I came across a heated newsgroup thread related to a recent survey comparison of medical specialty salaries and the revenue that each specialty generates for hospitals. Overall there is a general correlation between higher hospital revenue and higher salaries, but there are some outliers. According to the data, ophthalmologists generated one of the least amount of revenue for hospital yet reported income that was in the middle of the pack. You can read the official survey data on Merritt-Hawkins.
Naturally, there was some animosity from those specialties who felt short-changed by the system. Why would a certain field be compensated more for contributing less to the system? The devil in the detail, of course.
This topic presents a good learning opportunity for all doctors.
A study is only as good as the data given
We’ve all taken part in clinical or laboratory research at some point in our lives. Some of us conduct research in our jobs. We all know that variables need to be controlled, and shoddy survey research is only as good as the respondents’ responses.
In this survey, both hospital and office-based specialties are lumped together. Certain medical fields like dermatology, ophthalmology, and psychiatry are office-based fields. For the most part they function independently of hospitals, and generate revenue from professional charges as well as ancillary services. They do not typically bring in much revenue to hospitals.
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Why? These specialties are unique:
- These specialties typically do not consult other specialties, so the referral chain ends with them.
- These specialties typically do not order high volumes of ancillary testing such as lab work or imaging.
- Procedures that these specialties perform can typically be conducted outside of the hospital. Anything done outside of the hospital translates to zero revenue to the hospital.
- They’re also not likely to be employed by the hospital either.
If you look back at the survey, a field like ophthalmology isn’t going to bring much revenue into the hospital. An ophthalmologist isn’t likely to be employed by a hospital either. So the reported salary of an ophthalmologist isn’t likely to have any correlation with hospital revenue at all.
In contrast, neurosurgeons employed by a hospital are going to be more common. Most of their surgeries are performed in the hospital, and their work brings in significant technical revenue to the hospital. A hospital could contract with independent neurosurgeons for their services, but from a business standpoint employing the neurosurgeon would give the hospital much more control.
Key points in the business of medicine
It’s never a good idea to make career decisions based on money especially in medicine. What might be a hot field with great compensation may no longer be the case your entire career. The key points I impress upon my students to assess are the following:
- You need to choose a field that you enjoy.
- Once you’ve narrowed down your potential options, get a sense of what you can do with your expertise. Inpatient, outpatient care? Lifestyle?
- Understand how one’s skills within a profession translates into income. You don’t have to understand everything, but getting a head start will allow you enough time [read: years] to synthesize the right questions to ask in the future.
If your career specialty is already set, it’s not too late to reassess what you understand or not about your field. If you are an internist, you probably already have a good sense of job options available like outpatient care or hospital medicine. Study how revenue stream occurs. Figure out where the middlemen are, and ask yourself if you are okay with how the system you are in works. Realize that not every one of your peers will share the same values that you do. Make sure that whatever you decide to do helps to preserve your profession. I’ve seen plenty of doctors “sell out” their profession to make a quick buck. Don’t be that gal. We’ve worked too hard to throw away everything.
The bottom line? Don’t get mad if someone else seems to work less and earn more! If that is important to you, figure out what you can do to make it right! You’ve got an entire career to do it.
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