The “Low Income” Physician

crispydoc Uncategorized 12 Comments

A recent comment from a colleague in pediatrics began with the qualification, “I am a low-income physician…”

As an amateur bird watcher, I take joy in the picturesque names that come with this hobby. Resplendent quetzal is a favorite; another is a Cuban term for a tiny hummingbird, pajaro mosca, which translates roughly to housefly bird.

Low-income physician seems a similarly colorful term, with connotations at once counter-intuitive and easily imagined. A figure in a disheveled white coat on the freeway offramp, holding a cardboard sign, “Discount appendectomy, today only!”

On the one hand, I completely understand that there is large earning variability between medical specialties. Compared to orthopedics, neurosurgery, or the ROAD to happiness (radiology, ophthalmology, anesthesiology, dermatology) it’s true that the income for pediatricians is substantially less.

On the other hand, I was trying to imagine how such a statement might sound to someone outside of medicine. This plea would play differently to my mother the retired public school teacher than it would to my mother-in-law the retired corporate lawyer.

What, in fact, might the equivalent lament might be for a non-medical high income professional?

I’m the lowest paid CEO of a fortune 500 company – my company ranks 498.

I’m an investment banker, but I specialize in non-profits and charities.

I’m a public interest lawyer. (This one may not be so far-fetched. Over a decade ago I briefly dated a public interest attorney whose income was low enough to qualify for low-income housing in Santa Monica, alongside some of her clients!)

So is the pediatrician, like that public interest lawyer, a modern day Franciscan monk who embodies a willing vow of poverty within the profession? Or is this simply self-pity, permitting comparison to become the thief of joy?

Do pediatricians not select their specialty with eyes wide open and the ability to obtain the same information the rest of us had in medical school? Other than the handful of medical students who were in school to become the fifth generation ENT in their families, most of us simply found something we liked and pursued it until it became our job, hopefully our career, and if we were exceedingly fortunate our calling.

I ask these questions openly and honestly, because I’m not completely sure how to answer them.

I realize I might be an insensitive jerk whose dual physician household and emergency medicine income has blinded me to the very real struggles that a single-income pediatrician  household might be facing, but I hope that’s not how this is taken.

I’d welcome feedback, both from physician readers who feel like their low-income specialty is a hardship, as well as from any readers (even you, mom) who feel like the term low-income physician can’t possibly be the case because all doctors are wealthy by definition.

And if no one comments, perhaps it’s too much to ask that physicians feel safe unburdening themselves in a public forum where lower-earning workers might belittle their struggles, and we’ll call it lesson learned (Alternately, maybe no one is reading this vanity project.).

Comments 12

  1. “So is the pediatrician, like that public interest lawyer, a modern day Franciscan monk who embodies a willing vow of poverty within the profession? Or is this simply self-pity, permitting comparison to become the thief of joy?”

    It could be both.

    It depends on the person and the tone in which the statement was said 🙂

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  2. Your life is what YOU make it. Pediatric primary care as near as I can see is a specialty done by a PA. I’m not dissing the dignity of the work, but that seems to be the reality. Part of the gig seems to be living a victim life. I read a blog last night by someone who is a primary care med/peds doc and it was a non stop bitch a thon about how she’s getting gypped that she has to work 45 hours a week seeing patients AND AND the paperwork sucks! My only response was DUH! As I thought about it more I decided she’s in a kind of 7 stages of grief over becoming an adult. Medical school and residency is a time of protection from reality, and we live in a time where “you can be whatever you want” is hawked as a norm. Yes you can be whatever you want but with that choice comes the consequence, in this case low pay. There is now a Doctor of Nursing which is a post graduate largely online RN degree and these people think they are “Doctors” and woe be unto you as an MD or DO if you try to point out a distinction.

