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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWhy do US doctors make so much more than German doctors?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426124/http://www.payscale.com/research/DE/People_with_Jobs_as_Physicians_%2F_Doctors/Salary
A German GP starts at €48,000, which is about $54,000, and after 12 years builds up to a maximum salary of €84,000, which is about $95,000. It's harder to get good numbers on American doctors, but payscale at least says they start on average at $175,000 and after 12 years on average make $200,000 (specialists make more, GPs less, but $150K seems to be a floor, which is almost 3 times what a starting German GP makes).
Why do we pay doctors so much more?
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akbacchus_BC
(5,704 posts)
Recursion
(56,582 posts)Germany is a much more expensive place to live. Their doctors graduate without debt, though.
akbacchus_BC
(5,704 posts)not carry a hefty student loan like the US and Canada!
You said it, their doctors graduate without debt, which means that Germany is progressive!
Codeine
(25,586 posts)
demmiblue
(36,893 posts)That should be an insta-ban.
Codeine
(25,586 posts)tabasco
(22,974 posts)Groceries are much less expensive in Germany and much better quality.
Gas is much more expensive in Germany, but a lot of things are cheaper.
Germany is ranked cheaper in cost of living by these people:
http://www.numbeo.com/cost-of-living/rankings_by_country.jsp
yeoman6987
(14,449 posts)That takes up a chunk of american doctors pay.
Kingofalldems
(38,485 posts)than German doctors?
Seems to me that liability meme comes from the republican side quite a bit.
emsimon33
(3,128 posts)It is VERY expensive in the US.
Recursion
(56,582 posts)Not sure if a word got cut off there.
emsimon33
(3,128 posts)Medical school. I injured my right should and am typing with one finger of my left hand.
Spider Jerusalem
(21,786 posts)Recursion
(56,582 posts)There are certainly medical companies in Germany
Spider Jerusalem
(21,786 posts)
DFW
(54,437 posts)There are private (as opposed to government) and semi-private health insurance companies as part of the overall setup here. If you make over a certain gross income, you are tossed out of the health insurance plans that make up Germany's patchwork health insurance scheme. You then have to get what is called "privat" insurance, which means you pay up front and then ask your insurance company to be reimbursed. "Privat" patients get preferential treatment, get seen right away where normal citizens have to wait weeks or months. often get one bed rooms in hospitals, etc. Doctors here love them , as they can bill the patient directly, and don't have to assemble paper and send it in to the patchworks companies to get paid. I was quoted a "mere" €2500 a MONTH for "privat" health insurance here in Düsseldorf when I moved here. I decided to keep my US health insurance, nasty though it is. No way I'll be out of pocket $34000 yearly with my Blue Cross, no matter WHAT the deductible. There are also private clinics with doctors who make a fortune here, too. This is not the Soviet Union.
djean111
(14,255 posts)They don't care how much doctors get paid because they can just keep raising premiums. And the number of doctors is kept lower due to lack of school space and the insanely high cost of becoming a doctor. It is a closed system designed to scoop up more and more money from captive customers. It costs so much less to become a doctor in Germany that the doctors can afford to make less money.
http://college.lovetoknow.com/cost-medical-degree-germany
3000 euros is about $3,393 dollars.
I have read that becoming a doctor in India used to cost a very reasonable amount, but costs have risen so much that students are going to China and other countries where the cost is still reasonable. Here, we limit the number of doctors by limiting the number of schools and raising the costs.
pugetres
(507 posts)and how do they give back?
emsimon33
(3,128 posts)Medical school costs a fraction of what it costs here:
http://www.young-germany.de/topic/work/jobs-career/career-how-to-become-a-medical-doctor-in-germany
http://college.lovetoknow.com/cost-medical-degree-germany
linuxman
(2,337 posts)People travel from all over the world, bypassing places like Germany in order to be treated by American physicians.
For anyone who's ever been close to a doctor or had one in their lives, they can understand that the compensation received is in many cases the least they can expect for the demands put on them.
I think the real question here is why German doctors are paid less.
