how important is salary?

I think the salary definitely matters... its just like what you can say about give and take... If you are putting extra efforts, taking extra stress, less vacations, less time with family.. then you ought to be paid good... It doesn't mean I am doing orthopaedics just for money... I love being an Orthopod but if I am not getting enough for what I am doing, then I ain't gonna do it.
I would rather do something like PMR and just enjoy with my family and outside the hospital then.

you all make me sad ....

if money was the issue, you should have gone into business. it is a sad state of our youth today and the new generation Y.

if you are really concerned about money, medicine in general will really disappoint and frustrate you.

the business side of medicine takes away the heart of medicine. remember you should feel privileged when a patient accepts you as their physician.

love what you do ... the money will follow ... if you are concerned about money ... go into radiology or anesthesia ... where u have little patient meaningful contact

The way I think of it is about VALUE not necessarily money or salary. We, as physicians, are at the center of this health care industrial complex. Things dont move or happen unless there is a physician to sign on to it... I mean everything. Thinking of it that way, physicians are grossly under-compensated for the value-add, they bring into the system. Even taking a look at the negative part of our system, malpractice, requires a physician on both sides. No one can bring a malpractice case to court without a physician beside them. Yet even in these cases, physicans are usually paid a nominal fee (like 10-20K), not a percentage of the award which is how the lawyers are paid. At some point, it's not even about the salaries- they are only representative of how much power we are losing in this system.

One concept that gets lost in thinking about salaries is the time value of money. 300K in 1990 is not the same as 300K in 2010, in real and nominal terms. So for an entering orthopod to expect making 300k in 2010 baffles me. I am not saying it is not enough to live by but our compensation is going down, not staying the same. Our salaries don't even account for inflation.

Lagbaja, brings some very important issues to the table.

Staff, I am moved by your, "you should feel privileged when a patient accepts you as their physician" speech. But it is not unreasonable for orthopods and physicians in general to care about falling reimbursement and the business side of medicine. Too often, fellow "hollier than thou" physicians and society in general make the medical community feel somehow guilty about caring even an ounce about money. To address financial issues within medicine does not mean one doesn't love their job, is less devoted, or cares any less about their patients. To assume that "generation Y" has their priorities screwed up because they (we, although I am well beyond generation Y) discuss VERY REAL financial concerns is conceited and judgemental. While not always the case, usually those who chastise younger physicians who discuss financial issues are older orthopods and physicians who practiced in the "golden age" of medicine, have made their retirement, put their kids through college (or at least have a good start) and have paid off their virtually non-existent med school loans. In these cases, it makes the one criticizing appear at best hypocritical. It is easy to criticize others for caring about money when you are financially set yourself.

Let's look at a basic FACT. Physician reimbursement as a whole in 2006 was DOWN 17% from 2002 and continually merging insurance companies posted record PROFITS during this time, all the while health insurance premiums have increased. While orthopods are still earning a decent living, look at our colleagues in FP and Peds who spend nearly as long in post-undergraguate training and earn less than some of the drug reps bringing them donoughts and certainly less than the guys opening boxes of implants in the OR. That is the real "sad state" of affairs in our society, and not the "Youth" or "Generation Y's" attitude as "Staff" would imply. I am not knocking those people for their ability to earn a living. They certainly have the right to earn whatever the free market can bear. But so do physicians. But if we continue to IGNORE financial concerns because of some unspoken sentiment that it is somehow wrong, the situation will only worsen, ultimately leading to an increasing shortage of those physicians, and ultimately adversely affect patient access to health care. Physicians should not be criticized for efforts to take back some of the pie from the government and insurance companies, because just like every other sector of society, no one outside of the physician community will care enough to make any effort to protect physican income other than physicians themselves. Politicians aren't going to do it. Nurses aren't going to do it. Insurance company execs aren't going to do it, etc.

