Why do Internal Medicine doctors make so little?

Question

I read on wiki answers that Internal medicine makes only about 150,000. Sure, that's not that little, but I also read that doctors specialized in Anesthesiology make about double. Isn't that kind of strange? What exactly do doctors in Anesthesiology do? Numb pain with needles?

Answer 1

Marie is right.

Internists have it bad.  Insurance companies tell them how to practice and what medications they can and cannot prescribe for a given patient (regardless of what is best medically).  The legal climate dictates that they order tests and refer patients unnecessarily, and spend a disproportionate amount of their income on malpractice premiums.

In anesthesia, we do a lot.  The bottom line is, we keep people alive while surgeons cut them up.  General anesthesia without resuscitation = lethal injection.  We take over some of the body's natural processes, like breathing (which is kind of important), and monitor and influence cardiac function and fluid balance, in addition to what we do with consciousness and pain management.

We DO numb people with needles (4 spinals, 3 femoral nerve blocks and an interscalene block for me yesterday!), but it's not just doing the procedures that's important.  It's knowing who needs what and why, and that's pretty complex.

We have to know a little bit about the surgical side of things, and a lot about the medical side of things, because many of our patients have concomitant diseases, and we have to know what the impact of the surgical intervention is going to be.

Every anesthetic has to be tailored to the individual patient and procedure.  The anesthetic that is perfect for one patient might kill another one.  We have to be able to deal with emergencies (like surgeons putting a hole in the pulmonary artery by mistake, or a woman in labor with fetal distress, or people not breathing).  We always have a "Plan B" (and C and D...) in our back pocket because patients and surgeons don't always act like we expect them to.

We get paid more because we take more risks.  Every one of our patients can die right in front of us because of what we do.  Internists have a lower level of acuity in their practices.

I'm not putting down internists - they work hard and deserve a LOT better than they are currently getting.  There is a movement toward dumping insurance companies and going fee-for-service only, which leads to much better medical care.  (That's what I'm going to look for when I need a doctor)

Answer 2

The biggest reason is the question of specialization.  More years of training lead to higher wages, as a rule.  They do procedures that cost more, and there are fewer of them.

Internal medicine doctors are general practitioners.  You can also go on to specialize from an internal medicine background by doing fellowships in things like GI or pulmonology or nephrology or cardiology after you complete a medicine residency.  Specialists in those fields make more, usually, than GPs.

Anesthesiologists, as Pangolin can tell you, do all kinds of things.  They sedate patients for surgery, do epidurals for childbirth and other procedures, they can be pain management specialists, perform lumbar punctures (spinal taps) and if it is 3 AM and you just cannot get an IV started, an anesthesiologist is your best friend in the whole world.

The average salaries, though, are just the average.  Some internal medicine doctors make more than that; some make less.  Same for every other specialty.

Answer 3

My guess is that the make the money because of liability. They are responsible for the calculation of dosages, picking the right anesthesia and administering it. There are a lot of problems associated with anesthesia and not making the right calculation, picking the wrong one could lead to untoward effects like death.