Can a doctor break even at $47.50 per hour?

People literally can’t stop talking about Dr. Keith Smith’s defense of his right to earn a fair wage.

In addition to complaints about welfare bums and greedy doctors, there are many thoughtful comments. We are highlighting the best ones, including this one from primary care doctor, “clicky.” Be sure to check out the hourly wage comparisons at the end of the post.

To share your ideas on doctor pay or the patient ROI on healthcare, email me at [email protected], or comment on this post.

“Perspective is everything!


I’m a primary care doctor who works in the hospital and office (and, yes, I treat Medicare patients. Also, I’ve cared for patients lacking insurance and have never received a dime for treating those patients).


1. Four years college.

2. Four years med school ($50,000 a year fully out of pocket, not having received any taxpayer subsidies).

3. Four years residency (working 80-hour weeks at roughly $10 per hour). For many specialists, residency is five to seven years. Some go on further to do one- to three-year fellowships.

4. $300,000 debt after finishing medical school.

5. Weigh the opportunity cost of this education (my computer programming/engineering friends in Silicon Valley having been making $50 per hour for the last 12 years in which I’ve paid $300,000 for my further schooling).

6. Studying four to six hours a day for many exams, including paying to take (and attend Kaplan review courses for) the USMLE Step 1, 2 and 3.


1. $8,000 rent each month (roughly $100,000 a year).

2. Three office employees (roughly $150,000 a year for receptionist, medical assistant and medical biller, including their health insurance, Social Security, 401(k), disability and other benefits).

3. EHR ($40,000 for the first year, then monthly for IT/customer support).

4. Miscellaneous (e.g. office supplies, office furniture, office utilities, multiple phone/fax lines, multiple computers, medical equipment, injectable medications, my licensing/credentialing/malpractice fees, etc.).

5. Annual overhead expenses roughly $300,000.

6. Making $285 over six hours ($47.50 per hour) is nice, but won’t allow me to even break even with the office expenses. That is why many doctors don’t accept Medicaid (and possibly soon to be Medicare) patients, because for each patient you see, you lose money. Obama has promised to cut Medicare reimbursement to hospitals and physicians even further, which will likely close many doctors’ offices and clinics. Medicine is a business like any other. There are rich and poor doctors, just as there are rich and poor artists, musicians, business owners, or any other profession.

7. Doctors’ visits are expensive because of the litigious environment that exists in the U.S. When I treated patients in rural villages in India, you don’t have to charge as much because the overhead is less (OK, I treated them all for free after the 2005 Tsunami). The good things is that I had no worry of being sued by these villagers. The bad thing is their poor access to medical care, as many hadn’t seen doctors in years, and would never be able to get to a cardiac cath within the one-hour standard for treating ST-elevated heart attacks.


1. My guitar teacher: $40 per hour

2. Physical therapist: $45 per hour at Kaiser Northern California

3. Pharmacist: $55 per hour

4. Acupuncturist: $65 per hour

5. Chinese herbal medicine “doctor” in Bay Area: $60 per hour

6. Chiropractor in San Francisco: $85 per hour

7. My computer/engineering buddies average $70,000 to $120,000 annually since graduating college at 22 yrs old.

8. My dentist charged me $200 for 15 minutes of face time

9. NFL referee: $200,000, up from $150,000

10. Investment bankers: $150,000 to $300,000-plus

11. Senior architect engineer: $200 per hour

12. My malpractice attorney: $310 per hour (haven’t been sued yet, thankfully)

13. Mitt Romney: $42 million in 2010 and 2011 (paying a 14 percent tax rate)

14. Alex Rodriguez: $29 million ($275 million over 10 years), not including endorsements

15. Justin Bieber: $55 million ($300,000 per show)

16. Oprah: $290 million

17. Dr. Smith as paid by Medicare: $47.50 per hour — edited to add

People were upset about Dr. Smith complaining about making $285 over six hours. Get a grip!

Perspective is everything!”

Comments have been edited for clarity and length.
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