[Editor's Note: If you just found this article on Doximity, please realize this is a GUEST POST, written by a guest, not me. Please direct all hate mail to the actual author of the post: https://sidehustlescrubs.wordpress.com/contact/
Today's guest post comes from Side Hustle Scrubs, with whom I have no financial relationship. It reminds me of a post I read a while back about physician burnout that basically argued that doctors should shut up and quit whining about burnout. The basic gist of it was “Lots of people don't like their jobs. There's a support group for it–it meets on Friday nights at the bar.” So while I am very empathetic about physician burnout, its causes, and most importantly its consequences (unhappiness, divorce, suicide, bad patient care etc), I agree with Dr. Side Hustle Scrubs that a bit of perspective really helps sometimes. Medicine is a pretty good job when you step back and take a look at it from an outside perspective.]
Many doctors live in a bubble. Their best friends are doctors. Their spouse is a doctor. Their neighbors are doctors. They spend their free time reading medical journals and doctor blogs. Their vacations are only pseudo-vacations because they go on travel CME or bring work with them while they're gone. They even listen to the White Coat Investor Podcast on the drive to the airport.
After a while in the doctor bubble, you may start to actually believe that doctors have it worse than everyone else. I can assure you as someone who is married to a teacher and has mostly non-doctor friends — their jobs suck too.
I'm not saying job satisfaction isn't important. It is important and you deserve to find your version of happiness. I'm just saying that before we start bemoaning the sad state of medicine we should look around and appreciate how good we've got it.
Do you ever find yourself fantasizing about having a different job? Wish you could go back and do it all over again? Let's look at the roads not taken.
You Make More Money Than Everyone
Although there is a wide range of physician salaries, we're doing pretty good as a group. According to the 2018 Medscape Physician Compensation Survey, the average specialist earns $329,000 a year and the average primary care physician earns $223,000. Let's take a look at how that breaks down by specialty:
You can argue that these figures may be skewed by a few outliers, or that your personal salary doesn't match this data, but these numbers were based on over 20,000 physicians spanning 29 specialties.
Thanks to the Bureau of Labor Statistics, we can see how our salaries compare to just about any other alternative career we may have chosen. Look at some of the things you could have done with your life — lawyer, dentist, airline pilot, engineer, teacher. They are all admirable career paths. I know a lot of doctors who would be freaking out right now if they had to settle for the salary of a sitting US Senator ($174,000)! Could you imagine having to scrape by like a Supreme Court Justice? Blech!
Don't whine about your salary either.
According to the most recent IRS data, to be in the top 5% of incomes you need to earn $195,778. To be considered in the top 1% of household incomes you need to earn $480,930. Congratulations! We've made it to the mountaintop! It's all downhill from here.
Other People Have Educational Debt
Believe it or not, other people take out school loans too. Yes, our loans are a lot larger, but so are our paychecks. A recent study by Credible.com of 91,000 professionals with graduate degrees looked at what percentage of monthly income each profession had to dedicate to servicing their student loans. We didn't even crack the top half! Of course, if you take White Coat Investor's wise advice to live like a resident you'll be dedicating more than 7.5% of your paychecks to knock those loans out quick.
Poor optometrists. You'd think they'd see it coming.
(Most of Us) Don't Work Exorbitant Hours
On a recent podcast, Jim acknowledges that he has found the unicorn of medicine jobs. He works eight eight-hour shifts a month. Although the rest of us aren't quite that lucky, the majority of physicians have work hours similar to a lot of professions. According to the 2014 Work/Life Profiles of Today's U.S. Physician published by AMA Insurance, ~75% of all physicians work less than 60 hours a week.
25% of physicians are clinically insane.
Teachers: The National Education Association estimates the average teacher works 50 hours a week, including 12 hours of uncompensated school-related activities.
Lawyers: A recent American Bar Association survey showed that more than half of respondents work at least 50 hours a week, with ~25% working more than 60 hours a week. Does that remind you of any other profession you can think of?
Investment Banker: Prepare to feel nauseous or humbled, depending on how empathetic you are. Here is a Wall Street Oasis survey of average work hours for investment bankers.
The AVERAGE investment banker works between 77 and 87 hours per week.
