Doctors Could Make Less Money.
And, maybe they should.
One of the excuses I keep hearing from my colleagues is how little time they have.
Not enough time to take care of themselves
Not enough time to spend on leisure
Not enough time to read
Meanwhile, they work long hours and take additional shifts to make more money.
Far be it for me to tell someone what the right work-life balance is. I am not interested in what you do at home or your free time.
What I am interested in, is your competence as a doctor.
How Do You Have Time For That?
When I speak to my colleagues, I often engage them with unorthodox perspectives about health that expose the non-sense we’ve been taught in medical school and are “expected” to practice with the threat of malpractice.
After a couple of conversations, I typically get a question like:
“How do you have the time to read all this?”
What do you mean “how”?
I am a doctor, and so are you. It is our duty.
This is the path we chose.
We must continually be pushing the boundaries of our knowledge, so that we can better understand the body and help our patients.
Of course, sacrifices must be made - as they always do.
Your employers, which by and large have become insurance companies, have flashed an impressive salary in front of you. What’s the catch?
Work. Work. Work.
Don’t ask questions. Don’t deviate from “guidelines” or hospital policies.
Don’t stop to consider if what you are doing is actually hurting more people than it is helping.
Work.
Look, we’ll give you all this money.
What Say You?
Will you take this offer?
Do you even understand what this offer entails?
You have an education and training that has woefully underprepared you for the reality of modern disease. During any patient encounter, your guidelines and society recommendations push you down management pathways which optimize for profit and return business, whilst minimizing legal expenses.
You have accrued a tremendous amount of debt. You have forestalled any other endeavors in life.
Now, the time has come.
All that is asked of you?
Propagate everything you have been taught and use it to generate income for your employer.
Don’t think too much about it.
In fact, they’ll even let you work extra to keep you distracted with more money.
Need to prove to the licensing board that you have been “reading”?
Not to worry. We have industry approved “continuing medical education” modules and credits.
You don’t really need to think deeply about anything.
Just answer this multiple-choice question.
How Do I Do It?
How do I have the time to read all this stuff?
I work less.
I spend more time with family.
I spend more time thinking about the cases I encountered when I was working.
I spend more time asking questions and trying to find answers.
I spend more time learning to be a better husband, father, brother, son, friend, coworker & neighbor.
I work less.
Yes, I make less money than I could. But, these other things are more important than money.
Of course, you have student loans - we all do.
The problem is, you know deep down that much of what you do for patients is futile. How much can your soul take?
That 5th prescription drug isn’t really going to improve their life. The next test isn’t going to give you some critical insight. The surgery may have a complication.
You continue to put patients in harms way, because that’s “how it’s done.”
Then one day, you will see your bank account and think:
“Did I deserve this?”
“Did I meaningfully improve any patient’s life this week?”
“Or did I just keep them alive, whilst they continue down this path of futility?”
How long do you think you can live with that?
Work less.
If you want the people in your life to believe you when you say:
“I am a doctor, because I want to help people.”
Even if you can fool those around you, how are you going to fool yourself? Your conscience?
You will know.
This knowing will drive you deeper in one direction, or another.
Work less.
Make less money.
Stay true to your Oath. Hone your knowledge and your skills.
Question your assumptions. Question what you believe to be axiomatic.
Work less.
You will survive.
And, more importantly - so will your patients.
So far as I can tell, what’s really driving the focus on maximizing quantity over quality is the high - & ever increasing - proportion of MDs who now work for healthcare systems rather than themselves. I’ve been in academic med for almost 20 years & I’ve watched exactly the same process in 2 states: systems suck up as many community hospitals & private practices as they can, until they dominate the entire market & there are few (if any) opportunities for patients to find help outside these behemoths, who have strict triaging/referral policies and years long waiting lists for appts.
It’s not primarily about loans or unavoidable costs (eg. malpractice premiums), but about meeting the financial demands of bean counters & bureaucrats. Ironically, by giving up their autonomy & resigning their clinical autonomy to “standard of care” protocols, they are putting themselves out of business… & the “healthcare” employers who they work to please are rewarding them by replacing them with mid-levels who make (sometimes) a fraction of what they do.
And from the patient perspective… if all an MD is going to do is spend 10 mins figuring out which Rx they should add to their existing polypharmacy, why *would* they prefer an MD over a PA?
No wonder there’s both burn out and a growing chorus of disgruntled MDs complaining about midlevels being called “doctor” & the like.
Honestly, it’s appalling how often I know more about something than my doctor does. I had a doc tell me recently that my cholesterol was high and I should stop eating dairy and avoid shrimp. That’s 1990s information. No, I never went back.