Saturday, February 04, 2006

Benjamins-- or Perhaps Georges

I suppose there are many things that can get on my nerves, but yesterday’s theme seemed to be money. Let’s face it: being a doctor has long been associated with having a good income. Not having any doctors in the family, I was not sure of exactly how much one could expect to earn prior to starting medical school. It is not perhaps the easiest way to make money, but most do pretty well, and there is quite a variance in income between specialties. One thing however, is consistent: hostility between privately practitioners and physicians retained by the hospital. Given the field that I am applying to, I will definitely be among the latter group.

Either path has its advantages. By having one’s own office, you can set your own hours and pretty much work as much or as little as you want to. I have trained with physicians who consistently work 14-hour weekdays, plus additional 6-hour days on the weekends. I don’t really see the point in working so hard that you can’t sit back and enjoy life, but whatever. I am sure that their account balances will be many times more than whatever I will accumulate.

Physicians based out of a hospital tend to be salaried or contracted for a certain number of hours through a large group. And while this method is certainly less lucrative, you don’t have all of the expenses of retaining an office staff and paying for equipment. This choice is much more appealing to me personally, as it means I can focus on seeing and caring for people, rather than worrying about overhead, mortgages, and how long it is taking for insurance reimbursement.

Currently I am rotating through a specialist’s office. While I enjoy the sharp wit of my current preceptor, she was unfortunately out-of-town yesterday, so I worked with her partner. He was very opinionated about my choice of career and clearly not of the same philosophy, and that’s totally fine. However, I did find it completely disturbing that when a new patient walked in stating that he wanted to pay cash for an expensive injection series, this physician completely changed his office protocol in order to accommodate charging the patient’s credit card before he changed his mind. It was hard, but I kept my mouth shut later that afternoon when he complained about how difficult it is for physicians to get reimbursed.

I think throughout the day, we just continued to aggravate each other. Our conversations always remained at a pleasant tone, but somehow he ended up defending his Canadian training-- which I hadn’t even known about, and made a point of letting me know that he was on the admissions committee of a medical school I did not get accepted to four years ago. Isn’t political bullshit fun? He also was charming enough to let me know that he doesn’t take on students as they couldn’t pay him enough to slow his schedule down. Nice. My school does not reimburse clinical preceptors, period. And while I think that policy is due to their inherent greed, and that some recognition is appropriate, I do not think that payment necessarily is. With my current level of training, I am doing quite a bit of work for them—for free. It was annoying to hear him say that after he’d dumped his hour-long new consult appointments on me all day long. He only had to spend 5-10 minutes with each new patient after I had done all of the work of interviewing and examining them thoroughly.


Later, I went out to dinner with a classmate of mine and we exchanged our current woes. Across the restaurant from us, a local news anchor was dining alone. I couldn’t help but notice after he was gone that he left a $1 tip—for dinner! I couldn’t believe it, so I stood up and peered at the table again. Nope, there was a single dollar there, folded in half by itself. Are you kidding me? How can someone who is bringing in six figures tip a dollar for dinner? Granted it was at a pizza joint, but he had a full meal and a beer. Did he think it was a pleasure for the rest of us to have him in the room with his newspaper? Did he think that the restaurant appreciated losing a four-person table on a Friday night to a single diner? Don’t people know that servers only get paid about $4 an hour and live off of their tips? People always talk about gaps between white and blue collar workers, but I guess I’m just becoming more sensitive to it. And not to be mean, but he was much more scrawny in person than he looks on television!

Am I looking forward to a future of disparity between myself and my colleages? I didn’t grow up with having extra money to throw around. My parents raised three children on a lot less than I’ll be making. I realize that my career choice means that I will be making quite a bit less money than other physicians, but I don’t care. I went into this to help people and because I like challenging myself. I don’t want to ever get to the point where I’m begrudgingly putting down a dollar that took less than a minute’s work to earn at the dinner table for my server. I also don’t want monetary gain for myself or my employer to have any influence on what I do for my patients. While I will have to be financially savvy about not ordering unnecessary tests, or admitting patients for stupid reasons, I don’t want to end up influenced by insurance plans or credit cards.

I know that as a student, I am still quite idealistic, but isn’t that where we all should be? Unfortunately, I know that as I start into my residency training, cynicism and desensitization are coping mechanisms that many young physicians end up turning towards, but I’m not looking forward to it.


Sweet Lucy said...

I just randomly happened on your blog while surfing around (shows how exciting MY Saturday night is...) and I appreciate your sensitivity to patients.

Often, emergency rooms dealing with psychiatric patients try not to admit them because of costs...which I find utterly disturbing. It's a fine line between trying to get people the care they need and trying not to ruin their lives with the insane cost of it all.

Keep on truckin'.

Kate said...

Thanks for letting me know you were here! I just read some of your entries and am sorry to hear that you had to go through such an ordeal to get help for B.

Chris said...

Seems like you were surrounded by "jackassery" on this day, between the supreme being specialist and the tightwad news anchor, ha ha. Thank goodness you are an enduring person!

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