Sure – other jobs may work similar hours, but we work the undesirable hours. We work nights, weekends and holidays. Many of us work in a 24/7 specialty that can't simply turn off the lights at 5PM. There's no way a police officer, firefighter, paramedic, nurse, pilot or chef would know what that's like, right?
My brother, the chef, has worked some horrific hours over the years. For a while, he was working 14 hour days 6-7 days a week. He often had to show up at 4 AM to start the prep work for the day ahead. Sometimes when I was disimpacting a nursing home patient before sunrise it gave me solace to know that somewhere across town my brother was stuffing a turkey.
Everyone Experiences Burnout
“You just don't understand. Medicine isn't what I thought it was going to be. I just don't have that passion anymore.” You don't say. I'm sure that everyone else who picked a career path in their 20's is still filled with unbridled passion.
Here's a look at the 2018 Medscape Physician Burnout & Depression Report:
Looks like Crispy Doc isn't alone.
Surely these grim burnout numbers are unique to medicine. We work way harder than everyone else, right? Let's compare our burnout rates to the rest of the American workforce and see how we stack up.
One recent Gallop poll reported that 23% of American workers feel burnout “very often” or “always” and an additional 44% feel burnout “sometimes”. 67% of workers surveyed experience some degree of career burnout. Every occupation is up in arms about burnout — teachers, lawyers, IT, even military drone pilots. Is it possible that all work and no play makes Jack a dull boy, regardless of occupation?
Sure, other careers deal with burnout, but physician suicide is a real problem. All this burnout is killing us. A 2016 study published in Morbidity and Mortality Weekly Report looked at suicide rates by occupation. Healthcare professionals had a suicide rate of 17.4 per 100,000. That's not good. What's more surprising is that 11 other careers had higher suicide rates than us.
Despite the fact that we should presumably be experts on how to die, we're getting shown up by a lot of people. I would expect some creative solutions from engineers, but artists?? Color me surprised.
Society Respects You
Isn't it a shame how no one respects doctors anymore? We've been completely replaced by Google and all we have to show for it is that tuning fork you bought in med school and haven't used since. If only we could go back to a simpler time when our profession was held in high regard.
I've got bad news — there's only one direction to go. A Harris poll surveyed 2,537 Americans and asked them to rank jobs by prestige. Guess who's still killing it (metaphorically).
Prestige doesn't pay the bills. I want to be respected for my high ethical standards. No problem – a recent Gallop poll showed that we're still seen as a pretty trustworthy bunch.
So we're only the 4th most trusted profession. I suppose we'll have to settle for being the highest paid, most respected profession with work hours and burnout rates similar to many Americans.
It's Called Work for a Reason
When I'm in need of inspiration, I like to reflect on the wisdom of one of the greatest minds of the 20th century: Red Foreman of That 70's Show.
“That's why they call it work. If it wasn't work, they'd call it ‘super wonderful crazy fun time' or ‘skippedy-do'.”
Sometimes adulting isn't fun. There is a reason why people get paid to work. No one would show up otherwise. Yes, we have hard jobs. Yes, we had a long road to travel before our first paycheck. Yes, the modern medical system appears to be designed to squeeze every last drop of satisfaction out of the job. This profession still beats 99.9% of the jobs you could have chosen. Good choice!
Stop Whining and Start Changing
Side Hustle Scrubs
This is not intended to be a “shut up and be happy” post. You do not have to accept the status quo. It's OK to feel burnt out, apathetic, disillusioned or all of the above. You deserve to be happy, but whining isn't going to get you anywhere.
Need some inspiration to make a change? Go check out 10 Things More Productive than Whining About Job Satisfaction (and the Doctors Who Did Them) on Side Hustle Scrubs.
Get inspired by physician role models who made meaningful career changes to improve their job satisfaction. *Spoiler alert — White Coat Investor is one of them.
What do you think? Do you think physicians whine more than other professions about their job dissatisfaction? If so, why do you think that is the case? Do we worry about and talk about burnout too much? Sound off below!
Side Hustle Scrubs, you know I love what you do on your site, but I am going to have to sing a different tune on this one. In fact, the major reason my site exists is to teach other physicians and physicians-in-training how to use the tools of financial independence to prevent and treat their burnout (and not make it worse with bad behavioral finance decisions).
The problem in medicine exists because the system refuses to change despite what physicisans are saying. Realizing how great our job is and ignoring all of this will result in more burnout, not less.
