A case for paying doctors more

America loves two things: complaining about health care and assuming doctors are doing just fine. (We also love fries,
but that’s a different column.) Here’s the uncomfortable truth: if we want timely appointments, stable primary care,
thriving rural hospitals, and fewer “sorry, the next available specialist is in June” moments, we need to make being a
doctorespecially the kinds of doctors we’re short onfinancially sustainable and professionally tolerable.

“Pay doctors more” can sound like an expensive punchline, because many physicians already earn high salaries. But the
argument isn’t “doctors deserve yachts.” It’s “the system is starving critical medical work, then acting shocked when
access collapses.” Compensation is one of the clearest levers we have to improve retention, rebuild primary care,
stabilize practices that serve Medicare and Medicaid patients, and keep the workforce from quietly drifting into
burnout, early retirement, or concierge medicine.

Why this conversation feels awkward (and why it matters anyway)

Most people interact with medicine when they’re stressed, scared, or sickand bills are rarely a mood booster. So it’s
easy to assume that physician pay is “the problem.” But physician compensation is only one piece of U.S. health
spending, and it’s tied to something people care about even more than prices: whether you can get care when you need
it.

Meanwhile, doctors don’t just “see patients.” They run small businesses or operate inside complex health systems.
Payments from Medicare, Medicaid, and private insurance shape which services practices can afford to provide, whether
a clinic can hire enough nurses and medical assistants, and whether that family doctor can keep the lights on without
seeing 30+ patients a day like they’re speedrunning a video game.

Doctors are expensive to trainand we’re asking the pipeline to run on fumes

Time is money (and med school takes a lot of time)

Becoming an attending physician typically requires four years of medical school plus three to seven (or more) years of
residency and fellowship training. During that time, physicians-in-training work long hours while earning far less
than they would in other high-skill careers with similar academic intensity.

That training isn’t just a personal sacrifice; it’s a national workforce investment. When pay and working conditions
lag behind the reality of the job, fewer students choose lower-paid, high-need fields (like primary care), and more
practicing physicians reduce hours or leave clinical care. The pipeline narrows at both ends.

Debt + residency pay: the early-career squeeze

Medical education debt commonly lands in the “house-sized” range. AAMC reporting has cited a median debt around
$205,000 for medical school graduates in the class of 2024, and the four-year cost of attendance can be far higher
depending on the school and living expenses. Meanwhile, first-year residents’ stipends are often in the
mid-$60,000sreal income, but not exactly “comfortable” given the hours, cost of living, and loan burden.

This is where compensation becomes more than a number on a paycheck. If you want graduates to choose family medicine,
pediatrics, geriatrics, and psychiatryand to practice in underserved communitiespay has to compete with the very
real math of debt, housing, childcare, and years of delayed earnings.

Pay isn’t just about “being nice”it’s a workforce and access strategy

Shortages aren’t abstract; they show up as wait times

The U.S. faces persistent physician workforce gaps. AAMC analyses have projected physician shortages on the order of
tens of thousands over the next decade, with especially sharp pressure in primary care and certain specialties. When
the workforce is stretched, patients feel it as longer waits, delayed diagnoses, and fewer choicesparticularly in
rural and lower-income areas.

Compensation isn’t the only factor driving shortages, but it’s one of the fastest ways to change behavior at scale.
Better pay can help clinics recruit and keep physicians, extend office hours, reduce turnover, and make it realistic
for doctors to stay in clinical practice instead of switching to non-clinical roles.

Primary care is the canary in the coal mine

Primary care is where prevention, chronic disease management, and early detection live. It’s also where the payment
system has historically been stingy compared with procedure-heavy specialties. Surveys and compensation reports
regularly show large gaps between primary care and many specialtiesgaps that send a loud signal to medical students:
“Do you want meaningful continuity of care… or do you want to pay off your loans before you’re 50?”

Paying primary care more isn’t just about fairness; it’s about capacity. Strong primary care can reduce downstream
complications, keep patients out of the hospital, and help specialists focus on cases that truly need specialized
care. In other words: paying more upstream can be cheaper than paying more downstream.

“But doctors already make a lot”true, and still not the full story

Pay varies wildly by specialty and setting

On a broad level, physicians are among the highest-paid workers in the U.S. The Bureau of Labor Statistics reports a
median pay at or above roughly $239,200 for physicians and surgeons, but that headline hides a big reality: averages
don’t describe what different doctors actually experience.

