During rotations, one of the things I do during my downtime is to surf the web on my smart phone, reading up on the future of medicine. (When I say the future of medicine, I don’t mean the nitty-gritty, details about the latest research on peptides, receptors, and hormones. Booooring … I mean the big picture, where-is-medicine-going, broad point of view.)
That is how I came across an very interesting article, The Doctor Is Out. It brings to light how miserable doctors are with the profession. Doctors are so miserable, profitable businesses have sprung up to guide doctors out of clinical medicine. The author made another point: By opting out of the healthcare field, doctors are failing their obligation to society.
She writes …
There’s another question, too. Is medical education a public good or a private possession? When physicians incur $200,000 or more in debt acquiring a medical education, it’s easy to see how they would feel that the education is theirs to do with as they please. Yet the American taxpayer contributes to the education of physicians by funding state universities and medical schools, and by funding resident training with Medicare dollars. Aren’t American citizens entitled to service in return for the billions that they spend each year on medical training? How would they react if they knew that so many of the doctors they paid to train are abandoning clinical practice if they possibly can?
This is where we disagree. And here’s why …
Why Medicine Is a Privilege
Those who believe medicine is a right have the following arguments:
- Medical care is a necessity, and should be available to all.
- Taxpayers’ money is used to train doctors. So doctors have a duty to give back to society.
Medical Care as a Basic Need
What is a basic need? It is anything you need to live. It includes food, shelter, and yes … medical care. But let’s focus on the first two items: food and shelter.
If you are penniless, do you have a right to eat? If you have no money, do you have a right to a roof over your head? If yes, why not show up at McDonalds, Applebee’s, or your local pizza parlor and demand food? If yes, why not show up at a property manager’s office and demand an office to live in?
Sounds absurd, does it? So why is it ok to demand medical care?
Medical Care as a Repayment to Taxpayers
Taxpayers’ money is used for many things, especially education. Their money goes to fund elementary schools, middle schools, high schools, and universities. Essentially all professions, not just doctors, are trained using taxes. So why don’t lawyers, accountants, engineers, or whatever other profession have the same perceived “obligations” as doctors?
They should render their services to whoever demands it. They should give back to society. They should let a third-party dictate how much they can make, and profit handsomely off of their hard work. They should never make a mistake, lest they get sued for everything they have.
It’s crazy talk, right?
Most people who go to trade school, college, or university do not get a free ride. They take out loans at interest rates that are 2x higher than rates for mortgages. They pay a ridiculously inflated tuition — one that has outpaced inflation for decades.
Therefore, beyond what everyone else got, no one gave doctors anything. We have loans at the same crazy-high rates. We pay the same ridiculous tuition.
Some may argue that taxpayers pay for doctors’ post-graduate training — mainly residency and fellowship. Well … doctors “receive” taxpayers’ money as much as you “receive” your employer’s money. The doctors and you both had to work hard for the pay. If anything, a doctor is underpaid in residency. A resident’s hourly wage is around $10 / hour while a lesser-trained physician’s assistant makes more than $30 / hour. Anyone with a brain larger than a pea can see that doctors get a bad deal. Unlike other professions, doctors who wanna get licensed have no choice but to go to residency. (Trust me … If residency was optional, like it is for other healthcare professions, I would not sign up for it.)
What Medicine as a Privilege Looks Like
Because you have as much “right” to medicine as you do to food and shelter, doctors have a lot of leeway in who they choose to serve. A doctor can be as self-serving as he wants, or as generous as he wants.
Genius marketer, Perry Marshall, writes in his book, 80/20 Sales and Marketing:
Government most definitely has its place; but any politician who tells you he can solve inequality problems through policy alone is either lying or self deceived.
Charity and the will to do good can only come from the heart.
When an economy is blessed with good-hearted wealthy people who sincerely wish to make the world a better place, it will prosper. When the wealthiest people are greedy and corrupt and self-centered, no amount of legislation can ever fix it.
Doctors who wanna serve society selflessly will do it, even without government intervention.
But when they are compelled by government and insurance companies to be servants (literally), they will rebel. There won’t be mass protests, because doctors are not very strong politically. But instead, they will opt out of unfair environments. They will turn to non-clinical jobs.
Why do you think it is so hard for Medicaid and Medicare patients to find doctors? Because doctors are refusing to play a game they cannot win.
Ever since my third year of medical school, I have already determined not to accept any form of insurance. If there is really is a doctor shortage, patients would pay good money to see me. If not, that means I’m not needed in the area and I would go somewhere else.
For patients who demand medical treatment because it is their “right” …
For patients who tell me, on our very first meeting, that they’ll sue me if I mess up …
I have no problem kicking them out of my practice. I don’t wanna be around people I don’t like.
For those who are grateful for any medical care …
For those who are respectful and realize that I am doing them a favor by being a doctor …
I have no problem giving them care, even if they cannot pay. (Heck, I even plan to give free care later down the road.)
Basically, I will give care on my terms. Not on the government’s terms. Not on the insurance companies’ terms. Not on the patients’ terms. My terms.
Take it or leave it.
If You Think You Can Do Better …
The reason why I write so much about money and medicine is because I think doctors as a whole are being taken advantage of. Financially, doctors get the short-end of the stick. And yet, they’re stuck with the bad reputation of being overpaid and greedy. It’s not greed. It’s about being compensated for their time and efforts.
If you think doctors are failing their duty to society by refusing to be indentured servants, feel free to walk the way you talk. Become a doctor yourself. Go to college. Take the MCAT. Get into medical school. Take the licensing exams. Get into residency. Get a medical license. Jump through millions of hoops. And provide care for everyone who demands it. All the while, someone else will profit off of your hard work.
But hey, at least you’re fulfilling people’s “rights.”
For thoughts about medicine and its future, visit the About Alex section and look for “Musings (My Philosophy on Medicine).”