Monday, August 10, 2009

Doctors Have Feelings, Too.

I voted for President Obama in 2008. I even registered as a Democrat to support him in the highly contested Pennsylvania Primary. Unfortunately, 2012 may be different.

I am a 33 year-old physician, currently in my seventh year of post-graduate education. What does that mean? It means that after graduating from medical school in 2003, I went through three years of internal medicine residency and four years of cardiology fellowship. How many times have I been asked: 'When will you be done with school?' I cringe—I’m a real doctor!—but the fact is, I haven't really been paid like one since completing medical school.

The average starting salary for an internal medicine resident in Philadelphia is about $45,000 with an annual increase of $2,000. If you hypothetically figure that a resident earning $45,000 works 80 hours per week and gets one month of vacation, that works out to be $12.78 an hour, before taxes. Minimum wage in Pennsylvania is currently $7.25 per hour.

You probably think I'm complaining about nothing. We have 'job security' in these 'uncertain financial times'. We obviously get decent health care coverage. We get to live the excitement of 'E.R.' every day of our lives. And according to the U.S. Census Bureau, $45,000 is an average annual household income. So what am I complaining about? Well, here are a few more numbers for your consideration, according to the Association of American Medical Colleges. $139,517—the average medical school debt
at the time of graduation. 75.5%—the percent of graduates with at least $100,000 of debt. 87.6%—the number of graduating medical students with outstanding loans. This year alone, I've paid more than $4800 for mandatory licensing fees and certification examinations. That’s nearly 10% of my income. Gone.

Obama likes to talk about the discordance between the cost and results of our imperfect health system, yet he doesn’t acknowledge the culpability of our legal system. As our
government tries to cap out-of-control health care spending, he has publicly opposed caps on malpractice awards—the single greatest bane of a doctor's existence. To be sure, there are physicians who commit malpractice and/or order unnecessary tests for profit, neither of which can be defended; but there are many, many more who order tests to defend themselves against frivolous lawsuits. The New Yorker article on McCall , Texas is definitely interesting, but I don’t think it can explain away the possibility of defensive medicine.

So how does the Obama administration propose that we save money? The 2010 Physician Fee Schedule for Medicaire and Medicaid recently suggested a more than 40% cut in reimbursement for certain vital components of cardiology, not to mention cuts in every other field of medicine. While I don’t claim to have the answer, I know that Obama’s approach will only serve to degrade physician morale even further—and put private practice medicine at risk.

How about this instead? Limit malpractice awards in all states. Put physicians in the jury box, so that allegations of ‘malpractice’ can be judged appropriately; and guarantee that any physician who follows established guidelines cannot lose in the courtroom. If you do all three, most physicians will order tests more selectively. The system will gradually correct itself.

I didn't become a doctor to get rich, but I didn't become a doctor to struggle either. I've had to take too many tests, I've had to endure too many sleepless nights on call, and I've had to make too many sacrifices to watch my profession get squeezed in the name of reform. President Obama is worried about a 'brain drain' in finance if we limit executive bonus? Well, how would we all feel about a 'brain drain' in medicine? If morale in medicine continues to fall, we'll all find out very soon.


  1. I agree mostly whole-heartedly! I think tort reform should be a key component of any health care reform.

    The issue of physician compensation is a fascinating one. I think the princeton economist uwe reinhardt writes about it best - his basic conclusion - focusing on reducing physician compensation would result in small cost savings and a demoralized medical community. I'll post the link when I find it!


    Here's the link!!