Compensation reports (such as Medscape and Doximity) routinely show substantial spreads by specialty, region, and
practice type. Some specialties command very high compensation, while many primary care and cognitive specialties
earn far lessoften while carrying equally intense responsibility, time pressure, and emotional load. Policy that
“pays doctors more” doesn’t have to mean “pay everyone the same.” It can mean “pay the most-needed care more
competitively.”

Opportunity cost and hidden overtime

Physician pay is also compensation for delayed earnings. Many doctors finish training in their early to mid-30s,
while peers in other fields have been earning, investing, and building financial stability for a decade. Add the
reality that many physicians work evenings on documentation, review results after clinic hours, and triage patient
messagesand the “hourly wage” story becomes more complicated than annual salary suggests.

What’s really driving burnout (and why compensation matters)

Desktop medicine: the EHR and documentation load

Many physicians describe their job as “two shifts”: the one with patients, and the one with the computer. Research
has documented substantial time spent in electronic health records, including work outside scheduled clinic hours.
This isn’t just annoyingit’s a key ingredient in burnout, and burnout is a key ingredient in quitting.

Higher compensation doesn’t magically delete the inbox, but it changes what practices can do about it. Better pay
can support more staff, better workflows, scribes, care coordinators, and realistic patient volumesreducing the need
for doctors to absorb uncompensated administrative work late at night like it’s a hobby.

Prior authorization: the weekly paperwork treadmill

Prior authorization has become a widespread source of delay and frustration for patients and clinicians. AMA survey
reporting has cited practices completing roughly dozens of prior authorizations per physician per weekwork that eats
staff time and creates treatment delays. When physicians feel they’re spending significant time fighting for care
they already know is necessary, morale drops. And when morale drops, people leave.

Compensation matters here in a practical way: if payments are tight, practices can’t afford the staffing needed to
manage insurance complexity. That pushes more administrative burden onto physicians themselves, worsening burnout and
reducing clinical capacity.

Will paying doctors more raise health care costs?

Physician spending is a slice, not the whole pie

U.S. health spending is enormous, but not all categories are equal. CMS data show physician and clinical services are
about one-fifth of national health expenditures, while hospital care is closer to about one-third. That doesn’t mean
physician spending is “small,” but it does mean that blaming doctors for the total bill misses bigger drivers.

Also, not all “doctor spending” is doctor pay. Physician payments often help cover practice overhead: staff wages,
rent, equipment, malpractice insurance, technology, and compliance costs. If reimbursement doesn’t keep up with
inflation, practices don’t just get poorerthey get less able to serve patients.

Smarter ways to pay more without paying “more”

Paying doctors more doesn’t have to mean writing a bigger national check with no plan. The goal should be targeted,
value-minded compensation improvements that increase access and reduce expensive downstream care. If a better-paid,
better-staffed primary care practice prevents avoidable hospitalizations and complications, the system can spend
more where it helps and less where it hurts.

There’s also a strategic angle: when physician payments fail to keep up with practice costs, doctors may consolidate
into hospital-owned groups to survive. Multiple policy discussions warn that consolidation can raise prices in
commercial markets. In other words, underpaying independent physician practices can accidentally fuel more expensive
care settings.

Policy ideas that actually pencil out

1) Put Medicare physician updates on a predictable inflation track

Medicare physician payment has faced long-term pressure from inadequate annual updates. Organized medicine and
policy analysts have highlighted substantial inflation-adjusted declines in physician payment over time, and MedPAC
has discussed reforming the update framework to better reflect practice-cost inflation (the Medicare Economic Index).
A stable update mechanism would reduce “annual crisis budgeting” and help practices plan staffing and services.

2) Rebalance payment toward evaluation-and-management (cognitive) care

If the system pays far more for procedures than for thinking, diagnosing, counseling, and coordinating care, it will
keep producing the workforce it rewards. Rebalancing doesn’t require vilifying specialists; it requires aligning
payment with national needs. NEJM discussions on primary care payment reform emphasize that simply tweaking RVUs is
not enoughpayment models must support the real work of high-value primary care.

3) Pay for time and complexity, not just volume

A 30-minute visit managing multiple chronic conditions can be far more valuable than a quick transactional visit,
but fee-for-service often undercompensates that time. More time-based payment options, better add-on codes for
complexity, and stronger support for team-based care can let doctors spend appropriate time with patients without
financial penalty.

4) Make primary care a financially rational career choice

This can include higher base reimbursement, meaningful care-management payments, loan repayment tied to service in
underserved areas, and predictable compensation that doesn’t require unsustainable visit volumes. If primary care is
the foundation, pay it like the foundationso it doesn’t crack.

