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August 02, 2010

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FMF is entirely correct and the case be be shown quite easy using some simple math. The amortization tables for paying off the loan are instructive.

If the 140K is at 5% interest and put on a 10 year pay off schedule the paying is $18,000 per year. If its put on a 20 year pay off schedule the payment is $11,000 per year.

So if the worst paid doctor professions make 175K they have either 157K (10 year) or 164K (20 year) to work with after the debt service of their student loans.

I guarantee you that's a lot more cash flow than a starting farmer has to work with.

And even if the debt was doubled to 280K, they would still have 139K (10 year) or 153K (20 year) after debt service. This is not only manageable but it puts them in the top 5-10% of wage earners after you take out their debt service costs.

In addition Doctors have had to live on meager means while going through residency so they should not have built up some kind of lifestyle that cannot be supported by these funds. They certainly might see other doctors living that way but they haven't been living that way for the 5 years of residency. So once they get their big pay check. They can drastically increase their lifestyle, pay down all their student loan debt, and still have way more money left than 90% of Americans.

There is no excuse at all for doctors to not end up wealthy other than over indulgence.

Oh believe me, I feel the exact same way. Even if doctor's pay a third of their salaries towards insurance, they could easily live off the other third and pay off their loans with the last third. The ones that aren't building wealth are simply choosing to live in more expensive neighborhoods and drive nicer cars.

For anybody who is going to argue that the car is part of the image they need, I can honestly tell you that I have no idea which car in the parking lot is my doctor's when I go in...unless he gets a vanity plate, how would anyone know?

I agree with you. Higher income does not necessarily lead to higher wealth, but it almost always leads to higher expenses. Money finds a way to be spent. Unless you have your spending under control, you need to make a ton more than just a few hundred grand a year so that you don't outspend your earnings.

@Money

There is no income level which prevents you from outspending your earnings. Countless deca-millionaire celebrities have proven there is no limit to how much they can make and still have to file for bankruptcy.

Personally, my argument was that being a doctor doesnt have an ROI that is as impressive as many think it is. Ability to build wealth? Sure. Does anyone really have an excuse not to try and build wealth?

I think this quote from the same article supports my statement a bit...

"Family practitioners earned $16,000 less in 2009 than certified registered nurse anesthetists, registered nurses who have worked in the field for at least one year and then return to school for 24 to 36 months to qualify for a master's degree. That's a lot less training than the four years of medical school, one year of internship and then residency you have to go through to become a primary care physician."

@Money Obedience I like your comment that "money finds a way to be spent." It reminds me of Parkinsons Law: Work expands so as to fill the time available for its completion.

So in the same vein, "expenses expand so as to use up the income gained"...or something like that.

This is exactly what we need to avoid! (Whether you are a doctor or not.)

I do believe insurance costs for doctors, as well as the amount paid in taxes, are being forgotten. A quick Google search will reveal malpractice insurance can easily cost upwards of $100,000 a year. Obviously these salaries are after that insurance is paid, but it goes to show a need for malpractice reform. Additionally, at IRS.Gov, you will be able to calculate that, on $175,000, you will be paying 40,091 a year in taxes (obviously zero deductions, etc.). This is also before you count state taxes.

This is not a "defense" of those with higher salaries having little in savings, simply an attempt to point out that there is a correlation between higher salaries and higher "outside" responsibilities.

Those numbers would be stupidly misleading if they didn't already include things like staff and malpractice insurance, and so on. I would assume that means after those expenses, because they are mindblowing.

I find it disturbing that my vet makes more than my family practice doctor because she doesn't have to deal with all the insurance and so on. I'm pretty sure everyone can agree that healthcare is totally whack in this country because every doctor is supporting a couple handfulls of people who are just moving paper.

I agree with most of the comments. I believe many doctors are overpaid for what they do. I realize that these are smart people that have lots of school behind them, they should be paid well, but some of the salaries just seem over the top to me. They charge alot because people/insurance will pay that much. They keep themselves in high demand by limiting the number doctors. They often complain of how stressful and busy their job is. Yet they only allow 1/3 of those that apply to med school in. Much of what the doctors do could be done by non doctors, but through regulation of laws they make it so we are forced to get our care through them.

billyjobob - I'd rather have fewer, more qualified, and higher paid doctors than too many underpaid, unqualified doctors.