Human101948
(3,457 posts)Among the seven nations studied—Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States—the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia. The 2010 edition includes data from the seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
http://www.commonwealthfund.org/publications/fund-reports/2010/jun/mirror-mirror-update
People are fleeing the high prices in US medical system
In fact, America’s health care system may soon find itself competing with one of India’s innovators. Building on the success of India’s medical tourism boom—a $1 billion business that is growing by 30% a year—Narayana Health (NH) is opening a 2,000-bed multispecialty hospital in the Cayman Islands. A short hop from the American mainland, it will begin providing care in early 2014. Uninsured and underinsured patients will be able to receive high-quality treatment at an internationally accredited hospital for less than half of what they would pay in America. The proximity of NH’s beachhead may well pressure U.S. hospitals to develop the innovative practices and systems that we describe in this article.
https://hbr.org/2013/11/delivering-world-class-health-care-affordably
Sunlei
(22,651 posts)has Parkinson's and went there for stem cell treatments. He's been back 3 times and has improved. His wife told me the clinic also treats people with MS, heart, & lung diseases with stem cells. In his case they used his own stem cells to treat his Parkinson's.
Almost like the USA has tiers of medical treatment, it doesn't seem equal to me.
We're stuck with medical treatment that is the most profitable for Doctors, Insurance Corps, and medicine Corps. For example, instead of a kidney transplant where someone would then have an almost normal quality of life, people have to be on years of cheap but very 'profitable' treatments until they die.
linuxman
(2,337 posts)I'm stating that quality of care in terms of knowledge and skill is better in the US. There is a reason for why american medical univerities are deluged by foriegn apllicants, both for residencies and for their initial medical schooling.The fee commanded for that level of skill is on par, and it is quite high.
I never even came close to insinuating that availability for all and cost were better, simply that the level of skill posessed by our best physicians is worlds better than most places around the world.
Yes, people without money travel outside the US for procedures. Conversely, people from other countries with money travel here when able for the procedures they choose not to receive at home or in the European states you've mentioned. Why would they do such a thing? The prestige of saying they were treated in the United states? Doubtful. People shop where they can afford. When they can do better than breyers they buy bluebell, and so on.
All I'm saying is that the US has a superior knowledge, skill, and experience base, which as in all other fields results in a higher price for services. When American premeds compete for spots at London regional hospitals and foreign leaders stop coming to our shores for surgeries, I might be convinced that we've slipped in terms of skill, and that the doctors are being paid too much. Until then, I don't begrudge them one red cent.
Human101948
(3,457 posts)Medical procedures, tests, scans and prescription medicine cost far more in the United States than in eight other countries, the International Federation of Health Plans said Thursday in its annual report.
“The price variations bear no relation to health outcomes; they merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure,” said Tom Sackville, the group’s chief executive.
http://www.latimes.com/business/la-fi-mo-healthcare-costs-in-us-far-exceed-other-countries-report-says-20140416-story.html
The reason people come to American medical schools is because they want to make big bucks. They rarely return to their native lands as you may have noticed on a recent visit to your local hospital.
All I'm saying is that the US has a superior knowledge, skill, and experience base, which as in all other fields results in a higher price for services. When American premeds compete for spots at London regional hospitals and foreign leaders stop coming to our shores for surgeries, I might be convinced that we've slipped in terms of skill, and that the doctors are being paid too much. Until then, I don't begrudge them one red cent.
“The price variations bear no relation to health outcomes; they merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure,” said Tom Sackville, the group’s chief executive.
MillennialDem
(2,367 posts)large country in terms of population, so if one person from say Italy travels to Germany for a medical procedure that's the equivalent of 4 people from Italy traveling to the US for the same procedure.
Competent specialists are just masters at their craft and researchers. There are plenty of such people in other countries. Just FWIW many, if not most transgender Americans travel to Europe or Thailand for gender reassignment related procedures because not only is it cheaper, but the doctors in those specialized fields are quite frankly better. Very few Europeans travel to America for the same procedure. Granted it's a small field, but if the knowledge base in the US is so great, why does what I said happen?
Anyway back to general medical related stuff - leaving aside people who travel to other countries for lower prices, there are Europeans who travel to America and Americans who travel to Europe for specialized procedures. I was barely alive when it happened but didn't Rock Hudson go to France for HIV treatment? Regardless, this is a tiny subset of the population that can afford such things anyway.
Also, Europeans tend to live longer than Americans...
Response to linuxman (Reply #10)
TubbersUK This message was self-deleted by its author.
TubbersUK
(1,439 posts)Do you have any data to support your view that the difference is one of quality?
LeftOfWest
(482 posts)
we can do it
(12,196 posts)
JustAnotherGen
(31,902 posts)
TexasTowelie
(112,441 posts)Human101948
(3,457 posts)The average cost of malpractice [insurance] premiums as a percent of national health spending is around 1 percent. The cost people attribute to the system is what is called "defensive medicine": that doctors will order tests or do procedures not because they're convinced clinically they should do it, but they always have in mind: "I'm sitting in a courtroom and they say, 'Did you do this test?,' and if not, the jury would nail me."
