The Doctor in America Self-employed private physicians who charge a fee for each patient visit have been the norm for American medical practice. Most physicians have a contract relationship with one or more hospitals in their community. They refer their patients as needed to the hospital, which usually charges according to the number of days a patient stays and the facilities - X-rays, operating rooms, tests - he or she uses. Some medical doctors are on salary. Salaried physicians may work as hospital staff members, or residents, who are often still in training. They may teach in medical schools, be hired by corporations to care for their workers or work for the federal government's Public Health Service. Physicians are among the best-paid professionals in the United States. In the 1980s, it was not uncommon for medical doctors to earn incomes of more than $100,000 a year. Specialists, particularly surgeons, might earn several times that amount. Physicians list many reasons why they deserve to be so well rewarded for their work. One reason is the long and expensive preparation required to become a physician in the United States. Most would-be physicians first attend college for four years, which can cost nearly $20,000 a year at one of the best private institutions. Prospective physicians then attend medical school for four years. Tuition alone can exceed $10,000 a year. By the time they have obtained their medical degrees, many young physicians are deeply in debt. They still face three to five years of residency (住院医生实习期) in a hospital, the first year as an apprentice physician. The hours are long and the pay is relatively low. Setting up a medical practice is expensive, too. Sometimes several physicians will decide to establish a group practice, so they can share the expense of maintaining an office and buying equipment. These physicians also take care of each other's patients in emergencies. Physicians work long hours and must accept a great deal of responsibility. Many medical procedures, even quite routine ones, involve risk. It is understandable that physicians want to be well rewarded for making decisions which can mean the difference between life and death. Many physicians in the US are self-employed private physicians.