5) Cut admin wasteand share the savings with frontline care

Documentation and prior authorization aren’t free; they’re just paid for with clinician time, staff burnout, and
patient delays. Standardizing prior authorization, simplifying reporting, and aligning quality measures can reduce
non-clinical work. Those savings should translate into better staffing and better compensation for clinical teams,
including physicians, nurses, and support staff.

6) Expand and fund residency training strategically

Physician supply is constrained by training positions and funding. AAMC workforce work has repeatedly emphasized
that continued investment in graduate medical education affects whether shortages worsen. Expanding residency slots
where shortages are most severeand supporting training sites in underserved areashelps turn “we need more doctors”
into “patients can actually see a doctor.”

7) Address pay equity and retention where shortages bite hardest

Compensation gaps by geography and demographics are not just fairness issues; they’re access issues. Targeted
incentives for rural practice, better support for safety-net settings, and transparency in compensation structures
can improve retention and stabilize communities that are currently one resignation away from a care desert.

What health systems and employers can do tomorrow morning

Not every fix needs an act of Congress. Health systems can reduce burnout by investing in staffing, removing
low-value administrative tasks, and building schedules that don’t assume physicians are infinitely rechargeable.
Employers can implement team-based care models that let doctors practice at the top of their licensewhile staff
handle tasks that don’t require an MD.

Compensation should reflect reality: complexity, responsibility, and the market pressures pulling doctors away from
clinical care. Paying doctors moreespecially in primary care and underserved areascan be paired with expectations
that improve access: longer appointment times for complex patients, more care coordination, and coverage for same-day
urgent slots that keep people out of the ER.

Experiences from the front lines (a 500-word add-on)

Picture a family physician in a small town where the nearest specialist is two hours away. She knows most patients by
name, because she’s delivered their babies, treated their parents’ diabetes, and helped teenagers navigate anxiety.
Her day starts with a full schedule, but the real work begins in the in-between moments: calling a cardiologist to
squeeze in a high-risk patient, coordinating home health for an older adult who can’t drive, and explainingagainwhy
a medication is necessary. She’s not “just writing prescriptions.” She’s running a logistics operation with human
lives attached.

Now add the financial reality. Her clinic’s reimbursement is heavily tied to Medicare and Medicaid rates. Staffing is
tight, so when prior authorization piles up, it doesn’t disappearit lands on her desk. She stays late to finish
documentation, because leaving notes unfinished means tomorrow’s care slows down. She’s proud of what she does, but
pride doesn’t pay for the medical assistant she can’t afford to hire or the extra half-day she’d like to set aside
for chronic care visits. When pay is too low, the clinic’s choices get grim: shorten visits, see more patients per
hour, or stop accepting certain insurance plans. Patients feel that as “can’t get in,” “they rushed me,” or “I had to
go to urgent care.”

In a busy emergency department, an ER physician watches the downstream effects of thin primary care coverage. People
show up because they couldn’t get a timely appointment for a worsening infection, uncontrolled blood pressure, or a
medication refill. The physician treats what’s urgent and tries to connect them to follow-up carebut follow-up care
is the part the system has been underfunding. The ER becomes the safety net for problems that should have been
addressed earlier, in a clinic with time to listen and plan.

Or consider a pediatrician who spends a large part of the day counseling families: vaccines, nutrition, asthma plans,
mental health, sleep. Those conversations are high-impact and time-intensive, yet often reimbursed at rates that
barely cover overhead. When compensation doesn’t match the work, pediatric practices close, merge, or stop taking
certain plans. Families end up driving farther and waiting longeruntil that “routine” issue turns into an urgent one.

These experiences aren’t rare; they’re predictable outcomes of a system that underpays time, thinking, and continuity
compared with procedures and facility-based care. Paying doctors moretargeted toward the specialties and communities
we rely on mostcan mean fewer closures, more staff support, more appointment availability, and a workforce that
doesn’t feel like it has to choose between caring for patients and surviving the job.

Conclusion: Paying doctors more is paying for access, quality, and sanity

The case for paying doctors more isn’t a sympathy campaign. It’s a practical plan to protect access, especially in
primary care and underserved regions, and to keep clinical medicine viable in a system with rising costs and rising
administrative burden. Yes, some physicians earn very high incomes. But the care America is short oncontinuity,
prevention, chronic disease management, rural access, geriatric careoften isn’t the care the payment system rewards.

If we want fewer care deserts, shorter waits, and a medical workforce that can stay in the game, compensation has to
reflect the value of the work and the costs of delivering it. Pay doctors more where it matters mostand pair it with
smarter payment policy and less administrative nonsenseso patients get more care, not just more billing codes.