The AMA [American Medical Association] has estimated it could be up to 10 percent [of tests]; we don't really know what it is. I also tell doctors: "Well, on the other hand, these tests are profitable for you. So if we abolished malpractice, would you give up 10 percent of your income?" And that's not so clear to me whether they wouldn't do these tests anyhow....
We asked doctors in all these different countries: How much is your malpractice insurance? Will you ever be sued? And [they had] very low insurance rates, and no, they don't ever expect to be sued. So how do those other countries maintain quality in medical care?
If you take Germany, for example, the doctors are employees of the hospital, and the whole hospital is accountable for everything that happens in its walls. With us, we have the strangest system: A hospital is a free workshop for an independent businessman or -woman called the doctor, who can go in there and order nurses and everyone around and cause costs, etc., but is actually sort of independent. The hospital isn't really accountable for the work even of the anesthesiologists and the radiologists, because they're freestanding entrepreneurs. That system is much more difficult to control, quality-wise. In the other countries, where doctors working in a hospital are employees, there is internal quality control.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/doctors.html
How much of a doctor's revenue goes to malpractice insurance? A March 2002 government report by MedPAC, a congressional advisory commission, says doctors, on average, were expected to spend 3.2% of their revenue on malpractice insurance last year. That compares with 12.4% for staff salaries, 11.6% for office expenses and 1.9% for medical equipment. Calculations based on two surveys published by Medical Economics magazine — widely read by physicians — last year show that OB-GYNs paid the most for malpractice insurance, as a percentage of their revenue, 6.7%, and cardiologists paid the least, 1.5%.
http://usatoday30.usatoday.com/news/nation/2003-03-04-malpractice-cover_x.htm
TexasTowelie
(112,441 posts)1) The cost of liability insurance is more in the U.S. than Germany.
2) Business model -- physicians in the U.S. deal with more insurers with different forms, they have more administrative staff to deal with that workload, and more claims are denied payment which means that U.S. physicians are waiting for reimbursement for care longer.
JustAnotherGen
(31,902 posts)One in a comprehensive family practice - the other an ob-gyn . . . When I was living it up ten years ago they were struggling under the double burdens of massive student loans and liability insurance.
They were both in 2009 and remain today advocates of single payer. They also both resent Medical Insurers undermining their ability to treat their patients.
Hoyt
(54,770 posts)expenses. It's not as burdensome as some complain.
TheKentuckian
(25,029 posts)that significance increases.
That is too big a piece to blow off even if it isn't exactly driving them into the poor house.
Hoyt
(54,770 posts)they are injured, misdiagnosed, etc., due to negligence.
TheKentuckian
(25,029 posts)to be dismissed as nothing.
bemildred
(90,061 posts)In other words financialization of the business to maximize profit and rent-seeking behaviors from our formerly great educational institutions.
Snobblevitch
(1,958 posts)to be treated by our physicians.
hedda_foil
(16,375 posts)Mayo is in Minnesota, but is not a representative sample of Minnesota physicians.
mainer
(12,029 posts)US doctors don't make those incomes until they finish their residencies, usually at around age 28 - 29. So here's a 29-year-old MD, hundreds of thousands of dollars in debt (If they owe for private undergraduate as well as med school, they might owe upwards of half a million dollars), they don't own a home, they probably have a family by now, and they're working 60 hours a week. I think they deserve that income.
Plus, ironically enough, they have to pay for their own health and disability insurance. Unlike German doctors who have a safety net.
840high
(17,196 posts)
snappyturtle
(14,656 posts)They chose their profession and can pay off the debt. Have three in the family and they are wealthy...all of them.
Many pay for their own health insurance on far less than what doctors earn. Please.
greatlaurel
(2,004 posts)LBJ said "you can convince the lowest white man he's better than the best colored man, he won't notice you're picking his pocket. Hell, give him somebody to look down on, and he'll empty his pockets for you."
Complaining about doctors' salaries or university professors' salaries is just an updated variation of this. Divide and conquer, rinse and repeat.
Why don't you talk about what we pay health insurance company CEO's? That is where the real money is going.
