Apparently, many specialists at private universities earn more than university presidents, including, you guessed it, your friendly reproductive endocrinologist.
From Sunday's New York Times:
"Generally, fertility doctors are among the highest paid. At Cornell, Dr. Zev Rosenwaks of the Center for Reproductive Medicine and Infertility received $3,149,376, and at New York University, Dr. James A. Grifo, a professor of obstetrics and gynecology, was paid $2,393,646. Both substantially out-earned their presidents."
Now, I'm torn when I read this. I love my repro-endo doc (who is neither Jamie Grifo nor Zev Rosenwaks, just for the record). I think he is extremely talented (although so far, not so successful with me). And I know he has spent years and years honing his expertise. I get that. And I want him to be well compensated.
But it raises the sticky question of whether reproductive endocrinology is primarily a for-profit business or a medical speciality. What is the mission of these practices, and is it congruent with that of the hospitals in which these departments are housed? Based on these salaries, I am willing to bet my left ovary that RE departments are among the biggest money makers in many university hospitals. And I suppose there should be some recognition of that in the form of compensation.
I suppose. But this seems just a wee tad out of control to me. Especially since these treatments are quite difficult for many to afford. Is the high price of IVF based on what these procedures reasonably cost or on what the market will bear? And if it is the latter, is that ethical?
What say you, fellow infertiles? Is there a problem with high compensation for REs? Why does it bother you, or not?
Mo
I think that it's not too much at all, after all it's physician compensation, and if we want the best to be working as RE's we gotta pay them!
ReplyDeleteThat being said, I don't think they get paid that much in Canada (ivf costs are cheeper, I think around 5k for IVF cycle).
Wow....I think you raise a good point. I often wonder if this whole infertility thing is more of a "business" than treating a condition.
ReplyDeleteFood for thought.
Duck,
ReplyDeleteI hear you. And I'm not anti-compensation (even have vested interest in physician compensation, since Will is a Dr.), but it just seems to be SOO much. Or maybe it's not? Troubles me on some deep level.
Mo
that's interesting. i guess i don't have to feel bad calling my RE's cell phone on the weekend, now, huh??
ReplyDeleteWow!! Like you said, I knew they made a lot, but millions? Please, don't let this have been just for one year. This is another one of the reasons insurance companes (as much as I hate them) would really help us IFers. By covering our IF expenses, they would have to determine reasonable IVF rates and contract at those rates with the docs. Maybe a more reasonable IVF cost norm would be established instead of clinics charging whatever they please. In my dreams...
ReplyDeleteI'm all for just compensation. You compensate people for their extra years of schooling, for their expertise, etc. . . but yet, this still seems excessive. Especially when I think about the fact that I only actually saw our dr. three times in the year that we were treating there.
ReplyDeleteAndrea - This is compensation for one year. You make a good point about how insurance coverage would help out, in so many ways.
ReplyDeleteThank you for this post. I, too, am concerned about the exorbitant cost of IVF at some university infertility centers, and the huge discrepency in earnings. I agree REs should be adequately compensated, but just for one particular procedure, we had urologist quotes varying between $4k (private practice) and $10k (university IVF clinic).
ReplyDeleteIf only more of the money went to research. My current RE said he used to charge $2k for IVF as that's what it really cost him in 1997 when he opened his clinic. He now employs many more people, and his business has grown to include 3locations. He now charges $5,500, including ICSI, which is still less than half of Cornell's $12k. Of course, Cornell has a great lab...
I used to be bothered with how much they get paid but once I saw my laparotomy pics of the inside of me and realised how intricate all that operating was, I think he deserves that and then some.
ReplyDeleteSeriously, it IS expensive but for anything health-related I have absolutely no problem paying for expertise because I don't want people who don't know what they're doing practising on me. This is the only body I have LOL
Now don't get me started on the insurance companies!
I hear you, Leigh. It just grates that these compensations are higher than say, a neurosurgeon, or gynecological oncological surgeon, who arguably do very complicated work too...or, heck ANYBODY.
