Everyone likes to complain about how much money doctors make. Many people hear the word “physician” and equate it with a mansion, BMW, and lavish vacation. But physicians don’t make nearly as much as you think.

After finishing high school, physicians spend a minimum of 11 years in training. Specialized physicians train even longer, sometimes for as long as 20 years. These are years spent making no money while in school, or making very little money during residency and fellowship. And by the time these individuals are “real” physicians, they are already in their mid-to-late thirties and have spent years struggling financially to support themselves and their families.

During the three to seven years of medical residency, physicians in training who abide by the maximum 80-hour-work-week mandated by the Joint Commission make approximately $11 an hour before taxes. Some residents impermissibly work over 100 hours a week, which makes their hourly wage even lower. Many residents travel to numerous different hospitals, cover the cost of their own gas, and even have to pay for parking at the hospitals where they work. Residents pay hundreds of dollars to attend conferences to improve their knowledge in their area of practice and thousands of dollars to study for and take licensing exams.

Now, you might think that this is a small price to pay to make the big bucks starting at age 35. Wrong. Physician income decreased in 2011, malpractice insurance premiums and other costs are on the rise, and reimbursement rates are declining. Although the potential 26.5 percent Medicare reimbursement cuts were avoided in the fiscal cliff settlement, the fix is only temporary and the increases could still kick in sometime in the future.

At the same time, the cost of medical school tuition continues to increase faster than the rate of inflation. The average osteopathic (D.O.) medical school graduate has $205,675 in debt, and the average allopathic (M.D.) medical school graduate has $162,000 in debt. And as of July 1, 2012, graduate students were no longer eligible for subsidized Stafford Loans offered by the federal government, which will cause medical education debt to increase even more.

So, you think doctors are in it for the money? If they once were, they aren’t anymore. Nearly half of all physicians regret going into medicine. And when asked whether they feel they are adequately compensated, only 51% of physicians say yes.

Healthcare costs could bankrupt our country, and the high cost of physician salaries is a contributing cause. However, we cannot reduce physician salaries until we reduce the cost of physician training. We cannot expect physicians to spend up to 20 years and hundreds of thousands of dollars in training and then pay them a meager salary.

While your radiologist or orthopedist may be making enough money to be considered “rich,” some physicians risk going broke. Your primary care physician may not even be making enough to pay off her medical school loans. Plus, high expenses and debt repayment cause all physicians’ take-home pay to dwindle.

So next time you are jealous of your physician’s salary, remember the time and sacrifice it took to earn that salary, and that her take-home pay isn’t nearly as high as it appears.

And yes, I note in the interest of full disclosure, that I am engaged to a resident physician.