The AMA has pushed for years to artificially restrict the number of physicians that universities are allowed to push out. If I recall, that number has been held steady for a couple decades or more.
As of a few year ago, anyway. I haven't been paying attention recently and the situation may have developed.
[1] https://www.stlouisfed.org/on-the-economy/2023/feb/nominal-w...
According to one historical physician earnings survey [1]:
> During 1987-1990, median earnings for physicians were $143,963 (interquartile range, 96,718-175,850) compared with $157,751 (IQR, 101,279-203,281) during 2006-2010 ($13,788 increase or growth of 9.6%; P < .001).
If we take the most conservative time interval (1990 to 2006) and plug it into the Bureau of Labor Statistics CPI Inflation Calculator [2] we see that the median 1990 physician wage would be equal to 224,080 in 2006 dollars.
Median physician wages as of now are $229,300 (2022) according to the BLS [3] or $255,200 (2020) according to the US Center for Economic Studies [4]. Plug that into the CPI Inflation Calculator, and the 1990s median amounts to 291,509 in 2020 dollars. So yes, physicians have seen a sizable decline in real wages over the last 35 years. Americans overall saw a significant uptick in real wages in the same time period. Per capita healthcare expenditure has also gone up significantly in the same time period.
Also, when discussing physician compensation, it's important to remember that there is a very heavy rightward skew. Mean wages are not representative of the typical physician. According to the CES report [2], the mean physician wage is $343,600, while the median is $255,200. This is why you will see dramatically different "average" numbers on physician wages in different outlets -- you should always check if it is a mean or a median.
[1] https://jamanetwork.com/journals/jama/fullarticle/1456053
[2] https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=143%2C963.00&y...
[3] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
[4] https://www2.census.gov/ces/wp/2020/CES-WP-20-23.pdf
[5] https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=143%2C963.00&y...
Fun examples -
My dentist has a waiting list of like 3-4 months to schedule a cleaning, so if you don't schedule the next one as you leave, you'll be out of luck later. HOWEVER, if you opt for any of the elective procedures (ortho/veneers/etc) they have vast availability and can take you next week. Funny that. And this is the third or fourth dentist we've used in the city, after dealing with both negligence and worse overselling elsewhere.
In my condo there's a dermatologist specialist that makes enough money to own two homes before 40 and operate his own practice in Manhattan & in the rich suburb of his second home. He always seems to be home by 6, and the last time I saw him, he was wheeling one of those coolspa coolsculpting machines around in his newest truck..
My previous GP was great but she only worked 2-3 days/week.
My GI is great but while its hard to get in to see him, he'll get you booked for a colonscopy/endoscopy ASAP at the clinic he also owns across town.. and the followup appointment to read you the results. All about that ROI and $/hr maximization.
Glad that I’m not the only one who notices this drop off in practitioner quality and focus on upselling. The only thing they even discuss at dentist visits are the optional, expensive cosmetic treatments. When you make it clear you have no interest they end the conversation and leave.
It’s like they have all bought the same practice management course. Once you realize what they are doing it feels very sleezy.
I can't speak to dentistry, but physician income tends to be lower in HCOL areas because they tend to be oversaturated with physicians and thus fewer patients per physician.
It's paradoxical. It's the reverse trend of almost every other profession.
As for why for physicians to live and work in HCOL areas, it tends to be more about personal life. For example, if your spouse has a tech job, you may find yourself to the Bay Area even though your income potential as a physician there is much lower than it would be in the Central Valley. Or you might prefer the public schools in the HCOL areas. Or maybe you prefer to live in an HCOL area to be close to family. Or maybe you like to travel and prefer not to be a 5-hour drive from the nearest international airport.
This might be true for primary care and family practice. I don't think it's true for specialities. And part of why it is true for primary care is because nurse practitioners can do that job now.
What has changed is most physicians no longer work for themselves or for physician owned groups. Working for private equity will burn anyone out. Physicians also spend more time overseeing cheaper midlevel practitioners. That itself could be a source of increased burnout (got into the job to treat patients not manage midlevels), but the second order effect is that their direct care patient mix has shifted higher acuity (potentially more stressful to handle) patients.
Do you have a source you can point to? This is the opposite of everything I’ve heard or read.
Back in the 80s and 90s, it was projected that there would be a physician surplus about 10 to 20 years down the road, so the AMA advocated cutting the number of residency positions [1, 2]. But those predictions didn't bear out, and in recent years (about the past 10 years), they have advocated increasing the number of positions [1, 3]
In my opinion, a lot of the talk about artificial physician scarcity is BS. We have more physicians per capita than the UK, Australia, or New Zealand, but fewer than most EU countries. So we are roughly in the middle of the pack for developed nations. The problem is not a lack of physicians, but the fact that the US has a much larger rural area than most other nations and that you need a certain density of physicians in those areas. But you can't fix that simply by training more physicians -- you train more, and they'll predominately move to the cities too for the same factors.
[1] https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...
[2] https://www.openhealthpolicy.com/p/medical-residency-slots-c...
[3] https://www.ama-assn.org/press-center/press-releases/ama-fun...