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Undoubtedly, doctors in the United States make a lot of money, especially when compared with their counterparts abroad. American doctors earn on average three to five times what European doctors earn. But American doctors' salaries are high for several reasons. The first is the cost of education. In Europe students go directly to medical school after high school and their educations is free. In the U.S., podiatrists must be licensed, which requires three to four years of undergraduate education, the completion of a three-to-four-year podiatric program, and passing scores on national and state examinations. The average medical student acquires approximately $200,000 of debt before completing their training. And with two to three years of residency to follow, paying less than $40,000 a year, most podiatrists are already overworked and undercompensated before ever opening the doors to their practice.

Another reason U.S. doctors experience greater earnings is market forces. In a single-payer system the government can bargain down the prices of products and treatments, which leads to lower income for doctors. But in the U.S., aside from Medicare for the elderly, no such mechanism exists. Economists tend to focus not on how much doctors get paid, but on how they are paid. Many theorists believe the current fee-for-service model incentivizes overspending and that a flat rate and bonus structure should be implemented to curb rising health care costs. However, upon analysis, physician salaries are not a significant chunk of overall health care spending in the U.S., accounting for only about 10%. That figure is nominal when compared with insurance company overhead, billing expenses for doctors' offices, and drug company advertising.

The current U.S. health care system is an expensive and inefficient patchwork system of insurance, with forprofit financing of private insurance and millions of uninsured unable to meet premium, deductible and out-of-pocket payments. The basic principles for true reform will not be achieved by cutting provider salaries. However, with doctors receiving little to no public support (even from their own patients) on the issues of declining reimbursements and diminishing income, there is continuous downward pressure on salaries to control health care costs.

Changes must be implemented in order to equalize the system. Consider liability reform and medical education subsidies to offset declining incomes. Frivolous lawsuits, rising medical school costs and increasing office overhead also must be addressed. Without subsidizing the training and schooling involved in becoming a doctor and without addressing the medical malpractice crisis, physicians should not be expected to take a pay cut. Many podiatrists would undoubtedly accept a lower pay scale, salaried position, or even a single-payer system if they were explicitly paired with reform and subsidies.

Also consider the notion of opportunity costs. Presumably, many podiatrists could have opted for jobs in finance and management, law or even consulting instead of choosing to go to medical school. People do not choose a career in medicine just to make money, as the opportunities are far greater in business, law and information technology. The average podiatrist earns only $114,000 per year. Professions that are highly skilled and require extensive training and commitment deserve to be paid at the highest levels.

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