How Much Should A Doctor Get Paid?

Found this in-depth New Yorker article on a doctor’s compensation (thanks, Tilo!): Piecework: Medicine’s Money Problem. Atul Gawande tackles a topic near to my conscience, what with my doctor brother and my grappling with these issues on a near-daily basis. Forget doctors, what is anyone worth?

Most people are squeamish about saying how much they earn, but in medicine the situation seems especially fraught. Doctors aren’t supposed to be in it for the money, and the more concerned a doctor seems to be about making money the more suspicious people become about the care being provided … Since the early nineteen-eighties, public surveys have indicated that two-thirds of Americans believe that doctors are too interested in making money. Yet the health-care system, as I soon discovered, requires doctors to give inordinate attention to matters of payment and expenses.

How does one measure relief from pain and salvage from death? I argue that the act is priceless – it should command no money and all the money in the world. How is this paradox broken? If, according to one of my favorite adages, money is how people with no talent keep score, the amount of money made is not as important as what one does with it. A pat response I often receive when posing such a rhetorical question is that a service is worth what the market will bear. I argue that there is a fine line of responsibility between doing justice to and abusing what the system is willing to put out. After all, even doctors have services provided to them by others.

This is where the power of community comes in. My grandfather, a rural general practitioner, received bushels of fruit and vegetables in return for, as an example, the safe delivery of a local farmer’s baby. Standardized monetary payments fail in this regard. It wasn’t a matter of how many gourds or papayas were dispatched, but that they were within the means of that particular farmer. In a way I cannot quantify, that exchange, now dismissed as primitive, seems so satisfying and natural to a human cycle of living. I hope the world finds something civilized in returning to such interaction.