Friday, March 29, 2013

Yes, Yes, Becoming an M.D. Involves Traveling Down a Long, Expensive Road

Still, I would feel more sympathy for this guy if he hadn't forgotten to tell us his starting salary when he completed his residency and got his first gig at full pay.
First, I was 32 when 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.
True, but you also might not have a job. So there you go.

Here's the thing: If your first job as a full-fledged M.D. pays, say, $250,000.00 per year,1 you can live very comfortably while paying off your entire student debt load in five or six years. If you're already used to surviving on the "salary of $39,000" that you earned as a resident, even with that type of rapid pay-down it should be a very comfortable transition.
Also, as I did not start saving when I was younger, financially speaking, I have lost the past 10 years without the ability to save and invest to earn compounding interest.
You traded one type of investment for another, and ended up in a career that (I hope) you love. Do you have any regrets?
In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.
That could mean a lot of things, but I suspect that he's saying that when you agree to accept insurance you're often going to end up being paid by a scheme other than straight fee-for-service, such as a D.R.G., and thus you may not (technically) be paid for the full scope of services you provide to a specific patient because you've agreed to accept a specific fee for any treatment that falls within the D.R.G. That's not the same thing as going unpaid, and obviously you think it's a good deal on the whole because you continue to accept insurance and continue to make a large salary. Most businesses could only look with envy upon such a definition of "not reimbursed".
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.
In other words, on the whole you got a very good deal for your investment of time and money.
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....
That's going to vary with specialty. There are highly paid specialties with regular office hours, for those who choose that path. Some doctors choose to become administrators. Some choose lower-paid specialties that allow them to spend lots of time with their families. These are the choices we make.

Let's be clear here, other well-paid professions have the same or greater demands. The lawyers you complain about may be working 80 hours per week, and virtually all of them make less money than you did on your first day of full-fledged practice. Some accountants can barely come up for air during tax season.

Yes, it would be ideal if everybody could earn a massive paycheck without their work ever impinging upon family time, but if you look around you'll find that a great many people sacrifice family time for their jobs while collecting a pretty meager wage. Next time you stop by a 24-hour big box store, grocery store, pharmacy or gas station at midnight, ask yourself - how many people working at that store have families?
...our large student loan debt...
Large, but easily manageable. Many other graduates with high debt loads would find your position enviable - and with cause.
...the age at which we can practically start saving for retirement...
Median household income in Michigan is around $50K per year. Typical compensation for a gastroenterologist is about $330K per year. So in the space of six or seven years, you'll earn roughly the same amount as a pretty typical U.S. family will earn over a career, perhaps more. So tell me again, how hard it is to save for retirement.
...and the pressure we face with lawyers watching every move we make.
Sorry... I'll try to avert my eyes next time.

No, seriously, I recognize that nobody likes to be accused of malpractice, and acknowledge that doctors feel some pressure from the fact that they can be investigated and sued for malpractice if things go terribly wrong for one of their patients, but what does that have to do with the cost of a medical school education? Besides, bringing malpractice into the picture belies your prior argument that doctors "are not represented when laws are made" - states have for the most part bent over backwards to create legal environments in which it's exceptionally difficult and costly to pursue malpractice litigation, and where damages are artificially capped even when it's beyond dispute that a patient has suffered catastrophic injury from the most egregious malpractice. What more do you want?2

I'm not going to argue with you, that the cost of obtaining a medical degree is high, and that there are significant burdens on those who enter the medical field. You want the public to subsidize medical schools and residencies, so that you graduate with a lower debt load and, after your initial medical education, have a more comfortable lifestyle? I'm listening - if we give you that, what are you offering in return? How about we reduce compensation for medical care to an amount more in line with the amounts paid by the rest of the world? Do we have a deal?
1. That's on the low side for a gastroenterologist.

2. The implied answer is "absolute immunity". One of the things that "tort reform" advocates gloss over is that with low "pain and suffering" caps on malpractice verdicts, the big exposure is for economic damages - largely future medical care. One of the reasons our malpractice costs are higher than the costs in nations with comprehensive national health insurance is that a national health plan will cover much, sometimes all, of that future cost. I would happily take the trade.


  1. Let's say I offer you a deal: For the next sixteen years, you borrow from me $25,000 per year. I'll invest that for you in an annuity. At the end of the 16 years, you'll owe me $400,000. I will then pay you $350,000 per year for the next thirty-five years, and you'll also have world-class health insurance, but any income you earn will be deducted from your annuity payment.

    Raw deal or great deal?

  2. Also, isn't employment for new doctors way way higher than that for new lawyers? I never hear of doctors not finding work.

    1. The unemployment rate for doctors is less than 1%, which functionally translates into "If you're admitted to practice, you can get a job."

  3. That's about what I figured. My friend has a new boyfriend who has an ex-fiancee (I know) who got a job as a GP in Midland. She made $5000 *a week*. Now she had about a quarter million in loans but still...most people don't have $5000 *a month*.