I think there are some pretty basic and reasonable factors that figure into this.
1) although doctors don't have to be brilliant (and I think it's actually a disadv to be a genius in medicine, but that's another topic for another day), throughout the world they are typically drawn from the ranks of the brighter students in the population. Medicine has to be able to draw these students away from the other opportunities they can pursue, which are potentially even more lucrative.
2) Medical training is long. The process is also somewhat difficult. You have to compensate people for their additional training, otherwise no one will want to bother with spending the time to do so.
3) Medical training is expensive. Going to a private medical school without resources or financial aid requires borrowing hundreds of thousands of dollars, and even a public medical school is expensive.
I think under our current system, it's reasonable then for American-trained physicians to expect good compensation for their work. However, does this mean all doctors should be paid equally? Of course not, because the same factors that influence the relative pay of physicians impact the pay of different types of physicians. It's for that reason that I think specialists should be paid more than primary care physicians (PCPs).
The angienadia blog argues the opposite, that PCPs should be paid on par, if not more, than their specialist peers (http://angienadia.blogspot.com/2010/03/why-do-primary-care-doctors-deserve.html). It's an argument that I wholly disagree with, and an argument that will become important as society struggles to lure more students into primary care, in addition to controlling overall health care costs.
First, the little I've seen of medical practice today has shown me that primary care can be in fact reduced to a simple "gateway" that merely redirects patients with complex disease to other physicians with the additional training to manage and treat them. This can serve as the basis of a model where PCPs can be supplemented, and even work side-by-side with health care pracititioners like nurse practitioners, nurses, or physicians assistants to serve three roles: 1) prevent disease 2) identify treat simple disease and lastly 3) exclude diseases they cannot manage and refer those patients onto specialists.
My critics would argue that PCPs can actually go above and beyond that model by serving in several roles
1) The role of a "brilliant gateway" that can not only prevents and treats simple disease, but can identify and treat even complex disease.
The problem with this argument is that the reality in medical schools today is that typically only subpar medical students enter primary care. Furthermore, the status and image of primary care has deteriorated so badly in medical schools that I believe it would be almost near impossible to quickly induce top medical students to enter primary care, even if salaries there were raised to match specialists'.
2) A "medical manager" that can coordinate care to identify and select the most cost-effective care, and secondly, avoid expensive and unnecessary care.
Unfortunately, PCPs have already once-proven themselves incapable of managing care this way. One of the major reasons for the advent of the Health Maintenance Organization (HMO) was the perception of a need for a third-party (outside of the control, and influence of physicians, and in fact superseding physicians) to manage care in the face of growing costs. If PCPs were in fact used as medical managers, I would question how government could realistically enforce laws against PCPs taking advantage of their position for their own gain.
3) Medical training is expensive. Going to a private medical school without resources or financial aid requires borrowing hundreds of thousands of dollars, and even a public medical school is expensive.
I think under our current system, it's reasonable then for American-trained physicians to expect good compensation for their work. However, does this mean all doctors should be paid equally? Of course not, because the same factors that influence the relative pay of physicians impact the pay of different types of physicians. It's for that reason that I think specialists should be paid more than primary care physicians (PCPs).
The angienadia blog argues the opposite, that PCPs should be paid on par, if not more, than their specialist peers (http://angienadia.blogspot.com/2010/03/why-do-primary-care-doctors-deserve.html). It's an argument that I wholly disagree with, and an argument that will become important as society struggles to lure more students into primary care, in addition to controlling overall health care costs.
First, the little I've seen of medical practice today has shown me that primary care can be in fact reduced to a simple "gateway" that merely redirects patients with complex disease to other physicians with the additional training to manage and treat them. This can serve as the basis of a model where PCPs can be supplemented, and even work side-by-side with health care pracititioners like nurse practitioners, nurses, or physicians assistants to serve three roles: 1) prevent disease 2) identify treat simple disease and lastly 3) exclude diseases they cannot manage and refer those patients onto specialists.
My critics would argue that PCPs can actually go above and beyond that model by serving in several roles
1) The role of a "brilliant gateway" that can not only prevents and treats simple disease, but can identify and treat even complex disease.
The problem with this argument is that the reality in medical schools today is that typically only subpar medical students enter primary care. Furthermore, the status and image of primary care has deteriorated so badly in medical schools that I believe it would be almost near impossible to quickly induce top medical students to enter primary care, even if salaries there were raised to match specialists'.
2) A "medical manager" that can coordinate care to identify and select the most cost-effective care, and secondly, avoid expensive and unnecessary care.
Unfortunately, PCPs have already once-proven themselves incapable of managing care this way. One of the major reasons for the advent of the Health Maintenance Organization (HMO) was the perception of a need for a third-party (outside of the control, and influence of physicians, and in fact superseding physicians) to manage care in the face of growing costs. If PCPs were in fact used as medical managers, I would question how government could realistically enforce laws against PCPs taking advantage of their position for their own gain.
