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We're no stranger to the immigration hot button here; we all want some way to filter for attractive women and investment dollars where we live and less competition for labor, but the want for those things proves weaker than the iron laws of supply and demand for both. However, here's a problem in the immigration debate that I don't think has come up in discussion before: ladies and gentlemen and undecideds of the Motte: how do we fix the doctor shortage?
And I mean globally. The solution many places settled on after it became clear that it was difficult to impossible to train more doctors locally is to import them, but this simply moves the problem around and causes brain drain as market efficiencies mean doctors move where they can get paid more.
Accounting for inflation, apparently physician pay growth is lagging although I'm not sure if anyone has more up to date information on whether this is still the case.
The easy low effort swipe is to make it easier to qualify as a doctor, but doing so without lowering medical standards and/or quality of care seems more difficult. There's also the simple calculus where people are less willing to take on, in the US, large amounts of student debt and to commit to the many years of study it takes to become a qualified doctor. After which you can look forward to high stress, long hours, dealing with patients, and potential lawsuits. It's no surprise that people would rather hustle sneakers or crypto or streaming when the effort to do so is significantly less.
Previously, governments would subsidize medical training as they saw medical professionals as a necessary function. Now, why bother? If there are opportunities and more money to be made elsewhere, they'd just move elsewhere after being trained, which would be happy to take them. Is there a low effort politically achievable band-aid fix, like making mandatory provision of medical care within the country a necessary precondition of qualification? But that'd make the profession even less popular - if you're a Kenyan doctor, fuck staying in Kenya if you can get paid multiples of that elsewhere.
Disclaimer: I'm asking for entirely selfish reasons. Working on a new investment thesis after the last one turned out spot on although with limited rewards so far for being right. I foresee this problem getting much, much worse as doctors retire, populations trend upwards in age and require increased medical care.
Doctor pay feels like something “when the data doesn’t fit the anecdotes usually the data is wrong” - which I think was a Bezos management philosophy.
I feel like I have a lot of friends dads who are doctors and clearing low 7-figures. My gut says the data isn’t capturing a lot of Doctor pay. Health care spending has exploded; granted a lot of this is the expansion of the administrative state; but are you telling me Doctors have failed to capture any of the increased spending?
Biotech stocks, pharma, etc haven’t done great the last decade. Who’s getting rich in medicine? We all know overall spending has exploded.
Not sure how old you are but if you are in your 30s or 40s then you are looking at an old problem, if you are younger I'm not sure what that's about very, very few doctors make 7 figures even in the U.S.
Physicians used to make considerably more relative to inflation, have much lower debt (which later snowballs into wealth) and had other options to bring in money - medical inventions, ownerships of practices and other stuff, less regulation of conflict of interest and advertisement, and so on. Loopholes have been patched, reimbursement has been adjusted, and wages have declined relative to inflation.
Neurosurgery is the only specialty (and maybe vaguer things like spine) that is making 7 figures without something weird happening like fraud, sketchy cash practice, charing a department, or ownership. But ownership is.....gone.
People who already had a bag are doing great but the young aren't catching up.
It is possible you are living in a good area with the most successful people, but up until recent a few specialties still had averages below 200k in the big metro areas.
This is apocryphal so not sure how true it is, but a friend who does recruitment for a large hospital on North Dakota told me they are trying to pay rare specialists upwards of 900k to move there and stay. Something about how its ND which makes it hard to actually get these people, forcing them to pay them obscene amounts of money. How true is something like that?
If only there were a lawyer equivalent of this. jesus_ive_seen_what_youve_done_for_others.jpg
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Medical pay is a bit unusual - the fancier the job (prestige work at an Ivy for instance) the less the pay. Sometimes literally to the tune of hundreds of thousands of dollars. Most desirable locations (that are also more expensive!) like NYC, Boston, Seattle... they all pay less. Again sometimes to the tune of hundreds of thousands of dollars.
It can take a significant carrot to get fancy specialists who make "enough" and sacrificed the entirety of their 20s and sometimes 30s to go to shitty locations.
I can believe 900 for like Vascular for instance. More for neurosurgery. Not really close to that for most others.
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Most I am referring to would be parents dads. So 55-70. All seem to be in the $1-5m pay range. Sometimes they moved to medical adjacent later in career. (Pharma, Corp Scientist)
The articles with headlines “Doctors don’t make any money” seem as truthful to me as Civil Engineers grade American infrastructure a “D” and we need to spend trillions fixing it.
I mean you are looking at end career people.
However they are absolutely not making 1-5 million per year unless they are department chairs at major institutions or own extremely large practices. Most executives at run of the mill mid sized businesses don't make that much in comp. 1-5 million is (per google) the amount that executives at KP (one of the largest and most important health systems in the country) are making.
They might have wealth that matches that pay range but that's through being boomers and having come up during boom times and making investments and getting paid in an environment that does not exist now.
A good example of this is ophthalmology - in the 90s they were filthy stinking rich. Then the government changed their compensation structure and while still well paid it's probably a fourth what it was in the 90s. But if you are friend's dad is a former 90s eye doctor, he got a bag.
The situation has changed though.
You can also just google salary averages for various specialities the numbers are off sometimes but they aren't off by millions of dollars.
That's just not what people are getting paid.
I'm not complaining about my compensation, I am stating that it isn't what you think it is.
I can’t just google “average salaries”. If we’ve learned anything the last few years data lies. I just know anecdotally every Doctor I’ve ever met over 50 is quite wealthy. I’d have to do fundamentally research to figure out what’s going on.
Believe my best friends dad does goes cardiovascular. They have ten homes and 25m in brokerage accounts. My gut says mid-career ops exists where someone no longer gets classified as “salary” Doctor and earnings magnify.
The AMA is powerful. They’ve restricted supply of Doctors. It doesn’t make sense that real per capita medical spending more than 2x between 1990-2025 and the AMA didn’t get a cut of that. “Everyone else” in medicine got rich except Doctors is what you are saying.
This is conspiratorial thinking. Physicians pay for services which you can see public approximations of that show salaries, they then use these numbers in negotiations. They are off by a little, not millions of dollars.
Additionally something is horrifically off with your sample, ten homes and 25 million in brokerage accounts is a lot of fucking money. That's a lot of non-physician business, luck with investments, or fraud.
Also, you have to listen when I say that the 80s and 90s aren't what is happening now.
Tons of doctors in their 40s and 50s are still paying off loans. A saw a physician publishing data to other physicians showing that the average 40-50 year old physician is worth less than a million dollars.
Things change. Don't be like the woke people who refuse to acknowledge that you can turn of the affirmative action funnel because women started outnumbering men higher education in the 80s.
I've repeated a million times here that the AMA is not doing what people think it is doing, and none of what they are saying is how the physician supply line works. If you have doubts watch a Sheriff of Sodium video. Also that's not what the AMA is. People act like it's some mandatory guild instead of a much reviled in the field organization that lobbies for its own interests which are abstruse and not related to physician interests.
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Plastic surgery? Granted he's 50, so not just out of med school, but the plastic surgeon I know is making so much money he doesn't know what to do with it (and thus wastes a bunch on truly stupid shit). And he's not in Vegas or Scottsdale or LA.
Yes practice owners in things like Derm, Plastics (especially if the latter is doing cash practice for fucking surgeries!!!) can make tons of money. The total percent of physicians doing that is a rounding error.
Likewise the highest paid public employee in most states is either the college football coach or the head of a surgical department. But executive pay has little to say about the average Joe.
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