What medicine was like in ancient Babylonian society ... by Jan Henderson

What medicine was like in ancient Babylonian society


in POTPOURRI |
by Jan Henderson, PhD


Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883).

The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.

Ability to pay and malpractice

According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s fee varied with the social status of the patient. There were three classes in ancient Babylonian society. The upper class included wealthy landowners, affluent traders, officials, and priests. Freemen were farmers, clerks, and craftsmen. And then there were slaves.

If an upper class citizen was severely wounded and a physician (using his “bronze lancet”) saved his life, the physician received 10 shekels of silver. If the patient was a freeman, the fee was five shekels. For a slave, the physician was paid only two shekels.

JAMA of 1910 benevolently describes this as “regulating fees according to the patient’s ability to pay.” One might also wonder, however, if there were any differences in the alacrity and quality of care.

Ancient penalties for malpractice also varied by social class. If a physician caused the death of a “man” (presumably either upper class or freeman) or destroyed his eye, the physician’s fingers were cut off. (See, malpractice policy could be worse.) For the death of a freeman’s slave, the physician was required to pay the monetary value of the slave. If it was just the loss of an eye, the penalty was half the slave’s price.


The esteem and remuneration of physicians

The JAMA article continues with an attempt to estimate the income of physicians relative to other members of Babylonian society. Laborers at the time of Hammurabi earned eight shekels of silver a year. Admittedly, the standard of living for laborers may have been low. Earning one and a quarter times the annual wages of a workman for a single operation, however, seems “fairly satisfactory,” in the restrained wording of 1910.
This seems to indicate, the article concludes, that “four thousand years ago the medical profession was highly esteemed and rewarded.” If the editors of JAMA could have seen 100 years into the future, I wonder what they’d say about the esteem and remuneration of physicians today.


Jan Henderson is a historian of medicine who blogs at The Health Culture.

MJA Insight: New study highlights medicine’s big earners

MJA Insight: New study highlights medicine’s big earners

Issue 4, 26 July 2010
FEMALE specialists are earning less than their male colleagues and the inequity is considerable, according to one of the few surveys of specialist incomes conducted in Australia.

Compared with their male counterparts, female medical specialists are earning almost 17% less, according to the report released last week by the Melbourne Institute at the University of Melbourne.

“The large gender differential has implications for health care costs, as the proportion of female graduates is now around 55%,” the report’s authors wrote.

The overall self-reported average pre-tax specialist income adjusted for age, experience and hours worked was $316 570, based on a sample of more than 3700 specialists,  from the public and private sectors.

Annual earnings of self-employed specialists exceeded those of salaried hospital-based specialists by close to 27%.

The big earners
The highest paid specialists included diagnostic radiologists and orthopaedic surgeons, followed by other surgeons, obstetricians and gynaecologists, and intensive care specialists.

Psychiatrists, paediatricians and thoracic medicine specialists were the lowest earners.

Greater experience, less complex patients, college fellowship, more time spent in clinical work and working in regional areas were all factors that increased income.

“These variations are likely to arise from differences in the cost and length of the requisite training in each specialty, the complexity of skills required, the market conditions for specialist services, and historical relativities in the Medicare Benefits Schedule,” the authors wrote.

“It would be of interest to explore whether the pay differentials between specialists are in line with demand for these specialties (and potential shortages), or whether they are mainly driven by the cost of training and complexity of required skills,” they said.

Specialists better off in some states
Specialist incomes also varied by geographical location. Compared with specialists based in NSW, those in Western Australia earned 7.3% more and those in Queensland 14.6% more.

Specialists in regional areas also trumped their city-based colleagues, earning close to 6% more, but those working in Tasmania earned 12.9% less than their NSW peers.

Hours worked
The analysis showed the mean weekly hours worked by both male and female specialists was around 45 hours, and annually, 51.6 weeks.

General practice
Like their specialist counterparts, female GPs earned less than their male colleagues but the difference was greater, at 25% less than men.

GPs working in larger practices, regional and rural areas and areas where the supply of GPs is low had higher earnings, but the mean gross annual personal income for a GP was $177 883, more than 30% less than specialists.

Predictably, self-employed GPs and those who do on-call and after-hours work had higher incomes.

Gender divide a surprise
The report’s principle investigator, Professor Tony Scott, said in a media statement that the gender gap was surprising given that men and women in medicine had the same level of education.

“Our results have adjusted for differences in hours worked, years of experience, and a host of other factors. It could be that female doctors see a different mix of patients than male doctors,” he said.

“We are puzzled and will continue to look into this,” said Professor Scott, who leads the Health Economics Research program at the Melbourne Institute in Victoria.

The analysis is based on data collected from the national longitudinal survey of doctors called Medicine in Australia: Balancing Employment and Life (MABEL).

Full report: What Factors Influence the Earnings of GPs and Medical Specialists in Australia? Evidence from the MABEL Survey.