Why are they separate?

I am interested in a lot of things and I have many hobbies.  It’s an adverse effect of loving learning for its own sake and it leads to the familiar label: jack of all trades, master of none.  And so it is with medicine.  I do not know where I belong, and I feel torn between the worlds of medicine, law, and business.  That they often overlap should come as some conciliation, but it just muddies the issue for me.

So what is one to do?  I try to seek the advice of people I think are learned.   I am trying to decide whether or not to become an MD, MD/JD, or an MD/MBA.  I have a relative who works in the State department.  He’s as sharp as they come, and has the enviable life of traveling to a new country every three years to learn their language, represent the US, and manage the affairs of foreign relations and immigration (as I understand it).  He comes from physician stock so he is no stranger to the world I am entering.  He has an MBA and he has many smart friends with JDs.  He seemed like a logical person to ask.

But within the first few moments of speaking with him, I heard so much that betrayed that impression.  Why do people think that it is “okay” for physicians to work for less and less pay because medicine is so expensive?  How can they keep a straight face when saying, “Well it’s one of the qualities of a physician that no matter what the conditions, no matter the pay, that they are healers and will help people”?  Why do people think that because my future livelihood is invaluable means that they can strip away its monetary value?  Shouldn’t it be the opposite?

To all of those that say, “Even if you are payed less in salary, there are other benefits such as the gratitude of your patients and that is a sort of payment”, I ask you: why should they be separate?  When I pay someone to fix my car and they do a fantastic job, I am grateful AND I pay them what they are worth.  Why, in medicine, do you think it’s okay that they are separate?


8 Responses to Why are they separate?

  1. Sabra says:

    They are not separate for anyone. My husband works for Roto-Rooter and not a day goes by that someone doesn’t expect him to cut his price by half. Nevermind that when he cuts the price, he cuts his commission, which cuts his paycheck, which cuts the number of bills we might actually get to pay that week. No one likes paying for anything, it seems. You should be off curing cancer while starving, and my husband should replace an entire sewer line for under $500 (the actual cost is usually at least 10x that) while living in his van. Expecting people to work for next to nothing seems to me to be an outgrowth of the “life should be fair” mindset, which honestly strikes me as very immature.

  2. […] has a great writeup dealing with the belief that physicians should be satisfied with less and less pay because they are […]

  3. whatnext says:

    perhaps you can follow in the footsteps of the Mad (former) Coroner of Allegheny Country, PA–Dr. Cyril Wecht, MD, JD –and recipient of my Biggest Local (and National) Pain in the Butt award for 25 years running. Dr. Wecht has made a very , VERY profitable career out of being both physician and lawyer, so i guess it can be done. i’m at least 99.9% sure that you could do both while also exhibiting 99.9% more class (and less rampant verbosity) than the estimable Wecht has ever shown.

    he once wrote us a venomous letter (his usual style) in which the word “pusillanimous” appeared. it’s the only time i’ve ever heard that word used outside the Great Hall in the Land of Oz.

  4. rebalukacs says:

    Well, how much is my health worth? As a medical professional, would you prefer cash or check?

  5. You bring up a wonderful topic that can not be dealt with in one meeting, lecture, or series of text books. It is something that is proliferated through academic medical centers, although times are changing. We are here for “patient care.” That is usually the statement that makes everyone silent. When it comes down to it, someone has to pay the light bill.

    The truth is that because medicine was so profitable for physicians for so long, we fell asleep at the wheel and allowed the insurance companies to slowly nickel and dime us out of our reimbursements.

    Also, the basic mentality of many patients it that medical care is a right, and so they flat out tell you that they have no intention to pay. Then they get upset when you send them to collection.

    anyway, nice writeup. I like the analogy to your mechanic. I am a surgeon so it is quite appropriate.

  6. A Starving Artist says:

    I read your blog this morning and expected to come home and find people from every discipline telling you what gets asked of them and to please cut prices and throw in freebies. As an artist, I have to require payment up front for commissions and then still throw in a few cool things that were not asked of me as the customer tries to haggle a lower price so I owe them money back when I’m done. One of my friends is a lawyer who doesn’t go pro bono but winds up doing cases for less as they take longer and he knows the client can’t pay. Our car mechanic gets hit up constantly for favors. I think that the price of living has gotten so high and people are spread out so far that they try to pay as little as possible and have no shame in asking for it. What gets to me is that we put so much hope in our doctors, then get angry and accuse them of having “God complexes.”

