Doctors enslaved

Doctor’s enslaved to money; an important part of the health-care reform equation

What makes physicians so unhappy?  I ask myself when I end angry phone calls with frustrated physicians.  I ask myself this when a surgeon walks through the emergency department where I work, spouting a tirade of profanity that makes the paint peel off the wall.  And I wonder when I hear a potential medical student talk to a physician, who tells the bright eyed young man or woman, ‘don’t do it!’

I have my theories.  That’s because the ER is a great place to watch, listen and learn.  I trained in a large urban teaching center and have practiced in a busy, semi-rural community hospital for 15 years.  I tend to pay a little more attention since I’m also a writer, and always looking for a good story, snippet of conversation or character.  By now I know a lot of characters, and what I see is lots of frustration.  But the question is, what can we do to ease that frustration and create a happier, more functional medical work-force?

I don’t think that physician unhappiness has to do with patients; not exactly.  Every physician has his or her favorite story of the nightmare patient.  You know, the one who calls at all hours for Viagra refills, or the one who saw my partner and insisted that she be admitted for her bad perm.   Like the drunks who play with rattlesnakes, or the swooning teenagers who ‘pass out’ until their girlfriend or boyfriend arrives, then immediately want to go home.

Patients have been difficult as long as anyone has pretended to be a healer.  ‘For the last time Thack, you aren’t turning into a cave bear!  You’re just hairy!’  And frankly, they entertain us; the weirdness we see keeps us coming back, voyeurs of human silliness that we are.

Physicians are sometimes unhappy because we’re busy.  We belong to committees, go to meetings, attend CME conferences, educate students and residents, see patients, volunteer in the community and still try to ‘squeeze in’ family time (often as an afterthought.)  We don’t often say no; certainly not often enough for our own good.

And, as always there’s money.  What with reimbursement falling and the number of uninsured patients rising, turning a profit in medicine can be very hard.  Just the costs of regulatory compliance, filing insurance and paying malpractice are enough to make medicine unprofitable for lots of physicians; so they become more and more dissatisfied with their careers and lives.  Some people think that’s the essence of what makes physicians unhappy.

But from what I’ve seen, making money isn’t exactly money that’s the problem.   For all our problems with reimbursement, physicians can still make a fair amount of the green stuff.  The problem with making money is that we spend it.  And when we spend it, it goes away and we need more.  And the battle is joined.

It’s understandable.  Physicians start their careers in debt.  The average medical student graduates with a burden of educational debt that is currently somewhere around $120,000 and during residency, starting salaries are only around $40,000.  The doctor starting practice after residency needs to make some money to catch up and cover debt.  But he or she also wants to enjoy the money that’s finally in that bank account.  So, doctors start to spend money like…doctors.

We buy new cars to reward ourselves, and houses for our spouses that are too large and too costly.  We have children, which is great.  But we think the children need expensive pre-schools and lessons in order to be proper doctor’s kids.  When we’re not careful, we throw money around like Columbian drug lords in Vegas.  The problem is, their money does not depend on hours worked or patients seen.  Physician income does.  We get our cash by seeing patients and doing procedures.  We make money on effort, not on money itself.  Rather than being like bankers or investment experts, we more resemble factory workers or building contractors.

So, in order to maintain wealth, we have to keep working hard.  And if we spend more, we have to keep working harder to pay off debts.  Working harder is tiring, and keeps us away from our families and hobbies. And the cycle goes on and on.

Then, if we wake up unhappy one morning, or realize our families are dissolving before our eyes, or if we feel a desire to cut back, we simply don’t have a choice.  We are enslaved to a certain level of income.  However miserable the practice may be, we’re stuck.  If the partners are hard to work with, or the administrators won’t listen to our problems, we have to smile and keep coming back.  If the patients are more and more complex and less rewarding, we have to continue seeing them.  If the depression is overwhelming, and we actually consider suicide, we feel guilty admitting it or seeking help; after all, there’s work to be done and money that needs to be made!  So we go on and on, falling deeper and deeper into misery.  And if we just want to go and build boats for a living, well that just isn’t going to happen, is it?

Of course, we do other things that hurt our finances.  For instance, we make bad investments hoping for quick returns.  I have an anesthesiologist friend who used to love to day-trade.  He lost tons of money, and still works as an anesthesiologist.

In our unhappiness, we also mess up our relationships.  This can be an expensive problem; just ask any physician who is now working twice as hard to pay for wife one and wife two, along with child support.

My point is this:  Just as the Bible says it’s the love of money that’s the root of evil, likewise it isn’t what we make, but what we need, that enslaves us.  If physicians want to be free to enjoy life, free to move, free even to rebel or quit, they, we, all have to need less.  And perhaps the wisest thing that our directors, partners or even employers can do is to remind us of this…frequently.  Rather than encourage lifestyles that require large infusions of cash, we should encourage reasonable lifestyles that allow large infusions of time-off and happiness.

If we physicians can just learn, we’ll find that the happiness and contentment we want may just be easier to attain.  Sure, money isn’t the only problem, and this isn’t the only answer, but it sure is part of the equation.  So give it a try!  Sell what you don’t need and cut back.  Start out in a smaller house.  Drive a used domestic car.  Get your kids’ clothes at Target and Wal-Mart.

Furthermore, if you’re just starting out on your medical journey, don’t spend money you don’t have in anticipation of how much you’ll make.  Because if you do, the act of getting that money will be harder, and feel more painful, with every passing year.  And the things you purchased as part of the ‘doctor life’ will give you less and less joy.

My friend Robby said it best, in his finest South Carolina accent.  ‘Grandpa always said that the key to happiness wasn’t to get what you want, but to want what you have.’  It doesn’t get any simpler than that, does it?