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.

"MY DOCTOR OWNS A $$ 800,000 HOME WITH 4 AUTOS ---4 CAR GARAGES."

"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.