Before I even start, I want to clarify why I’m writing this particular post. It’s not about me at all, it’s not because I feel proud of anything, it’s purely because I think this is something that is incredibly misunderstood. And as someone who has a level of experience with this, I think some misconceptions need to be clarified. It’s not meant to be personal, but it’s impossible to relay some of the facts without it sounding that way, so sorry about that. Also, it got really long. Sorry about that too.
I belong to a facebook group of moms and many if not most of the women there are great. I have asked a number of questions and gotten many helpful answers and been directed to awesome resources that I didn’t have on my own. For that I am very grateful. But there are a few things about this group, which I think really represent society at large, that irk me. And one of them has to do with medicine and doctors.
Every few days, someone will post about something their doctor did or did not recommend and then they’ll ask for advice. Inevitably, there are people who encourage the person to trust their doctor and there are others who write scathing criticisms of everyone in healthcare. They’re predictable rants- your doctor isn’t well informed, they don’t read the research, they are only in it for the money, they’re only recommending x, y or z for the money and if only they could do a google search they’d realize that the doctor is wrong and if you follow their advice everything terrible will happen.
And I can’t help but just be endlessly frustrated by this. Now let’s be real, there are some seriously crappy doctors out there. But there are some terrible teachers, lawyers, plumbers, cooks and if we judge every profession by its worst member, we’d probably never leave our homes. And so, I think we need to take this skepticism of doctors and dismantle it a little and look at what truth their is in this vitriol.
Before a doctor can even apply to medical school they need a bachelor’s degree. Big whoop, I know. Then they need to take and pass the MCATs, have good community service or research and be a good all around applicant. The medical school application process is a giant pain involving flying for face-to-face interviews with not a ton of warning and then waiting for a response. It’s pricey and nerve wracking.
And then there’s medical school. As someone who only witnessed it and did not participate (thank God), I can say that it is unbelievably difficult. It requires discipline, intelligence and patience. And a lot of caffeine. Oh and money. The average public medical school cost is $162,736 and the average private medical school cost is $181,058. No matter how you break that down, it’s a lot of money.
Once medical school ends, residency begins. All American doctors must complete several years worth of residency, which is sort of like on the job training, to become an office or hospital based doctor. Residency can vary in length from 3 to 10+ years, depending upon the specialty and often is followed by a year or two of fellowship, which is like super specialized residency for lack of a better explanation. During this time they are paid roughly a public school teacher salary (at best), but the exact amount depends upon the area since residency salaries are adjusted for cost of living. Also, keep in mind that during residency most physicians are working 80 hours a week. When you break down their pay by the hour it’s embarrassingly low.
Several years ago there was a loan deferment option for residents based on economic hardship, but that was removed under George W. Bush (please, ask me how I feel about this) and now residents must either pay their loans during residency with their amazing pay or choose forbearance, which means they don’t have to pay, but the loans continue to accrue interest. From experience, since that’s the option we were advised to take (and took) let me just tell you it’s A LOT of interest. In my husband’s case the forbearance had a 48 month limit, so now he’s having to make loan payments while in residency. And then once residency ends, the monthly loan payments are over a thousand dollars each month for decades.
I know what you’re thinking- but doctors make so much money!
They really don’t. I’m not going to say they’re underpaid, but they’re hardly overpaid. Most non-surgeons (who typically make more and have longer and more arduous residencies), make somewhere in the neighborhood of $170,000 their first year out of residency. It’s certainly not nothing, but it’s not quite the rich millionaire status that most people seem to think and you have to keep in mind loan payments and the astronomical cost of malpractice insurance.
So there’s the cost and the income part of it. I think it’s important to note that most hospital based doctors are salaried. While you may receive a bill from a surgeon, chances are, they’re not getting what you pay in their pocket, the hospital is and it’s contributing to a set salary. If you really think that your OB is suggesting a c-section for your breech baby because she wants more money, you are ill informed and skeptical to a fault.
Beyond that is the ongoing education component that seems to be often missed. My husband (who let’s be clear, isn’t some sort of super doctor. I mean, he gets good reviews from his attendings and is a good physician, but I don’t want you to think he’s an anomaly) spends 4-5 hours a week reading articles. Some of them are assigned by his attendings, but many of them are simply ones he found to make sure that he is up to date on pertinent research. My point is that it is VERY likely that your doctor is doing research regularly. That they are reading scholarly journals and paying attention to new information. The kind of stuff that gets peer reviewed, not so much the kind of stuff that appears in google searches. Please don’t assume that your doctor isn’t keeping up to date on research, they have continuing education requirements and the vast majority of them are doing the best they can for their patients.
There is an emotional toll to being a physician as well. If you ask my husband, who is only 5 years out of medical school if he would do it again, he will tell you without hesitation that he wouldn’t. He loves his job. He loves helping children and giving them quality of life, finding out new ways to treat illnesses and making a difference for his patients. You can see him come to life when he talks about cases that were tricky or about times they figured out the right medication combo, it’s just awesome. But what is hard for him and others is the naysayers and the parents. He has been part of teams that have spent countless hours finding the right medications for critically ill patients, only to have parents refuse them because they have a potential side effect of diarrhea. He has been “fired” from a patient’s care because his team suggested a treatment that the parents googled and found could cause weight gain. I wish I was kidding, but truly, I’m not. Last month he had to stay late at work so the grandparents of a patient could drive 2 hours to yell at him because their grandchild had a mild and reversible reaction to a medication. And this isn’t outlandish or unusual. This is common.
I know it reads like a whole lot of woe is them and I’m not trying to paint it that way. I just think that the picture that so many have that doctors rely only on the information they learned in medical school while they count their piles of money and try to trick patients into paying for extra treatments really couldn’t be farther from the truth. And I think that the way people ignore doctor’s advice in favor of google searches is terrifying. I think being an informed patient is absolutely awesome and that everyone should be. But I think that trusting Dr. Google over a person who has completed years of training is just stupid.
I know that I’ve probably lost most people by this point, but I guess I am just hoping that by sharing this, which is only a fraction of what I could say about this issue, is that people will take a breath and stop assuming the worst in their doctors. The vast majority of them do what they do because they truly care for their patients. They care about their outcomes and their quality of life and truly want what’s best. And to be accused of being money grubbing and uneducated is one of the reasons why so many doctors wish they had gone into a different field.
Just keep in mind that your doctors are people just like you. They’re husbands and wives and parents and good people. They went into this field to help people and helping their patients, regardless of the personal cost, is what they do each day. And while you’re making them stay late so you can berate them, they’re missing dinner with their family. Or when they come in at 8pm on a weeknight to check on your child, they’re doing it at the sacrifice of time with their family. So maybe instead of assuming the worst every time, you might try the benefit of the doubt at least occasionally. You might be surprised.