I have come to the conclusion that doctors, and their income, are treated with contempt because of their association by default with the poor and the uninsured. You don't have to go far to read both in the mainstream media and in the blog world words of sheer anger at the incomes most physicians attain. I believe these feelings of anger and dissatisfaction toward an entire field of professionals has everything to do with their association with the poor and less educated. So before you start spamming me as being arrogant, read on. I am notarrogant. I am only calling it how I see it.
How many poor and uneducated people do you know that have accountants?
How many poor and uneducated people do you know that have architects?
How many poor and uneducated people do you know that have their own lawyer to handle all their legal issues. (minus the government funded DA for the poor)
How many poor and uneducated people do you know that have their own investment banker?
How many poor and uneducated people do you know that have their own financial planner?
How many poor and uneducated people do you know that have their own consulting firm on speed dial?
How many poor and uneducated people do you know have contact with higher education administrators or professors?
What we have in this country are entire populations of highly successful highly educated and wealthy individuals who put in their 60 hours a week. Who lead. Who manage. Who educated themselves to increase their financial worth in this capitalistic society. Folks who rarely have a business relationship with the poor and uneducated folks of this society, or daily contact in some way or another. In our capitalistic society, business relationships are built around money. If you have the money, you get the service or product.
They way I see it, doctors are in a league of their own. Unique in all regards. You have no other profession of highly education individuals who work with the poor and uneducated as their normal course of business. Doctors, who carry the longest educational journey, also have the least wealthy as their normal clients.
I believe, to a large degree, that this association by default with the poor and uninsured, has everything to do with the view of doctors as pompous, arrogant, greedy and overpaid. In no other profession is contact of this nature a part of the normal business climate. It is also why I believe that the entitlement mentality runs rampant. That a doctor's service is viewed as a right to take without compensation. It's a battle of class warfare. Two classes of individuals from entirely different economic poles that would otherwise rarely see each other (except perhaps at church).
The poor see the doctor's house or the doctor's car and view them as greedy and overpaid. What they don't see is the accountant, the architect, the lawyer, the consultant. They don't see their house and their cars. Out of site. Out of mind. What they see is their rich doctor. They simply don't have access to other services out of their financial reach. And yet the doctor is the enemy. Having access to the services of a highly educated professional, more so in time than any other profession on earth, costs money. And access to that service should be viewed in the same financial rigor as other highly paid professionals. If we as a nation wish to continue having excellent doctors taking care of the poor and the uneducated, we as a nation will have to find a way to pay them. Because, at the rate things are going, we, as a nation, have decided that comprehensive care doctors are not worth the money, but endless xrays, labs and procedures are.
You get what you don't pay for America. If you can get your head out of your ass long enough to see the serious destruction occurring in our comprehensive care foundation, and stop believing that doctors are paid too much, you will see that your own bias is without merit. That you are exposed to highly educated individuals that have a gift few others can master. And if you choose not to pay them for their gift, they will go elsewhere to practice their craft for others willing to pay them their due.
It's your choice America. Continue the rhetoric against overpaid, under appreciated physicians. Or accept that they are worth every penny, and more, for their personal sacrifice and intellectual capacity, that no other profession offers (or is forced to offer) at similar discounted rates, including FREE.
Now do you get it?
17 Outbursts:
I'm not sure I agree with that. I can understand the poor thinking that doctors are over-entitled, but why would the rich care?
Rather, I think that doctors symbolize sickness in peoples' minds. We're viewed with disdain because we represent pain and suffering. The feelings about illness itself are transferred to the doctor.
(Oh, God, I sound like a Freudian. I'm not even a psychiatrist...)
dr_dredd, i think that happy was comparing doctors to the other rich people accountants, lawyers, etc. the poor and uneducated don't have access to these people, they can't afford them, they don't need them, thus they don't see them and their lifestyles! if they did they would not be complaining about how extreme hugely over-paid doctors are. i agree for the most part. yeah i agree with dr_dredd that doctors do represent illness, pain and suffering but doctors also represent healing and wellness and health.
keep it up you get me thinking when all i really, really wanna do it turn off my brain and try to relax and catch a couple of Z's! I'm definitely liking your blog.
Right on, man. The sheltering of the elite does not happen in medicine. The successful CEO of the local insurance company doesn't interact with the poor; he sells to the other elites. It makes docs an easier target for the have nots.
I totally agree.
That is hands down the best post I've ever read on the subject.
Wow.
You, rock.
How about attorneys that deal with people that have DWI issues or disability issues? That seems like another area where the haves and the have-nots would intersect.
