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    Your Voice: Foolish to presume doctors earn too much, others deserve more

     I would like to respond to your piece, “Doctors’ salaries are not the problem behind rising U.S. healthcare costs,” (First Take, December 10, 2017) and wish to clarify further why physician incomes are not to blame. 

    Several arguments are made routinely in the media assailing physician incomes in this country. These arguments generally fall between “doctors make too much” and “other people are more deserving of this income.” However, the logical and factual basis for these arguments tend to fall apart on further examination. Worse, the media position has largely been one-sided and failed to consider whether their information is flawed or wrong. 

    One argument is that doctors are simply paid too much. This line of thinking arises from comparisons to other first-world countries. However, no one really asks whether this type of comparison is valid to begin with. Physicians are, indeed, paid more in the U.S. than in Europe. But so are engineers, accountants, and every other professional in their respective categories. While doctors in Europe make less, they are generally the highest paid professionals on average in their respective countries. Aspiring young students have little opportunity to choose other careers for better pay unless they luck out. 

    One of the primary reasons that professionals are paid less in Europe is simply because a lot of the wage structure is designed to protect lower-income people. Less educated workers are supported much better in Europe than in the U.S., all on the backs of professionals. Is it any surprise then that the vast majority of medical breakthroughs, inventions, pharmaceuticals, and tech industry development is from the U.S.? 

    Another argument is that doctors’ incomes are simply too high due to an artificially constructed environment that protects their incomes. This is a prejudiced argument. It presupposes that the integrity systems in place to ensure competent doctors are trained are flawed and exist to limit entry and make it easier for doctors to keep their incomes. Such arguments are generally supported by the false premise that nurse practitioners have the same outcomes as doctors. Generally, these articles fail to acknowledge that the studies that purport this similarity are limited in scope. These limited evaluations do not take into account complex decision making for complicated diabetic patients, multifactorial conditions, arrhythmias, heart failure, and so forth. 

    I could discuss how malpractice hardly exists across the ocean and whether it would be acceptable here at all. I could also point out that to bend the cost curve we really need to cut expenses related to insurance, pharmaceuticals, and malpractice and that physician pay is a pittance in this regard. But that is for another day. 

    Jay Kot, GME III
    Pittsburgh, Pa.



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