Soapbox Session: Physicians

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.

21 Responses to “Soapbox Session: Physicians”

  • Jules G.:

    Well said, Katie. I have a friend who is a general practitioner, and when asked, he also says that he wouldn’t go through it all again if he knew what he was going to be up against. Enormous hours, enormous pressure, and enormous stress from upset patients and parents. I went through cancer treatments about 7 years ago, and while I trusted my doctor implicitly, I also felt the need to get myself “informed” so that I could be my own advocate. In my case, I did that by getting a second opinion from another oncologist as to treatment options, but I’d appreciate your thoughts on how people can become educated enough to advocate for themselves without having to resort to the inaccuracies of Google.

    [Reply]

    Katie Reply:

    @Jules G., Sorry for the delay in replying. I kept meaning to come back and reply to your question but only seemed to remember when I wasn’t at a computer.

    So, the ways that I keep myself informed without becoming Dr. Google is by choosing my sources carefully. I like PubMed and Google Scholar for searches about diagnoses and treatment and Epocrates for information about medications (you’ll need to sign up, but it’s free). The two former offer links to abstracts and articles that are peer reviewed and published in high quality magazines, the latter offers information about medications, including an interaction checker, images of pills, etc, and lists side effects without bias.

    As a rule, I try never to use any website that has an obvious bias. Examples would be natural news or any vaccine website, as both have strong agendas and you can bet the information you’re getting isn’t of the highest quality. I like the CDC for information because they list side effects in black and white and don’t sugar coat much. If you can’t find any information on any of those sites, by all means, do a google search, but then take the extra few minutes to fact check what you’re reading. I had a mother in that FB group last week try to convince everyone that there were no thimerisol free flu shots (wrong) and that all of them contained anti-freeze (also wrong). It took me less than 3 minutes to prove her “source” wrong and in the end allowed the real information to be presented.

    I guess my best advices is to be skeptical. Fact check the internet because you can pretty much publish whatever you want on here, whether true or not. :)

    [Reply]

  • Thank you for being brave enough to post this. Pick any issue — the vaccine ‘debates’, which pit anecdotal correlation over actual studies published in peer-reviewed journals, or use of antibiotics — and people are consulting Dr. Google as their on-call physician. I’m glad people are taking healthcare into their own hands and trying to become informed, so they can be active partners in their own care, but vilifying healthcare professionals is not the way to do it.

    [Reply]

  • Anna:

    My dad is a general practitioner and his only advice when we were in high school/college was DON’T GO TO MED SCHOOL. He’s past his residency and still is gone 12 hours a day for work, only to come home and be on call most nights and weekends. My mother who is a pharmacist actually started earning more than him in the last few years (she works hard too!) – we had a comfortable lifestyle but certainly weren’t “rich” as some college friends immediately assumed when they found out my dad is a doctor. He works hard for his patients and, honestly, most of his frustrations are with the hospital/medical group he works in rather than patients (probably because he focuses on geriatrics and they’re too old to google everything to death!). Either way, being anything other than a super-specialized surgeon (and after the decade+ of extra school it takes to become a super-specialized surgeon), doctors work hard for not much more than what first year lawyers make (who only had three years of school to get through). As a lawyer, I outearned my dad (who had been practicing for 25 years) within 2 years of starting at my firm.

    [Reply]

  • Well said. Thank you for posting this.

    [Reply]

  • Susan:

    You have some great points and it’s valuable to see things from a different perspective. Most people don’t have your access or ability to know what goes on “behind-the-scenes,” so to speak. As someone who doesn’t know any physicians personally, and who only sees them when I or someone in my family is sick, it can be difficult to be sympathetic to doctors’ and nurses’ plights (long hours, time away from family, feeling underpaid) b/c in that moment, I’m just worried or stressed about my child’s illness and/or filled with fear about their health. So that’s another perspective to keep in mind–when patients are acting unsympathetic, doctors and nurses shouldn’t take it personally, but remember that the people they’re caring for are in need of sympathy and understanding as well.

    [Reply]

  • Sophia:

    I just wanted to add some perspective on the income question:

    A household income of $170,000 is in the top 7% in terms of income distribution. TOP SEVEN PERCENT. That means more than 93% of US households. Yeah, it ain’t the 1%, but that is exceptionally outside the norm for the vast majority of Americans. It’s so far outside the norm that most people can’t even comprehend it.

    I take your points on the other topics, and can appreciate that there are various expenses associated with a physician’s profession that could complicate the picture financially. And I know you and your husband aren’t there yet. But you will be someday. So please, do NOT argue that doctors really don’t make so much money. Because compared to the rest of America, they really, really do.

    (And please don’t call me a jealous hater troll. As part of that 7%, I’m just trying to make sure that everyone up here retains some perspective about the rest of the country.)

