I was not shocked to see that the AMA came out against the public option. I appreciate the doctors who have taken a stand against the AMA on this issue. Thank you. Most doctors I know are with you. And I want to say that I don't begrudge you your well earned and deserved income. I think you deserve it. There are plenty of people who deserve to be compensated like heroes who aren't (teachers) and plenty of people who don't deserve it but who are (attorneys like me). I suppose three wrongs don't make a right.
The most salient complaint I hear about the "overpaid doctors" logic of many is that doctors come out of medical school with too much debt. I can sympathize because I came out of school with roughly a quarter million dollars in debt myself. While I think it would be a boon for our economy to make higher education free, I realize that's not on the agenda right now. But since we're discussing healthcare, I think subsidizing medical school, if not making it free, is a crucial part of any health care reform. My argument in depth and some data on the flip.
According to the AMA (I think it's fair to use their data arguing against them):
Student debt statistics
$139,517 – According to the Association of American Medical Colleges, the average educational debt of indebted graduates of the class of 2007. The average debt of graduating medical students increased in 2007 by 6.9 percent over the previous year.
75.5 percent of graduates have debt of at least $100,000
87.6 percent of graduating medical students carry outstanding loans
Source: AAMC 2007 Graduation Questionnaire
I almost find that number incredibly low.
According to this table, which purports to use the LA Times as a source, in 2003, a family practice doctor could expect to earn about $130,000 per year in their first year out moving into the closer to $200k range over the next few years. To pay off those student loans in 10 years, the monthly payment would be about $1,600, most of which is not tax deductible. More commonly, a consolidation of 30 years would put the payment at about $900 per month, with approximately one third as interest and therefore deductible.
Of course, almost everyone has some student loans, so comparing it to a zero basis isn't fair, but that's still more than most of us. (Though it was way less than me, but I went to school for a lot of years and mostly at private schools, so...)
Yet at the same time, there are only approximately 130 medical schools in the US, graduating approximately 16,000 doctors per year. Is that enough? I'm not sure that it is. If there are enough doctors, there are apparently not enough primary care doctors. This is because that's a tougher, lower yield business. Would it make a difference if there wasn't a huge student loan repayment hanging over doctors when they choose whether or not to go into the field?
Doctors will have to tell me. I have no direct experience. By way of analogy, let's just say that when I started law school, I planned on my career looking something like A Civil Action and less like The Borg. I'm much closer to the former reality now, but my first 5 years out of law school were definitely all about working for the man. Was my debt part of my decision making? You bet. Among many other factors, mostly financial, the job offer I accepted was because of those realities, and not because of my highest dreams.
Maybe I should have known better or found another way. But I didn't, and I don't think many doctors can be expected to do it as a matter of noblesse oblige either.
Therefore, in order to work on these incentives, I believe that a part of Health Care reform we are discussing needs to address the incentives of doctors. Not only would this somewhat inoculate (no pun intended) against some of the political opposition they would create, but I also think it's the right thing to do.
I'm not a legislator, so I won't presume to get too specific, but how about either making medical school free, building more, all while assuring quality, or loan cancellation programs—and don't just limit them to the battle pay situations where Perkins loans get cancelled. It also might create a bigger talent pool of people willing to give medical school a shake.
Doctors provide a valuable and important service. We wouldn't be clamoring for health care they way we are if they didn't. Yes, they do better than most of us, on average. But I still think properly managing incentives is an important part of political change.
What are your thoughts?