Wednesday, January 18, 2012

Doctors are Broke

Well, according to this article more and more doctors are broke. I know, it sounds crazy. When Stacy started telling me what the article said I could sense the collective incredulity of this nation rising all around me. Here are a few actual comments (grammatical errors and all) that appeared below the article. By now they're almost certainly buried beneath the other comments that have been coming in fast and furiously.
"It's amazing that Doctors complain about their salaries. Who asked them to go to school for 12 extra years after high-school, take out hundreds of thousands of dollars for tuition, and start working in their mid thirties. They put themselves in this situation."
"What a shame they will have to sell their homes and by a cheaper 20 room house, trade in the Rolls Royce for a Hummer."
"Complaints about their 9-room million dollar home (for just him and his wife), not being able to afford that 4th porsche he just bought his wife for christmas (really?), not being able to go to the bahamas because the two week trip to Italy and Spain cost more than he thought."
This article caught Stacy's eye and piqued my interest because we are discussing this all the time. We're not so worried about our Rolls and Hummer, though. Our Saturn has been with us since 1998, broken dome light and all, and our Dodge minivan is almost 10 years old. And we are happy to drive each into the ground. We've always opted for utility over luxury. And yes, we own a nice home, a home that is large enough to house our small business. It is wonderful to have such a short commute and to be able to live true to our own values and goals. And it is liberating to know that every choice we've made has been because we have felt it was right for us and our family.

Before I get into saying much else on the subject I have a couple of caveats.

  1. Our path is our own choice. We own that 100%.
  2. We recognize how fortunate we are to not only have a business that we built the way we wanted to, but also to be able to support our family, even in difficult economic times.
  3. We are incredibly grateful that we've both had the opportunity to get both undergraduate and graduate degrees. There are a lot of people who'd probably like that chance but don't get it.

A few things came to mind as we read and talked about the article. There is a huge discrepancy between the stereotypical well-to-do physician of a few decades ago and the "newer" doctors of today. A lot of us live in "normal" homes, drive "typical cars," and shop sales and bargains. Receiving our degrees did not give us the combination to the bank vault.

While there are definitely physicians that are doing very well, and that may even flaunt it a bit, that minority is shrinking rapidly. Most of the doctors I know do well but are not rich. The doctor you deal with most frequently, your primary care doctor, is probably paying a lot more for overhead like malpractice and supplies and receiving far less back in return for his or her services. I knew that Medicare tries to reduce reimbursement to physicians every year, but the article pointed out that the law expects Medicare to act this way. Private insurers tend to follow Medicare's reimbursement practices so that means most insurance providers are trying to give less and less to doctors each year. What other job can you think of where the expectation is that a worker is likely to take a pay cut every single year?

One benefit of doing more complementary medicine is that we rarely have to deal with insurance companies to get paid. Our patients and clients pay us when we are done and that's that. This means that we aren't listed in any insurance plan's list of providers so we need to find other ways to bring people in the door, but simplifying our billing is worth it. Plus, we get to practice without too much interference from third parties. We get to treat patients by talking to them and deciding together what the best course is. I never have someone reviewing charts to make sure I'm hitting my goals for treatment success, or auditing if I'm using the proper number of needles and then adjusting my reimbursement accordingly. If I do well, people keep coming, and they bring friends.

The cost of a medical education is huge today, and the reimbursements to physicians in practice are decreasing each year, so it is no longer a given to tell someone "don't worry about the debt." It has taken us into our mid-to-late 30s to get to the point where we can find enough money to save for retirement and our children's educations. We've always done something, no matter how tight our money has been, but we lost out on 10+ years of early retirement savings, so anything we make above an average salary is already earmarked for student loan repayment and saving for the future.

Lost in all of these complaints about doctors' salaries is the fact that most of them work a lot of long hours to make that money. I was talking to a friend of mine whose wife is a pediatrician. He mentioned that her hours haven't been that bad. She works about 50 or so hours a week. How many people out there are dreaming of the 50-hour work week? We both thought it was a little humorous that after the insane hours of residency we are calling 50 hours "not bad." And the hours just to get through medical school are incredible. I figured out once that during my first two years of med school I took over 120 credit hours of classes. I graduated with my bachelor's with about 130 credit hours of classes--in four years! And the third and fourth years of med school are like "residency light." You work full-time hours and then some.

I guess my point in all of this rambling is to say that none of this is simple. I wish the formula was take out loans/get a great job/make lots of money/live securely forever, but it's not. There is no formula, even for those of us trying to make wise financial decisions. And the Suzy Ormans of the world don't have a simple solution for us either. We're the financial oddballs, and it can be frustrating at times, but things could be a lot worse. I just wish people would stop misplacing their frustrations with our system of healthcare delivery and start looking deeper for the larger problems. I'm still waiting for that article that tells me how those poor CEOs at big insurance companies are going broke.

I have a feeling I'll be waiting for a long time.


Boquinha said...

Such a great post, Sweetie. I especially love your closing lines.