ReplyDeleteThat's a lot of money. But every time I'm tempted assume that I know better than a free market how much someone's services are worth, I try to remember that incentives are powerful things.
ReplyDeleteI *want* fertility to be a highly profitable industry, because then it will attract talented people and capital to fund innovation.
If my RE's practice were a government-regulated enterprise with a year-long waiting list for "free" IVF, would the doctors care as much what their success rates were? Would they be constantly trying new procedures and technologies to try to improve outcomes? I doubt it.
I have always been suspicious of the whole fertility thing. I'm suspicious of every test (is it really neccessary?) It has even crossed my mind that my RE cancelled my last cycle so that he could collect more fees while I cycle again (althought I don't really believe this).
ReplyDeleteI think part of my suspicions are because of my husband's urologist. He was not a big fan of REs and basically told us its a cash business and be careful.
I am just so scared of being taken advantage of because I want a baby so badly. It makes you feel very vulnerable.
Whew - now there is question I am really not qualified to chew on...
ReplyDeleteGreat debate though!
ILCW
Your aise a very interesting topic about the cost of becoming a mom/dad when the old fashioned way just doesn't work. Dr. Deborah Spar a professor at Harvard wrote an interesting book called “The Baby Business: How Money, Science, and Politics Shape the Commerce of Conception.” It can be touchy and controversial at some points but it raises some things to think about such as how “This is the first business I’ve ever encountered that did not identify itself as such,” Spar said. “It’s emotionally and politically laden, so we don’t want to talk about it. Would-be parents don’t want to think of themselves as consumers, and most providers don’t identify themselves as businesses."
ReplyDeleteThere is a link to a breof article about it here - http://thedartmouth.com/2007/02/06/news/harvard/ - sorry I don't know how to link in blogger.
Also if you are at all interested in the book I can get you a copy.
Wow, I knew they were well paid, but that is a LOT of money.
ReplyDeleteYes, it's a business, but at the same time, aren't physicians in "the business" to help people? Wouldn't more people be helped if they were able to afford it?
Yup it is a bit much, I work in doc comp, but, in canada so it's hard for me to compare, but, if we pay millions to hockey players and all they do is chase pucks these guys make our dreams come true.... maybe I'm biased because I really like my doc!
ReplyDeleteThis is an interesting topic. There's a good thread about the article on the IVFC NY board.
ReplyDeleteOn a personal note, I was given a hard time from a secretary at Cornell when I wanted to make an appt with a dr there. I knew I could not afford to cycle there, but I wanted this dr's opinion and was willing to pay out of pocket for his consultation fee. The secretary was insisting that I needed to pay an additional $300 for day 3 blood work with their lab, even though I had records of my day 3 b/w from one of the other highly respected NYC clinics. I wound up not having that consultation, but it sure sounded like it was all about the money to me.
Dora
ReplyDeletethanks for the tip - checked out the IVFconnections thread. lively discussion!
Mo
Wow that does seem a little excessive. I too am all about just compensation but with so many struggling to afford it it just seems a little out of balance. The hard part is, that we are stuck with whatever they say it is suppose to be that is what it is. It definitely seems more like a "business".
ReplyDeleteThat's pretty well paid. My DH and I were counting up the people waiting in the clinic for ultrasound on the weekend. We lobbed out some figures and guessed at overhead etc but came up with a number of about 3 mill profit - once salaries of employees had been subtracted (and we paid them all 100,000)
ReplyDeleteOf course, if we get a baby out of this I couldn't care less.
No baby? Might start to wonder...
I decided long ago if my kid wants to get an MD I won't help support them for it unless they want to be an RE or plastic surgeon. Internists make peanuts in comparison especially considering how much med school costs... engineering phds are full rides in comparison to all those student loans for MDs.
ReplyDeleteIt is totally a big business that is why some clinics won't take patients that risk their numbers (like me) or push them toward DE.
What I wonder is what the poor nurses are paid and they get the most shit from us patients. They probably get almost nothing in comparison.
