Okay, enough already. It seems like the media’s flavor of the week is focused on determining what a doctor’s annual income is, and whether that magical guess-timation is too high or too low.
The underlying assumptions driving this hunt include: 1)coming up with an average annual income (gross/net) would somehow be reflective of individual physician practices or be meaningful in any shape or form, and 2)even if the previous assumption is correct, that exactly how much physicians are getting paid is clouded in a cloak-and-dagger manner.
We are wasting too much time and effort asking the wrong question.
Knowing the annual income of a typical government job position makes sense because one knows with some accuracy the number of hours demanded of the employee, along with other relevant details usually spelt out in an employer-employee relationship. Physicians are not employees of the government. Functioning similar to ad hoc consultants, the government pays a certain fee for specific services rendered; there are no set number of hours expected of any individual doctor. One family physician may work as little as 1 or 2 days a week, while another might put in 80-hour work weeks.
And that’s not even taking into consideration the fact that not all services provided any one doctor are the same. It is not hard to see that performing open heart surgery is different than a psychiatric evaluation, and that different specialities require varying degrees of investment of time, tuition, and training. Compensation for expert services in different fields are expected to be quite variable.
The media has painted a picture of how nebulous and murky the process is of nailing down an accurate answer to the question “How much does a doctor make a year?”. In fact, if one was so inclined as to figure out exactly how much an individual doctor makes, it’s actually quite easy: in Ontario, for example, exact money figures are listed (to the penny!) in the publicly available Schedule of Benefits. Every citizen can look this up and figure out how much a physician can legally bill the government for every medical service rendered. Transparency is not the biggest issue.
The biggest problem is that we are asking the wrong question. Instead of pondering whether an “annual doctor’s income” is reasonable, we should be dissecting the individual items of the Schedules of Benefits, and asking ourselves questions such as:
“How much should we pay for a hip replacement?”
“What should a family doctor be paid for a newborn check-up?”
“How much is having a physician on call 24/7 to treat life-threatening emergencies worth?”
Those are much harder questions to answer, but at least we’d be asking appropriate ones that actually has practical implications linked to discrete tasks and measurable outcomes.
So please stop asking what the average doctor makes a year – that number will not help us gauge the value of healthcare dollars spent, nor guide policy decisions. The answers we seek are in the details of a different unit of measurement: how we value and pay for individual specific healthcare services and outcomes.