TBF
(32,098 posts)
DemocratSinceBirth
(99,714 posts)Getting into med school is freaking hard. My cousin graduated from Harvard and it wasn't easy getting into med school. And with residency you are talking about over a decade of training.
lumberjack_jeff
(33,224 posts)Medicine is expensive here because doctors are scarce - by design.
http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/
If we had 130 law schools (instead of 200) and 200 medical schools in the U.S. (instead of 130), it would probably go a long way to solving our “health care crisis.” More MDs at much lower salaries along with fewer lawyers and lawsuits would be a good thing, wouldn’t it? Can’t breaking up the medical cartel, training more physicians, and lowering MD salaries be part of the discussion for health care reform?
DemocratSinceBirth
(99,714 posts)I don't know much about getting into med school but I thought if you went to Harvard it would be easy, obviously not.
JI7
(89,271 posts)But doesn't Harvard have a lot of legacy admissions .
What did you friend get undergrad degree in ?
DemocratSinceBirth
(99,714 posts)Undergrad degree=science
840high
(17,196 posts)physicians in our family. You are so correct.
fadedrose
(10,044 posts)If a doctor isn't working in a group clinic, and he has his own office and staff, the health care costs for his employees is very high. And more employees are needed just to handle the great variety of insurance companies that patients use to pay.
Single payer would eliminate a lot of the doctor's expenses.
Ilsa
(61,698 posts)to get their degrees and licenses. I can't imagine what one of them would do with $200,000 in debt and something falls apart to prevent them from licensure or working.
Donald Ian Rankin
(13,598 posts)There's a table at http://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people
That's obviously not the whole story - two data points do not a statistically significant causal link make - but I suspect it may be part of it.
lumberjack_jeff
(33,224 posts)... then yes, it is a causal link. Supply and demand are real things. When the supply of a thing is constrained the price of it goes up.
Doctors are expensive because there aren't enough of them.
greatlaurel
(2,004 posts)Last edited Sat Sep 19, 2015, 02:24 PM - Edit history (1)
The years in medical school mean no income, as there is very little time for a part time job. To get an MD at a public school means between $250,000 to $300,000 in debt. Residents are not very highly paid, either. It takes a lot to pay off that sort of debt, then add in the costs to start up a practice.
Matariki
(18,775 posts)so it's more like 8 years of school plus residency.
Hoyt
(54,770 posts)a few years in rural or intercity areas. At what US docs make, they can pay off their debt quuckly, even if they choose, as most do, to live in large cities.
TBF
(32,098 posts)Who would go to school that long to make $54K/year?
The whole healthcare system here is out of control, but then I could say that about capitalism as a whole.
Why do investment bankers make millions? Why do CEO's make millions? Why do some dot.coms generate so much investment money and turn their employees into millionaires? This is how it works in this country. When you step back and look at it there is no way to justify such bizarre behavior.
Hassin Bin Sober
(26,343 posts)Now things have changed in the last several years. The hospitals are buying up all the family gps.
A friend mine he'd her practice sold to a local hospital group. She said she received a large raise. With that comes the quotas for admissions. So yeah, she is in sales now. Sales people can make a lot of dough. Especially when they have a client that isn't going to shop around.
mnhtnbb
(31,404 posts)I am a retired hospital administrator. My husband is a psychiatrist/psychoanalyst (in practice for
47 years) who had a faculty medical school appointment at a VA hospital for many years. He always combined his private
practice with an equal commitment to caring for people with limited access (because of the insurance industry) to mental health care. My brother is an MD/Ph.D. who went from a teaching position in a University
Medical School to Big Pharma in a position focused on developing oncology drugs and will probably retire in a year or so from there. His wife is a retired RN who primarily worked in NICU's.
So, yes, lots of views/experience in US health care over the last 50 years.
Here's my answer: the practice of medicine in the US has become a business, which means it is committed to profits,
maximizing the bottom line, and minimizing losses. Medicine used to be about the practice of an art/science which
was devoted to taking care of people. The insurance industry in the US has really contributed to the bastardization
of the delivery of health care, IMO. They are also about profits: they make money by denying services to people.
We hosted a German foreign exchange student when our youngest son--who was taking German--was in high school. He is now in medical school--in Austria--and following in the footsteps of his father, also an MD. I don't think that money is what motivates him.
Our son is also not motivated by money, as he is pursuing a graduate degree related to theatre!
So, my answer is that, basically, the delivery of health care in the US is all about money. You will find the docs who make the least--family practice, pediatricians, psychiatrists--are probably the least likely to be motivated by money and more interested
in taking care of people.