Oh, for God's sake, pull your elitist, pompous head out of your ass and stop whining. You have no idea how privileged you are to be intelligent and resourceful enough to acquire the educational and financial rewards you have.
Most of "the poor" don't have the intellectual capacity to become doctors, lawyers, accounts, or other skilled professionals. Some are able to acquire an education beyond high school, yes, but far more are so limited as to be consigned to a lifetime of low-wage, low-skill employment. They are punished enough by their circumstances, and deserve more than your outrageous contempt.
If you feel tainted by your association with human scum, go open a concierge practice in a wealthy neighborhood and stop ranting about how much better you are than others, and how under-appreciated you are by society.
Self-pity is unbecoming.
Happy
You remind me of an "elite wanna be". You abuse everyone who makes more money than you and you have obvious disdain for those who don't. My guess about you is that you were a maybe middle class (or lower middle class) who made great grades but always envied the "upper crust" growing up. The trend continued through college where you were not included in "society functions". So, you go to to med school to get some power and money. To your dismay, you chose the wrong specialty for that. Now, you are still being treated like you have been treated throughout your whole life.... So, you hate everyone. Your story is very common and your perspective is not unique. I saw it my med school class and see it now. I have agreed in the past about many of your insights regarding the mechanics of physician pay, MNB, etc., but your obvious "chip" is now too much for me to take so I will quit reading your blog. Please take it from a fellow physician......"let your anger go".... Get a therapist. Whatever. Life is extremely short. My guess is that 99 percent of your hot air stems from your severe anger and insecurity for never having been included in the popular crowd.
I think there is truth to the resentment of doctors and the fact that they are one of the few professionals with whom poorer people have relationships that bridge class boundaries. I suppose the same could be said of dentists, but their compensation structure presents more barriers than does the typical medical practice, at least the ones that take ordinary insurance, Medicare and Medicaid.
Are patients unappreciative of the resources they have among the doctors who see them? Some are. Most aren't, in my experience. But the ones who behave badly easily figure more significantly than they should.
The poster above who chided HH about self-pity needs a little time out. You seem too ready to relieve the underprivileged of personal responsibility. I am sure if you have as much contact with the poor as I have, you know those who are true victims of misfortune from those who suffer consequences their own self-destructive behaviors, not out of ignorance but out of indifference. They aren't so hard to spot and they have a way of announcing themselves. By the same token, becoming a physician capable of earning a good income is no accident, even for those fortunate enough to have generous personal and family support in obtaining the education needed to become a doctor. It does take commitment and effort and stamina well beyond the abilities of most people, even most educated people. That is a simple fact and, for those who deny it, all I can say is that they are ignorant.
Is HH depressed and angry? I hope not, but the circumstances that face generalists who are caught in the scissor of poor payment and high operating expense, it is tough to find some kind of relief. There certainly doesn't seem like anything coming. Anything good, that is.
As for those who think they will be better served by a system that pays from a single source--the government, most likely, all I can say is that they should enjoy the comfort expectancy and anticipation can give. Because that will be about as good as it gets. It won't yield a giant state smorgasbord where everyone can have and choose what their "needs" and wants dictate, all facilitated by happy, shiny new-system professionals freed from the miseries of the dark multi-payer past. No, it will be steam-table fare, and you had better learn to like what is served, unless you would rather do without.
As for the elite wannabe comment, it sounds like the kind of dismissive talk from someone who did enjoy club membership but who has the luxury of pretending to disown the privilege. Old story, that. You don't have to be pining for acceptance on the other side of the country club hedge to be angry that the medical profession has been sold down; the seeds of that were sown long before any of the present group practicing got their diplomas. This is merely the entitlement end-game. It would anger anyone.
anon 5:24. A few comments to correct your inaccuracies. I may start by saying, first of all, if you have been a regular visitor of the Happy Hospitalist you would know quite well what my position is. I am Happy. I love my job. I love my wife. I love my family. I love my dogs. I love my life. I could not have asked for a better outcome, thus far in my pathway through planet earth.
With that said, you need to understand, that when I blog about the financial failures of the system, the corruption and destruction occurring in the health care market, I am not blogging about me. I am blogging about the institutional failures of the system. Look back to the very beginning of my blog 11 months ago. I have always maintained a personal satisfaction with my job. In fact, I blog constantly about how hospitalist medicine has left the failed economics of the Medicare National Bank. I love what I do. And my wife loves having me around.
My aspirations in life are not money driven. The other day in church, the pastor said it best. We live in a performance driven world. A world about collecting things. Ultimately, when you get right down to it, when you die, everything goes to auction. What's left are the memories.
