The three things that I remember about doctors from my early days are : they are always late, their writing is awful and in an emergency you always ask “Is there a doctor in the house?”. From infancy it has been ingrained into us that doctors are the ultimate saviors and so to be revered almost as the right hand of God. After all on graduation they all take the Hippocratic oath, which states so beautifully their lives objectives:
“ ..I will apply, for the benefit of the sick; all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug... If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.... May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
So I was used to calling doctors in emergencies and they always have responded in the best traditions of this covenant. That is until I went to Las Vegas last month. There I found that the modern version of sacred oath had taken on a different meaning to some doctors. And it happened like this.
On our second day in Las Vegas, I came down with a severe case of food poisoning. Deeply perturbed, my wife called the hotel staff for their hotel doctor and was given two names on their roster. She called the first one- one Dr.(name withheld)- and explained the nature of the emergency, first to the nurse and then to the doctor. Rather than asking details for his diagnosis and prescription, his first (and it turned out later only) questions were whether I had adequate insurance. My wife explained that we not only on Medicare as primary but also had a backup of Aetna provided through World Bank. The doctor declined to take Medicare and when my wife said she would pay cash, he still declined saying that he would not even give a receipt for his services as he was then hassled by Medicare administration. This wrangling continued for some time without any resolution. So we called the second doctor on call- one Dr Siddhu- who spent the entire conversation taking the details of the ailment and suggesting a course of action. As for insurance, he said that we should not waste $ 300 for his bedside visit but that if his course of action did not improve the patient by the evening, it would be better to take him to the local hospital.
In short, in the course of ten minutes we met the worst and the best of the medical profession. One doctor who honored his Hippocratic oath and the other who epitomized the hypocritical hucksters of the profession that plagues the nation who is more interested in money than in curing.
Of course, there’s no question that doctors in the United States make a lot of money, especially compared with their counterparts abroad. American doctors make, on average, four times what French doctors earn. And it's not just because everyone in America makes more money: The gap between doctors' incomes and those of professionals is far bigger in the United States than elsewhere. In the 1990s, the ratio of the average American doctor's income to the average American employee's income was about 5.5. In Germany, it was 3.4; Canada, 3.2; Australia, 2.2; Switzerland, 2.1; France, 1.9; Sweden, 1.5; the United Kingdom, 1.4. But the core of good health care is the primary care doctor and yet primary-care doctors make significantly less than specialists. While the median salary of a family doctor is $137,000, the median anesthesiologist makes $260,000.
American doctors' salaries are high for several reasons. The first is the cost of education. In France and Great Britain, students go directly to medical school after high school, and their entire educations are free. In the United States, students must first get a bachelor's degree before attending medical school, and the average medical student's debt is $155,000. Then come at least three years of residency, which usually pays less than $50,000 a year. After all that, it's no wonder doctors feel entitled to six-figure salaries. Another reason U.S. doctors get paid a lot is market forces: In a single-payer system like Britain's, the government can bargain down the prices of treatments, which leads to lower income for doctors. No such entity exists in the United States—Medicare is big, but not that big. Finally, there is the notion of opportunity costs. Presumably, many doctors could have opted for jobs on Wall Street or in management consulting instead of choosing to go to medical school. "They sit in the Princeton eating clubs," says health care economist Uwe Reinhardt, "and one guy just got a starting job at Goldman for $150,000. Another guy says, 'I'm going to medical school to take on $35,000 a year in debt.' That leads to a kind of hunger for money to catch up." A fourth reason is the power of their lobby- the AMA- which had managed to limit the number of doctors graduating for well over a few decades.
So the real question is how much is enough? The bottom line is that the medical profession in the U.S makes a good living despite their grousing- much better than the average man but in comparison to the hedge fund managers not so much. But then again do we really want the noblest profession to be hankering after greater profits rather than curing the sick and finding a cure for cancer?
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