Doctor, do you have enough money?

Are you paid fairly for what you do?

How much are your services actually worth?

Of course you are worth more than you are paid. Enough money is never enough.

“The market decides.”

But, in medicine, there is no way that it is a “free market”; the American medical marketplace is historically rigged by innumerable visible and, to the average person, invisible factors.

We live in one world. Ask Detroit about wages for making American cars as good as the Japanese; ask North Carolina about wooden furniture; Motorola about manufacturing TVs and cell phones; Pittsburgh about steel; the garment district of Manhattan about clothing; Long Beach about passenger airplanes.

Why do you think medicine is immune to the economic realities of the global market?

Whether you participate in, or show open contempt for, American “organized medicine,” over the decades it has taken very good care of us American physicians.

In this month’s Health Affairs, a study supported by the Commonwealth Fund of New York reports that the 2008 per capita spending for U.S. physician services was $1,599 while per-person spending for physician services for the 34 member countries of the Organization for Economic Co-Operation and Development was $310.

In cross-country comparisons of primary care physicians and orthopedic surgeons, they reported that U.S. primary care physicians were paid 27% more for public insurance and 70% more for private insurance patients than their counterparts in Australia, Canada, France, Germany, and the U.K.

For orthopedists it was 70% more for public and 120% more for private insurance patients.

U.S. physician incomes, after expenses, including malpractice expenses, were also greatly higher.

The study did not assess true medical need, use of evidence-based medicine, or patient outcomes.