There are three key factors that lead to job satisfaction – autonomy, feeling competent at your job, and getting support from your administration.
With the direction medicine has headed over the past 20-30 years, autonomy has continually declined and many have seen less and less support from non-clinical administrators who often haven’t ever practiced medicine.
Taking the line of thinking “that we need to realize how great we have it and stop complaining” is a false dichotomy. We can both (1) choose to work hard and realize that our jobs are pretty good in the grand scheme of things at the same time that we (2) question why the system produces a ton of physician burnout that the individual physician often feels powerless to change.
There is nothing wrong with seeing that some things need to be changed, pointing them out, trying to make it better for everyone, and taking our own course of action if none of that works. This last bit is what you suggested at the end, and so we can agree on that – and you know I’m doing what I can on the side as well, including my book that was published on Monday.
More than a doctor each day is estimated to kill themselves (400 annually), which is higher than the average population. This isn’t just coincidence, and it also isn’t something that will just go away by “realizing we have a great job.”
TPP
I totally agree that physicians don’t have to settle. Everyone should care about job satisfaction. Whining doesn’t lead to change. Only change leads to change.
The worst part of burnout is the feeling of hopelessness – that there is no way out of your situation. Luckily there are many great physician role models (yourself included) who can show us the way.
WCI is right – a little perspective makes all the difference. Money may not buy happiness, but try convincing all the non-physicians in your hospital how tough we’ve got it. It’s OK to acknowledge how good we’ve got it and still strive for a better, more humane medical system. Thanks for being part of the solution.
I can get behind that idea. Whining without trying to change things is unhelpful and non-productive.
I think these systematic problems require systematic solutions and, ironically, that is what my post is on today. Pure coincidence, but aptly timed nonetheless.
I think this post will produce an interesting discussion, which is always a good thing in my opinion.
I think both sides are valid here. There will never be a change unless we speak up and demand it. People will continue to try to overstretch and overwork us while trying to make a buck for themselves. However, physicians can very easily look like we’re whining. After all, we are one of the highest paid professions. To effect change, we have to provide the public with actionable tips and data, rather than complaints.
This article, and many of the replies, are tone deaf, reek of victim blaming and further stigmatize mental health issues. Physicians have a suicide rate more than double the general population. If anything, depression and other mental health issues are likely UNDER reported due to the concerns about seeking help leading to loss of licensure, job, etc. And burnout rates are incredibly high and have not been improving despite these statistics and the concerns being raised by physicians, which you unfortunately dismiss as “whining”. What kind of outcomes do you think a psychiatrist would have if they told their patient’s that they were “whining”? It’s dismissive and unhelpful. The first part of fixing any problem is recognizing there is one. Where do you draw the line between “whining” and reporting a systemic issue in medicine that is leading to serious consequences such as burnout, suicide, early retirement, leaving medicine for another profession, all of which exacerbate the physician shortage?
Income is better than most, true, but this doesn’t seem to be improving physician satisfaction or burnout. And depending on who you read, when you factor in the dept to income ratio and the delay in obtaining income because of being in training for so long (opportunity cost) many if not most physicians are not as well off as many seem to think. This may be different among higher paying subspecialties though it should be noted these are a subset of physicians. But hey, you can find evidence to support whatever point of view you like.
Other people have longer hours, burnout, debt? No kidding. Doesn’t make a physician’s situation better. This is like the trope of “you should be happy because there’s starving kids in Africa.” Others having it worse doesn’t make your situation better. If anything it’s more depressing to see that others are also getting screwed by the economic situation we’re all in.
So despite the income, others having debt and burnout, other jobs having negative aspects about them (seem to have skipped over the negative aspects of medicine: toxicity, violence towards healthcare workers, increasing administrative BS and less time with patients, etc) physicians still have higher rates of depression, suicide, and burnout. Why? Your take seems to be that they’re all just whining and not appreciating what they have. Wonder what would happen if I said as much to a depressed, anxious, or suicidal patient. This article is at best worthless and at worst harmful.
I’m going to side with TPP on this one as well.
I think it is great to point out that problems exist with other professions as well and it is not us against them. I think it speaks to a larger societal problem that such a large percentage of the population feels this way. Suicide and burnout is a far reaching problem that crosses all occupations. I would venture to guess that financial problems play a large role in this regardless of profession.
