Veronica: My knowledge of my own doctors of the last several years is their income is determined by specialty, location and how much they wish to work.
You're right. Specialists make more, but must complete a fellowship in their specialty. Physicians who choose from idealism to help the indigent (or work in VA hospitals) are the ones receiving lowest pay. They must also work longer hours -- for a variety of reasons -- bringing their hourly wage way down.
For example, the Boston job my friend declined was a "hospitalist" position. It would have almost doubled the pay, increased vacation time, and provided a 7-days on/7-days off schedule. Such doctors only work in hospital; whereas doctors treating the poor usually combine clinic and hospital service, requiring "calls," where doctors must be available to respond to emergencies and routine treatment calls around the clock, then do morning hospital rounds before clinic hours start.
Fewer and fewer Americans want that kind of grueling schedule with low hourly pay, and most of those who do are mere DOs. Hence the US "naturalizes" a huge amount of foreign physicians, with all the resultant cultural problems it engenders.
On the other side of the spectrum are the amoral, profiteer doctors, who buy and sell practices, use "naturalized" physicians as temporary slave labor, do everything in their power to game the system, and are rarely brought to justice. Those are the guys living in McMansions, who always drive the latest Mercedes. Much like the character "Wellbeck" in the Paddy Chayefsky movie "The Hospital."
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