The average American salary overall is about $42,000 a year.

The average family medicine doctor in the United States pulls down about $200,000 a year. The average internist or pediatrician earns about $175,000 a year. A general surgeon earns about $290,000 a year.

In comparison, a primary care physician (comparable to an internist, family doc or pediatrician) in the UK, under the NHS, earns between £53,249 to £80,354, about $90,000 to $130,000 at current currency rates.

The salaries of American doctors are huge, terrifying, for anyone trying to bring down health care costs in the United States. Why are American doctors so damn expensive? Medical school is a big part of the answer.

Per the American Association of Medical Colleges (AAMC), the median cost per year (tuition, fees and health insurace) to attend a private medical school in 2008 was a whopping $42,622. Public medical schools were only slightly cheaper, $41,429 for out-of-state and $22,984 for residents.

Add in at least $15,000 a year in living expenses, and the cost of a four-year bachelor’s degree and a newly minted medical student in the United States is easily hauling around three-quarters of a million dollars of debt by time they saunter out with an MD degree. The obligate first job of any medical school graduate is residency, typically a brutal three to five years of work, paying about $40,000 a year.

Running right down the median costs, paying off that $800,000 or so in debt (financed at about 5% a year) over the next thirty years of work eats up about $4300 a month; paying it off in ten years would cost nearly $8500 a month. A pediatrician or internist can expect to make about $14500 a month before tax; paying off this debt over thirty years will cost them about a third of their gross income. About half of that money will go to the financial services industry, in the form of interest.

If you want physician’s salaries to come down in the United States, without a true reduction in physician compensation, the natural choice would be to aggressively subsidize medical education and ensure young doctors come out of school carrying much less debt. A small amount of public investment up front will reduce a massive and ongoing source of inefficiency in the American medical system.