Also, in response to your complaint that they're just charging as much as they can - the next time you're offered a raise, turn it down or don't complain about what someone else is making.

I work with Merritt Hawkins, the physician recruitng firm cited in the Forbes piece regarding doctor incomes. The issue of physician earnings is complex. $175,000 is a good salary, but it is one primary care physicians generally don't earn until their mid thirties due to the length of their education and training, both of which require considerable skill and sacrifice. There are many other career options they could select that would pay them more. In addition, their level of responsibility is high -- lives are literally in their hands -- and much of what they have to contend with in terms of regulation and bureaucracy is extremely onerous. The real question, however, is do physicians provide a service commensurate to their incomes? Those who have undergone critical surgery or other medical procedures, or have seen their love ones subjected to such procedures, know the answer. A physician who can repair a heart, replace a lung or save an injured child is worth every penny he or she gets. No one asks what the doctor is earning when they are under the knife -- they just pray the doctor knows what he is doing. Good doctors deserve high incomes and respect for what they do

Philip --

I don't think anyone is disrespecting doctors. The issue being discussed here is whether or not they should be wealthy based on their incomes. And it's my opinion that they should.

Two things you said caught my attention as being a bit off:

"$175,000 is a good salary, but it is one primary care physicians generally don't earn until their mid thirties due to the length of their education and training."

Ok, so? What percentage of people in the world earn $175k by their mid-thirties? Not many. What percentage of people in the world EVER earn $175k. Not many. You're proving my point -- doctors make a TON of money and should be wealthy.

"There are many other career options they could select that would pay them more."

Like??????????????

Malpractice insurance premiums are not typically as high as the horror story worst case examples you hear of. Sure a high risk specialist in individual practice seeing lots of patiences in a high cost state might pay $100,000 but they're probably doing >$1M business. Median malpracice premiums are in the $10-$20k and many doctors don't pay the insurance themselves if they work for a hospital or a group.

Lets not forget that there is a legitimate need for the insurance and its not just a way to screw doctors out of all their money.

@ Ross ... Ross, I believe that there are many well qualified students that are turned away because the AMA would like to keep their nimbers limited. I don't think they are turning down 2/3 of the applicants because they are not skilled or smart enough.

My point on their fee's are because they have a monopoly (almost) on what they do. Lets say you need a heart stent. You have a choice of Dr Smith that will do it for $8000 or you can see his partner Dr Jones that will charge the same. Unless you live in a big city or are willing to drive somewhere farther, this would be your choices. My hope would be that we would have more options and their would be some competition amongst the doctors. This alone would help bring down health care cost.

$175K a year is good money. I'm no doctor, but in 2007 before the economy tanked I came close to that amount as a commissioned salesman.

$175K a year doesn't change your life. It's not much different than $80K a year. You still need to live cheap if you want to retire well. Maybe a nicer car and a vacation or 2 a year, but that's it if you don't want to end up spending it all.

Income taxes start taking a big hit. A real big hit. The year my income peaked, my wife and I paid $50,000 just in income taxes, not including payroll taxes and all the other taxes everyone gets hit with. Half this country pays basically no income tax.

Neither of us had to deal with big student loans.

For what they go through, the responsibility they take and the malpractice insurance they have to pay for... and the education debt - $175K for a doctor is chump change.

FMF,

Sure, 175K is a lot of money, but think about the fact that 175K is essentially a doctor's FIRST real year of salary.

Between ages 22 and 35, a professional in other fields can earn 175 K many times over, and be considerably wealthier than a doctor, potentially with less school debt to show for it. Think about it this way: you probably maxed your 401(k) almost every year during those 13 years that a doctor is undergoing training and wasn't able to. The worst part is that doctor's can't make up that lost time of putting nothing in 401(k)s, and has to take a large chunk of the money they are making to be able to retire comfortably.

Doctor's can be wealthy, but I don't think they really gain any significant amount of wealth until near the end of their careers -- and that is what I think phillip miller is getting at.

Aaron --

"Between ages 22 and 35, a professional in other fields can earn 175 K many times over."