Also to me being an RE seems way less complicated than say being an oncologist or something like that. There are a few standard procedures/surgeries and a few standard protocols that get tweeked to tailor them to the patient then you need a good, clean lab and an embryologist that knows what they are doing. It isn't brain surgery right. Maybe I am being judgy but I am in a rotten mood tonight.
Although I'm grateful for the medical advances, I think it's mostly about business. And business is about making money. I agree with Nepsi with regards to the nurses. Spend more $$$ on them. They are on the receiving end of our explosions, and the better qualified the nurse, the better the whole ART process, which I think probably correlates directly with live birth success rates.
ReplyDeleteHoly crap!
ReplyDeleteGiven that IVF is more expensive in the U.S. than in most other countries, it would seem that the prices are inflated. I guarantee that REs in other (cheaper) countries aren't in that ballpark.
But Coach Pete deserves every penny.
Dora-
ReplyDeleteI was reading through and I just saw your note about the day 3 b/w at cornell and when I had my consult there they did not require that. They do some other E2 measurement that is more sensitive or some such bs but I would have said no way to that for a consult too. Weird. I wonder if it is based on which RE you pick? I already spent a fortune on the crazy tests SIRM wanted before a consult there and I am not willing to do that again since those tests and the consult turned out to be bunk.
Doesn't bother me at all. Think of all the people who earn salaries like that. Actors, Star athletes, high powered business execs. Why shouldn't the doctor who works their ass off to give you the most precious part of life earn. My RE earned every penny that she got fro curing me of my fibroid/endo/scar tissue problems and getting me pregnant. And if I could go back in time I would for sure go into reproductive science instead of microbiology. Not for the money. Because of what it means to those of us that can't just get pregnant.
ReplyDeleteNepsi, this RE has 2 secretaries. One was a pleasure to deal with, the other was a cranky gatekeeper. Actually, I decided against the consult because I realized that my very advanced maternal age and my very poor response to stims was too much for even Cornell's "old girl" specialist to overcome.
ReplyDeleteI think it is ridiculous. Other countries do it for much cheaper. And without insurance coverage to make treatment an option for everyone, IVF will continue to be an option only for people with extra wads of cash they are willing and able to gamble away while others get rich.
ReplyDeleteIt has always bothered me that money is even an issue when it comes to pregnancy, and that some of us simply don't have the option to continue pursuing our dream of parenthood. It's just wrong.
It is important to realize that these two RE physicians are outliers. In fact, all of these docs represent a very small number of highly compensated health care professionals, even within their own specialty. I am sure that the junior - or less well known - members in their groups are well paid, but earn a much smaller sum.
ReplyDeleteGiven that this was a sample of individuals from private institutions, it is heartening that the top salaries are huge, but not so much compared to banking and sports.
So, why so high salaries? The docs I see on this list are actually not the wealthiest doctors I know. Not by a long shot. The ones that do really well have opened large scale enterprises - MRI centers, dialysis centers, botox centers, etc. - or have developed a successful new medical device and patented it. The docs on this list have been fortunate in many respects, but also have impressive CVs. They have toiled in labs and produced a wealth of medical knowledge. They have pioneered new techniques, perhaps at times when their colleagues were shaking their heads in disbelief at why someone would rock the boat. Additionally, I think they have been successful money raisers, either directly through their clinical care or through their gift of shmooze.
So, sure repro endo is a business. But I wager that the great majority of these docs do it for the love of the science and helping others. It doesn't hurt that it pays well too. Ironically, repro endo docs probably make more on average than cardiothoracic surgeons - but I wouldn't choose either based upon the car they drive.
-Will
Will-
ReplyDeleteI'm just bitter I didn't realize I would love embryology and I am trapped in a chemistry lab hoping I don't get cancer from the chemicals. Toiling in the lab can be fun or awful for sure. Also Cornell is cutting edge and really do go out of their way to advance knowledge. That is how I rationalized the price of the cycles there. Also, my RE there was the most compassionate of all the REs I've been to or had consults with. I think I am just peeved at the industry in general because it really has drained us dry. Makes me wonder how certain unemployed women swing this when we are both killing ourselves to be able to afford it. I do think part of the reason MDs charge so much is the crippling cost of schooling. I don't agree with the amount it costs to put someone through medical school. It should be heavily subsidized... at least for the people who do well in school. 50% of the graduating class has to be in the bottom 50% right.
