Are doctors paid
well?
Or are they normalised
to the lack of a major motivator?
Young Bankers
A person known to me did an internship with a bank/financial
services firm during the summer break at the end of the first year of a three
year degree course. For those two months this bank intern was paid including
allowances which works out pro-rata to about £21000 per annum. The hours were
very long, typically from about 8.30 am to 10.30 pm the work was very demanding
including working on live projects. The output was measured and critical
developmental feedback was provided very frequently with no tick box exercises
or euphemistic language. The allowances included dinner and taxi back home if
the intern worked after 8 pm. On the first day the Managing Director of the
firm set aside time to meet the intern before the start of the internship. Just
before leaving the team gave the intern a farewell lunch at a Michelin starred
restaurant.
All this for an intern with one year university education
doing a summer job for eight weeks.
I know reliably that internships in banks after the second
year in university is much more common and those youngsters are paid a little
bit more.
The starting salary for investment banking and other higher
profile areas in banking after a bachelors degree are $100000 to $150000 after
bonuses. Starting salaries with an MBA ranges between $120000 to $220000. In
the UK for a first year analyst in investment banking is £60000 without bonus
(I learn that a few first year analysts make more than £100000 after bonuses).
For other areas of banking the first year pay ranges from £40000 to £60000.
Young doctors
I looked at my junior doctors, house surgeons (now called
Foundation Year One trainees) in the UK. After five to 6 years in medical
school they are first responders to many critical situations that could involve
risks to life and limb - their pay is £22636. They get no food from their
hospitals even if they worked through their lunch/dinner breaks which many
often do. They do not get any allowances. I am informed by quite a few house
surgeons from many hospitals that they had not seen their consultants for up to
five days and not seen their clinical directors for longer. When these house
surgeons leave after four months of work (it used to be six months) it is not
always they get a send off dinner and never in a Michelin star restaurant.
Hull York Medical School has recently required their senior
medical students to do night duties which involves more than simply shadowing,
possibly actual work such as clerking etc; these medical students are not paid
for it. I am sure HYMS are not alone in this. I know of no medical student who
worked in a hospital or GP practice doing supervised clinical work for which
they got paid.
Some/Many India private medical college house surgeons see
and treat patients without pay after having paid lakhs of rupees as capitation
fees to enter medical school and then lakhs of rupees as course fees for 5 years.
Young doctors and young bankers, both need to have consistent
excellent academic record and great CVs. They need to perform under high
pressure situations within very narrow time constraints. The number of newly
qualified doctors more or less matches the number of young graduates who enter
the banking industry. Doctors work shorter hours, banking analysts do 100 hour
weeks; however I have many years ago as a young doctor before the EWTR worked
80 hour weeks for many years and the pay was not equivalent to young graduate
analysts in banking. Surely someone is bound to come up with the emotional
argument of public money, please give it a rest for at least two reasons,
junior doctors working with private healthcare providers do not get any higher
pay and we constantly hear from the BBC and other public sector bosses about
the need to pay themselves competitive rates when compared to private sector.
There is no question that doctors especially young doctors
are not paid well. Add to that the longer very demanding education, the stress
of dealing directly with individual members of the public's health in often resource
constrained circumstances and the very restrictive regulatory atmosphere - the
mix is quite a downer for most doctors. Having made a choice to do medicine
most people switch to serving the public, relieving pain, noble profession type
of thinking to validate their thinking and keep their sanity.
Any doctors in the
rich lists?
Four out of 400 in the Forbes USA rich list have medical
qualifications. Of these four only Gary Michelson ranked at 328 seems to have
made his money from his practice as a doctor - he is an orthopaedic surgeon
with 250 patents. Thomas Frist Jr is a medical doctor who made his money by running
hospitals. Two other doctors made their billions by their involvement in pharma.
In the Forbes world rich list there is only one person who
has made his billions through healthcare. Thomas Frist Jr of HCA comes in at 262 in the world rich list, as
already said he owns hospitals.
In the UK's list of billionaires there is no one who made
their cash through healthcare (unless you include Branson who owns Virgin
Health but I am not sure he made his billions from it).
Considering the fact that the need for healthcare is
universal and eternal (as opposed to cola drinks or branded retailing being a
non-essential option) it is very unnatural, strange that there are no doctors
in the rich list.
Financial motivation
is normal. Are doctors normalised to the abnormal?
Being a hands on doctor treating patients does not pay great.
So, not only a junior doctor is paid a fraction of what
their banking colleagues are paid, they do not have a hope of every making it
rich by treating patients as a clinician. Our reward systems do not seem to
rate the direct saving of life, direct relief of pain and other direct clinical
forms of patient contact very highly. There is no financial case for young
highly intelligent, hard working high achievers to be doctors. Further, there
are no future financial opportunities for doctors.
We may or may not want to or be able to remedy it. However
when we look at the big picture and recognise that doctors are also normal
human beings with normal emotions but have adjusted to the low finance reality
there may be a certain element of hidden, difficult to explore, difficult to
understand, motivational deficit which may be impossible to resolve. After all
doctors may not be paid as much as bankers but they are paid much more than the
rest of the working people; so any doctor who argues about not being paid well
could be seen as greedy, unethical and unprofessional - so it is not the done
thing.
One major motivation in life, a normal wish that rewards are linked to
effort, especially for the young does not exist for doctors. The medical
profession will have this permanent cloud, this eternal chain to its feet in
the form of direct financial or motivational levers which are unavailable. That
will have its impact on society. The profession is now normalised to it hence
unable to argue forcefully or think of innovative means to break through.
The medical profession is fighting the phenomenon of
normalisation of the abnormal by confronting a large number of bad practices to
improve patient safety (hand washing, routine catheterisation for surgery and
many others come to mind). Will they be able to do the same for generally
superior financial rewards for the whole of the profession?
©M HEMADRI
Follow me on Twitter @HemadriTweets
Selected sources:
http://www.businessinsider.com/10-richest-people-in-medicine-2012-9?op=1&IR=T
http://www.forbes.com/sites/edwindurgy/2013/03/04/the-worlds-richest-billionaires-full-list-of-the-top-500/3/
http://www.forbes.com/billionaires/list/#page:1_sort:0_direction:asc_search:_filter:All%20industries_filter:United%20Kingdom_filter:All%20states
http://www.careers-in-finance.com/ibsal.htm
