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Saturday, August 30, 2014

Lo, the poor, downtrodden physician

Today (August 30, 2014), the Wall Street Journal published an article titled "Our Ailing Medical System," written b y Dandeep Jauhar, a practicing physician.  If you haven't read it, it's worth your time.  The article is not, really, about our medical system, it's about the changing role of physicians within that system, and how doctors are reacting to it.  Let me give you a taste:

In the past four decades, American doctors have lost the status they used to enjoy.  In the mid-20th century, physicians were the pillars of any community.  If you were smart and sincere and ambitious, at the top of  your class, there was noting nobler or more rewarding that you could aspire to.
Today medicine is just another profession, and doctors have become like everyone else [except they get paid a lot better for it]: insecure, discontented and anxious about the future.

As I read that, and much of what followed, I found myself re-writing it from the point of view of elementary and secondary public school teachers.

Public opinion of doctors shifted distinctly downward too.  Doctors were no longer unquestioningly exalted,  On television, physicians were portrayed as more human--flawed or vulnerable...U.S. doctors spend almost an hour on average each day...dealing with the paperwork of insurance companies...
Jauhar points out that, while the average annual income of doctors in the U.S. quintupled in real terms between 1940 and 1970,from $50,000 per year to $250,000 ("...American doctors at midcentury were generally content with their circumstances.  They were prospering under the private fee-for-service model...They weren't subordinated to bureaucratic hierarchy...").  He attributes at least part of that prosperity to the creation of the Medicare and Medicaid systems (both virulently opposed by the AMA, by the way. 

How does all that compare to the situation of public school teachers?  Let's begin with income.  according to one source, annual salaries for public school teachers were around $1,500 per year in 1940/41; in 1970, the average was around $9,300 per year, and around $53,000 in 2008.  Making the same inflation adjustment as Jauhar makes for physicians, we get:

1940:  $23,300
1970:  $52,500
2012:  $51,700 (most recent data I could find)

So the 30 years between 1940 and 1970 were also good times, in terms of earnings, for public school teachers.  Sort of.  Doctors earned a bit more than twice as much as teachers in 1940--but almost 5 times as much in 1970.  And while the earnings of doctors, on average, has continued to rise (not for GPs, but overall), teachers' earnings have stagnated in the succeeding 40+ years.  Some how this does not induce me to feel much sympathy for doctors.

Meanwhile, control of the curriculum has been largely removed from the control of teachers and assumed by boards of education (often subject to quite severe political pressure, as the hysteria over the "Common Core" curriculum indicates).  Students are increasingly subjected to high-stakes testing, and the tests are also outside the control of the schools, and the teachers, entirely.  public school teachers have, increasingly, become subject to almost complete outside control of curriculum decisions, of student assessment systems.  And the prestige of teachers has been continually assaulted (not least by such publications as the Wall Street Journal).  Job security is under attack across the country (see the recent actions against teacher tenure in California) and teacher pensions are now increasingly regarded as unearned and undeserved.

Jauhar calls for actions to restore the independence and professional status of doctors (and it's not clear, to me, that there's a real problem here).  I can't take this nearly as seriously as I take what is happening in public education.  And the next time the Wall Street Journal wants to come to the aid of a profession, I have a suggestion for them.


Blogger Alon Ben-Ari said...


Like you I read the WSJ piece about our ailing medical system. Indeed I am part of it. I wish to put things in proportion. I agree with your description about how the curriculum and authority of teacher was hacked from educators into the hands of politically driven committees.I agree that control over content and curricula needs to go back into the hands of the professionals.
You wonder how independence can be returned to the hands of physicians, you are clearly not instructed at the way insurers are manipulating care, clinical decisions, and so on to benefit thei botton line which is basically your money and mine. You are unaware of the beaurocratic burden laid onto physicians.Let alone the subjection of the medical profession to hierarchical beaurocracy.
2.While you are correct at showing that salaries of teachers have stagnated over thirty years you fail to rememebr that the making of a physician is more than triple the length that of a college professor, and a much more arduous process. No, MS/PhD is not as intense as residency. Neither is the practice, let alone the responsibility. While both teachers and physicians provide valuable services, there is still a difference. This is the reason Medicine is a serious descipline to reckon with despite more than 2 decades of direct on slaught. Not for long though.

Ben-Ari A. , MD.

2:39 PM

Blogger Don Coffin said...

Actually, I am fairly well aware of those issues. My wife worked in hospital administration for about 25 years, and I absorbed a lot as a result.

One point--my comments about education pertain to elementary/secondary, not to college/university.

And, knowing a fair number of people who have become doctors, I know a bit about the educational process as well. (I also taught for 25 years at Indiana University and know fairly well a number of people at the IU Medical School.)

I don't disagree much about the role of insurance companies. But they can't both be driving doctor incomes down and patient costs up--their net incomes aren't that large. And it is still the case that physician incomes have increased quite a bit faster than the incomes of most professionals.

And, when all is said and done, I continue not to have a lot of sympathy for people who are among the highest-paid professionals in the country.

10:12 PM


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