Correspondence
Return on Educational Investment
N Engl J Med 1994; 331:747-748September 15, 1994
- Article
To the Editor:
In their comparison of the educational costs and incomes of physicians and other professionals (May 5 issue), Weeks et al. found that dental specialists and attorneys working in law firms did better than specialist physicians.1 I suspect the performance of dental specialists may have been inflated.
First, it is not clear that the extra years of training in a dental specialty were considered. Most training programs also require payment of tuition. Second, the presentation of data on an hours-adjusted basis highlights working conditions rather than compensation. It is not surprising that certain professions require long hours. People pay taxes on their annual aggregate income, not on their hourly earnings.
1 ReferencesRichard B. Kaplan, D.D.S.
New Jersey Society of Periodontists, Caldwell, NJ 070061
Weeks WB ,Wallace AE ,Wallace MM ,Welch HG . A comparison of the educational costs and incomes of physicians and other professionals. N Engl J Med 1994;330:1280-1286
Full Text | Web of Science | Medline
To the Editor:
I believe the opportunity costs of advanced education are higher than those shown by Weeks et al. They assumed that the opportunity cost is the income that could be gained by starting work immediately after high school and is the same for all professional groups. Isn't the opportunity cost the income level appropriate for the next lowest level of educational attainment? Thus, for the years spent in graduate school, the opportunity cost would be the income of a college graduate, whereas for more than three years of residency training, the opportunity cost would be the income of a general internist.
Robert Melsha
401 Rue St. Peter, Metairie, LA 70005To the Editor:
Most people find windowless work environments unpleasant and highly undesirable1,2. Specialist physicians, including radiologists, invasive cardiologists, anesthesiologists, and to a lesser extent obstetrician-gynecologists and surgical specialists spend much of their professional lives in stressful, windowless areas of hospitals. It is unusual to find a lawyer or businessperson who works in an office without windows. Although it might be possible to design operating rooms and radiology suites with outside windows, the cost would be extremely high. Perhaps the marketplace has augmented the tangible compensation for these specialists to balance the intangible negative factors associated with working 50 to 60 hours per week in a confined, windowless environment.
2 ReferencesRichard K. Baumgarten, M.D.
Henry Ford Hospital, Detroit, MI 48202-26891
Kaplan R . The role of nature in the context of the workplace. Lands Urban Plan 1993;26:193-201
CrossRef | Web of Science2
Finnegan MC ,Solomon LZ . Work attitudes in windowed vs. windowless environments. J Soc Psychol 1981;115:291-292
CrossRef | Web of Science
Author/Editor Response
The authors reply:
To the Editor: In response to Dr. Kaplan, we did consider additional training time for specialist dentists. We allowed two years of additional training at an income approximating that of medical residents. Consultation with the American Dental Association and information available in their annual report on dental education1 made this approximation seem reasonable. We have a fundamental difference with Dr. Kaplan's suggestion to ignore the number of hours worked in the analysis of the return on investment. Are people indifferent to the choice between two jobs with the same salary, if one requires 20 hours per week, and the other 80 hours per week?
Mr. Melsha wonders whether we underestimated the opportunity costs of advanced education. This is an important issue. Although changing the opportunity costs incurred by college graduates would not change the results of our analysis (since it applies similarly to all professional groups), altering the opportunity costs in postgraduate years could have an impact. Changing the opportunity cost when making comparisons within a profession is relatively straightforward, but large assumptions are required when making comparisons among professional groups. Should a fourth-year medical student be considered to have an opportunity cost equal to that of a lawyer in the first year of practice? Estimating opportunity costs as a result of partial completion of a course of training (e.g., how much a second-year law student could earn above and beyond the earnings of a college graduate) would be particularly troublesome. To avoid these problems, we chose a simple strategy -- one in which each person has the same opportunity cost. We are, however, currently examining the effect of using different opportunity costs within the medical profession (to recognize, for example, that a second-year surgical resident may be working as a general practitioner) in an effort to examine this issue in more detail.
Dr. Baumgarten suggests that the market has provided extra compensation to physicians who work in a windowless environment. Unfortunately, we do not have data about the prevalence of office windows in various specialties. We are afraid that adjustments to physicians' earnings based on the quality of the view from their offices might adversely affect the incomes of physicians in Vermont.
1 ReferencesWilliam B. Weeks, M.D.
Amy E. Wallace, M.D.
H. Gilbert Welch, M.D.
Veterans Affairs Medical Center, White River Junction, VT 05009
