(Long post warning.)
Someone purporting to be a doctor posted an open letter on Quartz recently with a litany of complaints about how hard it is to be a doctor in America. This may be tough to explain to most people, given that the top nine, no, ten, no, seven, no twenty-one highest-paying occupations in America are medical professions, and doctors & surgeons average $168,650-$234,950 annually,* but our dear doctor spends many excessive words trying to explain to us how tough life is.
*I understand that salary goes up big time later, so young doctors tend to make less than that. That’s true of most professions, which is why they’re pretty good investments in the long run even if they make you poorer in the short run.
Keep an eye out for the repeated slamming of basically all other professions and the possibly rose-colored view of doctors’ motivations as you read this. I’ve tried to trim the fluff, but there are a lot of words here that are just unnecessary.
Dear Washington, D.C.:
I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared among many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your own family, friends, or colleagues.
This is not going to work for me. Let’s try this again.
I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared among many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your
own family, friends, or colleagues.
Somewhat better, Mr. Outstanding Physician. But we’re not here to mock your writing ability; we’re here to mock your ideas.
I then enrolled at St. Louis University to advance my training for a total of eight years of intense education, including undergraduate and medical school. The goal was to prepare me to take care of sick patients and to save the lives of others (four years of undergraduate premedical studies and four years of medical school). After graduation from medical school at age 26, I then pursued training in internal medicine at the University of Michigan, which was a three-year program where I learned to manage complex problems associated with internal organs, including the heart, lungs, gastrointestinal tract, kidneys and others. I then went on to pursue an additional three years of specialty medical training (fellowship) in the field of gastroenterology. The completion of that program culminated 14 years of post-high school education. It was as that point, at the tender age of 32 and searching for my first job, that I could say that my career in medicine began.
I quote this in its entirety because it’ll be important later. I will just note here that the US has a shortage of primary care doctors, not specialists, so if your goal is to “take care of sick patients and to save the lives of others” you might have done that. If you were really as selfless as you claim, you’d have done in Somalia.
For me, it began in college, taking rigorous pre-medical courses against a large yearly burden of tuition: $27,000 of debt yearly for four years. I was one of the fortunate ones. … I was fortunate to have graduated from college with “only” $25,000 in student debt. Two weeks after finishing my undergraduate education, I began medical school. After including books, various exams that would typically cost $1,000-$3,000 per test, and medical school tuition, my yearly education costs amounted to $45,000 per year.
Unlike most other fields of study,
You know, the easy ones. Like yours.
the demands of medical school education, with daytime classes and nighttime studying, make it nearly impossible to hold down an extra source of income. I spent an additional $5,000 in my final year for application fees and interview travel as I sought a residency position in internal medicine. After being “matched” into a residency position in Michigan, I took out yet another $10,000 loan to relocate and pay for my final expenses in medical school, as moving expenses are not paid for by training programs.
… I stared meekly at numbers on a piece of paper listing what I owed for the two degrees that I had earned, knowing full well that I didn’t yet have the ability to earn a dime. I didn’t know whether to cry at the number or be happy that mine was lower than most of my friends. My number was $196,000.
Rookie. I borrowed three quarters of that in less than three years.
$196,000. That was the bill, for the tuition, the tests, the books, the late-night pizza.
You don’t get to claim pizza. You’d have eaten regardless. Same for rent. Those costs apply in every other universe.
I then relocated to Michigan and moved into a small condo in Ann Arbor, where I started my residency. As a resident in internal medicine, I earned a salary of $39,000.
I wonder if you could have known what a starting resident in internal medicine earns before you started med school. Seems like there should be some sort of place where information can be looked up.
All the while, interest continued to accrue on my motherlode of debt at the rate of $6,000 per year due to the high-debt burden. Paying down this debt was not possible while raising two children. My wife began working, but her meager salary as a teacher was barely enough to cover daycare costs.
A lot of people I know believe that poor people are at fault for having children they can’t afford. You probably know those people, too. You’re probably also one of those people, then.
During residency, my costs for taking licensing examinations, interviewing for specialty training positions, and interest on the large loan ballooned my debt further, now exceeding $230,000, all before I began my career as a “real doctor.”