WinkyDink
(51,311 posts)mnhtnbb
(31,404 posts)now are simply pill pushers and leave the time consuming--and not economically
efficient--provision of therapy to other disciplines: psychologists, clinical social
workers, and marriage and family therapists.
Some of the reason for that is that psychiatric residents no longer receive the kind
of intense training in doing therapy that they did when my husband was a resident
back in the late 60's/early 70's.
I also, of course, was referring to psychiatrists as among the specialists within
medicine who make significantly less than specialists in the higher paying specialties:
radiologists, anesthesiologists, orthopedic surgeons, neurosurgeons, plastic
surgeons, dermatologists...
http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=3
This chart is:
I can tell you--having done our taxes for the 30 years we've been married--my husband has never made anything close to
$200K/year. Not even close.
WinkyDink
(51,311 posts)Matariki
(18,775 posts)That's what my sister-in-law's daughter owes for her medical school degree.
riderinthestorm
(23,272 posts)creating an artificial shortage
http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html
But that’s not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down “deficient” medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.
Still, the AMA along with other industry organizations until recently had issued dire warnings of an impending physician “glut” (whatever that means beyond depressing member wages), even convincing Congress to limit the number of residencies it funds to about 100,000 a year. This imposes a de facto cap on new doctors every year given that without completing their residencies from accredited medical schools, physicians cannot obtain a license to legally practice medicine in the U.S. Even foreign doctors with years of experience in their home countries have to redo their residencies–along with taking a slew of exams–before they are allowed to practice here.
Rex
(65,616 posts)As always you never focus on the real problem.
MannyGoldstein
(34,589 posts)I'll write more later, gotta run now. But basically the system is totally rigged. Look up CPT codes and Medicare reimbursement panels, you'll probably see what's going on.
mainer
(12,029 posts)US doctors who owe hundreds of thousands in debt and annual insurance premiums vs German doctors who owe nothing and have no malpractice premiums. Aren't there worse disparities to be fussing over?
JNelson6563
(28,151 posts)I have met few doctors in America that I can stand to be with.
Julie
Starry Messenger
(32,342 posts)Health care is also free. Priorities in spending can do all sorts of things, with societal will.
hunter
(38,328 posts)
moondust
(20,006 posts)Some other, wiser countries haven't allowed abject greed to overpower and tyrannize every aspect of life including medical services.
Victor_c3
(3,557 posts)what bothers me is how much money top healthcare executives make from the sickness and suffering of those paying insurance.
A certain part of me believes that if you go to college nearly a decade and you put in 80 hours a week for years as an intern you should be entitled to make more than the average person. Not everyone is cut out to do that sort of work.
However, that does't mean a person who works 40 hours a week working at Walmart or Target shouldn't be able to make enough to support themselves to a respectable manner either.
There has to be some sort of a happy medium out there.
Additionally, doctors make a decent amount because of their labor, not because they dump a bunch a couple of million dollars into bonds and derivatives and whatnot and skim fat off the top of our economy. There is a huge difference between the two sorts of wealthy people.
CanSocDem
(3,286 posts)...in socially advanced countries. It is a human right.
.
Adrahil
(13,340 posts)I would not do a U.S. doctor's training or job for Germany doctor wages.
I have to think that in Germany, the workload is a bit different.
TheKentuckian
(25,029 posts)make anything, that would be stealing from shareholders and executives.
I wonder what nurses, medical assistants, and coding clerks make elsewhere. I bet we maybe can demand a haircut for them as well on the same logic. Yay! What about garbage men and janitors? What do those jobs pay in Calcutta?
Race to the bottom is best for everybody but "stakeholders" we can't begrudge the successful, riiiiiiight!?!!!?
LiberalArkie
(15,728 posts)to be treated as such.
geek tragedy
(68,868 posts)riderinthestorm
(23,272 posts)You seem to post these types of open question OP's where the answers are readily available with a minimum of googling, then you disappear.
Are you ever interested in a response?
herrbockelmann
(1 post)None of the really good doctors I know, i. e. the ones who REALLY help you, is in it for the money. They are genuinely interested in helping people. When they know that someone can' t afford good health insurance, they lower their fees so that the person can afford treatment. It' s called solidarity. And they do have families, and they are in debt, but they don' t care about how much money they make because they say they love their job so much.
I made these great experiences with doctors in Germany, though... I love the US, but the health care system here is very interesting. I know you can never generalize, and I am sure that there are many great doctors here in the US as well who are not in it only for the money.
Just haven' t met one of them yet...
