Bottom line is, what most people equate with “wealth” is in fact not wealth at all—just a lot of expensive things with no savings in place for emergencies or investment growth. It doesn’t matter if you drive a Ferrari and live in a million dollar home; if you can’t survive more than a a few months without income from working, you are NOT wealthy. Biggest blunder made by many physicians, and those in other fields with high incomes.

In response to other comments, first of all, while medicine may not apply to “Economics 101″ I would argue, in fact, that it does to a large extent.
For instance, last year Congress overturned a planned Medicare cut. Why? Because so many physicians said they would refuse to see medicare patients if it passed. In effect, what happened is they saw that the DEMAND would far exceed the SUPPLY and had to pony up the money.

The same could be said for physicians, and groups of physicians who contract with insurance companies. If enough docs say, “I refuse to accept insurance company X because their reimbursement is unacceptable to me” then eventually people who pay for this coverage will be upset since no one will take their plan. They either pay out of pocket or find a new insurance company. Insurance companies need doctors to accept their plans and physicians DO have some degree of bargaining power when they approach it wisely, particularly as a large group of physicians who are all on the same page.

Where I live, if you want to be in the most attractive city in the state, your pay will be 20% less than other areas. If you’re willing to go to smaller towns that are more remote, you can earn substantially more. Supply and Demand at work.

If you think the market will correct by just finding more FMG’s, changing the curriculum, etc, to find people willing to work for less, you are naive. These changes take MANY years to implement. Most residencies could not, should not, and will not be reducing the number of years of training. How could you possibly shorten medical school? What would you cut out? Is there a governing body that would oversee curriculum changes nationwide, and what would they decide is not useful?

The best solution, if reimbursements do continue to drop, will be more mid level providers. And that is scary in itself. I’ve worked with some who are great, I’ve worked with some that flat out scare me and I didn’t want working under my license.

It will be interesting to see how things change in the next 20 years, that’s for sure. I suspect big Pharmaceutical companies will be the first target.

Med schools have to turn away qualified applicants every year. That FM residency in Podunk that American graduates won’t consider is swamped with more FMG applications than you can shake a stick at. A reduction in average pay might make some difference in the amount of applicants, but until med schools no longer have full enrollment and hordes of FMG’s don’t continue to see a future in whatever medical dregs they can scrounge up here as ten times better than whatever prospects they had in their home country, it’s not going to make any difference in the number of practicing physicians churned out every year. There’s really a hell of a lot of slack there to still be taken up.

You also have to think the bright-eyed “I just wanna help people” pre-med crowd aren’t all completely duplicitous. I’d say it’s really not 100% about the money for most. The cynicism and greed usually come after it’s far too late to quit anyway. Not everybody’s got the guts to pull a Hoover. You’re also presuming perfectly informed and rational actors with an realisitic appreciation of their abilities and prospects, which is where most economic theory falls flat. Law schools aren’t flooding the market with people aspiring to be that government bureaucrat sitting in a drab office pulling 40K a year, they’ve got dreams of a bright seven figure future in corporate law with enough time left over for pro bono work combatting civil rights abuses. Nobody’s imagines themselves as that average slob when filling out the applications, they only let smart people into law school, after all.

http://www.amazon.com/Millionaire-Next-Door-Thomas-Stanley/dp/0671015206

It goes into detail what MD is talking about regarding wealth and not income. Compliments to MD regarding your argument as well as Shining Hectors comments.

(http://www.amazon.com/World-Flat-History-Twenty-first-Century/dp/0374292884) Shining Hector this book has a segment about where globalization can affect health care and dealing with doctors across the ocean.

Bronx you have a valid point as well regarding income opportunities. One of my MBA professors offered to get me a job doing consulting work for a considerable amount of money when I finished my MBA. He was up front with me about not having a life while having this job.

So if you want to earn a considerable amount of money you will have to work for it.

But for my businesses, I don’t mind putting in the work and enjoy what I do as well as the freedom (although I still have other unique stressors), so it makes it easier to put in the long hours.
And to add to the argument made by MD, I have seen our attorneys and accountants work “their butts off” and put in long hours as well, but they enjoy what they do so that makes it worthwhile to them.

Ultimately it depends on the person and what is important to them.

Good luck to you all