We all know (at least those that frequent these type of blogs) that a high salary does not mean high wealth. We have a spending problem as a whole and when we get caught into that trap we indeed start spiraling down as part of our already limited mental bandwidth is now focused on the ever increasing debt we have to pay.
I get it that there are some professions that have similar or even higher hours in the work week but to say that each hour is equivalent would be a huge disservice to doctors. Our profession by its very nature typically deals with life or death situations, critical thinking etc. I honestly think that the most valid non medical comparison to a job that requires such intense focus would be an air traffic controller. You are not allowed to have an “off day” or a whoops my bad kind of moment without severe repercussions. A chef is not going to be sued if he forgot to add parsley to a dish. A doctor will if he forgot to tie off an artery or left a sponge in a patient.
Intense focused concentrated work over long periods of time is mentally draining. I am one of the lucky ones in that I have tailored a practice that is a dream job for a physician (I do outpatient radiology essentially 8:30am-5pm, 4 days a week, no call, no weekends) and I still feel mentally taxed especially when reading 50+ mammograms a day when I am on that modality that week. The intense focus required to pick up calcification the size of a tip of a pin is taxing. I do get highly compensated for that (and my salary is well above what is reported in the averages for my profession) but there is a certain point where money doesn’t matter if you are getting burned out to accomplish it.
But overall it is a nice perspective on the plight of everyone, not just physicians.
I often think about an attending I had as a fourth year medical student. I was on an internal medicine rotation on a cold winter day. We sat in a warm conference room, drinking our coffee and mentally masturbating about some zebra diagnosis. Outside the window was a construction crew working in the snow. My attending pointed to the construction workers and said “next time you start to feel sorry for yourself, just remember there is someone who would give their left arm to be in your shoes.” (Although to be honest, using a jack hammer sounded more fun than spending one more minute discussing Goodpasture’s Syndrome)
Maybe it was because I grew up broke in a blue collar family, but it was refreshing to hear an attending admit that being a doctor isn’t all bad. The doctor echo chamber is the perfect set up for a pity party. A little perspective goes a long way.
Then why didn’t they go to med school? I don’t understand that argument at all. I earned my way to where I am today. Before anybody brings up any “oh but you were a white rich kid who had every opportunity and took advantage of the system and they couldn’t”. No. I’m black, grew up in a poor house, worked my ass off when my friends got into drugs and gangs, and made it. While I understand not everybody wants to go to med school, I feel bad for those with TRULY no opportunity to work towards a good career (people in 3rd world countries, North Korea, whatever), not American construction workers.
I completely agree with the perspective projected by XRAYVSN. Comparing our hours with non medical care hours no matter how fast paced would be unfair. Dealing with life and death situations as well as successful clinical outcomes demands a lot of caution, dexterity and attention to details. The pressure to rush due to the patient load and administrative demands can make those hours challenging. You are forced to meet up these responsibilities without compromising patient care. Not just to save your license, but that’s just who you are.
I agree that comparing medical and non medical hours can be a false equivalent.
I’d much rather run codes and do critical care 40 hours a week than risk being shot as a state trooper or run into burning buildings as a firefighter. Sure….they may only make 1/8th the salary working similar hours, but they’ll never know the stress of an unannounced JCAHO visit.
I certainly agree whining is not going to get physicians anywhere but it is important to remember this problem is not just about the doctors. The increase paperwork, bureaucracy and rushed care visits are affecting the patients. When highly skilled and experienced doctors leave medicine due to lack of job satisfaction or sustainability of their current situation the medical system loses a provider and a teacher. It is these exact doctors who are leaving who were the ones that trained and mentored the younger doctors in the past so they lose, the patients lose, the healthcare system loses. It is a problem that demands attention and a movement towards improvement rather than acceptance and a “you have it good” mentality. which will not foster meaningful change.
I enjoyed this article. Quite a perspective adjuster.
1) I do make “phat stacks”.
2) I paid back my $83,000 (and my wife’s $40,000) in loans in 8 years because I made a great wage.
3) I’ve always worked about 45-50 hours a week, 5 of these from my side gig.
4) I’m 54 and can see the light at the end of the tunnel, and by “ the tunnel”, I mean full time work of any kind, for anyone.
5) I agree that they pay you for work…because it’s work. If I could make the same $$ for the same hours running a small business in many other fields, I would.