If you believe that I am unhappy with my position as a hospitalist because I have failed to achieve "elite wanna be", I don't even know what that means. I have personal satisfaction and happiness across all aspects of my life. I have chosen a pathway that I am fulfilled in all regards. If you believe I was unhappy with my current position, you see to believe I am incapable of changing directions. If I hated what I do, or if the time ever came that I was not satisfied with my position as a Hospitalist, I would be the first to jump ship. That being said, I am completely satisfied with my current life path.
I do not fall trap to the Jones' next door mentallity. I strive for personal satisfaction. I am that guy who gets more satisfaction out of spending 10 hours on solving a math equation than giving up. I am that guy that gets far more satisfaction out of giving away things then spending it on my self.
Your beliefs in me are simply not true. I grew up middle class. I drove an ordinary car. I grew up in a nice middle class home. Not extraordinary by any means. But certainly respectable. My parents drove a station wagon, two of them in fact, at one point. I drove a beat up 4 door sedan.
I am as happy now as I was making $40 a year as a resident physician.
Your flaming of me seems built on the basis of your own experience with the elite. In fact, I have no desire to be "elite." I am quite happy with my status in life.
Let me give you an example of pompous elite. While at a Society of Hospital Medicine conference in San Diego this year, my wife and I were dressed in jogging gear. We decided to skip the ceremonies and go exercise. A whole elevator full of doctors carried us down 11 floors. On the way down a doctor lady made a medical comment using big fancy doctor words. She then turned to my wife and I and said. "I'm sorry. I didn't realize there were lay people in here." My wife and I looked at each other and just smiled. We laughed at how elitists some folks must feel for achieving their doctor status. I think it's pathetic. In fact, that's elite. And I have no desire to be elite. In fact, it bores me.
I fart in front of my wife. I burp and make man noises every day. I adjust myself multiple times a day. I occasionally cuss and say gross jokes. My old med school friends, while highly intelligent physicians in their own right, are mostly all middle class homeboys who worked hard their entire lives and make a great living. They are all specialists. And they make way more than me. And it makes no difference to me. I grew up eating, not being fed. And that will always be a part of who I am. A work ethic I am proud to carry everyday.
Those who strive to make money their priority in life will be sorely disappointed when they wake up one day and wonder where all the time went. I will not fall into that trap. I grew up middle class and have middle class values. I relate well with the vast majority of folks. The elite that you speak of really don't interest me professionally or socially. So, anon, you are pretty much wrong on all accounts.
Keep reading HH and you'll understand that my concerns and rants are thrown squarely on system that is structured financially to systematically destroy comprehensive care. I system that enriches specialty care(on a relative basis) at the expense of comprehensive care. When you have a fixed pot, you have to have reference points and the reference points are all relative to each other. SO as goes comprehensive care, so goes our cheap and effective health care delivery network. If you are an elite specialist, I welcome you to my blog. Stick around. You may just learn something. Or change your views in life.
So before you start spamming me as being arrogant, read on.
I did and you are.
What is it with your self-centered view of the world?
Don't you know people are highly repulsed by the obscene amounts some CEOs receive as bonuses, sometimes while they are being fired?
Don't you see people are exasperated at politicians who help themselves to the communal pot?
Ambulance chasers, lobbyists... we know those people do not deserve the millions they have.
Get over yourself. Please.
Happy, I'm a gastroenterologist. The only one in my county in NH. I trained in the Navy, where I did four years of primary care Internal Medicine as well as GI. When I came here, I thought there wasn't enough business for a straight GI practice, but I so wanted to live here that I did IM and GI together for the first seven years. Besides treating GI bleeds, cirrhosis, IBD, etc. I rolled out of bed for MIs, COPD exacerbations, DKAs, etc. I've done intubations, cardioversions, thoracenteses, and even emergency pericardiocentesis. In 2003 I decided that being on call for IM and then coming home to sleep, only to be rolled out again for a GI bleed was not the way to live. That year I was also tapped to be a temporary member of the Board of Trustees for the local hospital. There I learned that my work was generating more revenue for the hospital than the surgeons and orthopedists!
I found an old building, gutted it, and built an endoscopy center because I knew that I and my family deserved that money, not some hospital sitting on a huge endowment. I have since become a bit of a pariah, once being called an "entrepreneurial doctor" as a pejorative. But I took it as the compliment it inadvertently was, because I had learned that *no one--NO ONE--has a right to anything that comes from the sweat of another's brow. Health care is not a right, it's a gift.