The average income in the US is roughly $50k. I'm not sure what the average salary for someone between the ages of 22 and 35 is. If it's $35k (pulling a number out of the air), then a doctor earning $175k per year starting at 35 earns more cumulativly by age 38 than the average guy. Even if the average guy earns $75,000 starting at 22, the doctor still earns more in total by the time he's 44.

Doctors earn above average salaries. Do you (or anyone else) disagree with this? If so, I'd like to see some data that shows me how $175k is an average salary.

This level of income should lead to above average numbers of wealthy doctors when compared to other (lower income) professions. It doesn't.

FMF,

Philip said : "There are many other career options they could select that would pay them more."
You responded: "Like??????????????"

I think maybe PHillips point is more about how much primary care physicians making the $175k level compare to the other doctor specializations who make much more. A more lucrative 'career option' for a family practice doctor would be to instead become an orthopedic surgeon or urologist making $500k or $400k.

@jim,

And it seems that many of those doctors with the 500k salary also have very little wealth left to show for their huge salaries which is even more inexcusable.

I think FMF's entire point was that the reasons given for why Doctor's are "unable" to accumulate a lot of wealth don't hold water. Even the lowest paid Doctor's make more than enough to accumulate quite a bit of wealth and the high paid ones make enough to be excessively wealthy. Their problem is they don't seem to be able to apply the hippocratic oath to their finances.

I get a kick out of the comparison.

Doctor vs Farmer. Farmer wins. Yeah for the "little guy"

It's nice motivation for those who need motivating. Stories that little old you and little old me can get there if we try are nice.

But it just isn't very real. Farmers wealth mostly comes from inheritance of the land. Few farmers just decide to be a farmer, buy some land and machinery and get after it.

They inherit the farm. And the machines. And the knowledge. Quite a leg up in my opinion. You mean if I inherit 500 acres of paid for land worth $2million dollars I will be wealthy. Really?

Here is the simple truth. You earn what you are worth. If you earn 35K, that is what you are worth. Think you are worth more? Prove it.

Doctors sacrifice for years,sometimes over a decade. People who start business take an enormous risk. The payoff usually comes years ordecades later. But that is usually all that many see. The success. They don't see the sacrifice. Because the sacrifice is invisible

Those that earn $500K, or Millions are worth it. Because they prove it. You want to emulate a doctor, or a sucessful business owner. Then emulate them. Sacrifce years of your life to get the point they are at.

Success is defined by what you had to give up in order to achieve it. So what have you given up.

Being frugal is nice and works for lots of people, but sometimes you just have to realize there are lots of different types of people out there, many of whom sacrificed way more than you, and now they reap those rewards. Whether or not they save doesn't matter. What matters is that you care what someone else does with their money.

Worry about your money and you life and your sacrifices. Let the neighbor mow their own lawn.

I'm not disputing the doctors should become wealthy eventually, but the one thing that no one has accounted for is the lost time. Just to get the lowly family practice job you are looking at 4 years for a b.s., 4 years of medical school, then another 3 years of residency. That's 10 years of schooling with virtually $0 income.

The other point that I think was missed in this article is medical school isn't just 140k in loans. You have to account for the potential undergraduate loans as well. 140k is actually on the low end for medical school these days, but that's on top of 80k or more just to get your bachelors.

Very, very interesting piece. I'm a resident physician so it's all the more pertinent to me. I really can't argue with the article or the comments. There is simply no reason for physicians not to be able to become wealthy with that degree of earning power. I think that many physicians have been deprived for so long and work under such taxing conditions during training that they see it as their right to "go for the gold" and live lavishly at the end. Keep in mind that in addition to the debt burden, there is a big loss of productive years as one commenter pointed out. Not all residencies are 3 years either (mine is 7, and I'm not due to graduate until I'm 33) and during that time we're literally paid at around $10-11/hour based on a calculation with the hour requirements (80 hours/week x 49 weeks/year or around $50k). Again, if you're smart with your money that wouldn't be a problem, but that it sorely lacking apparently. Student loan rules have also put an end to being able to defer loans during training which means that interest accrues for the 3-5+ years of residency and other training.