6) If I started over at scratch, I’d probably still pick medicine, but would have chosen one that makes more $$ like Dermatology or Radiology…in order to retire earlier…although the answer above makes Radiology sound tough…at least you can do it for fewer years due to the wage.
I have identified with the burnout idea, but this article paints all of humanity (most jobs) with the same brush. I think they may be right. A lot of 55 year olds in many professions don’t have the same eagerness to continue and fantasize about the unfettered leisure and freedom of retirement.
Why wouldn’t they? Life is more than work and at some point, it’s partly the absence of work and the pursuit of other passions. I’m not burned out…I’m pre-retired.
Bring on retirement. I’m quite sure I won’t have any trouble adjusting to it as people say. Hiking with my wife, travel to the many places on my list, open water swimming, triathlons, reading, writing another book, getting up when I want, taking care of the cabin and acreage, fishing with grandchildren…heck, I can’t wait and my job is not that bad.
Doctors spend most of their training being told they’re special. By the time they’ve earned their first attending paycheck they’ve heard they’re special for 10-20 years. It’s easy to forget that their problems (finding career satisfaction, balancing work and family, finding their true purpose) are far from special. In fact, they’re downright ordinary.
Medicine has its flaws, as does every profession. I will celebrate the good, try to change the bad and accept that no job is perfect.
Bravo!! It needs to be said. You are going to get a lot of hate as people role in to read this but I will stand with you.
After residency no one is forcing us to work so hard to the point of burnout. We work hard because that is our nature and because we want to get paid well. I could easily adjust my work flow to see less patients in a day and have more time to BS and post on WCI but I have found a good balance for me. Some people who have massive debt do not have that option but if they follow good advice they can get out of that in a few years. If I worked half time in primary care I would still be paid more then the average american and I would be bored as heck.
I am sure I will catch flack, which is OK.
You can’t lob this kind of grenade into the #1 Physician blog and expect universal praise.
The doc blogosphere is a big place with varied voices. I consider this opinion piece a counterbalance to some of the doom and gloom voices.
More importantly, I’ve used my 15 minutes of WCI fame to highlight all the great physician mentors who can show us the way to actually achieving career satisfaction. No matter how desperate your career may seem, there is a path back to happiness.
The stress and burnout in our profession are real.
Suicide is no joke, for sure.
We need to understand the problems and work on them.
But the main message of this post is the message I deliver to fellow physicians.
What else do you want in a job? You use your brain and education. You are in the top 3% of income. You are respected, safe, and have good job stability. You are treated like a boss and catered to by staff. Oh, yes, and you help people! You can see it as a calling and get true meaning and spiritual practice at work. What other job has all of those benefits?
Most doctors haven’t worked in other jobs. They have no idea of the pain and struggle of a single Mom scrub tech who works 12 hours shifts on her feet and then goes home to triage the rest of her life and juggle bills.
We have it good. Change what we can – for sure. But also have serenity and gratitude for this wonderful calling and profession.
Few people have gone wrong by living life with humility and gratitude.
Many a physician has burned bridges by buying into their own hype.
As the original physician finance blogger, you know better than anyone that it is easy to point out Medicine’s flaws. The harder (and more important) task is finding the solutions. Thanks for all you’ve done and continue to do.
Amen to “the single Mom tech scrub.” Most eye-opening job I had was working as a Wal-Mart as a cashier one summer. I realized that there were adults working 50-60 hours a week, juggling Wal-Mart/Arby’s/McDonald’s minimum wage jobs to try and piece together salary/support/health care. Then there was the summer I worked on a farm for $5/hour (back in the day), until immigrant labors came along for $3/hour. Always figured it had to be pretty tough or they would not do backbreaking work (and much older than me – I was a robust teenager at the time) for $3/hour if there was another option…
Figured I was lucky to have a chance to be well-compensated for working hard (and became a lawyer, aka the butt of everyone’s jokes and disdain but I like the work :D). A lot of people work hard and are not well compensated. And while the nature of their work may differ, the feelings they have about what they can/can’t provide for their kids doesn’t. Have always felt lucky to have the intelligence, good health, and opportunity (even if it did mean borrowing the full cost of education), to move forward in life and the security to know my future kids will not have to worry about basic financial security.
