Money an Important Factor in Physician Work-Life Issues

Five years ago, physician concerns with the nation’s healthcare system were two-fold: They said they were spending less time with patients, and they needed to work harder to maintain an income. Those same concerns are often voiced by today’s medical doctors.

“If money is your hope for independence you will never have it. The only real security that a perosn will have in this world is a reserve of knowledge, experience, and ability.”—Henry Ford

Five years ago, physician concerns with the nation’s healthcare system were two-fold: They said they were spending less time with patients, and they needed to work harder to maintain an income. Those same concerns are often voiced by today’s medical doctors.

William Weeks, MD, MBA, associate professor of psychiatry and of community and Family Medicine at Dartmouth Medical School, conducted a study to examine these concerns. The results, published in an April 2003 edition of Archives of Internal Medicine, did not “confirm the prevailing concern that physicians are working harder or longer, or that their incomes are declining.” So, what’s up?

“I’m guessing that some of the fun was squeezed out,” explains Dr. Weeks in a recent interview with PFNLive.com. “Physicians like to talk to patients and spend time with them, and instead they’re probably spending more time doing paperwork and administrative things. They’re getting paid the same, but they have these administrative burdens that squeeze out the number of patients they can see.”

Money Isn’t Everything, But …

Dr. Weeks points out that according to the study, money isn’t always the most important concern when it comes to physician work-life issues. Instead, it’s often the quality of the work within the same, or even reduced, hours that is a key element. So is the comparison factor.

“There have been studies in business that a lot of the satisfaction with your income is not so much what you make, but what you make compared to the guy sitting next to you,” says Dr. Weeks, who got his MBA from Columbia University and his MD from the University of Texas. “If you’re a primary care physician and you do all the work and then refer someone to an orthopedist, and they’re driving a new Lexus while you’re driving a Subaru, it might get to you after a while.”

As a case in point, Dr. Weeks’ research has repeatedly revealed that, no matter how the data are sliced and diced, women physicians earn substantially less than their male counterparts. Women physicians often remarked that even though they were full-time ranked faculty at a medical school, a male physician, just out of residency, would often receive a higher salary than theirs. Male physicians’ response to this, says Dr. Weeks, is most interesting.

“Men frequently respond by saying things like, ‘Maybe women don’t want to make this kind of money,’” Dr. Weeks explains. “I’m always perplexed by that. Why would someone want to do the same work but not want to earn the same income?” Studies also noted that there was no race bias when it came to physician incomes. African-American males and white males earn about the same amount, but white women doctors earn between 10 and 30% less in annual income than their male counterparts. “We looked at 14 specialties, and we have never found that women don’t make statistically less than men.”

It’s a Specialty

Another discrepancy, says Dr. Weeks, is the ongoing huge disparity that exists, salary-wise, between primary care physicians and specialists. The challenge in addressing the growing shortage of primary care physicians is compounded, according to Dr. Weeks, by this disparity and the belief that PCPs have a worse lifestyle.

“Students making the decision about what residency to go into are more often considering lifestyle,” says Dr. Weeks. “It’s been written that the more primary care physicians you have in a hospital referral region, the better outcomes that served population has. And yet there are no incentives, either from a lifestyle perspective or a financial compensation perspective, to get more people doing primary care. So we’re concerned right now that there’s a fragmented healthcare system.”

Dr. Weeks’ studies have included an examination of the return on educational investment. For example, educational investment is about the same for everyone up until medical school. From that point on, “Future income is based on your next five years of training,” says Dr. Weeks, noting that primary care physicians do three or sometimes four years, while specialists typically put in five. “It’s easy to think, “If I had just done one more year, I might have been a radiologist, and I might have doubled my income forever.’ Is that fair?”

Looking Ahead

Call it niche, concierge or boutique medicine, there’s a growing number of physicians who are gravitating to the beat of a different drum—forsaking insurance forms and paperwork headaches and charging patients a flat annual fee to provide them with unlimited primary care. Dr. Weeks believes there are great opportunities in this area.

“I think they’re going to try to wrest back control of what it is they do,” says Dr. Weeks. “If they’re in a big medical practice and they’re told what to do all the time, and what their productivity has to be, being totally at the whim of HMO pricing, they may go out on their own and say, ‘I’ll find people who are willing to pay.’”

Note: Next week, we’ll examine the efforts of a primary care physician who is doing just that … and making it work.

$241,690Average annual salary for a physician in a rural area.

$234,400Average annual salary for a physician in a metropolitan area.(LocumTenens.com, 2008)

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.

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