For the commenter asking why FPs don't just train to be urologists, the reason is that getting specialty training is merit-based, and fields like urology, dermatology, ophthalmology, etc. which offer very high pay and a good lifestyle are extremely competitive and out of reach to most doctors in training. The finances of healthcare are also in flux in a major way as is obviously well known. Most every insurer bases rates on Medicare which is the bottom dollar payer, actually paying below the cost of doing business. I think that the gravy train for very highly paid specialists is going to come to an end pretty soon as can be seen for example with the dramatic payment cuts for nuclear stress tests done by cardiologists on the order of 30%.

I have to agree with TMS, Troy, and Kevin in that the sacrifice made during the time (incurring the costs) of obtaining an education is substantial...to average $175k is not a lot considering their payday comes in their mid/late 30's. Nevertheless, the higher incomes increase the likelihood that one would eventually build a nice nest egg (late 40's/50's) and it seems to be well-documented that the amounts mentioned would constitute the highest 5% of wage earners.

Based on numerous sources, it seems that doctors and dentists are the worst when it comes to personal financial planning as they tend to make the best clients for those in the business. As long as they focus on the professional development and maintenance of their craft, I tend to give them a pass on their focus/interest (or lack thereof) on financial planning. Besides, it is a general rule of mine to never question whether doctors (or airline pilots) are worth their salaries given their daily responsibilities and potential impact on human life:)

I'm a primary care doctor, and I can tell you first off that those salary figures are pretty pie-in-the-sky numbers. For primary care docs to make 175+k, they are either doing a boatload of procedures or putting in a ridiculous amount of hours in a densely privately-insured population (never with Medicaid or Medicare populations).

I agree with the basic message that doctors should be able to accumulate wealth without extraordinary difficulty. However, a few points should be reiterated:

- while most 20-somethings were living it up, future doctors were buried in textbooks and classrooms, forgoing a huge amount of social interaction for the sake of education

- given the # of hours worked in residency, doctors are essentially making less than minimum wage for 3-7+ years and are obviously hard-pressed to contribute to retirement...not likely to happen until at least age 30. Since time is the biggest factor in wealth accumulation, doctors are at a disadvantage compared to those who can start a career 8-12+ years earlier.

- the litiginous climate of the US makes medicine a minefield for doctors. Bad things happen and are ultimately not a problem if we provided defensible care, but a single lawsuit can wreak havoc on one's life, even if it results in no judgment.

- you have no idea what a primary care doctor's day involves. Direct patient care is just the tip of the iceberg. Behind the scenes, they are dealing with insurance companies, reviewing a plethora of paperwork, answering phone calls, authorizing medication refills, and on top of all that, providing FREE care after-hours when "on call".

I'm not complaining about what I make...I'm quite satisfied. Then again, I happen to be very frugal and have no interest in "keeping up with the Joneses".

Believe me, though, when I say: It's not about the money...I would have quit medicine long ago if I were in it for the money.

I'm looking over another survey of physician earnings, and it confirms that the abovementioned figures are probably exaggerated. According to Medical Economics Magazine, which surveyed > 100,000 docs:

2009 Avg. total earnings for FP's and internists was $162,500, with approx. 30% earning less than $120,000.

There are obviously some ridiculously high-earning outliers skewing the data...operating their boutique medical practices with laser therapy and Botox injections.

FSCM summed it up very well.


Like Troy, I get a kick out of the comparison.

I also know there are deep flaws with comparing these two professions and their respective capacity for wealth accumulation.

For the 'average' Farmer to come out ahead of the 'average' Doctor, one must ignore the reality of farming over the past 100 years. Namely, that where once there were 7 million family farms, there are now fewer than 2 million with a few hundred folding every day. Of those farms that survive, more than half rely on non-farm income just to make ends meet. Doctors and farmers both rely on leverage, but it is the farmer whose loans can put him out of business. The remaining population of farmers being compared to doctors, is thus not average, but is among the most successful and fortunate. You can only rack up so much debt and then you don't call yourself a farmer anymore. Then you might consider yourself a truck driver, farm manager or farm laborer; hauling and tending someone else's crops & livestock. Include those job titles and the comparison comes back around to reality. The average physician is far wealthier.

