It's not entirely true that doctors earn a lot of money. Some earn a lot more.

When the Kansas Department of Labor published its 2005 wage survey, the 10 highest-paid occupations were all doctors. In 2006, nine of the top 10 were docs. In 2007, same story.

In 2008, all 10 were doctors.

With all the recent attention to health care reform, it's natural that some of the focus will be on doctor pay. But how that fits into the health care picture isn't simple.

"There's a tendency in compensation discussions to make good guys and bad guys," says Dr. Alan Wedel, a partner in COMCARE, a family practice clinic that seeks to provide comprehensive health care. "I think the most sustainable models integrate care and the economics of the business side."

Just how much money Kansas physicians earn isn't readily available, but there are some indications beyond the state's wage survey. In its annual filing with the Internal Revenue Service, Salina Regional Health Center reported in 2005 that it paid (the late) Dr. Mace Braxton $364,154. That same year it paid Dr. Robert Fleming, a Wichita doctor, $303,579, and Dr. George Jerkovich, of Salina, $231,112.

Fleming is a thoracic surgeon, as was Braxton; Jerkovich is a psychiatrist.

In its latest filing, Salina Regional's highest paid doctor is Jerkovich, at $262,802.

That's small potatoes compared to the amounts paid by Hays Medical Center. In 2005 it reported paying Dr. Jeff Curtis $971,550 (plus $32,662 in benefits). It also paid Dr. Christine Fisher $934,788 (plus $32,662 in benefits); three more doctors were paid $813,057, $766,976 and $523,479.

All five are heart doctors.

That was in 2005. In 2007 the hospital was paying three doctors more than $1 million a year: Curtis, $1,185,300; Fisher, $1,184,945; and Dr. Gary Benton, $1,124,203. Two other doctors were paid in excess of $600,000.

In comparison, the chairman, president and CEO of Kohl's Corp., a $16 billion-dollar-a-year business with 1,000-plus stores (including one in Salina), has a base salary of $1.3 million.

It's not that doctors in Hays earn vastly more than those in Salina. The difference is that several of the surgeons who practice at Hays Medical Center are employees and therefore appear in the filing; at Salina Regional, doctors who provide similar services are self-employed.

Moving toward specialties

Not all doctors earn that kind of money, of course. A survey by the Los Angeles Times found that family practice doctors can expect to earn around $135,000 a year, while heart and brain surgeons typically earn over half a million.

And it is that huge disparity that alarms some health care observers. The thinking goes like this: Specialists earn much more than generalists, which is luring an increasing number of medical students into specialty fields, which reinforces the tendency to treat rather than prevent.

"We pay a lot of money for high-cost, specialty care after people get sick," said Peter Hancock, spokesman for the Kansas Health Policy Authority, a state agency that advises the Legislature on health issues. "We pay little to prevent those high-cost problems."

So is the growth in specialty medicine one of the forces driving up health care costs?

"The overwhelming belief is that it is," says Dr. Joshua Freeman, chairman of Department of Family Medicine at the University of Kansas Medical School. "I share that belief."

There's no doubt medical school students are migrating toward specialty fields. A recent study looked at the career paths chosen by internal medicine students. Internal medicine is a field that allows students considerable leeway in determining whether to be a generalist or specialist, Freeman said.

In 1998, more than half (54 percent) the internal medicine graduates chose generalist fields. By 2003, that had fallen by half, to 27 percent. There is increasing talk that the United State faces a shortage of primary care doctors.

Salina looking good

The good news is that Salina doesn't have a shortage of family doctors, Wedel said.

"The hospital's needs assessment shows we don't have an immediate need in primary care (physicians)," he said. It does show that a number of doctors are nearing retirement so the supply of young general practice doctors could well be an issue in the near future.

"Medical students are turning away from primary care for three reasons," said the Council on Graduate Medical Education, a congressionally formed group that gives advice on how to meet the country's need for doctors, in a statement to Congress earlier this year. "Poor income relative to other specialties; few primary care models during their exposure to clinical medicine; and the high, unfunded administrative burden required to care for complex patients."

That's a lot of debt

The cost of becoming a doctor pressures some medical students to seek out higher-paying specialties, Freeman said. The average debt by the time young doctors leave medical school is around $175,000. That compares to the average of $98,000 for veterinarians, $26,500 for other graduate school students, and $19,000 for undergraduates, according to Kansas State University's financial aid office.

Freeman points out that a key component of medical school education is the residency, in which medical students practice as doctors under the supervision of hospitals. These teaching hospitals are eligible for reimbursements from the federal government, but only if the hospital adheres to federal guidelines for the residents. Those guidelines don't always allow residents to get the training they need to become generalists, Freeman said.

At the same time, hospitals naturally want doctors to provide care that generates the most possible income, Freeman said.

"Your hospital has an interest in having residents help the doctors who do the kind of work that will make more money for the hospital," he said.

Thus there are market forces that encourage hospitals to offer residents spots in lucrative specialty fields. The result is that even as the federal government is trying to reduce the cost of medical care, its programs are nudging residents into specialty care.

"The nearly $10 billion spent annually on graduate medical education can no longer afford to be bent to the needs of hospitals," COGME said in its statement. "We appreciate the need to help teaching hospitals with the problems of workforce and financial solvency that graduate medical education currently serves, but we cannot afford the byproduct of an overly specialized and expensive workforce."

No bleeding-hearts

Wedel said the divide isn't so much along the lines of generalist versus specialist, as it is along the lines of evaluate/manage versus procedure. General practice doctors spend more of their time looking at patients' overall health (and in the process helping them avoid needing care) than do specialists.

But compensation is geared more toward providing the cure, Wedel said.

The model isn't unique to health care.

"We are a consumption-based culture," he said. "And I think that if we could put the brakes on consumption in the health care industry -- as well as the food industry, and other areas -- we would be healthier across the board."

Freeman noted that the cost of getting a medical degree is significant. The average debt for students graduating from private medical schools is $175,000; it's somewhat less for public school grads, he said. That's a large enough figure to tempt residents who have a choice into going with a higher paying field.

"The amount you are paying on repayment can be 20 to 30 percent of your take-home pay," Freeman said.

That said, he doesn't expect the general public to feel sorry for doctors.

"Even the underpaid doctors are going to be in the top 10 percent," he said. "Nobody's heart is going to bleed for you if you have to live in a 3,000-square-foot house instead of a 6,000-square-foot house."

Join the Discussion:

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lightninghale says....
Until they start treating the cause and stop masking symptoms will health care cost come down. Until they prescribe medications that really work, and DON'T cause another problem will the costs come down. I Would like to try low dose naltrexone for a skin condition, only $35 a month, no side effects in low doses. Do you think my doctors knows anything about it helping auto immune diseases? NO. But they do want to put me on injections that cost $1000+ a pop, with the risk of liver damage, renal toxicity..... They don't truly want you WELL, they want you well enough to keep you coming back so they can line their pockets. The hospital will bill you for things you didn't get. If you take the time to figure out the billing. One shouldn't take for granted that they don't make "mistakes". If the health care providers think that medicare is paying they might take advantage of that and double bill them.
9/6/2009

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No Government Healthcare Period says....
I don't care how much they make I don't want government run health care. This is not a good enough excuse for it. If is was passed Statcare would probably no longer exist and maybe those very talented Doctors who save lives wouldn't either.
9/6/2009

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