Comment by labcomputer
3 hours ago
The dirty little not-so-secret is that we pay doctors too much in the US. To the tune of several times as much as other large developed countries, like Germany, France and England. Medical care in the US will never ever be as cheap as those countries as long as the providers here earn 2x or 3x.
That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created each year).
Another part of the problem is the bloated administrative bureaucracy of hospitals in the US, we well as the fact that you aren't allowed to build a new hospital (and yes, this is actually true) unless you can prove that a hospital is needed in a particular community.
With no competitive market for healthcare providers, nor a competitive market for places where they work, why shouldn't they extract as much as they can from the rest of us?
They get away with it, too, because "medical doctor" is one of the highest trusted and most reputable professions. It's badthink to discuss these things in polite company.
Until we fix those things, it simply doesn't matter how the insurance/payment system works. Every time I hear that we need to get rid of private insurers, nobody can seem to explain how doing that will save more than 10-15% despite the fact that insurance companies have a statutorily-limited profit margin.
The shortage of physicians has nothing to do with medical schools. The immediate bottleneck is a shortage of residency slots. Every year, students graduate from medical schools but are unable to practice medicine because they don't get matched to a residency program. (Some do get matched the following year.) This is primarily due to limited funding from Medicare, although some residency slots are funded from other sources.
https://savegme.org/
I agree that certificate of need laws should be repealed to increase competition between healthcare facilities. That only impacts some states, not the whole country.
https://nashp.org/state-tracker/50-state-scan-of-state-certi...
That's not true. You can look at the residency match for 2025 here:
https://www.nrmp.org/match-data/2025/05/results-and-data-202...
While many specialties are fully filled, we need pediatricians, family medicine, and internal medicine docs. They're generalists and where the largest shortage is. There were 147 unfilled slots for pediatricians, 805 for family medicine, and 357 for internal medicine. They don't have the applicants; it's not the slots.
> There were 147 unfilled slots for pediatricians, 805 for family medicine, and 357 for internal medicine. They don't have the applicants; it's not the slots.
You lost me...from your cite[1]:
I'm curious what conditions merit a "match".
Aren't a lot of these shortages scattered around rural areas where young doctors really don't want to move to? I understand from a buddy who is currently in med school that there are all sorts of incentive carrots being deployed to attract doctors to these underserved communities.
[1] https://www.nrmp.org/wp-content/uploads/2025/05/Main_Match_R...
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My statement above was correct. There are students who graduate from accredited medical schools with MD/DO degrees but don't get matched. Part of that is because some of them simply don't apply to programs that have extra openings. Medicare / Medicaid pay primary care physicians below market rates so students are naturally reluctant to pursue those specialties.
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But aren’t the specialities where the highest salaries are? So to reduce costs, shouldn’t those have more slots?
Doctor salaries alone do not account for the hundreds of billions in profit that health insurance companies extract from us. You are right there is not a competitive market place because the US government cannot provide a universal plan for anyone. We all know the insurance companies would fold overnight as government welfare programs are extremely popular (just look at how much corporations love government welfare).
Odd how the most popular programs in the US, social security + medicare, are the ones with zero means testing.
Maybe let's not blame one of the few only noble professions left in our greed fueled world.
Blame the hospital administrators or pharmaceutical reps before you start blaming doctors.
It’s a red flag whenever someone talks about healthcare and they focus on health insurance companies and hospital administrators. It’s a sign that they’re working backwards from some ideological beef rather than looking at where the costs actually are.
Health insurance companies have profit margins around 5% or less. Hospitals are half that. A Subway franchise has a higher profit margin. That’s just not where your healthcare dollars are going.
Hmm...sniff test sampling:
- HCA[1]: FY25 profit margin = 9.0%
- UHS[2]: FY25 profit margin = 8.6%
Yeah, a bit of disaggregation is needed here, but in these companies, labor expense as a percentage of revenue is on a declining trend YoY while revenue continues to grow.
What's the prevailing ballpark ratio of doctors to all other hospital staff again? And what details are buried in that ever so opaque and increasing "other operating expenses" line item?
[1] https://www.sec.gov/Archives/edgar/data/860730/0001193125260...
[2] https://www.sec.gov/Archives/edgar/data/352915/0001193125260...
The issue is not that health insurance companies make too much money (ok, it's not the only issue)They, along with the system they put in place introduce immense amounts of friction into every medical interaction and prevent doctors from practicing good medicine.
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The problem is that health insurance companies squander immense amounts of money on adjudicating claims. Huge amounts of GDP are spent on fights between insurers and providers over what is covered.
