Have you ever had so much on your mind that if you began writing you feel like you might not stop for hours? This is where I’ve been. For a long time. There’s so much going on in our world, and things that I feel deeply about are changing all the time. I’m filled with anxiety, dread, and a tad bit of hope.
Today, I’m going to start with being a healthcare worker. I dedicated an entire decade of my life to education while my friends with MBAs were out making 6 digit incomes, I was still paying to learn. And for another 5 years I’d be paid 10% of their salaries. I invested time and my parents invested a lot of money (and the fact that I didn’t have student loans is a blessing for an entirely different post). I did that because I knew I’d eventually have the chance to help a lot of people. I’d become a surgeon because I wanted results, and I wanted them fast. I started my career a couple decades behind those that got paid nearly twice what I currently get paid.
Does the public know this? No. They still think doctors are criminally overpaid. Even Rand Paul threw Dr. Fauci’s $420,000 salary in his face—someone with over 5 decades of experience saving lives and getting us through the AIDS crisis and now dealing with an entirely new world and another pandemic.
The public doesn’t even know HOW we get paid. They don’t realize that we tell an insurance company what we are worth only to have them come back and tell us we will only be paid 25% of that rate.
Did you know that doctors 30 years ago were paid MORE for the exact same things I do today? So with a salary nearly TWICE mine, they had almost 6 times the purchasing power I have.
When a surgery costs a patient thousands or tens of thousands of dollars, the surgeon might see $500. The anesthesiologist another $500. The hospital thousands. The insurance company gets the remainder.
That’s right, doctors’ pay has been decreasing over the years. Meanwhile, inflation doesn’t stop. Meanwhile, wages for our employees go up. Insurance premiums go up. Supply costs go up. Childcare costs go up. Then there’s the cost of our education. Twenty years ago, medical school debt was about $125,000. It is now twice that. And interest rates are higher.
We spend the same amount of time getting our education, spending twice as much to get it. (Not to mention the accrual of interest). Then we get paid half the amount for the same amount of work. But we keep hearing boomers say “pull yourself by your bootstraps” or “keep your head down” and work harder for more money. The numbers are skewed in the boomer doctor’s favor. By a large amount.
Yet another factor is malpractice insurance. Rates of which are $25,000 a year or more for a surgeon. Another cost that is up 150% in the last 20 years.
Also, the number of administrators per doctor is about 16:1 currently. So most of the money in the system isn’t paying a doctor but an administrator averaging 6 figure salaries if not more.
Physicians have been vilified as greedy and paternalistic by some. Yet, for generations they have been revered as some of the most honorable people in society. They sacrifice time with family for their patients. They treat the sick knowing they themselves may get sick. They make split second decisions that may or may not save a life—all based on years of dedication to their art. With scientists at the bench and on their wards, physicians have worked hard to make medicine better. To allow people to live longer, healthier lives. To decrease infant mortality rates. To decrease maternal mortality rates. To decrease the chance of dying of a random traumatic incident. To stop heart attacks in their tracks. To allow for recovery from a stroke. To beat cancer. To prevent cancer altogether. To make better medicines. To have better prescribing practices. To make surgery safer. We have worked tirelessly for over a century to add years, if not decades, to the average human’s life expectancy. People that would have died from diabetes a hundred years ago can live well past 70-80 years. Disabilities and genetic abnormalities are not an early death sentence in large part to doctors that have studied diseases diligently alongside bench researchers to make these diseases controllable, treatable, and sometimes even curable. Most of what physicians do today would seem like black magic or miracle working just 200 years ago. We don’t educate ourselves any less, we educate ourselves MORE. We don’t expect less from our colleagues, we expect MORE. And the general public has come to expect the very best of what we have to offer.
Then, there’s insurance companies. The Absolute Worst thing about healthcare. Someone came in and profited off a relationship between two other people (a doctor and patient). Then, with barely more than GED, their minions starting telling doctors what was necessary and what wasn’t. When that happens, it’s just more money in the insurance company’s pocket. A health insurance CEO makes nearly 20 times what I make in a year—with less education—and that doesn’t include huge yearly bonuses which are equal to what I will bring in during my ENTIRE career.
However, now the general public thinks our education was worth nothing and they know just as much because they’ve “done their own research”. I had no idea so many people worked in our labs! They no longer respect our education, our work, our opinion.
I’ve had people make light of doctors being “burned out”. Of nurses quitting. People try to say we weren’t cut out for the job we’ve spent our entire lives preparing for and half of it actually doing. They ask “well isn’t that what you signed up for?”.
In a generation, the practice of medicine has changed dramatically. We save lives we couldn’t 30 years ago. But often times insurance companies tell us how to do a job we THOUGHT was between us and the patients. A sacred relationship that has been violated beyond recognition. When an insurance company denies a treatment, a work up, etc the DOCTOR gets blamed or questioned. Or their staff gets the nasty “Karen” at the front desk or on the phone. We get paid less to do more. We pay more to do our jobs.
And NOW, we are paying for it with even more personal sacrifice than any time preceding. Without the public’s respect, without the knowledge that we are doing something honorable, how do we keep going?
Without our family members’ hands on our backs—saying “it’s all worth it”, “I’m so proud of you”, and “how can I help?”—why do we keep showing up every day?
Spoiler alert: we shouldn’t.
Yes, this very politicized pandemic has divided MANY physician’s homes. Divorce. No longer talking to sisters, brothers, parents, children. When we needed their emotional and physician support the most, our own family members began questioning our treatment, the death we see every day, the denial of the very thing we thought we were “called” to do.
We are berated on the phone from all sides. Insurance companies deny our care, deny ongoing care, tell us we can’t order certain things. We spend hours on peer reviews and prior authorizations to be denied. Then patients think they know better—they stop their well-researched treatments to end up succumbing to a disease that is treatable. Then the family blames the doctor. The hate and vitriol spewed from patients and family members in the name of “advocating” for themselves—demanding unproven, or even disproven, treatments—is disgusting at best. It affects our staff, it demoralizes entire offices, entire departments, entire hospitals. Administrators tell everyone to do more with less—see more patients every day, spend less time with each patient, but maintain good outcomes and good patient satisfaction scores. As a nurse, take care of more, sicker patients for the same pay. Oh, and I’m also not going to raise your pay to that of traveling nurses. And when you get sick, show up. Work faster AND harder, but don’t expect a monetary reward. Don’t expect help with childcare—not physically or monetarily.
But most definitely, don’t expect to be trusted. Don’t expect to be respected. Don’t expect that you are an honorable member of society. Who told you that?
Just show up. Keep your head down. Pull yourself up by the bootstraps. That’s what’s going to keep our healthcare system from collapsing.