There was another comment someone left on the article that said something along the lines of, "Who asked them to help people anyway?!?" Ummm, seriously?

I absolutely HATE that anger and frustration gets directed at physicians instead of the system.

Doctors generally go into medicine to help people. I'm not one bit convinced that that's why insurance companies started. THAT was about money, not helping people. And THAT is where the problem lies now. Grrrrrrrrrrr.

Jimmy said...

Interesting perspective. I like it. I'm curious as to what are the the larger problems you refer to? Also, I believe to a degree (not sure to what degree) that in the US, poverty has more to do with how we spend than what we earn. In some cases at least.

Emily Foley said...

I know 5 doctors personally: You; my brother-in-law CJ that didn't do a residency but is making well over $300,000 a year; my brothers father-in-law, a plastic surgeon, that makes over $700,000 a year and owns a home in Hawaii that he regularly takes all 6 of his daughters and their families to visit; my high school seminary teacher's husband that is an orthopaedic surgeon and does a lot more than live comfortably; the last is my friend Natalie's husband that finished residency last year and got a job as an anesthesiologist at a private hospital in Virginia. Before he had his first paycheck they purchased a $600,000 home and last week he bought a brand new Infiniti so he could "hold his head up high when he drives into the doctors parking lot."

You're just the wrong kind of doctor. :)

Dr. Mark said...

Jimmy--If you start looking at where the money goes in health care, a disproportionate amount goes to testing and diagnostics. Yes, it costs a lot to develop new technology, but it's not always better. And many physicians are losing the ability to actually examine and diagnose a person with their hands instead of relying on testing. Patients are now demanding more tests that are unnecessary, but that they think they need because their friend had them, or an article in Readers' Digest suggested that "There Are 10 Tests Your Doctor Won't Order, But That He Should."

Medications are also more expensive, and more and more people are demanding them for everything. I can't tell you how many people wonder why I won't give them an antibiotic for their cold symptoms that popped up last night.

This is a lot to basically say that there are plenty of places that the money is being spent besides on the fee to see your doctor.

Emily--I can't disagree with you on that one. Unfortunately those salaries are the ones people use to talk about how their primary care doctor (family doctor, internist, pediatrician) is rich. Um, he is probably not. Specialties that perform surgeries or other procedures get paid very well. Insurance companies have a more difficult time determining how much someone's brain power is worth, so unless you do something fancy with a medical instrument, you are probably going to be paid poorly.

And don't get me started on malpractice.

Boquinha said...

Dude! That is some serious income. Yeah, that doesn't even TOUCH what family doctors make.

Did you read the article? There are some doctors taking cuts year after year or making, at times, nothing, and being forced out of practice.

Holy Moly. That kind of money just doesn't even seem real to me. Wowzers!

Boquinha said...

I should clarify -- the article isn't talking about the plastic surgeons and other specialists. It's talking about family docs, etc.

Dave Johnson said...

When we owned our service business, we had quite a bit of interaction with local clinics and family practices. It didn't take long to realize the exact truth of what you're saying. These poor guys were trying to make ends meet, just like us. Except they were doing it with crushing amounts of student loan debt. I'll never forget one exchange in which a pediatrician watched me restoring some tile under a desk chair.
Him: How long does that take to fix?
Me: About an hour, then it needs to dry overnight.
Him: So you'll be home by midnight?
Me: Yep.
Him: And you got here at 9. (p.m.)
Me: Yep.
Him: And you get paid no matter what. I figure I'm actually in the hole today. I've been here since 8. (a.m.)Must be nice.

This guy was actually pining for a service job in which he got paid without all the insurance and malpractice hassles. He was in a particularly bad and melancholy mood that night, but I can't count how many times medical clinics had to put off paying us because they were so behind on their bills. These were good, responsible people, but it simply didn't pay to be in family practice.

I also think the media is largely to blame for this misconception about doctors. They portray them as rockstars and celebrities. This is why I appreciate Scrubs so much.

Dr. Mark said...

Dave, I appreciate your comment. It's good to get inside information from a so-called outsider.

I've always said that "Scrubs" is the most realistic medical program when it comes to capturing the "feel" of what it's like to be a doctor. I've seen at least portions of most of the medical dramas that have been on network television over the past decade or so. Medicine is simply the setting for the high drama.

Dr. Mark said...

I just saw this article about doctors taking out record numbers of business loans just to stay afloat. The system is broken for sure.

Boquinha said...

Wow. Great article. Saw this in the comments -- EXCELLENT POINT and I totally agree:

"We really need to cut out the middle man who is taking money from the insurred and taking money from the Doctor's, and that amount is getting larger and larger, hence the Dr's are going broke. Our rates keep going up, the Dr's fees are going down, and the insurance companies are getting rich."

Dr. Mark said...

That's one of the reasons cash-based practices are so enticing. The doctor and patients can negotiate reasonable rates that reflect the quality of service involved. And when you cut out the middle man, the quality usually goes up.