I think there are some prerequisite jobs every med school applicant should work: food service, customer service and manual labor.
Aside from the fact that much of medicine is customer service, it will give you an appreciation for how good you have it as an attending.
The summer I spent mucking horse stalls and baling hay on my uncle’s farm was eye opening. To this day I still am grateful for that horrific job.
Not sure “safe” is accurate, especially in the ED.
https://www.cbsnews.com/news/mercy-hospital-chicago-doctor-tamara-oneal-shot-dead-by-ex-fiance-juan-lopez/
https://www.hjnews.com/news/police-release-hospital-shooting-videos/article_19427e34-1286-11e4-ae9f-0019bb2963f4.html
I think that applies to a lot of positions now, i.e. elementary school shootings.
Sadly true.
Thanks, I needed this. Had to smile at the respect and ethics sections since I’m both a doctor and an officer (and married to a nurse!)
Yeah first world problems are still problems, good to find and fix them, but life could be worse. Could be a lawyer like my sister!
Most doctors’ lounges are full of Rodney Dangerfield impersonators talking about getting no respect.
For some reason the docs never complain to the hospital housekeepers, janitors, security guards or cafeteria workers.
You’re right – being a lawyer is always worse.
I love this post so much. I think the reason it is needed is articulated so well in the first line – most docs live in a bubble.
So many docs will complain endlessly, forgetting that we do have it really good. And a lot of the things they complain about are within their control to change, yet they are not willing to do so. I have a colleague who would rather spend 10 hours per week complaining about charting than give up 10% of his salary to hire a scribe.
The great thing about FI is that it gives us more of the tools to close this space between our current life and our ideal life. But if someone is not capable of finding happiness in their daily living before FI, there is no amount of money that will change that.
My wife (who is my main source of reality checks) often reminds me that just because someone wants to complain to you doesn’t mean they want to hear your solutions.
It is a doctor’s nature to try to solve problems. There are so many good physician role models out there who are willing to show you the way. The most important step in changing is wanting to change.
This is a great post. I’m not a doctor but I have a lot of friends that are and that I spend a lot of time with. I must admit, it gets tiring listening to my doctor friends talk about how unfair and terrible their career path is. The best line is hearing them say, “If I wanted to make a lot of money, there are far easier and better ways to do it.” I had one wise doctor friend respond once to the other docs that he doesn’t think doctors realize how hard people in other careers work for the same amount of money.
Doctors work their tails off and deserve all they get for it. And they put up with a lot of unpleasantness. And like this post says, a little perspective reminds us that so do a lot of other people (and they don’t usually make anywhere near what doctors make or have the same kind of job stability).
I think my saving grace is that I am married to a non-doctor and most of my closest friends are not doctors. I wouldn’t have the guts to complain to them about my first world problems. I work fewer hours than most of them (albeit more nights/weekends/holidays) and earn more than most of them combined.
Life outside the doctor bubble is refreshing, as long as you don’t mind checking your ego at the door.
Most of my patients from the “greatest generation”, would read this title and agree completely. The article points out the reason why. Do whatever you want with your life….but stop whining about it.
Thanks!
Amen.
Do what you want. If you don’t like what you’re doing, do something else. You get one life to live, and it’s too short to spend it complaining.
Doctors spent more than a decade working, sacrificing and clawing their way to becoming an attending. If you can make it this far, you can surely take the necessary steps to change your career trajectory and find some happiness.
Great post! Just to play devils advocate here, I think one incorrect assumption is that if we weren’t taking care of patients we would be working in restaurants or vocational jobs. I think doctors have the good fortune of being both very hard working and intelligent, and comparing our subgroup to the general population is misleading. When compared to those who I went to high school with, I would say I am faring quite well. When I compare my situation to those who were also performing exceptionally well in college and on standardized tests (that top intelligence bracket), I would say my situation is quite poor to theirs.
For one thing, at 10.5 years (4 med school + training) after graduating college I am still not making those salaries listed above — but my friends in engineering and law are, and have been for many years. Admittedly, those friends who decided not to do medicine and went into investment banking — in their early years they were working quite hard and we both complained about our 80 hour work weeks, but they weren’t complaining about their 50k salaries because they were making significantly more. Also, don’t forget the irony of working along side APCs making twice as much money for half the work hours often times doing the same work.
