Medicine and Money

How do we figure out how much to pay doctors? In medical school, we get taught nothing about business management or medical economics. What forces determine compensation? How are salaries decided? How come primary care is reimbursed at such a lower rate compared to specialists? Atul Gawande has written an interesting article describing how procedure reimbursement rates were set, but other than that, I don't know much.

In medical school, we are taught the idealistic approach: we see and treat whoever walks through the door, regardless of ability to pay. Like church and state, medicine should be cloistered from economic forces; we hope we are above such influences, though they drive so many other human interactions out there. No one should go into medicine for the money; indeed, the amount of time invested makes it a wholly unlucrative proposition.

For me, money was never a big factor. But now that I am thinking about residency and specialties, these issues are exerting more pressure. With the recent economic downturn, my friends in other fields have found themselves unemployed. Medicine may be insulated against such ebbs and flows and offer a measure of security, but these current events have raised the question of money. Many people I know are pursuing the heavy hitting specialties: orthopedic surgery, ophthalmology, dermatology, radiology. These "lifestyle" specialties were never attractive enough to me to pursue them, but I wonder: what makes them so high-paying? Should they be so high paying? Or should there be more balance compared to those in the front lines, the primary care physicians?