    [Reply]

    Katie Reply:

    That’s a really good point. I guess what I was trying to say is that, we’re not ever going to be millionaires or so wealthy that we don’t have to pay attention to our finances, which a lot of people seem to assume. Also, I think just remembering that in addition to the bills that everyone else has, the fact that we’ll spend the next several decades giving between 1 and 3 thousand a month to loan companies (just for my husband’s loans) really cuts down on the income we’ll see. I see your point and I probably shouldn’t imply that 170k a year isn’t a lot of money because it obviously is a lot (I myself have a hard time fathoming it), I just think that there’s an assumption from a lot of people that doctors are the wealthiest members of society, when that’s not really true.

    Also, I try to avoid calling anyone jealous hater trolls. Everyone is entitled to their own opinion, having one that differs from mine doesn’t make you a jealous hater troll, just someone with a different perspective.

    [Reply]

    Suzanne Reply:

    May I add the malpractice insurance expense part of it?

    Doctors take this upon themselves, many employers do not provide this benefit and depending on the specialty, it can be thousands of dollars each month.

    My gyno referred me to an Ob practice when I became pregnant. He’d stopped delivering babies three years earlier because he could no longer afford the insurance needed to do so. I hate to think what kind of insurance my neurosurgeon pays every month. Or my vascular guy.

    On the surface, it looks like the loans are the only ‘expense’ a doctor faces, but that eventually goes away. Insurance does not. If you net the insurance out of annual salaries, I suspect that many doctors are making what I’ll earn as a professor someday, for twice the time investment.

    It truly is a calling.

    @Katie,

    [Reply]

  • See, I read something like this and I really want to believe it. But then my firsthand experience with this is my cousin, who is a doctor, and who is also the most arrogant prick I’ve ever met in my life. (And I’ve met a lot of arrogant pricks. Hell, I used to have an online dating account.) The only reason he became a doctor is because of the paycheck and “social status,” and I honestly feel bad for the unfortunate souls who have him as their doctor. Yeah, he’s a smart guy who went to school for an extra-long time and yadda yadda whatever. He’s an asshole and a bully and it’s damn near impossible for me to talk to him for longer than 2 minutes.

    And like you said, don’t judge an entire profession based on its worst members. I get it. And I know most doctors had more noble reasons for choosing their profession, and probably care more about their patients’ welfare than how nice their brand new custom-built house is. That’s just not my own firsthand experience.

    [Reply]

  • Cindy,

    I see a lot of doctors. My new neurologist is the first doctor I’ve encountered in a long time who is an arrogant bitch. The last two were arrogant initially (both surgeons, and good ones), but once I told one off and the second looked at my xray and realized I was not kidding about my problem, they both became much more human.

    There are arrogant ones, but I’ve encountered a lot less of them than the doctors who partner with their patients.

    [Reply]

  • Kimybeee:

    I work in a hospital – primarily in pre admission and surgery now. I have worked peds, picu, l&d, women’s unit, perinatal and cardiology! Doctors are not overpaid! They are tired and stretched thin and most of them are awesome and kind and compassionate! I am not a nurse, but the things I have witnessed doctors do is super amazing! In every profession you have a few that are not the best and that is what a lot of people think of when they think of a doc.

    The last six months I have been a patient for multiple and some super serious problems. I didn’t google. The day I got my cardio diagnosis I went upstairs to the cardiology floor and talked to the charge nurse and clinical coordinator to get recommendations for a cardiologist. I am very pleased with and trust my cardiologist completely. Same with gyn, asked a l&d nurse with more than 20 years experience. I had a few in mind from my experience working with them and she suggested the ones I had on my list. I had a terrific experience and amazing care with my hysterectomy. I made my own choice on dermatology and was happy with my choice. Malignant melanoma, picked my own super awesome and wonderful plastic surgeon. Still waiting to get that one out of the way.

    Do I never google – absolutely not. But I don’t trust my medical care to the internet and doctors hate that. I will check something small. But I have never ever contradicted my healthcare providers. I have questions, and I want to make the best informed decision I can make. If your provider doesn’t make you feel 100% confident in your treatment plan then one of two things are wrong. You are a know it all or your provider doesn’t fit your personal tastes.

    I am very blessed to work with some of the greatest staff! I sat one day and listened to a trauma/ortho surgeon tell a family that if it was up to him he would amputate the foot of the person he had just finished operating on. He went on to explain to them why and why not it should be done. When he finished and they all walked off I turned around to my coworker and told her if that doc told me to cut my foot off I would! She said she would to – he is the best and we have seen it over and over. Do we have some douche bags, absolutely. But they don’t usually last. They move on to somewhere that people will like them.

    And as for the money part. The doctors parking lot is not full of jaguars and lamborghinis and ferraris. Most of them drive smaller SUVs and efficient cars. The ob/gyn that delivered my first child also delivered my sister and he drives an early 1990s explorer with the headliner falling out of it lol. I am certain he could do better, but that isn’t his style lol. The docs do the job for the love of helping people. Hospital administration is the ones making the big bucks!