These training years shouldn’t be excluded from this consideration either. Leaving out all of the missed opportunities like weddings, funerals, baby showers, birthdays, etc., you still have to consider the significant loss in investing potential from a compounding interest standpoint. Although we get a pretty big shovel later in our years, the loss of that decade in training can mean a lot when you consider long term worth — comparing salaries doesn’t mean much, it would be better to compare total worth based on age.
Also did everyone notice that 20% of physicians aged 60-69 are working >61 hours per week? That seems troubling….
Thanks again for the thoughtful post — always good to hear an optimistic perspective!
I agree that most docs have the intelligence and drive to succeed in alternative career paths. When I look around at all my friends from college who got advanced degrees, many of them took jobs as professors, researchers or scientists. They all make a tiny fraction of what we do as physicians despite having every bit as much book smarts and motivation.
Yes, there are the occasional unicorn jobs (investment banker, hedge fund manager, founder of Facebook). There are few career paths where the most mediocre person in the field can walk straight into a job making more than a quarter million dollars a year. We have found the promised land.
I think we will have to agree to disagree on this point. Anecdotally, my comparable cohort of friends are doing much better financially and with better work life balance and without an huge debt burden (I am probably younger and am still in training). Additionally its not “walking straight into a job making more than a quarter million dollars” — its 11 years of training with a huge negative balance and a whole lot of missed opportunities. I think suggesting that is a walk into a promised land is unrealistically optimistic.
Some of these opinions about medicine may be due to differences in specialties and the bubbles people are in. A co-resident of mine left surgical residency before graduation to start over in a radiology residency and has never sounded happier. Radiology and EM tend to be well compensated and are often protected from call, relative to busy primary care practices, pediatric practices/sub-specialties or poorly compensated surgical specialties.
I think its well and good to suggest people stop complaining and change their situation, but I think what is important is that a lot of individuals feel trapped in medicine due to overwhelming debt burdens. Medical school tuition is disproportionately increasing compared to compensation. If you listen to some of the prices of tuition that the WCI and PoF talk about on podcasts, they are much less than what some individuals are walking out of medical school with now (and at much different interest rates). This a reasonable undertaking provided that the individual is correct in thinking that medicine will in fact be right for them, but I don’t know if this is true for all people. Unfortunately, I don’t think that pre-medical students ever get a real idea of what their ultimate job will be like, and unlike other professions, the cost (financially and time) of getting to the ultimate “attending job” make pivoting difficult/impossible. Pre-medical students should be truthfully and appropriately counseled on the undertaking they are going in on. I just worry posts like this paint an inappropriately optimistic picture of their future.
What is more evidence for physicians not having the ideal life is that a lot of physicians are aiming for FIRE. This is obviously one way to make that change you are suggesting. Its just unfortunate that after so much training and education people want to get out — but the thing is, I totally understand.
One last thing which I think is relevant — I have noticed throughout my training and experience that the people who are always saying “This is the best job in the world” are always the people at the top of the food chain (Chairmen/women, department heads, Full Professors). Maybe the best way to have more physicians saying that is to even things out a little bit.
I’m pretty sure I did a podcast about a doc who owes $1.1 Million in student loans. I don’t think it’s fair nor accurate to say I’m “underestimating the debt burden of graduating docs on my podcast or any other podcast I’ve been on.” I’m very familiar with the data and plenty of anecdotes. In fact, it would not surprise me if I am more familiar with the debt burdens of doctors than anyone else on this planet.
I think you very fairly estimate the cost and have done a lot to try and help people with them. I was referencing what I believe I remember you saying about your cost of tuition on other peoples podcasts.
Not sure what podcast you’re referring to or what I said, but tuition these days is pretty variable, from about $25-80K per year for med school.
You referenced the discrepancies in medical school cost around 7:30 on this podcast (https://www.choosefi.com/097-the-white-coat-investor-origin-story/) and it seemed like you were implying the loans were much less than current loans are.
All I hear from 7:30 to 8:00 is how I said med school was a little more expensive than undergrad when I went back in 1999. That’s true. Tuition at the University of Utah SOM in 1999-2000 was $10K. I also said it was a lot more expensive now. I think I stand by both of those statements and not sure why you don’t like them.
