I was throwing out old documents for a spring reset.
I came across an old contract that was presented to me about 5 years into working for my first position as a doctor. (I can’t call it “private practice” as no one that I know in primary care can afford to be self employed unless you have training different than other colleagues. The mere fact that you made it through residency training means you have 3 years of basic training in the primary care field and can take care of patients with entry level knowledge BUT the best learning comes with the next few years after graduation. (Practical application) I chose to postpone getting a salary for 1 year to improve my sports medicine knowledge as I thought basic training was lacking teaching about muscle and movement. (In addition to behavior, mindfulness, nutrition, alternative medicine and nutraceuticals...). I took another financial “pause” when I signed up for acupuncture certification, Integrative Medicine training (thank you forever Andy Weil!) and mindfulness/yoga teacher training (thank you as well Deepak Chopra!). I refuse to call the money/time spent for deeper training a “financial hit” since with better training I anticipate better fund-of-knowledge and more complex problem solving skills. (Which I anticipated would bring better patient outcomes, higher satisfaction scores and hopefully secure financial future for my family (was looking forward to transitioning to become a Med school teacher at 70 when my energy would fade but doesn’t look like it now)
I was always against the dictum that a doctor should be a good businessman. I think the concept of business is usually to end up financially secure by promoting a product that ultimately is better and anyone else’s. (Me first) The concept of healer is based on altruism with the gift/talent one was given to be shared with all. (Everyone else first)
So being a doctor is opposite being a business owner in theory and I know there are successful doctors but most are the super specialist that perform spectacular procedures on the sick and dying.
This is my first point that medicine has evolved and is spectacular. As I write this a mom that consulted me to help is going for a lifesaving procedure to destroy a deep brain aneurysm that would have taken her life. She will be fixed and released before Easter Sunday! (With no open skull surgery!!!) I also have a pancreatic cancer patient that is back home from a whipple procedure and going to tell stories of survival to his grandkids! (FYI “the whipple” 5year survival rate was previously 20%) Thank God science has evolved to figure out how to beat death...but at the price of big business also figuring out how to capitalize on it. Pharmaceuticals 1.3 trillion
Medical insurance 2.5 trillion
Hospitals took a 120 billion dollar hit from covid but too big to fail.
Which brings me to my 2nd point
Business capitalizes when opportunity presents (Art of the Deal) Healthcare has been “stream lined” to be run by business minded CEO’s. Physicians and nurses are the faces of a hospital system. I love the fact that most of the hospital board members are altruistic with the bottom line of keeping a community healthy!?
NOT!!!
There is more money in mopping up the sink than fixing the faucet. Surgical specialties and advanced disease super-specialists are currently the largest reimbursement by medical insurance ...so how do you think your “face of healthcare” is going default to in treating your disease? THE MOP. And I am grateful as my 2 above patients are going to survive.
3rd point
Buyer beware. Medical school students strive at being in the limelight regarding a specialty. I originally was to be a surgeon but the months before moving to the surgical residency in New Jersey I backed out of the position as the lifestyle while in training had as high divorce rate. I scrambled last minute for an open spot in any specialty and primary care family practice was lowest of the desired specialties then (and now as it’s the lowest paid salary along with pediatrics and preventive care at around 232,000$ which is nothing to sneeze at so when your student loans after graduation total 240,000$ a doctor should do ok in the long run. Ahh but the board that pays your salary has to make money too! How does a hospital system attract the biggest specialist to work for them without violating Stark Laws of giving kickbacks? Attract the super-specialist with expensive state of the art suites, operating rooms, procedure wings. (Mops) but what about those lowest reimbursed doctors? Keep them happy by providing a protected salary to help with start up and loan assistance costs so that the “faces” aligned as employee/doctors are a robust roster. This is where the rub comes in...protected salary is finite. Sooner or later the people paying for your face will want to have you sustain your own patient panel by incentivizing you to see as many patients as possible and turning the faucet on full blast. I certainly didn’t jump at the incentive brass ring and chose to do root cause analysis when it came to people suffering. I figured I can still make a decent living and practice medicine the right way-intense contemplation and personalize care instead of algorithm medicine (I call it lazy medicine-treat everyone with the algorithm as soon as they manifest any symptom/discharge patient and move into next room)
Not being business minded I ignored my take home and am not embarrassed to share but here is may salary base 21 years ago:
What I am embarrassed to share is my salary upon leaving my last job so I won’t post it ....but it was hovering around my year 2000 unprotected earning -with the threat dangling over me that it would go lower if I continued to practice and disregard the 15 minute unwritten rule. (It’s actually 10-15 minutes per patient to break even for the corporation you work for) ...try leaving a patient in 15 minutes when the laundry list of symptoms is as thick as the New Testament. When I first started out 1995 I used to empty a prescription pad in 1 day...average pad back then usually held 75sheets of paper (that’s 3 rx’s per patient visit)...yes I started out practicing lazy medicine.
When I finally woke up and realized younger docs straight of of training were making close to 100,000$ more than me...it was demotivating especially when paying for kids tuition going into a healthcare field (she decided to take Vet medicine probably seeing my stress level) I could “tap out” and choose to be an employee with a “comfy paycheck” and give a ton of prescriptions to Mop up any size spill... but I REFUSE as my promise to Mama when she died of pancreatic cancer (with no hope from her lazy doctor) was to follow my dream which was also her dream - utilize my God given talents and fix the faucet.
I am content with not making what lesser trained colleagues get for salary,
I am confident that my skills and coaching style are robust enough to design a template for stopping suffering with any disease state that seeks help,
I will not tolerate bullies, individuals that have a deceitful agenda or corporations that entice medical professionals to adopt an unhealthy/un-healing practice style in exchange for "a big paycheck" (supporting the hedonic treadmill)
Stop leaving
and you will arrive.
Stop searching
and you will see.
Stop running away
and you will be found
-Lao Tzu
