Posted on 05/17/2023 2:13:20 PM PDT by nickcarraway
We can change this by addressing the pay gap between child and adult medicine
A photo of a female pediatrician looking at her laptop while a mother and son sit on the examination table. "Don't waste all that schooling on being a pediatrician. Pick a specialty that will actually pay back your loans."
This is something future physicians hear all the time. Pediatricians have an average earning potential 25% loweropens in a new tab or window than their adult physician counterparts. Choosing pediatric medicine over adult medicine is an objectively poor financial decision, especially for students who are financing their education with loans.
Beyond disincentivizing a field that can be rewarding for empathetic people who enjoy being around kids, the significant wage gap has consequences for the future well-being of America's youth.
Undervalued and Underpaid
In 2022 alone, I withdrew $106,351 in loans to fund the upcoming year in my MD/MPH program (just over the estimated cost of attendance for a first-year MD student at my school: $99,151opens in a new tab or window). Meanwhile, first-year resident physicians at my school's health system make only $58,985.24opens in a new tab or window (pre-tax) annually for 80-hour scheduled work weeks. (This ignores the many unscheduled hours that hospitals often expect residents to work.) A high-cost education followed by a low payout during training isn't unique to my institution.
After 4 years of college, 4 years of medical school, and up to 7 years slaving away for a resident's salary, how can the medical system rationalize rewarding pediatric physicians with only 75% of their peers' compensation?
One excuse for this inequality is the suggestion that working with children is easier. I'd counter that with the fact that pediatricians must relearn a modified version of much of their medical training. They must study the unusual childhood presentations of common pathologies and dosing systems unique to pediatrics. They must tactfully balance the wants and needs of both the patients and their family members, advocating for the former when their desires do not align. Additionally, many pediatric subspecialists require an even greater number of years of training than their adult equivalents. One might assume that these extra years are the cause of their lower earnings, since longer training means fewer years of high earnings. However, even after accounting for these years of lost earning potential by modeling a shortened length of training, the lifetime profits of pediatricians were still 19% lower than of adult specialists.
The current structure of our payment system makes it near impossible for pediatricians to earn a fair salary. About 39% of childrenopens in a new tab or window in the U.S. are insured through either Medicaid or the Children's Health Insurance Program (CHIP), insurance options for low-income families. On the other hand, the single largest insurer of the adult population is Medicare, which is known to provide higher reimbursementopens in a new tab or window rates. Furthermore, the way in which CMS determines reimbursement rates depends on a committee of physicians. This committee allows only one seatopens in a new tab or window for pediatrics. This may inadvertently lead to better reimbursement for services that primarily serve adult patients, since other specialties have a louder voice through more "adult specialty" seats at the table. This issue is further aggravated by the fact that invasive procedures tend to be reimbursed at higher rates but are less common in children. Consider $1,200+ colonoscopiesopens in a new tab or window for example: a means of screeningopens in a new tab or window in adults but generally only a diagnostic tool in children.
The Consequences of Devaluing Pediatrics
As of 2022, pediatricians had the second lowestopens in a new tab or window physician salary, beat only by public health and preventive medicine doctors. This is dangerous because it decreases interest in the field of pediatrics, making it a less competitive specialty. It fosters an attitude of disappointment when "overqualified" students show interest in it and normalizes it as a "backup choice."
The narrative that pediatricians are less valuable than other doctors may prevent some pediatrics-inclined students from pursuing the field. At a time when almost 30% of medical studentsopens in a new tab or window report signs of depression (a number that is surely underreported due to fear of professional repercussionsopens in a new tab or window) and 53% of current physiciansopens in a new tab or window report burnout, shouldn't we be encouraging students to pursue their top specialty? It's only logical to assume that would help sustain their passion for medicine.
Living in a country where 1 in 5 childrenopens in a new tab or window are obese, 30% of female high schoolers have seriously considered suicide, and 1 in 25 of today's 5-year-olds will not make it to see their 40th birthday, indifferent pediatricians are something we absolutely cannot afford. The rippling effects of this pay gap are particularly damning in states such as Florida where 18.3% of childrenopens in a new tab or window have healthcare needs requiring the care of a pediatric subspecialist.
Over time, this salary imbalance will only worsen the shortage of pediatricians and diminish the quality of care available.
The pay gap between pediatric and adult medicine physicians is rooted partly in archaic misconceptions and imbalanced insurance payouts, and further influenced by a multitude of other factors. Pediatricians play a critical role in keeping our future generations healthy. We owe it to them and to our children to urgently push for changes in healthcare reimbursement and public attitude if we want to preserve the quality and accessibility of pediatric care.
Megan McLaughlin is a rising fourth year student in the MD/MPH dual degree program at the University of Miami Miller School of Medicine. She plans to apply to family medicine residency programs and focus her career on improving maternal and child health.
But I know some pediatricians who were much smarter than him. But in all fairness, not better with money.
I saw this the other day:
“The most dangerous place for a healthy child is the pediatrician’s office.”
There is a saying "Who is smarter, an MD or a DVM? The Vet, because his patients can't tell him what is wrong. The DVM just has to know."
Pediatricians are much like the DVM. I have seen the financial disparity between adult physicians and pediatricians in the preparation of tax returns. I have had both types of physicians as tax clients and the "adult" physician's pay is actually at least 50% higher that the pediatricians.
Doesn't seem fair, but "...that's the way it is..."
Become an abortionist and move to New Mexico, where the state government is making the state the Abortion Tourism Capital of America. Not only will you get paid for doing the abortions, you can sell the parts for even bigger bucks.
In all fields, some of us are not money oriented. In IT I sat between 2 men. One loved what he was doing so much he would probably do it for free.
I saw the other guy’s pay stub, current and YTD. All he did was copy/paste articles out of online magazines and say that should be the future of the credit card company. He was making over $20,000 per month. He was a good negotiator but Knoew zero about IT.
I was in the middle.
I currently have a co-worker who is worth 5 times what he is paid. Of course I have another co-worker who probably earns more but is worth 10% of what paid.
As an ivestigator in to previous life many years ago I saw th same wage gap across many occupations.
Some people are money motivated, some are not. Some know how to negotiate. Some don’t. Some have other people with other reasons for decisions.
It is the drug industry.
A doctor visit isn’t a hill of beans for either one.
Those ‘scrips on the other hand pay it all.
Pediatricians of color hardest hit...
Very true about drug company payoffs. What illnesses is most frequent with kids? Injuries from play, common illnesses, infections, and basic check ups. Their healthy bodies don’t consume vast amounts of drugs. We old farts need drugs all day long.
Hence the oush to get kids on puberty blockers Prozac, Adderal, and other profitable “gender affirming care”.
I know a doctor who was a specialist working in hand and micro surgery. He later switched fields. Boob jobs. Lots more money doing boob jobs.
This information about being a pediatrician reminds me about studying, going to college and getting a degree just to become a teacher. When, in fact, most college graduates could earn much more money in a different field than teachers do.
Anesthesiologists have the easiest job. Sometimes an injection, sometimes a tube down the throat. Then just sit there and turn knobs, check your watch, turn some more knobs...
Don’t they have high malpractice insurance?
pediatric residencies are 3 years not 7. That said the nonsurgical specialties (peds, internal med, family practice) are generally reimbursed at a much lower rate than the surgical specialties. It is much easier to define and quantify procedures than it is to quantify and reimburse for knowledge/thought processes.
Maybe they test the merchandise too much.
Perhaps getting kids into the Trans “pipeline” is one way for them to boost their income?
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