"There's probably only one thing
more secretive than patient confidentiality, and that's
a doctor's salary," my general medicine attending began
one morning. He then proceeded to give a sermon about
the specialities and their inequities in pay. Right
when I thought I might get some hard numbers, he propagated
his own frustrations onto me, ending with a cliffhanger:
"You'd be surprised how much things have changed and
how much they pay me as an internist nowadays." Naturally
he failed to elaborate.
Physician remuneration is almost
a taboo subject. Residents and medical students wonder,
but no one ever asks. When it does comes up in conversation,
it's all speculation and hearsay, usually concluding
with the vague compromise that whatever doctors make,
it's not a great way to get rich, but nor do they starve.
Certainly, one can look up statistics
on government websites and health region budgets, but
all those figures are distorted with variable overhead
costs and office hours. Published salaries do not specify
on-call stipends and rural premiums. Unless I found
a doctor actually willing to disclose his before-tax
income and the hours he put in, it would be next to
impossible to budget what I might earn when I graduate.
"It's probably because doctors
aren't supposed to care about money," suggested one
colleague. Another quipped, "Those that don't care about
money, have money."
I guess the noble medical profession
would be tainted if doctors started squabbling over
money — especially when their average salaries
are three to four times higher than the national average,
according to figures from CIHI and StatsCan. On the
other hand, when I graduate I'll have done 13 years
of university. Doesn't that entitle me to fair compensation?
SHOW
ME THE MONEY
Throughout my medical career, I've only had two preceptors
tell me flat out how much money they made. One was a
fee-for-service general internist at a community hospital.
She currently bills $205,000, but at one time billed
$400,000 and almost burned out doing so. "It wasn't
worth it," she warned me.
The second was a gastroenterologist
on salary at the university. "The first pay level is
$252,000. I'm happy with GI because I know that even
if I didn't work full hours, I would make as much money
as some other specialities, like rheumatology."
"Why's that?" I asked. How did
they determine that a gastroscopy would bill more than
a joint injection? Or why a thirty minute procedure
was worth at least double a thirty minute office consult?
He didn't have a good answer. "Traditionally
GI's been a better-paying speciality," he shrugged.
SCOPE
IT OUT
Med students and residents aren't stupid. If there was
a job that paid extremely well and had a good lifestyle,
versus one which worked you hard and paid ok, who wouldn't
apply for the former? It would be tempting to correlate
the number of applications to a specific program with
the mean salary of that speciality. Most residents and
students already suspect those specialities that pay
the most are the most competitive.
"I'm interested in interventional
cardiology," one fellow told me. Another one said, "I
like endoscopy and inflammatory bowel disease." Are
these procedures really that interesting? Or just well-paid?
I have yet to hear anyone proclaim they'd rather manage
inpatient heart failure and ascites than do echos or
dialysis.
Some food for thought as I try
to map out my goals. Many career counsellors have suggested
that money is important, that maybe one day I'll wake
up wondering why my former classmate over in the next
department is getting paid twice my salary.
Although money isn't everything,
I'm starting to think it hasn't received the attention
it deserves during my medical training.
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