Doctors are among the most esteemed professions in American society, enjoying a certain level of prestige as well as high income, with all US physicians averaging $363,000 in annual salaries, growing 3% from 2022 to 2023. The three top-earning specialties are orthopedics, plastic surgery, and cardiology, all exceeding $500,000 yearly.
However, there is a downside to this, with a public impression that doctors are wealthy and are being overpaid, which generates some resentment among patients and their families who are struggling with the high cost of healthcare. According to Dr. Oday Alsheikh, an ophthalmologist and healthcare economics reform advocate, the public often fails to see the huge time and financial investment needed to train a single doctor.
After graduating from high school, an aspiring doctor will need to take a four-year undergraduate degree that costs anywhere from $40,000 to $100,000; after that is four years of medical school, which is very competitive and expensive and could incur student debt of between $200,000 and $400,000. This is followed by a residency period of around three to seven years, but in some specialties, such as neurosurgery, it could take up to nine years. Dr. Alsheikh says that resident doctors make around $60,000 a year but, due to long hours, make only just above minimum wage on a per-hour basis.
All in all, becoming a doctor requires more than 10 years of study and costs hundreds of thousands of dollars, which is usually funded via student loans if the student does not come from a wealthy family. Additionally, they need to pass stringent medical board exams to gain the privilege to practice medicine in their subspecialty. Thus, the higher-than-average pay for doctors only just about makes up for many years of not being able to earn and the need to pay off student loans once they start working. This is on top of their life milestones, such as buying a house or building a family. Female doctors are more severely affected by this, as they often finish their medical studies in their early thirties, leaving only a few more years for childbearing. Dr. Alsheikh theorizes that this may be one of the reasons why female physicians are more prone to depression and burnout than their male counterparts.
"Doctors put so much work upfront to get where they are and, while they are well paid, they also haven't been paid for almost 15 years," Dr. Alsheikh says. "Factoring student loans, the cost of buying a house, and having to start building for retirement at a later age, doctors need to catch up, so they are going to ask for the highest possible salary. I believe that part of the problem is, why are we asking so much of our doctors? If society feels like doctors are overpaid, then don't ask for the moon. Don't ask for 15 to 17 years of training if you're not paying for it."
Once doctors have finished their training, they usually have two options—to become an employee or go into private practice. Traditionally, private practice paid better, but the income in this path has been shrinking due to decreasing reimbursements from payers, such as Medicare/Medicaid and private insurers. This has led to more new doctors choosing to become employees rather than start their private practice, while older doctors in private practice just choose to retire in the face of shrinking margins. Others, facing higher rates of depression and burnout, may decide to switch to aesthetic medicine or run cash-only private clinics.
According to Dr. Alsheikh, the exodus from private practice has resulted in a lower incentive for doctors to see more patients, which reduces the accessibility of care and results in longer waiting times, especially when seeing specialists. With Americans' lifespans becoming longer, this has created an even larger shortage of physician resources.
"It's good that people are living longer but, at the same time, it creates more demand for the healthcare system, with more people needing care, especially with the Baby Boomer generation aging," he says. "At the same time, we have a shrinking number of doctors, many of whom are seeing fewer patients per day than they did before. These create the imbalance, where there's a huge demand and not enough supply."
Dr. Alsheikh observes that the doctor shortage and the ongoing trend of consolidation in the healthcare industry, especially by profit-driven private equity investors, has resulted in health providers relying more on nurse practitioners (NPs) and physician assistants (PAs), which can take 60% less time to train, collect 85% of what MDs collect, and are paid one-third of what doctors are paid. While NPs and PAs are able to do many medical duties under the supervision of a doctor, this is just a stopgap measure, as the expertise of full-fledged doctors is irreplaceable in modern healthcare settings.
"NPs and PAs have become essential to keep organizations afloat, currently serving the frontlines of our healthcare system, but there's still a significant undersupply of doctors, which reduces the quality of healthcare delivery," Dr. Alsheikh says. "The system doesn't have enough doctors because it's putting too much stress on them. Furthermore, because the public thinks they're overpaid, payers are cutting down their reimbursements and creating a back door for other people to fill the gap. Thinking about it, why does the American healthcare system insist on such a high level of qualification for physicians? Ostensibly, it's to protect the patients and the quality of the healthcare system. But the system ends up relying more on non-doctors so that defeats the purpose of expecting too much from doctors."
As part of his mission to raise awareness about needed reforms in the US healthcare system, Dr. Alsheikh engages in research to find cross-sectoral solutions to various problems. In the future, he aims to publish a collection of his findings, which he hopes will guide the public and policymakers in creating a better health system that serves the needs of patients while providing ample compensation and opportunities for doctors and other medical personnel.
