Physicians And The Code of Silence
Updated: Dec 9, 2018
It is amazing to me that a group of people who can talk about rectal fistulas at the dinner table gets all bashful when it comes to the subject of money. Some of this is our tradition of service, of which we should be proud. Some of this is a lack of training despite many years of education. And some of it just strikes me as old-fashioned prudishness.
I have brought up the subject of compensation with colleagues and been met with uncomfortable silence. I once went through a formal, daylong interview for a position and not one of the three people I asked could tell me what the salary was. They wouldn’t even tell me the range of salaries of their current employees.
This is why people with finance degrees make fun of us when we aren’t around.
The two most readily available national salary surveys, Medscape and Doximity, are pretty much useless for individual job hunters. There are too many variables in each position to make generalizations helpful. The data in the MGMA survey is better but costs thousands of dollars to access. What you really need to know is how much physicians in your specialty, your city and with your schedule – in other words, your colleagues - are making. And they aren’t saying. Here are some reasons why this is a problem:
Divide and conquer. It is in the interest of practice administrators and employers to keep us in the dark about salaries. If none of us know what our colleagues are making, we are more likely to accept salaries and benefits that don’t reflect our worth. Add to this the newish trend of private equity groups buying existing medical practices. These groups are looking for a return on their investment, and one way they can do this is by bringing in new residency graduates at a significant discount to the more senior doctors. We should give these new attendings fair warning.
Gender and race disparities. Studies have shown that women earn less than men, and that people of color earn less than whites. There are still docs claiming “that’s because they are less productive!!”, even though all the data are corrected for RVU, academic vs private practice etc. We need more, and more transparent, data.
Financial illiteracy. If you found out a colleague is making 20% more than you are, you would probably want to know why. Maybe it’s because she has mastered coding in your specialty. Maybe if you buy her a coffee she will show you how to do it too.
Overconsumption. Physicians already tend to overspend on status symbols. I think this tendency gets worse when the only ways to measure wealth are external: the car you drive, the house you live in. Of course, the real answer to this is to ignore the external trappings of wealth (and if you don’t know what I mean, go read The Millionaire Next Door), but until we all achieve this level of enlightenment we will be tempted to show off.
Let’s start being honest about the field we are playing on. Medical student need honest guidance choosing their specialities, residents need guidance in negotiating contracts, and all of us need to work together to ensure we are getting paid our due.