Doc's who run up alot of debt to fund their education or build a practice still get to be doctors. The guy who borrowed against his inherited home and land to buy feed & equipment, spending more than the product garnered at auction is out of business in a few short years.

Wow. I'm a 30 year old engineer; been making a good income since I was 23. When I look at my (several) friends who are 1) still in residency, making $30k/year, 2) working 80 hours a week, 3) getting no sleep, and 4) delaying marriage, children, and many other things in life....I say, I sure hope they get paid well after all of that. I think I got the way sweeter deal - 7-15 more years for my investments to benefit from compound interest, enough sleep, time for family, ability to buy a house.

Financially, being a doctor is the ultimate in delayed gratification. Yes, you may make 200k, or 400k, but not until you're 35. Personally, being a doctor requires tremendous sacrifice. And thus it makes sense to me that there should be a financial reward at the end.

I certainly agree with FMF's key point that doctors make enough money that they should be able to be wealthy. Anyone think that $175k a year ISN'T enough to accumulate substantial wealth (i.e. >$1M)?? Why not?

Seems all the debate is about how much they make and if its 'fair' or not. Whether or not doctors make too much or too little is a different point.

I think the article was more "don't judge a book by its cover" kind of story.People hear or see Doctor and think rich and think poor when it comes to being a farmer.Both are hard jobs (In different ways). Both are important jobs and I respect either profession.

This all goes back to "How much you keep vs. how much you make". Unfortunately, doctors in general are not the most savvy when it comes to finances, and we tend to succumb to societal expectations of 'how doctors should live'. I personally know of a physician couple making 400+K in NYC borrowing money from their family so that they can purchase a 1.5 million dollar home. Quite silly don't you think?

Doctors love to cherry pick their numbers. Insurance rates for doctors may top $100k but they don't for doctors that make little. Family practice, for example, is on the order of a few thousand a year. Do nurse anesthesiologists make more money for less effort? Sure. Again, cherry picking. You can find a toll booth collector who makes more I'm sure too. By that metric, who doesn't make too little money? If all professions were judged by whether they could find another which makes more than it should, then we would have a real problem allocating money. The simple answer is: In America, doctors make good money. For those of you who find that statement offensive, refer back to title: Doctors should make good money.

Doctors should be able to become wealthy and I'm sure that quite a few do but you may have to track their age until late 40's to see this effect, given the early debt load and late start to big earnings.

The bigger issue is that the Medical eduction system is a ponzi scheme. Why should doctors have to go into that much debt? I have no issue with the long years of training but school should not cost that much. If that is the case there can be more competition and doctor salaries need not be that high. In the UK the average salary is around $80k USD per year.

For those who complain about a lack of competition I encourage you to look overseas. You can find great doctors, state of the art equipment, and wonderful care at 25% of the cost of the US healthcare system. I am talking about places like Thailand, Singapore or Hong Kong. It may well be worth the trip.

Mike

Troy (and others) --

The value of land and real estate are NOT counted in the net worth numbers above -- the book measures millionaires who have $1 million in investable assets.

FMF

I can appreciate that. But I wonder...where did those "investable assets" come from.

The land. The land grows the crops. The land feeds the livestock. Provides the CRP program. Etc.

It's like saying you inherited $1M and then invested that. The returns on that $1M grow to quite a substantial amount, eventually exceeding the initial 1M and it is true those earnings were not inherited. But they were created by inheritance. Without the initial 1M, there are no returns. And without the inherited land, there are no farmers with $1M

And that catalyst makes all the difference.

Troy --

I understand your point, but:

1. I wanted to make sure you (and others) knew the land was not counted in the net worth numbers

and

2. I think we can still see that the main point is true here: farmers make less than doctors (even with the "land" advantage) and yet they are much better off wealth-wise.

Like CJ, I too am a primary care physician. Those salary figures being quoted are very nice. Please show me where those jobs are so I can transfer there. My lawyer and accountant friends chuckle when I told them how much I earn for the amount of work I do. Anyway, I think the main culprit of doctors not being wealthy is lifestyle inflation. The majority of new docs (I being one of them) feel entitled to splurge once we are out of training. I was fortunate enough to shake it off after a few months and have gotten back to tract, but others I know of still continue with the exorbitant lifestyle and are digging themselves into a hole. Medical school does not prepare doctors to be good with their money.