    I tripped into medschoolhell and became a regular– I’m an arts person studying to go into psychology, but perhaps one of my nine kids will go to medical school (what am I saying?!!) I appreciate what you write. Thank you for the insight. My mother was an insurance lawyer. Doctors feared her. There was a lot of abuse of the system back in the eighties, not just with medicine but particularly with mental health. The pendulum is bound to swing back as patients get sick of lame insurance policies. . .

  7. I agree completely with your question. I have wondered that myself as the spouse of a medical student and having a view from the outside. I agree also with the post above that claims that due to past high pay in medicine in the past. As a professional in another field yet close enough to medicine I see how the individuals and groups surrounding doctors are the ones profiting. They have found a way to cheat doctors out of compensation by appealing to the assumption that doctors ought to do this because of their love for it and the oath they take. Shouldn’t an entrepreneur also do what he loves as long as it is for the overall good of all – to his own sacrifices of earning little? I don’t think that’s the actual case. Mind you this is issue is especially true for those in primary care. Surgeons these days also have the benefit of aligning themselves with medical device companies for development contracts that gives them additional income. Primary care (the very essential first stop for any patient) is being bullied.

  8. Carolin says:

    Perhaps the way insurance companies are managed is the main problem in this issue. My dad always tells me that back in the good ‘ol days, all that doctors needed was a couple of nurses to work with them, a secretary who could greet and direct people, and an accountant who would take care of the billing and whatnot (plus or minus an anesthesiologist, and some extra personell depending on your specialty). So physicians were able to make much more money, because there were very few people between them and the patient—in other words, there was less bureaucracy. But NOW, the whole managed health care thing has increased bureaucracy to ridiculous heights. And what happens? The more people involved, the more the money is split to all the third parties, the less the practitioners get.

    In more specific terms, in order to run insurance companies you need an array of secretaries, coders, managers, supervisors, and whatever else….where does the money to pay all this people come from? It is directly taken away from the physicians, where else?

    The other big problem I see with insurance companies is that they increase liability in doctors because they limit practitioners as to what they can and cannot do with certain patients. So if a physician is not able to correctly diagnose a patient because of the limitations set on them by the insurance companies, who gets sued? yep, the doctor….how screwed up is that???

    As future physicians this is the real monster that we need to fight. Insurance companies need to share the responsibility with doctors if they want to be so actively involved in the practice of medicine.

    At the same time we are a little bit better off here in the US than physicians in more socialized countries, in terms of compensation. At least here we have the option to open up a private practice and only allow to see patients with ‘unlimited’ insurance-, or at least not deal with HMOs.

    I saw a preview of Michael Moore’s new movie “Sicko” (on Oprah) and we should ALL watch it (I think it comes out in a couple of days- late June). It touches on the fact that insurance companies should be non-profit organizations, such as our police departments, and fire departments, which are also in the ‘business’ of saving lives. We would think it outrageous if the fire department picked and choosed whose house to save depending on its insurance premium, and tried to make a profit out of every case they were called to assist. So it should be outrageous to allow insurance companies to pick and choose how much assistance someone can get, if any at all, in order to make a profit. ETC, ETC….

    Ugh, such a hot topic. Non-medical people who complain about how much doctors make need to be informed that the doctors are not the ones getting all the money, it’s the insurance companies. Basically, physicians are the puppets, and the current managed health care system is the puppet master, and this dynamic needs to change ASAP, or else the practice of medicine will remain a cold and crude business transaction.

    Bottom-line, we definitely need more physicians involved in politics, so I definitely recommend that you go for the JD; I have actually considered doing the same. (Funnily enough, I am also accepted into an MBA, which I might do this year if I postpone my entrance into med school until next year). But if you’re going to invest time away from medicine, perhaps a JD would be a bit more substantial than an MBA. Though if you could eventually do both, that would be even better. And considering how driven you are, I am sure that will be the case =) See you at the top! ;-)

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