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The Taboo of Medicine and Money

I stumbled upon a blog post today asking the question “Do Doctors Make Too Much Money?”

As I read on, what started out as a simple question soon ballooned to over 100+ comments from patients, doctors, residents and spouses all with their strongly voiced opinion.

On one side, there are overworked doctors who see nothing wrong with the current billing system and in fact suggest that more compensation is necessary, especially for the primary care providers. Other patients complain about how little doctors know and how little “actual work” they do for their big pay cheques. There are quite a few comments that blast doctors for doing it only for the money, nice cars and long vacations.

There are examples of neurosurgeons who are working their butts off to get by. Others counter with stories of dermatologists with 40 hour work weeks clearing half a million.

The answer to such a question of physician pay is quite complex. When considering how much physicians are paid it’s not simply enough to look at hours worked. There are also lots of hidden costs and intangible factors to consider. Overheard costs and malpractice fees are paid by physicians out of their own pockets.

Or consider the opportunity cost of becoming a physician. Education is long and strenuous, easily taking a decade before students become licensed doctors. How can you put a price tag on youth? The interruption a medical profession has on family, the loss of relationships, the physical and emotional hardships endured is hard to count in dollars.

A doctor also faces a lot of unique job circumstances that are hard to quantify and put in numbers. How much can you pay someone to to face death and illness day after day? To have the blame of a patient’s death? There is also a lot of stress and physical toll working a job that require long shifts of 24-30 hours every few days.

Government and health insurance companies also have their own agenda. They want to implement policies and billing procedures that may not be to the best interests of the patient. Patients also have their own preferences. Some will demand the most expensive treatment while others will not buy beneficial medication because of the hefty price.

Medicine is a tough job but it still attracts the brightest. These are people who most likely would have succeeded (however you define that) in almost any job. Yet they have chosen to pursue medicine, and almost all (there are a few exceptions) will have done it for reasons other than money.

Yet there is still a taboo that doctors aren’t allowed to talk about money and salaries. Whenever a doctor brings up the topic of money, they are accused of doing medicine just for the money. That you see medicine as a way to make a living and that they don’t take it seriously and as a calling to serve others. They are branded and told if they don’t like their current pay, than maybe they should leave the profession and leave it to people who are more altruistic and actually care about healing others.

But money is a part of medicine. As much as you don’t like that idea, money affects medical decisions. To NOT talk about money and the economic choices in health care is actually harmful for everyone, especially the patients. Talking about the money medicine is an important aspect that should be discussed more openly. We need our medical students, residents and physicians to be know about basic health economics. Patients need to understand medical finances too.

There is nothing wrong with medical doctors talking about money. Just like there’s nothing wrong with patients, politicians, and even charities talking about money. There is a problem though when your underlying motivation for becoming a doctor is money. The patient should always come first. Money can be a good and bad thing, but we shouldn’t criticize doctors or health care workers as greedy salary earners just because they suggest higher pay. Similarly, doctors need to start looking at things from a patient’s point of view and why they believe physicians are paid too much. Obviously there is truth to both sides of the argument of whether doctors are making too much money.

So whether you’re a RN, health professional, doctor, patient, insurer: we need to stop accusing each other of greedy motivations and being such cynics and critics and we should get talking. We’ve ignored for too long the elephant in the room that is money and medicine.

Better use of our money will lead to more effective and efficient health care. If we are open to talking about money, more people will have their input which will hopefully lead to creative and innovative solutions. At the end of the day we shouldn’t be too worked up over physician salaries. Instead we should be measuring the quality of health care provided to patients. If talking about money can get us there, I don’t see why we shouldn’t start thinking and asking questions about it.

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  1. Joshua
    Joshua December 19, 2008

    Great post, I was actually planning to write an article soon about money, though not specifically about money and medicine.

    In any type of field, you are going to find a variety of people who have pursued that career with different motivations. In terms of medicine, it would be foolish to think that no one ever thinks of the money and prestige/image at all, in addition to actually wanting to be a physician for what a physician does. Obviously everyone values these factors differently, and we’d all like to think that our physicians are the ones who value money/prestige the least, but everyone is different.

    I disagree with the common argument (and that the author of the article you linked share) that physicians are not in it for the money, since “law/business/etc.” have greater earning potential. The problem with this idea is that earning potential is specific to each person – there are undoubtedly individuals who would make much more being a physician than they ever could in business or law, simply because of their natural skill sets, talents, and interests. So yes, in all likelihood, there are absolutely people in medicine because that is where they have the highest earning potential.

    One of the problems that I find with salaries in general, and not just in medicine, is that it is often not based on performance. Correct me if I’m wrong, but I would assume that specific physician types are paid the same in Canada for doing the same procedures. It doesn’t matter if your physician has a horrible bed-side manner or did an awful job, as long as he didn’t do something completely outrageous, he still gets paid the same as a great physician. Considering the lack of physicians, particularly in primary care today, there seems to be a ridiculous amount of job security for a physician despite how competent they are at their jobs.

    I see the same thing in the education system. I have had the most amazing teachers and the most awful teachers. I think the great teachers deserve to be paid more – the problem is that it’s far too difficult to create an objective evaluation system that our society can afford. It’s much easier and much more practical to pay everyone the same.

    I have met physicians who I think are ridiculously overpaid, and physicians who I think are probably ridiculously underpaid. I honestly don’t know what I would suggest because I don’t know the system well enough.

    Good article though, and def. some interesting things to think about.

  2. leafless
    leafless December 19, 2008

    Considering the amount of effort and money spent on education, I think doctors deserve every penny they are paid.

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