. The latest statistics show that monetarily, at least, doctors are doing very well indeed. Their pay is going up far faster than almost everyone else’s: Last year, according to a survey, their net income rose 12.5%, almost triple the rate of inflation.
The survey, conducted among 6,484 doctors by Medical Economics magazine, found that the median net income of all U.S. doctors rose almost $15,000 in 1989 to $133,000.
Among other figures from the survey:
* Annual incomes ranged from $87,000 for general practitioners to $296,000 for cardiovascular surgeons.
* One in five cardiovascular surgeons makes more than $600,000 annually.
* The typical obstetrician’s pay soared $36,000 last year, more than any other specialty.
* Only 6% of doctors make less than $50,000 a year.
Many doctors contend that they studied hard and put in long hours. They deserve to make a good living, they say.
“When you consider that we work a 60-some hour week, that we put 12 years of training in and we owe 50 grand when we start on average, I don’t think anybody is robbing the bank,” said Dr. Philip R. Alper, an internist in Burlingame, Calif.
“We don’t make an excessive wage,” he said. “I don’t have an apology to make.”
Some, in fact, fear that they are falling behind.
“Nobody feels bad for physicians. We do make a good living,” said Dr. Craig Czarsty, a family practitioner and doctor’s son in Oakville, Conn. “But is my earning power the same as my father’s was 20 years ago? Probably not.”
Specialists are particularly well off, but they contend that they deserve to make more than other people, including doctors in general care. Their work is often tedious and exacting, they say, and requires technical skills that take many years to perfect.
Dr. Thomas Purdon of the University of Arizona Health Science Center notes the special pressures faced by his colleagues in obstetrics and gynecology, whose earnings the magazine survey pegs at $194,000.
Besides the many hours seeing women through their pregnancies, labor and early motherhood, there is a real possibility that each is a potential courtroom opponent.
“The public expects an absolutely perfect product and doesn’t want to recognize that there can be genetic problems and other things that the obstetrician has no control over,” Purdon said.
“If things don’t turn out just A-OK, the first thing they do is try to find a lawyer to sue him.”
Yet an undercurrent of feeling remains--both inside and outside the profession--that some doctors are just plain money hungry. A survey conducted last year for the American Medical Assn. found that two-thirds of Americans think doctors are too interested in making money.
Some of the criticism even comes from the well-paid specialties. Dr. Peter S. Czachor of Kittery, Me., notes that when he retired five years ago, he was charging $700 for complete obstetrical care. Now doctors in his area are charging $2,000 for the same thing, and their malpractice rates are the same.
Those complaining loudest about physician avarice often are doctors in the lower-paying primary care specialties.
Buenaflor is the doctor who grew weary of dining room talk of physicians’ financial conquests. The final straw for him was an ear, nose and throat specialist who said he’d finished the year with an extra $160,000 that he couldn’t figure out how to spend.
Buenaflor is a family practitioner, traditionally the lowest-paid medical specialty. Last year, according to the magazine survey, they netted an average $97,000.
Often, when these doctors on the front lines of medical care talk about money, the conversation turns to specialists in more technical fields.
“I’m going to be in my office 12 hours today,” Buenaflor said. “I will net less than a colorectal guy across town will do for a 20-minute colonoscopy,” a routine diagnostic procedure.
Dr. Lorilee Smith, a rheumatologist in Modesto, Calif., said she believes the financial attitudes of many young doctors who set up practice in the 1980s simply reflect the decade’s fixation on money. She was struck by a conversation with a young dermatologist who moved into her building.
“After she had been here for a while, I told her what I made. She was shocked. She said: ‘But you seem so happy.’ Compared to dermatologists, I’m making poverty-level wages, even though I make great money,” Smith said.
Insurers have long paid high fees for technical procedures and operations and much less for the hours that primary-care doctors spend figuring out which of these treatments their patients need. But that will change, at least a little.
Beginning in 1992, Medicare will reimburse doctors more for their time managing and evaluating patients and less for technical services and operations. Private insurance companies are expected to make similar changes.
This will raise the pay for family doctors and lower it for many surgeons and radiologists. While the changes will narrow the spread, it certainly will not eliminate it. Doctors who deliver babies will still make considerably more than, say, the pediatricians who care for them later.