I began my career thinking that I could just not charge people who were poor. I thought that's how it had always been. Which it had, but those days are gone. When you are in the hospital on the birthdays, the wedding anniversaries, the Christmas mornings over and over again, but you can't afford to take your family to Disney World, your wife has every right to ask why you are doing that while the building contractor down the street has every weekend and holiday off and goes to Disney every year.
My burden is nothing compared to the primary care docs--one of whom I was until a few years ago--and yet I still feel exploited as I provide services for which I know I will never be paid. I have cases every day for which it will cost me more to bill than I will be paid. It is unimaginable that a primary care Doc could live like that.
Our lives are worth something. You can cut our pay as much as you like, **but you can't make people keep on being good doctors**. They will vote with their feet. Of my five children, not one would ever consider being a doctor, because they have seen what happened with me.
I can't imagine being anything else than what I am, but I can't see why any young person would want to follow the same path. The Boomers, having made this mess, are going to have a very unpleasant bed to lie in.
I don't think most consultants, accountants, architects and/or plumbers think that Physicians are overpaid -- if they bother to figure out how much they make.
Question: Why doesn't Happy hate lawyers.
Answer: They're not poor.
Great! I've never thought about this explanation before.
The first part of Happy's theory makes sense: Poor and middle class people are more likely to have direct contact with a doctor than with other highly compensated professionals.
So, they've got some first-hand knowledge of what a doctor does to earn her money.
Happy's proposing an elaborate class-based theory of resentment. He's ignoring a much more obvious explanation: Poor people don't feel like they're getting value for their money, or the system's money.
Why might that be? I'm not poor, but I'm too broke to afford health insurance right now. So, I've been going to a $25-a-visit walk-in clinic in the projects of Red Hook, NY.
The experience has been a real eye-opener for me. I'm a middle class woman and I've been lucky enough to have great doctors all my life--doctors so good that I've always thought, whatever they cost they'd be worth it!
The Red Hook doctors are terrible and they treat patients like dirt. The clinic doc I've been seeing literally can't recognize or spell the common medications that I take. I've met longshoremen with better beside manners! He's par for the course at the clinic, sad to say.
And I think I get treated pretty well because I'm better dressed than most of the other people in the dingy waiting room with vending machines on three of the four walls.
If Dr. Red Hook and his clinic were my only first-hand perspective on medicine, I'd probably feel like doctors were overpaid for the service they give.
Realistically, I doubt Dr. Red Hook makes much money, but he's rich by neighborhood standards.
Frankly, I doubt poor people are the sole source of doctor resentment in our society. Middle class people who scrimp and save to pay for health insurance for their families are probably disappointed a lot of the time, too. Especially, when their experience of the medical system is filtered through insurance companies that are set up to deny them care and hassle them at every step of the way. My boyfriend's doctor basically kicked him out of the examining room when he noticed that Darcy had an unpaid bill on his record--a balance due to an insurance company screw-up which Darcy fought for 3 months, successfully, or so he thought.
When you're busting your ass to afford health insurance premiums and then paying through the nose for your ever-increasing deductible, it's enough to put anyone in a bad mood. The average patient doesn't understand that the doctor isn't getting all this dough.
So, instead of positing class warfare, why not consider the experiences that people are actually having in the health care system?
Everyone's perspective is limited. I'm sure all the doctors on this thread provide excellent care and associate with other good doctors. They have staffers who deal with the bureaucratic hassles. They probably have good health insurance for themselves and their families.
So, from their perspective, it may seem purely mean spirited that some people resent their profession, despite all the good they do. But like poor patients who are used to being dissed by marginal docs, these good docs don't see the whole picture. I'm not blaming doctors, most of these factors are completely outside their control.
Instead of blaming the poor and labeling them as stupid or irrational or envious, it's important to think about what evidence they're basing their conclusions on. You don't have to agree with them to see where they're coming from.
I think the writer is trying to justify his own lifestyle and lashing out is a way of avoiding guilt. Poor don't resent doctors' money, homes, cars, etc. They resent being pushed aside for the insured or moneyed patient. They are only asking for a chance to be physically improved so they can get out there and get with it.
I have been fighting doctors for years. They have been insulting, assassinated my character and have been allowed by law to cause me more health problems than I first started out with. All because I had the audacity to put my own needs aside to take care of my terminally ill mother. Before that I worked mens jobs. I started with a simple sinus infection which led to chronic bronchitis (because they denied anitbiotic treatment) and now to COPD.
We don't like you because you refuse to listen, you refuse to treat then when you kill us you refuse to take responsibility for it.
That is why we dislike doctors.
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