I have not read the article yet, but I will shortly. But I wanted to put myself on the line before I read the actual figures(if it gives actual $ earned): I bet the reported figure is much lower than IT ACTUALLY IS IN REAL LIFE. It probably is very hard to get the true numbers. Having spent 36 years as a pretty high salaried non MD anesthesia provider( i.e. CRNA), I have some pretty good insight into the kind of money involved. Most of those outside of medicine, earning a living as an engineer or electrician or teacher or laborer such might be blown away by the money involved.
So why can't most of us know the actual figures? Most doctors are business men who own, or are partners in, their own corporations. So they have all kinds of ways of hiding their true income. They might pay themselves a salary, but the rest of the money is socked away some where else.
But just do some simple math to figure out what it should add up to. This example, plastic surgery, is not a good one, as they usually get what they charge insurance be darned. But I am having trouble quickly finding the info on others. Still, gives you an idea, and also very often 100% of these fees are paid up front by the patient whether or not insurance pays anythingwww.plasticsurgery.org/Documents/news-resources/statistics/2013-statistics/cosmetic-procedures-average-fees.pdf
Please notice that the average surgeons fee for a breast augmentation is $3700 and a breast reduction is $5200, a nose job(Rhinoplasty) is $4500 and eyelid surgery is cheap at $2800.
I have worked with plastic surgeons who operate all day long, some times doing 8 or 10 cases a day, 2 or 3 days a week. Now many of these cases will be more minor than those above, with fees of maybe only $1000 or $2000. Still, he/she might do at least 2 or 3 of the big cases(or more!), so you can see that would be easily 10-15K right there, plus all of the other minor cases. (BTW, look on your RP bill and find your surgeons fee for that. most likely, + or - 8K, range from $4000 up to about
$19,000.though who knows what your insurance actually paid. Much much less if on MCare. But X 3 or 4 a day? X how many days a week?) So, let’s say for the plastic surgeon at 2 days a week at average charge $4000 per case at a measly 4 cases a day: 4KX4X2= $32,000K per week. Thirty two thousand per week! But wait! We are not done by a long shot. What about
his office? Again, if they accept MCare or MCaide, prices will be much lower. But there is(or at least was) plenty of private insurance out there, and plenty of self pay. So how much do you usually get billed for an office visit? How much does your wife pay for the annual GYN checkup? $100? $200? I once had a GYN tell me he saw 100 patients in his office one really busy day, a few minutes each. So lets say $100X100= $10,000. Times 2 days a week? X 3/wk? And often these surgeons are also performing office surgery and that needs to be added in.
So just go back to the plastic surgeon above, just count 3 big cases/day for 15K/dayX2 days/wkX 48 wks/year= 1,440,000(1.44 million) per year. Now add in office revenue, which could easily match the above, but certainly adds a good bit. I wonder if plastic surgeons were listed at well over a million per year in the article? I will see shortly.
Now lets go far to the other extreme. I used to go down to the MS Delta to do full mouth restoration on poor kids(Medicaid) whose teeth had rotted out. MCare and Mcaid are the worse by far payments a doc can get. They typically pay only a small fraction of what private insurance pays. Still, the dentist/oral surgeon I worked with told me Medicaid paid him a flat $400 per mouth, plus whatever they paid for hospital and anesthesia. I would put them under general anesthesia, he would pull out all of their rotted teeth and pop in some implants. (The kids called it “getting a rack”) This is lowest fee surgcal work, as low as it gets with medicaid. Still, it only took him 10 to 30 minutes per case, and he would often do 10 or 15 per day. A measly $400 X 15 cases/day= $6000 per day. He would drive to various small hospitals across MS several days a week doing this. So lets just say only 2 days a week X $6,000 = $12,000 WEEK. TIMES 48 WEEKS per year = $576,000/ year. Wait! Plus his office on days he is not doing surgery! Have you guys paid for any dental work lately? How about
a crown? This is a dentist guys, working for Medicaid! Are you starting to get an idea of the kind of money involved?(mind you, I am making no judgments about
who deserves what, just stating facts)
Of course, all of these folks have office expenses, malpractice and such, coming off the top. But that is also a way of decreasing reported earnings. Have you ever been in a plush medical office building, maybe belonging to a group of stand alone surgeons? It is often times a big building. Maybe even with some business vehicles associated with it, used for travelling to the hospitals and such. Sometimes these vehicles are new Mercedes. So they might be paying for all of this out of gross earnings, but they still own it.