@FCSM - 7 years of residency. You have to be in a procedure oriented field. Please don't let the "lifestyle inflation" bug hit you once you are done. A lot of the surgeons in my hospital are really into keeping up with the jones'. They look like they are very rich, but they complain about the cost in private. But then again, that is the way they want to live.

I know some Family Practice and internal medicine docs who have very high net-worth. For the most part they are the exception rather than the rule. The key attributes they have that I have been able to identify were 1) they were good with their money and 2) they were good business people.

Building wealth can be distilled to a simple statement: Always spend less than you earn.

@KU: I couldn't agree with you more. I am in fact a surgery resident, but I'm currently on a research commitment which means that I have the advantage of time to moonlight for extra income. I'm using the proceeds to pay down debt and build a portfolio, which is what led me here. I think that fiscal responsibility will continue when I do graduate residency. I've been running numbers and would really like to be retired by 60 or so, plus an extravagant lifestyle isn't what I was raised to want. I'm much happier making sound financial decisions but I seem to be in the minority. Case in point: one of the staff physicians I work with is deeply unhappy and wants to leave the area, but is unable to because he overbought on his house and will take quite a haircut if he sells now. I asked him not too long ago about his retirement plans, stocks/mutual funds he recommends, etc. and from his answers it was clear that he has never put any serious thought into this at all.

@JimL: Thanks. As a new reader to this blog I look forward to more education on finances and participating in discussions.

I too am a physician one year out of training.
Should doctors be able to be wealthy? Yes. But not until later in life in my opinion.

I'm a [cognitive] medical specialist and I make below what is quoted for hospitalists, family practice etc. I even moved to essentially rural America in order to make "this much". Bottom line, those numbers are inflated! Were I to have stayed in the NYCs, Bostons, and DCs i would have earned 30-70K less. If I had stayed in an academic medical center in these cities, I may not have even broken the 100K mark! I'm miserable out here, but I feel that for me to make any headways in my financial life this is a worthwhile sacrifice for the next few years. I'm still living as if I earn 40-50K resident/fellow pay and everything else is going towards massive savings and school loan repayment (cosigned private loans - I need to get rid of these pronto for my cosigners sake). My hope is to regain some sanity and calm in my life in about 3-5 years and return to the city for the less pay but better lifestyle (for me) with something in the bank, and less debt. This is only going to push back marriage and kids until I'm knocking 40 years of age.

I watch Suze Orman and all these people call in in their 20s and 30s with major bank. All I can think of is that I'm in major trouble...and not because I live outside my means. Oh no. They've had a huge headstart. Not only have I been earning at most $10/hr for the past 5 years (given the ridiculous hours we work), my loans have been gaining interest. Which brings me to another point. A lot of newly minted MDs have much more than $140K in loans. And even if $140K debt is the amount one graduates with, by the time you are done with your 3-7 year residency at 35-60K salary, that debt is now over $200K because of accumulated interest. And its not as if you were able to contribute much of your salary towards loan during this time. I personally can't even think about buying a house! And I don't even have credit card debt, just that damned medical school loan which in fact is a mortgage in its own way.

It truly is delayed gratification x one million! Add onto that societal impressions that doctors are rich, some can't help but pretend to live that lifestyle. I'm not surprised therefore that doctors are having to work until their 70s-80s to make sure their nest egg can support them.

I think another important point is the fact that many do not go immediately into medical school. I am a first year right now & I would say that over half my class is 25+. This means that even if they go into fields with short residencies they will be 35+ when they start making real money. On top of that, many will be closer to 40, because they were older or because their field will require a longer residency.. at which point you would expect them to have a spouse & probably kids to support... I really see no way that money could be saved from those first few years & it would definitely take most until at least mid 40s-50s to accumulate savings/wealth.

Payscale.com places the median physician income at around 160-170K. Other salary sites (glassdoor, job salary, jobnob) concur with that estimate. A 2003 ADA representative survey found a median compensation of about 170K for physicians, but remember that "compensation" includes 401K and other benefits too. I think a physician median income in the 160-180K range makes sense, but estimates of 200-400K/yr for physicians are really off the mark.