Orthopedics is not immune to the phenomenon. In our institution, a level one trauma center, we have been looking for YEARS with futility to add trauma trained orthopedists to cover difficult cases. Because of the government regulated STARK laws, our hospital is not allowed to offer an orthopedic traumatologist any more than what any busy general orthopedist could earn in a small community. This is happening nationwide as many centers struggle to find trauma coverage. If the government would relax the restrictions, hospitals could then pay whatever the market could bear for a traumatoligist. Of course, at first it would be an obscene amount of money, but eventually as salaries rise, more residents would pursue trauma fellowships and the shortage corrected, with salaries eventally correcting to reflect the supply. That is how every other profession is allowed to operate in a free market system, but not medicine, and not orthopedics. As a result, more patients suffer from a lack of access to trauma trained orthopedists. This example could easily be applied to physicians as a whole.

So, although I apologize for the rant and the long winded post, in summary, I will NOT apologize to "Staff" and others like him or her who stand on their throne and cast stones at younger physicians who look to preserve their livelihood. Ultimately, it is patient care that is at stake.

That is all.

-ED

i guess i must respond to earthdawg's "hollier than thou" physicians, discuss VERY REAL financial concerns, and the grey haired comment.

i would like to just put out there i personally was not around in the golden era and i would appreciate some grey hair it would make me look older, but i appreciate that you putting me in the class of the grey hairs.

i guess i have to do the 1 2 3 thing ...

1. my point of criticizing the younger generation for looking at the dollars and cents is that medicine itself regardless of specialty has taken a hit financially. so, that as a primary factor or one of the factor in having someone chose a specialty sadden me.

2. the shortage that we in orthopaedic surgery are having in the areas of trauma and my area pediatrics; and the large amount of people now going into spine and sports really speaks to people following the dollar. there is a glut of sports physicians, yet in trauma and pediatrics there is a great need. can it be only money, most certainly not. but, i am sure if the income was same more people would consider the currently needed subspecialties.

3. most physicians now are not "salaried" unless they are in the old academic system, or an employee of a hospital. most physicians are in a system which is incentive based, meaning you get a percentage of your collections; or a straight, you pay your overhead with you collections and the rest is yours. so, going into a specialty for a specific salary is kinda misleading, because there is now salary; the quotes you may read about usually it has to do with the initial salary with incentive based on performance and collections. most of the money discussions depend on the practice, the location, our payer mix, etc..

4. money should always be a concern. i would agree with everyone. but, i would like to say that if money was a primary concern, business is probably an easier way of going about it.

5. as far as throne, i personally don't own one or choose to. i did not intend to cast stones at young physicians. but, it does disappoint me that so many would choose not to be in a specialty because of money.

as for me, i will continue to do my menial "job" as a lowly pedipod. dealing with out 60% medicaid population (0%medicare which is actually a good payer) and truely loving what i do. i will continue to pay my medical school loans on time. ... and one day i too will be financially set as my fellow classmates in there sports practices with their surgery centers.

i will continue to try try to inspire my students and residents to love the field of orthopaedics. and encourage them to challenge the status quo.

Don't you love how people learn to provide very long arguments on a WIDE range of topics, and then conveniently back them ALL up with a quote about patient care.

Has anyone considered that we, as physicians, aren't providing as much "value" to society as we used to? Patients ARE getting more resourceful and aware that the MD doesn't always know best. Paternalism is decreasing, and patients trust their doctors less, and rightfully so much of the time. Physicians in the United States over the past 50 years have benefited from overcompensation! I believe this is society's way of finally telling us that they know we aren't worth as much as we would like to think. When we finally figure out a good way to align patients decisions in pursuing healthcare with the actual value they place in it, then it might just blow your socks off.

If you really believe all you say, and if you REALLY HAVE PATIENT CARE AS YOUR PRIORITY, then it is quite clear that we need you lobbying on capitol hill to save the healthcare system. Hell, you could make a lot more money doing that as well, and according to your logic, you would improve the health of patients in our country. Get paid more and do more to benefit patients than you will as a practicing orthopod?

I would be interested in learning why your healthcare organization hasn't figured out how to deal with the provisions of the STARK law(s), whereas so many others across the country have modified their arrangements with physicians in the community successfully. It is fitting that you bring up the STARK law, being so concerned about money. You sound like exactly the type of physician that got us in so much trouble to begin with. Come on, let's hear about how you can complete your decision making without considering how it will affect you financially???

Well, maybe there will be room for another boutique surgery center for you to open, and you can leave the complete care for society's health to us. After all, it would be best for the patients in the end if you weren't involved.