The delusion continues (part 2)
From this survey of nearly 1,900 ID physicians, we learn that the median salary of a full-time physician that is focused on patient care is $210,000. The data are sliced and diced in many ways, and are interesting to review.
The spin in the discussion (alluded to in the title of the paper) is that things are really not as bad as we thought. The authors point out that the often quoted Medscape survey has a small sample size and underestimates the true salary of ID docs. And while that is true, we still need to maintain perspective.
We know that our biggest competitor is hospital medicine. So let's take a look at hospitalist salaries. In 2013 (2 years before the IDSA survey), the overall median compensation for hospitalists was $254,000. So for an additional 2 years of training, the Infectious Diseases doctor will earn $44,000 less than his/her hospitalist colleague. And don't forget, full time for a hospitalist is, on average, 40 hours per week. How many ID doctors work 40 hours weekly?
Unfortunately, for most internal medicine residents, this decision is a no-brainer and I doubt this new survey will have much impact. Spin on, IDSA, spin on.
To further put the $44,000 annual gap in perspective. Choosing ID over a hospitalist career will cost you millions over a lifetime. If you take the added salary of 44,000/year over 30 years (age 35 to 65) and assume a 5% increase per year, you end up with $2,923,000. So there are at least 3 million reasons folks might chose another career. And that ignores the salary lost in the first 2-3 years years during ID fellowship.
ReplyDeleteThis isn't to suggest money is the most important reason to chose a career but with training being so long (9-10 years post college where wages are lost) and school debt so high, money plays an important part in decision making.
A little perspective from the UK, where I practice (as the equivalent of a first year internal med resident). In the UK, (almost) all doctors are employees of the government's National Health Service, and pretty much every specialty is paid the same (around 200k in US dollars), whether you're a general internist, ID doc, family doctor, radiologist, or neurosurgeon. As a result career choice is driven primarily by interest, and to some extent by lifestyle (e.g. amount of on call duty). This means that ID is one of the most competitive specialties and tends to attract very high-calibre candidates. I know a lot of American doctors probably don't like the idea of being a directly salaried government employee (even though, indirectly, most of them are to some extent), but it brings a lot of rationality to things like this.
ReplyDeleteGreat point RobG. I don't think the decision not to enter ID is driven by the actual salary figures but by the disparity in salaries (i.e., equity), and what is viewed as the inherent unfairness of doing more training to make less money.
DeleteIn addition to crippling loan debt (ie $271,000 at 6.8% interest at the end of 3 years of residency)
DeleteMy goodness. The gender pay gap--with the sole exception of young women working in an academic medical center--is astounding.
ReplyDeleteThe authors do acknowledge this in the discussion, essentially with "we're not the only ones", "this wasn't the aim of the study" and "it will be important to address".
However, given the relative magnitude of this difference as compared to the difference in ID vs non-ID fields, understanding the reasons for this disparity may help tremendously with improving interest and pay in our field.