Many of these headhunting firms (Merrit Hawkins, etc.) get a cut of the salaries of the employees that they recruit for their clients, so they have an incentive to pay high salaries to recruited physicians. They also tend to be contracted to find physicians with critical skills and a work pace that are hard to find in the regular job market, so these numbers may reflect a more high end range for better skilled physicians. There are family doctors making 175K a year, but they are not representative.

Think about it. Overhead costs are rising. Medicaid reimbursements are being cut. Medicare reimbursements are seeing only small increases in total, but procedural reimbursements are being cut. Private insurers are cutting reimbursements as well. Physicians are dropping out of solo practice to work for groups or hospitals. How, in the heck, can physician salaries be rising at the rate that Merrit Hawkins, MGMA, etc. show?

Also, note one more thing. These are not salary packages. These are "compensation" packages that include benefits, 401Ks, healthcare, days office, signing bonus, etc. So the actualy salary is probably quite a bit lower....

To get a more realistic estimate of physician salaries, payscale is a better place to look. It seems that primary care physicians are earning more like 120-155K a year, depending on the specialty. Specialists and surgeons vary, but salaries seem to go from 150-300K a year.

This is a simplistic analysis of the situation. There are lots of reasons doctors aren't rich and you missed most of them.

1) We don't start making money until we're in our 30s. We miss all that early compounding the financial blogs talk about. There's not much earning or saving going on at all.

2) Taxes baby. Not only do we pay higher rates, but we get phased out of many deductions. This nonsense that "the rich" pay super low tax rates is bunk if it is applied to docs. We're not rich enough to be living off muni bond interest or capital gains. It's income just like yours. We're W-2 employees or 1099 contractors. Consider a doc making $150K (and there are plenty that make that or less including ALL of the doctors in the military, most pediatricians, and many primary care docs. He's losing about 7500 in state taxes, 5000 in medicare taxes, 13000 in SS taxes, and perhaps another 25000 in federal income taxes. Now he's into the 5 figures like many other college-educated Americans, and we haven't even gotten to the student loans yet.

3) Student loans- It's no longer unusual for a doc to have $200-300K in student loans.

4) Decrease in reimbursement. Student loans are going up, overhead is going way up (costs a lot to comply with all the new regulations about EMRs, HIPPA, EMTALA, Obamacare etc), and every December we stare a now 29% pay cut from Medicare in the face. Can you imagine another business that would even consider a 29% pay cut and try to stay in business. And that's 29% of gross, which after overhead might be 50% or even 75% to a doc that sees mostly Medicare.

5) Family and friend expectations that we're rich. Guess who's expected to pay when we go out to eat? You got it. Who do they go to for loans?

6) Financial "advisors"- Guess who's got the big target on their back? Do advisors go after lawyers and engineers and other highly paid folks? Nope- hit the doctors, they're rich!

In fact I had an "advisor" email me today and ask me how he could "prospect" doctors for his advisory business. Apparently he didn't realize I run a website where I help protect doctors from people like him. Unbelievable.

Docs dedicate their lives to helping others. The average emergency doctor donates $150K in medical care a year to those who cannot or will not pay. When you start giving away 40% of your labor for free you can start criticizing docs.

Wow, you actually just wrote an entire article on something that you truly know nothing about. Why would you waste your time? You guessed that beyond insurance, expenses "shouldn't have costs that are that much more substantial than what the rest of us pay." 1.) Again, you are completely guessing, and 2.) It is not rare for a doctor to pay more than 100,000 dollars a year in insurance. That gigantic insurance investment is on top of the THIRTY PERCENT payment to office overhead. So after a third of it is taken away, we then pay an amount that is equal to other people's entire salary in insurance. Then we pay another 5 grand to pay for licenses active. After we've cut down the amount of left over money, we're down to the low middle class range, where the rest of our money is spent paying off medical school. On top of all that, we work on average 55 hours a week, meaning over ten hours a day.
Again, I am honestly having an extremely hard time understanding why you would waste your own time writing about something you know absolutely nothing about. It is more infuriating than anything else.

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