I understand “concierge” medicine all too well – it’s a means of ramping up physician income by guaranteeing cash flow. The services offered in return for this fee are pretty much a sham, but hey, if someone wants to pay it, be my guest. The latest twist skips the pretense – some physicians are asking patients to pay a “voluntary administrative fee” of about $250 a year. (See this news report).
When my late uncle began his internship around 1946, he was making about $50 a month. His uncle, in turn, looked at him and asked, “So? For this you went to college?” My uncle devoted his career to research, first at a research center at a
Given a kickstart by the Medicare and Medicaid programs, medicine has become a very highly compensated profession. Wealth is seen as never before, as patients are more likely to have insurance to pay a fee to physicians and other providers. Leading edge procedures, such as open heart surgery, and a large upper middle class willing to spend cash for vanity procedures, all have led to incomes that have pushed well into the six figures. Observers argue that medical students are pursuing specialties because of the higher incomes, blaming medical school debt for this “need”.
So now we have some doctors asking for a payment in advance. Officially it’s voluntary, but you can imagine how it’s perceived by patients, particularly elderly patients in
And then we get to the income question. Physician incomes, in real terms, have been flat and even declining over the past several years. Have we reached the income wall, were incomes will continue to drop? Is the marketplace pushing back and saying “no – we’re not going to pay it”? US physicians make higher incomes than any other country, and no, smart and talented people will not all bolt for Wall Street. Because frankly, if people are going into medicine because one can make a lot of money, these are not the people we want in medicine in the first place. These are the people who go to medical school but don’t practice, seeking out even higher incomes in business, law or other occupations.
I learned a long time ago that there is always another way to make more money than you are making today. There was a time when there were more millionaires in dry cleaning than any other business. I know people who made a lot of money in scrap metal. I know people who made a lot of money as a trader on Wall Street, one who ran a Dunk’in Donuts.
Health care has become very expensive, the industry is under siege for doing a lot of useless things and charging a lot for it, and the people paying the bill are asking a lot of questions and want prices to come down.
Maybe the wall has been hit. It’s time to readjust your income expectations and live more conservatively. Every other business has its ups and downs, and medicine may be in a downward swing.