One last, of which I know a lot. Do you ever see a nurse practitioner or Physician Assistant? Is your office fee any lower? These employees often working in a docs office are normally paid much lower than a physician, but you are still billed about
the same as if you saw the Doc. Take me for example. A CRNA, probably the highest paid of the Nurse Practitioners. For a whole bunch of my years as a CRNA, I worked for MD Anesthesiologists(MDA). rather than for the hospital of self employed, though I did plenty of those also. But, as per CRNAs working for MD Anesthesiologists:health.costhelper.com/anesthesia.html
“For patients without health insurance, the cost of anesthesia can range from less than $500 for a local anesthetic administered in an office setting to $500-$3,500 or more for regional anesthesia and/or general anesthesia administered by an anesthesiologist and/or certified registered nurse anesthetist in a hospital operating room.…………………A 2010 survey by the American Society of Anesthesiologists showed a median of about
$60 to $64 per unit. So, an anesthesiologist might bill $600 for an appendectomy that takes an hour, or bill $2,500 or more for heart surgery that takes six hours.”
OK, here is the deal: The accepted norm is that that an MDA can “supervise” 4 CRNAs at a time. CRNA salaries vary widely with part of country, self employed vs work for MDA, how much call and overtime, etc etc. But let’s just use the gov’s BLS figures www.bls.gov/oes/current/oes291151.htm
for average/mean CRNA earnings: $158,900. Not bad, right? Not bad at all, good work if you can get it. That’s why I am often tempted back out of recent retirement as now, 15 months post RP, I am physically and mentally fully capable of giving anesthesia. Still, lets see how I compare to the big boys, who “supervise” me. Which often meant I may or may not see them a time or 2 during the day in the OR. And let’s just use the lowest figure quoted above of: “$600 for an appendectomy that takes an hour”. (go take a look at your MDA + CRNA bill for your RP. They are usually split, even if the great bulk of it ends up going to the employer/supervising MDA or hospital) I can tell you that with a fast surgeon I have often done appys in well under an hour, all day long. So, $600/hr X 4 rooms/CRNA= $2400 hour. X 8 hrs/day= $19,200 day. X 5 days a week in a busy OR= $96,000/wk. X 48weeks/year= $4,608,000 per year(4.6 million) Can you even comprehend such money? Most folks can not.
Now minus the overhead, the 4 CRNA salaries: $4,608,000 minus ($158,900X4)635,600= $3,973,000. Now even after you knock things down for no pays and what insurance will pay and self pays and down time and $100,000 for malpractice insurance, you still have to have 1+ million available for 1 supervising MDA, maybe a lot more.
Now I am going to the article and see if it even hints at this kind of money for anesthesiologists or other docs. All previous lists of this I have seen were a farce compared to what I knew to be the case. But figures closer to mine explain why the ortho surgeon I worked with up in ******** not only had a million dollar house, but at least one million dollar vacation home on the beach and a jet airplane plus pilot to fly his family to it. You don’t do that with a mere $250,000/year. This is also something to keep in mind when you ask a surgeon if you should have surgery, or whatever specialist if you should use their specialty. It takes a fairly righteous man to tell you that you don’t need his multi-thousand $ procedure if it is at all debatable.
And why would a female surgeon or anesthesiologist make a dime less than a male? Do they charge less for their services? If they make less, it is because they choose to work less.