Be careful what you, or your family, wish for

Another great story comes to me from a psycho-geriatric psychiatrist I respect a great deal. He's full of pearls of wisdom and a fountain of knowledge about obscure clinical syndromes. He also has lived an interesting life.

Flash back to Chile, many years ago. In that country medical students enter medical school directly after secondary school. Our young doctor-to-be is 17-years-old when he starts, and still barely shaving when he graduates at 21. Instead of completing his residency, he goes off kibbutzing in Israel. He is having a great time, and those stories are best left for another time. In this story he find out that he's been drafted by the Israeli military as the Arab-Israeli war has just broken out.

Our poor doctor is now sitting on a hill as a spotter for an artillery regiment. He looks through his field glasses and in the distance he can see the enemy lines. Imagine the horror felt by his family when they hear he has been drafted, they quickly mobilize and call up the Israeli army.

"Do you know what you have done? You have drafted a doctor! You have a physician working in an artillery regiment!"

The military, sifting through their paperwork, realize the asset they are squandering. Our young doctor is removed from the artillery lines and welcomes into the military as a doctor. In an armoured regiment. On the front lines. Now he can pop his head out of a tank and see with his own eyes the enemy, no binoculars required. In fact his task is to inoculate all the armoured soldiers - which requires him, on the front lines, to leave the "comfort" of the tank and scramble to each one individually.

You can just imagine him, screaming and waving his medic bag, as he darts from tank to tank, "Open up! I'm a doctor!" Nice that he made house calls.

Nurses earn more money than doctors?

I recently saw an article on Yahoo with the headline of nurses being paid more than doctors. The title is misleading, the actual article goes on to explain that Certified Registered Nurse Anesthetists (CRNA) make more money than family medicine doctors. It's a poor comparison, CRNAs have an extensive (and expensive) education and do not represent the earning potential of regular nurses. Family medicine physicians are the lowest paid doctors and do a year less residency than other MDs. Let's see a better comparison:

Salary data for Surgeon, Family Medicine, and RN come from the US Bureau of Labor Statistics (BLS), the CRNA Yahoo article quoted above. I note that the BLS reported a lower figure for family medicine than the article. I also note that physicians are paid during their residency while the CRNA is free labour during their MSN.

I am, in no way, denigrating the family medicine physicians. They are in short supply, not because of the lack of demand but the lack of interest by many medical students to enter the field. Prestige and additional money await specialists and bright students are encouraged to actively avoid the role of primary care medicine. High office overhead with an ever-increasing bureaucratic maze created by private insurance companies makes primary care less attractive as well.

I also suspect gender has a lot to do with this issue. Women now outnumber men in medical schools while men are entering nursing in larger numbers. Any field that is dominated by women has traditionally been poorly compensated. Doctors in Soviet Russia had little prestige and were very poorly paid. In all specialities except surgery. It is no surprise that the ranks of physicians were mostly filled with women except for surgery - almost entirely male. I see more and more of a slide in the salaries of Western doctors in the future. I also see continued improvement in the remuneration of nurses as more and more men enter the field.