    I think all of “physician” aspect of medicine is grinding to a halt and I think it’s by design. We are inconvenient and inefficient gate keepers to the MBA’s (who by the way ore largely idiots). AI is presently smart enough to pass all the parts of the national medical boards with ease. I read about an AI which you can have as an app on your cell phone that can diagnose melanoma better than Stanford dermatologists. There is nothing precluding this kind of app from taking over radiology and pathology. I used to teach EMT’s and Resp therapy to intubate and some of them were pretty good. I did my last ACLS with a nurse who made his business teaching ACLS and the guy was excellent. Can medicine turn into a cell phone full algorithms that behave in conjunction with the new Providers? We all be providers these days doctor nurse technician janitor each with some credential that appends 15 letters after their name. Of course the letters don’t mean you know your ass from your elbow when it comes to treating disease, but that may be a very different thing from getting paid. If you’re bitching about being a low paid doctor, look out you’re likely soon going to be a “not paid” doctor with your skill set falling to a PA, or a janitor with a cell phone.

    1. Gasem….please start a blog. I always enjoy your replies to others. (maybe just because you and I are in the same age cohort, have had some of the same interests…etc…)

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  3. Although pediatricians are typically at the lower end of the pay scale of physician salaries (pretty much every medscape survey they rank near bottom), I know a lot of pediatricians (a lot who work at my clinic) that pull in impressive salaries. Not sure if it’s part geographic location and part extending their clinical hours (they are often the ones that are the last to leave in my clinic and work on Saturday and Sunday).

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      Like Doc G at DiverseFI, there are ways that one can make a primary care career into a high-earning gig, but it takes someone with exceptional hustle to do so. Compare a pediatrician with an average orthopedist, and the former has to use above-average entrepreneurial skills in an exceptional manner to earn an income that the latter earns by following a default path. It’s your pediatrician friends working a weekend clinic who edge into the higher tier of earnings.

      A relative entered a primary care internal medicine residency, and then pivoted to an allergy and immunology fellowship on completion because of the added control over her destiny that the latter offered.

      I get why primary care specialties can feel like the Rodney Dangerfields in the house of medicine.

  4. The context is everything.

    I am an employed internist, I am pretty happy with my salary and what I make of it. Yet, when I read blogs and comments by people who each month invest more than my pre-tax paycheck, I definitely don’t feel like we are playing in the same league.

    I have friends in the tech industry who might make more than I do. They are very clear that they don’t work as hard as I do.

    I would never utter the words “low-income physician” in the office, where we treat people with a truly low income.

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      It’s a tough one, IM-PCP, and you are spot on that in many cases the leagues of medicine are orders of magnitude apart. Having said that, I don’t begrudge the folks who earn well in medicine – “Hate the game, not the player.”

      The tech industry tends to be hit or miss – for every lottery-winning startup friend, I’ve got a buddy who stays home with his kids because he followed a dream that went bust, and his wife is the reliable bread-winner.

      I try to frame a career in medicine as a gift. The high hourly compared to manual labor lets me work fewer hours and still earn enough, so I can spend the balance of time living my priorities. Not many careers offer that bargain. Sure, the price was my 20s, but being someone who had always felt a 40-something soul trapped in a 20-something body, I really didn’t mind the trade-off.

  5. Great post. I just found it today. I have been both a high income doc and a low income doc. When I was making big bucks I would mentally note whose car was in the parking lot at 2 AM when I was trundling in to deliver a baby. The high income people were there. Now I never enter the hospital in the middle of the night or weekends so really do not expect a high income. High income is like balancing multiple plates in the air every day. It is stressful. I think the work life balance issue is starting to effect medicine. It will probably even out some of this.

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      Could not agree more – the older docs like to diminish millenial docs as entitled, but the youngsters seem to also have their priorities and values front and center as they design their lives. If you haven’t already, check out Reflections of a Millenial Doctor to see someone who is clearly phenomenal at her job as she deals with burnout firsthand.

      If we as a profession can’t manage the work-life balance piece better, we are going to lose a lot of talented physicians who rightly decide they don’t need to live without those luxuries (family time, spouse time) that the rest of the world takes for granted.

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