Physician Income Disparity: Good or Bad?

If you visit Amsterdam, you will notice 16th and 17th century grand houses on prime real estate lining the canals, built by wealthy merchants of old. Each has a grand bay window without curtains that affords passers by a view of the exquisite rooms and furnishings. They were built that way so the commoners could get a look at how the 1% lived. People just love to gawk at the lifestyles of the rich and famous and get a view of their wallets. As such, when the annual US physicians compensation figures hit the press, they garner a lot of interest and comment. Who makes the most? Who got the biggest raise? Who thinks they were underpaid? What is happening to physician income inequality?

The contemporary version of the Amsterdam anecdote is taking a drive through the “doctor neighborhood” or Pill Hill, to see where the cardiologists and orthopedic surgeons live.

In general, there are significant income disparities between those that do procedures and those that don't, both in surgical and medical specialties. There are many arguments over whether income inequality in US doctors creates adverse, unintended effects and, therefore, needs to be fixed. Others, however, argue that physician income inequality is determined by historical economic, market, and political forces. In addition, the better-compensated group argues that they train longer, face higher opportunity costs, and are at a higher risk of an unpleasant encounter with our highly litigious medical environment. (Disclosure: I am an otolaryngologist-facial plastic surgeon, but no longer practice medicine full time)

In addition, the physician income disparity conversation is occurring in the context of the overall income disparity conversation, which tends to cast a halo effect.

The next time you find yourself tempted to engage in this cocktail party banter—which you should avoid at all costs if you ever want to be invited back again—consider these downstream effects and whether there is any credible data to justify your position:

1. The effects on patients.

2. The effects on medical student career choice.

3. The effects on resource utilization.

4. The effects on procedural disparities in different geographic areas of the country.

5. Student debt obligations and the opportunity costs of prolonged training, in some instances six to eight years of training after graduation from medical school.

6. The burnout and suicide rates of different specialties.

7. The happiness of different specialties.

8. The manpower needs of a given community.

9. The GME training and funding environment.

10. The politics of reimbursement at the medical society and payer level.

Many doctors make more than the POTUS. But, to paraphrase the Babe, most had a better year.

The next time you see that woman in the scrub suit leaving her five car garage in the red Carrera convertible, try not to let the Green Monster get the better of you. Just ask yourself, “But is she happy?” Probably.