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That is no longer true. What we have historically referred to as “health insurance” companies responded to ACA margin limits by becoming sprawling behemoths whose rampant self-dealing makes such profit margin calculations meaningless.
If you have a fixed profit margin, the way to make more absolute money is to allow your costs to increase. Insurance companies have zero reason to negotiate prices down.
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Show us the data. You want to make the claim, bring the evidence.
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> The dirty little not-so-secret is that we pay doctors too much in the US.
Doubt.
> That's partly because we have a doctor shortage here (medical schools collude to limit the number of new doctors created each year).
Now explain this trend[1].
[1] https://fred.stlouisfed.org/graph/?g=1T22Y
No, they are not paid too much. There's a lot of incorrect assertions here, so it'll take a lot to work through them.
Physician pay depends on specialty, but it can range from the low $100kish mark for pediatricians to $500-750k for certain kinds of surgeons. Family medicine tends to be around $200k. However, this amount ranges vastly by market and top pay often goes to those willing to work in more rural hospitals because no one wants to. For example, pay in NYC for physicians is appalling low compared to the rest of the U.S. market. In addition, certain systems have hard caps. For example, the VA hospitals cap physician pay inclusive of bonus at $400k. This is documented and you can in fact just look up a random doc at the VA with one of the many federal pay search tools.
While some doctors can make more, it typically because they own a practice and that increased pay comes from good old fashioned capitalism. Meaning, they tax the amount their nurses, NPs, medical assistants, etc. make just like all businesses make money per head on their employees. Whether you believe this is right or wrong is up to you. However, this is not any different that someone who runs, for example, a yard care business. More accurate pay can be found by those who work directly for large hospitals.
Next, the cost of medical education in the United States is vastly higher than other countries. Right now, medical school will cost you somewhere from $400-600k. This is in addition to whatever debt accrued during undergraduate. Further, medical school applications are highly competitive, so students often accrue additional debt by completing a masters in something like public health prior to entry to medical school. This means that someone may have upwards of $750k of debt when they finish medical school, but they still have somewhere between 3-10 years of residency and fellowship before they make attending money. During this time, the debt accrues interest and balloons.
Now, once you become an attending, you're still not good and expenses are vast. Shift work can vary from something like 7 12-hour shifts in a row for intensivists to 14 shifts in a row for hospitalists. Note, just because it says its a 12-hour shift doesn't mean you work 12 hours. They still need to chart and bill and if it's busy, that may be another few hours after the shift is over. In some remote clinics, an ER physican may work 7 24-hour shifts in a row. That may sound absurd and unsafe and it likely is, but it's the reality of the work. If someone is working that schedule, they have increased expenses to just, frankly, live. On the low end, it's very difficult to cook in that environment, so you have to buy a lot of premade food. On a more expensive end, having children on this schedule is extremely difficult. You either require a spouse that doesn't work or you need something like a night nanny. If you're working 12 hour shifts, you must sleep at night and you can't be up to take care of a baby otherwise you run the risk of killing someone the next day. Unless you're paying someone under the table, current nanny rates in large markets are about $20-25/hour. Insurance rates are also high. I don't mean malpractice either. Generally speaking, one needs to carry disability insurance because if one gets into a car accident and breaks their magic hands, there's no way to pay back that debt otherwise. These policies are thousands a year. That's just the start. They pay a large amount of money to buy their time back because they don't have it.
Next, there's a myth about limiting residency slots in order to increase pay, at least recently. I will not defend the AMA and some of they took, especially in the 1990s. Here's the 2025 residency match data:
https://www.nrmp.org/match-data/2025/05/results-and-data-202...
The number of offered and filled slots is on page 2 (or 13 depending on how you count). Some specialties filled all of their slots. Where the U.S. vastly lacks is pediatricians, family medicine, internal medicine (who can work like family medicine if need be.) Pediatricians had 147 unfilled slots. Family medicine had 805 unfilled spots. Internal medicine had 357 unfilled spots. These spots can be filled by people who graduated from U.S. medical schools, island medical schools, Mexican medical schools, or a vast array of other foreign medical schools. However, they're not filled because they don't have the applicants. That's not medical school collusion. That's the hard reality that medical school is extremely expensive and the training is extremely long.
Now, how do other countries handle things? One, their medical school is not as crushingly expensive. Two, places like Europe cap the number of hours a physican can work. If you want to pay American physicians less, you'd need to blow out their medical school debt, reduce their hours, and offer better benefits. Until then, no, really, they're not overpaid.
If you want to start pointing fingers, try the vertical integration of insurance companies, pharmacy benefit managers, and hospitals. I don't have the numbers readily available, so I'll stop here. But, really, it's not the docs.