This might be true for primary care and family practice. I don't think it's true for specialities. And part of why it is true for primary care is because nurse practitioners can do that job now.
[1] https://www.stlouisfed.org/on-the-economy/2023/feb/nominal-w...
According to one historical physician earnings survey [1]:
> During 1987-1990, median earnings for physicians were $143,963 (interquartile range, 96,718-175,850) compared with $157,751 (IQR, 101,279-203,281) during 2006-2010 ($13,788 increase or growth of 9.6%; P < .001).
If we take the most conservative time interval (1990 to 2006) and plug it into the Bureau of Labor Statistics CPI Inflation Calculator [2] we see that the median 1990 physician wage would be equal to 224,080 in 2006 dollars.
Median physician wages as of now are $229,300 (2022) according to the BLS [3] or $255,200 (2020) according to the US Center for Economic Studies [4]. Plug that into the CPI inflation calculator, and the 1990s median amounts to $291,509 in 2020 dollars. So yes, physicians have seen a sizable decline in real wages over the last 30 years. Americans overall saw a significant uptick in real wages in the same time period.
Also, when discussing physician compensation, it's important to remember that there is a very heavy rightward skew. Mean wages are not representative of the typical physician. According to the CES report [2], the mean physician wage is $343,600, while the median is $255,200. This is why you will see dramatically different "average" numbers on physician wages in different outlets -- you should always check if it is a mean or a median.
[1] https://jamanetwork.com/journals/jama/fullarticle/1456053
[2] https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=143%2C963.00&y...
[3] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
[4] https://www2.census.gov/ces/wp/2020/CES-WP-20-23.pdf
[5] https://data.bls.gov/cgi-bin/cpicalc.pl?cost1=143%2C963.00&y...
Fun examples -
My dentist has a waiting list of like 3-4 months to schedule a cleaning, so if you don't schedule the next one as you leave, you'll be out of luck later. HOWEVER, if you opt for any of the elective procedures (ortho/veneers/etc) they have vast availability and can take you next week. Funny that. And this is the third or fourth dentist we've used in the city, after dealing with both negligence and worse overselling elsewhere.
In my condo there's a dermatologist specialist that makes enough money to own two homes before 40 and operate his own practice in Manhattan & in the rich suburb of his second home. He always seems to be home by 6, and the last time I saw him, he was wheeling one of those coolspa coolsculpting machines around in his newest truck..
My previous GP was great but she only worked 2-3 days/week.
My GI is great but while its hard to get in to see him, he'll get you booked for a colonscopy/endoscopy ASAP at the clinic he also owns across town.. and the followup appointment to read you the results. All about that ROI and $/hr maximization.
Glad that I’m not the only one who notices this drop off in practitioner quality and focus on upselling. The only thing they even discuss at dentist visits are the optional, expensive cosmetic treatments. When you make it clear you have no interest they end the conversation and leave.
It’s like they have all bought the same practice management course. Once you realize what they are doing it feels very sleezy.
I can't speak to dentistry, but physician income tends to be lower in HCOL areas because they tend to be oversaturated with physicians and thus fewer patients per physician.
The incentives to stay in HCOL areas are usually non-monetary. For example, if your spouse has a tech job, you may find yourself to the Bay Area even though your income potential as a physician there is much lower than they it would be in the Central Valley. Or you might prefer the public schools in the HCOL areas. Or maybe you prefer to be close to family. Or maybe you like to travel and prefer not to be a 5-hour drive from the nearest international airport.