    [Reply]

  • Ann:

    Hello, I am an internal medicine doctor, and your post is just right on point. There are good and bad doctors, just like there are good and bad (insert any job title here). There are people that have good bedside manner and those that need a lot of improvement. You know, just like everyone else. So it is frustrating when people trust google or a side effect ONE friend happened to have over research and years of training. We really want to do what’s best for you, and while internet research can bring up a lot of information, without a knowledge base it can often be misconstrued. Although most of us make a comfortable living, by and large we are NOT in this for the money. Because money isn’t what keeps us going; it’s seeing people heal and thrive.

    [Reply]

  • I am having DIEP flap reconstruction surgery in about a month from now. Two highly trained plastic surgeons will perform the surgery which will take 7-10 hours for each of them. Each surgeon charges $22,000 for the surgery. But they don’t get $22,000. They get whatever the insurance company pays them and they charge me a small sum, $3,000. They write off the rest. They make good money on discretionary surgeries but their willingness to spend several days per week doing a complicated and exhausting procedure and accept whatever payment is allowed them is extraordinary. They feel like they should give back and when they operate this way, they are not getting the lucrative sums they could get by just doing cosmetic surgery. I think it is inspiring and amounts to quiet little heroics that nobody would ever know about.

    [Reply]

  • Kimybeee:

    My plastic surgeon for my melanoma on my leg also does mission trips. When he came back last time I asked him if he was out making the world a more beautiful place and he said he was helping make children feel whole and normal. He was fixing cleft palates and other issues that children in other places can’t get treatment for! I have known and worked with this surgeon for years. When I needed one myself it was a no brainier! When people think of plastics they think of boobs and Botox. When I left work last week at 6pm he had just talked to a family of a patient he had been working on all day and had two more patients to go. We have burn icu at our hospital and I am pretty certain that was what he was doing. He also works closely with the breast cancer team to do reconstruction for cancer patients. I would bring this doc and several others home with me! Lots of awesome docs out there!!

    [Reply]

  • Angelique:

    I appreciate your post. I have a great respect for my doctors, nurse practitioners and other medical providers, and that’s because they also respect me. Like you said, there are good and bad in every profession.

    [Reply]

  • Kimybeee:

    And I had a woman tell me her husband just about bled to death from a heart cath a couple days before I had mine. A real confidence builder lol. Of course that is a whole nother set of douche bags lol

    [Reply]

  • Litenarata:

    I agree with everything you said about people doubting the experience of an educated/trained person in favor of Google results, but I also agree with the person above who said that making $170,000 puts doctors in the top 7% of American incomes.

    That’s over $14,000 a MONTH. That’s more than many people make in an entire YEAR. (me, the last couple years, and most of my coworkers) For someone pulling in that much cash, saying their loan payments can be a $3000 a month, as though that is difficult for them to pay, is laughable. (They still have $10,000 left!)

    I know you’re trying to say that doctors aren’t often as rich as we imagine, but for the vast majority of America, there is really no difference between making $170,000 a year and being a multimillionaire. They are both equally unattainable and uncomprehendable. It doesn’t matter how much doctors actually make, we know that compared to us they are richer than we will likely ever be, so hearing them complain about loans and insurance doesn’t inspire sympathy.

    This comment probably sounds angry, but I’m not, because I’ve reading you a long time and I know you don’t mean to sound like you’re saying “poor, sad doctors, only making $170,000!”

    [Reply]

    Litenarata Reply:

    @Litenarata, I mean, $11,000 a month. Oops. Lol.

    [Reply]

    Katie Reply:

    @Litenarata, You’re right, I don’t mean that. I guess I think of it like this. Lawyers make a similar income with 3 years of graduate school and no residency. Their earning potential often greatly exceeds physicians when their training is not nearly as strenuous or painfully long, but no one seems to balk at that, when we hear daily how doctors are overpaid. $170k isn’t a small amount of money, at all, but I guess I’m thinking of it when stretched over the 10 year training period (where doctors work 80 hours a week for pitiful income), it just isn’t as impressive. But the point is taken, definitely.

    [Reply]

  • Sally:

    I wish the doctors would spend more time consulting with Dr. Google so they would understand where their patients, and their patients’ parents, are coming from.

    [Reply]

Leave a Reply

Welcome!
I'm Katie, a 30-year-old, wife, mom, former teacher-turned PT, who also had brain surgery in November of 2007. This blog chronicles my daily life, from mundane to crazy, often with far too much detail. Sit down, get comfortable and stay for a while.
Social Media Links
RSSTwitterFacebookpinterestinstagram
Email
overflowingbrain@gmail.com
Categories
Previously…
BlogHer Reviewer