Nicole
Will-
ReplyDeleteI'm just bitter I didn't realize I would love embryology and I am trapped in a chemistry lab hoping I don't get cancer from the chemicals. Toiling in the lab can be fun or awful for sure. Also Cornell is cutting edge and really do go out of their way to advance knowledge. That is how I rationalized the price of the cycles there. Also, my RE there was the most compassionate of all the REs I've been to or had consults with. I think I am just peeved at the industry in general because it really has drained us dry. Makes me wonder how certain unemployed women swing this when we are both killing ourselves to be able to afford it. I do think part of the reason MDs charge so much is the crippling cost of schooling. I don't agree with the amount it costs to put someone through medical school. It should be heavily subsidized... at least for the people who do well in school. 50% of the graduating class has to be in the bottom 50% right.
Don't mind my bitterness. I've had a few hack REs on my way to cornell who I am sure were raking in a lot of money and wreaking havok on patients like me with poor choices and overmedication. sigh.
Nicole
It is truly out of control. Really. Ridiculous that anyone would be paid that much, while charging people like me nearly 15,000 a pop plus meds(**starts looking for available NP jobs at Fertility Clinics).
ReplyDeleteBut then again, aren't we all out for $$. That being said, at least strike a balance...offer discounts based on salary, sliding scale IVF? I don't know, so people below a certain income can still get their foot in the door?
I mean, I'm all for making money, but 3 million....come on.
I also love my RE but this leaves me a little bit conflicted. We, like many of you, pay out of pocket for everything - every blood draw, u/s, syringe. It's brutal and I often joke that it's too bad we can't have a "free baby" like every one we know!
ReplyDeleteEveryone makes such good points about drawing the most talent to the field which means higher success rates, etc. But I wonder - does it really have to cost so very much?!
Thanks for the thoughtful question! Happy ICLW.
Have you guys heard this one?
ReplyDeleteWhat do you call someone who graduated at the BOTTOM of his med school class?
Doctor. :-|
Will, I think you make some good points, but if REs really wanted to help people they could advocate for better insurance coverage for infertility.
Dora!
ReplyDeleteWe have heard that one. Luckily, I don't think any of the RE's I know are anywhere near the bottoms of their class.
Mo
It is a lot of money, but I think about all the CEO's of these companies asking for bailout money. They are paid way more, with more perks for doing less than what my RE does.
ReplyDeleteMy RE experience is small, but it does seem that these particular doctors are available all the time. Even more than an OB/GYN who is delivering babies. While I think that $3 million is quite a lot, they might be earning their money.
ReplyDeleteAlso, the nurses, receptionists, case managers, etc. that I encountered seemed REALLY happy with their jobs - which indicates to me that they are probably well paid.
This comment has been removed by the author.
ReplyDeleteAs a Canadian, most of the American health care system bothers me. Health is a basic human right. However, baby makin' isn't a health issue. I suppose they can charge whatever they want and while sad, I can't think of any reason why that's objectionable in theory.
ReplyDeleteThen again, that same theory applies to professional sports and I find athletes' incomes objectionable.
Were I an IVF doctor, I'd want to help people more than myself. There's no way I'd charge that much.
(And I think Duck is mistaken. A friend who has wanted IVF told me recently that it's closer to $15,000.)
Reproductive endocrinology is a business and that is the problem with the whole US medical system. It's turned into a business, and as a result, prices are very inflated. If your insurance doesn't cover IVF, then you pay out of pocket. It's not about medicine or the patient anymore. It used to be that way, say, twenty years ago or more. I grew up with a father who was a doctor. I've seen it change. He has seen it change. When you have a father who is as traditional as western doctors get who thinks our medical system is screwed, you know something is wrong. That's not to say there are not ethical doctors out there. They are just fewer and farther between.
ReplyDelete