In which area of medicine is a doctor best rewarded?

Maybe there is a hierarchy of medical roles which is somewhat reflected in pay for different specialisms. In the US, for example, the pay scale for hospital doctors puts invasive cardiology at the top with annual pay of over $500,000 a year whereas lower down the scale is dermatology and anaesthesiology with pay in the US of about $340,000 per year on average.  Surprisingly perhaps general surgeons are ranked below plastic surgeons and radiologists in average pay.

In the UK, the pay system is less transparent because of the interplay between the public and private systems. An NHS hospital doctor doesn’t earn more than about £100,000 in basic pay, but with the merit system they might well be paid an extra £80,000. And on top of that, there might be private work where some disciplines have plenty of possibilities and others practically none. GPs have surprisingly high pay with recent reports showing that over 200 of them earn over £200,000 a year and some earn twice that amount – partly because the set-up of GP surgeries makes them more like businesses, with income per patient of about £150 a year – so practices with large (and healthy!) patient lists can do very well indeed. A linked pharmacy owned by the practice can increase GP pay significantly.

Reward for doctors isn’t just about money: for most medics it is more about quality of life and job satisfaction. Some doctors disciplines like dermatology are attractive because they are mostly daytime and weekday jobs, and there is very little need to be on call or to do gruelling shift work. Emergency medical work is clearly at the other extreme, but can be more obviously life-saving, and obstetrics is similarly 24-hour with frequent life or death decisions.

In terms of reward, many doctors will want to be in charge of their patient or at least have a meaningful say as part of the medical team. Surgeons clearly have that feeling of being in charge but the risk is that they exclude others with the thought that everyone is just there to support them. Some studies have indicated that this sentiment may be detrimental to the patient’s best interests. Patient outcomes might be improved if surgeons asked the anaesthetist what he or she thinks rather than just seeing them as having a narrow role.

The hierarchy of reward for the doctor may be very different from the hierarchy of demand for doctors. One observer recently told me that cancer gets a disproportionate amount of funding because it’s a disease of the middle classes, and that diabetes – which is often a problem for those with poor diet and fitness – gets a correspondingly lower financial input.

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