I am a surgeon. I went to Wake for undergrad and med school ($400,000). After next year, I will have completed 7 medical board standardized exams (4 of them extremely stressful), each one costing approx 1,000 dollars. I started residency at the age of 26 for my first real pay check (approx $50,000 a year). I also live in a city which has a high cost of living. I worked 80 hrs a week for 5 years, not including research, studying, administrative work and practicing surgery outside the hospital. Now I am going through another 2 years of fellowship. After 9 years of training after college, I am married with a son and living in an apartment. I can get called at any time at night and often do. I take calls that are 30 hrs long and get little to no sleep during those calls. I get 4 days off of work a month. I haven't had Christmas off in 5 years. My experience is not unusual for a surgeon. There is a lot of delayed gratification.
Also, just having a specialized skill brings in more money to the hospital than you could ever bill. Hospitals offer services to insurance companies and their customers. If the pediatric cardiac surgeon retires, then the hospital cannot offer that particular service and the insurance company will pay the hospital less for all of the other services. That is why Wake Forest has more negotiating power than a community hospital. It is very easy to replace a primary care doctor. It is very difficult to replace a pediatric cardiac surgeon. I have over simplified the situation, but you get the idea.
One way to decrease the overall cost of medicine is too decrease physician salaries, but it will be indirect. There will be less physicians doing less work, which will limit access to medical care. If you want to limit access to medical care to cut costs, why not just limit the number of physicians going into certain specialties and keep salaries high?
Also, just having a specialized skill brings in more money to the hospital than you could ever bill. Hospitals offer services to insurance companies and their customers. If the pediatric cardiac surgeon retires, then the hospital cannot offer that particular service and the insurance company will pay the hospital less for all of the other services. That is why Wake Forest has more negotiating power than a community hospital. It is very easy to replace a primary care doctor. It is very difficult to replace a pediatric cardiac surgeon. I have over simplified the situation, but you get the idea.
One way to decrease the overall cost of medicine is too decrease physician salaries, but it will be indirect. There will be less physicians doing less work, which will limit access to medical care. If you want to limit access to medical care to cut costs, why not just limit the number of physicians going into certain specialties and keep salaries high?