Occupational licensing is a pest indeed, but I feel less bad for you than for people forced into debt to be permitted to braid hair.
Relatives and friends often ask me, “Now that you are a ‘real’ doctor, aren’t you making the big bucks?” While I am fortunate to now be making a higher salary, some basics of finance make my salary significantly less than meets the eye. First, I was 32 years old as I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt.
You clearly weren’t paying attention up there, or to the world around you.
In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.
“We make lots of money, but it should be more.”
We, as physicians, are always available for our patients no matter the time of day. We do not record time spent with patients as a means to our reimbursement as other professions do. No, we listen to patients and answer their questions, however long it may take. Even if it is the 30-second straight hour of work, which happens very often, we listen, respond, and formulate a logical plan.
Yup, this is exactly the experience we’ve all had with doctors. Always available and endlessly patient. I see nothing to object to here.
And if we don’t do our work well, we don’t just lose business, but we can lose our livelihood through lawsuits.
Don’t you just hate it when you’re held accountable like literally everybody else (outside of government officials)?
You may ask why do we do all of this? It’s because we have pride in what we do. We truly care for the well-being of the human race. We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America. We are doctors.
That seems accurate.
In reading this letter, one may think that one has to sacrifice a significant amount to become a great physician. You may think we face physical and mental stress that is unparalleled. You may begin to think that doctors not only have to be smart, but they have to know how to communicate with others during very emotional times. You may think that we must face adversity well and must develop very rough skin to handle all walks of life, especially when dealing with sickness and death on a daily basis.
No, I think you should not have skipped English and math class.
Now that you see this additional aspect to our career, you may think that we have a tough job to tackle several tasks at once, demanding much versatility. You may think someone needs a great work ethic to do what we do. You must think that not only do we have to know science extremely well, we also have to know other areas such as writing, history, math, even law given the multiple calculations we go through in our heads on a daily basis and conversations we have with families. And finally, you must think we know finance, as we have to try balance a $230,000 loan while making $50,000 at age 30.
Ballsy, to claim knowledge of “writing” and “math” given this letter and your shock that borrowing money causes debt to rise. Also, you make way less than the average doctor. Maybe that’s because you’re still young, or maybe that’s because you’re a terrible doctor. Either way, the problem solves itself.
Now imagine, if you would, having $230,000 dollars in debt with two young children at age 30 and listening to the news with lawmakers saying that doctors are “rich” and should have their pay cut. Or that “studies show that doctors lack empathy.”
Ugh, studies. Don’t get me started. No doctor worth his salt would pay attention to a study.
Unfortunately, we physicians do not have much of a voice on Capitol Hill. There are not enough doctors in Washington, D.C., who can give the insight of this letter while you in Washington, D.C., discuss healthcare reform. … Many of the loudest voices in the healthcare debate are those of lawyers and lobbyists for special interests. They do not care about the well being of patients; that is what doctors do.
Well, yes. Everyone but you is an asshole. They only lobby for themselves, whereas you, the selfless caregivers, only wish you were better at lobbying for yourselves.
I want to make it clear that this letter is not just another story about the difficulties of becoming a doctor and being successful in medicine. I do not want you to think I am complaining about how hard my life is and used to be. In fact, I love my job and there is no other field I would ever imagine myself doing. My true wish is to illustrate the sacrifices doctors do make because I feel we are not represented when laws are made. These sacrifices include a lack of quality family time, our large student loan debt, the age at which we can practically start saving for retirement, and the pressure we face with lawyers watching every move we make. Yet we make these sacrifices gladly for the good of our patients.
Well, “gladly” seems out of place in this paragraph.
I want to challenge our leaders
I don’t have leaders. Stop saying that.
to address the points I have made in this letter, keeping in mind that this is an honest firsthand account of the personal life of a newly practicing physician. It is a letter that speaks for almost all physicians in America and our struggles on our arduous yet personally rewarding life. It is not just a letter of my own journey, but one that represents most physicians’ path on our way to caring for America’s sick.
I have no doubt that it’s an honest account of one man’s view of his own life and his importance to the world. I doubt it’s a worthwhile to contribution to any discussion worth having.