Physician Compensation: The American Struggle

In recent decades, significant attention has been devoted to healthcare reform in order to ameliorate the “healthcare crisis.” Comparatively little attention has been given to the unique set of historical circumstances that enthroned the United States as the number one healthcare spender in the world. Currently, the United States spends almost 3 trillion dollars a year on healthcare (roughly 17-18% of the GDP). Physicians in the US are the most highly compensated in the world; a specialist such as an orthopedic surgeon makes almost $440,000 per year. A primary care physician might make a more modest $185,000 per year. This thesis chose to focus on the constellation of factors that influenced the genesis of these incredible incomes. It is not necessarily obvious that physicians should be compensated this highly. Physicians around the world make far less, and many nations outperform the US in numerous healthcare outcomes. Interrogating the assumption that physicians should be compensated to this degree ended up leading to several key factors that shaped physician compensation: (1) the assumption that the elimination of suffering is an inherent moral good, (2) the influence that technologies such as the telephone and automobile had on physician practice, (3) the effect of urbanization on family relations, (4) a series of perverse incentives disguised or amplified by insurance, (5) the power of the AMA in shaping policy, (6) the ability of physicians to induce demand, (7) authority as a mode of control, and (8) the power of “sticky fees.”