I like them a lot. I was using it in my argument. I had said “Medical school tuition is disproportionately increasing compared to compensation. If you listen to some of the prices of tuition that the WCI and PoF talk about on podcasts, they are much less than what some individuals are walking out of medical school with now (and at much different interest rates).”
I am not the best writer, so apologies if I was unclear. The argument I was making is that the salaries listed in the article are people out of training, who likely had less medical school debt than people currently have. I instead should have said something along the lines of “If you listen to the cost of tuition that the WCI was seeing when he was in training, it is much less than what some individuals are walking out of medical school with now (and at much different interest rates).”
I definitely agree with that statement. I even wrote a book with a chapter dedicated to it.
I think there’s also some selection bias sometimes when I hear docs say, “Well everyone I know that was smart had no problem becoming a high-powered lawyer or investment banker.” The corollary in law school or business school to a middling state medical school doesn’t get you the job that makes the big bucks (and by that, I only mean $200k+) in the vast majority of cases. For med schools, it does.
I agree that business school and law school don’t guarantee a good salary after graduation. I think the mistake is at looking at the graph at the beginning of the post and point to this to say “see, even the lowest earning physicians are doing really well!”
Those are average salaries and are subject to significant skew from a small number of high earners. One prime example is a friend of my wife who is a pediatric cardiologist with a super-fellowship in imaging (7 years post training) got her first job at 180k/year. Now this isn’t even selection bias, this is straight up anecdotal, but I think that people should be pretty up in arms about this.
The clickbait title of “whining” (i.e. suggesting a juvenile complaint) is misleading and I think a lot of people have pretty appropriate concerns about reimbursement especially given the amount of time they may work or devote to patient care. Its easy to call it “whining” if you have a good situation where you are compensated well and can work a set number of shifts a month . But be mindful that not all people are so fortunate “just because they have an MD”.
Every view expressed has its own truths. Just wanted to point out that unless all your friends both inside and outside your medical bubble print out their bank balances for public review and discussion, not everyone who claims to be a millionaire are actually millionaires. “Friends” can often inflate their net worth to provoke jealousy. Just a thought.
Having read all the comments, I think there’s no perfect job. Some Physicians, dentists and mid levels have better job environments than others and so different perspectives must be accommodated. Contentment is a fundamental necessity. I have learned a lot from WCI, Scrubs and FIRE and can proudly say my financial track now looks more promising. Still have a long way to go, but learning to enjoy the good aspects of my job like the luxury to relax and play the guitar for 5 or 10 mins at the doctors lounge during brief downtimes. Will also avoid fights with administrators that I’m bound to loose to elude frustrations.
Totally agree that gratitude for the good parts and eliminating the bad is the best way to really make this the best job. They talk about this in the ChooseFI podcast here: https://www.choosefi.com/048-happy-philosopher/.
I think the only way to bring about change with regards to the bad parts of the job is to talk about them and logically approach conversation about how to enact improvements. Saying “Stop Whining” and accept what is wont be productive to getting people more fairly compensated or improve their lifestyle.
@ Side Hustle Scrubs, I understand your perspective. However, I think a lot of your data and arguments are skewed. You’re an educated person, so you understand that a lot of the figures you throw around do not fit the entire community of physicians. Many primary care physicians that I personally know are certainly not paid a quarter of a million dollars annually. Many are paid closer to that “Senator” salary of 174k that you referenced; and don’t even reach the referenced median you have for FP and IM. In addition, they are paid for 40 hour work weeks of scheduled patients yet spend most nights, weekends and even part of their vacation time completing charts and responding to calls from work and messages on their EMR, which are all unpaid hours . This racks up well more than 60 hours per week for these doctors. If you think that is an acceptable work balance then God Bless you . I think most of these physicians are less concerned with pay than the encroachment and overwhelming pervasiveness of their work into all their free time. Yes I get doctors are paid more than other professions and it’s not manual labor. I think you’re missing the point that as a whole, the United States due to unchecked and essentially deregulated Capitalism, has created an environment where employees are abused with both being overworked and underpaid. There is certainly a substantial pay gap between elite level management and the employees. Physicians are employees now and if you don’t think that things will continue to get worse, I would ask you to reevaluate your thoughts. It is not fair for any employee, whether it be a custodian, cashier or physician to be required to work excessive unpaid or underpaid hours.
“unchecked and essentially deregulated capitalism” is the the main issue here?! We are one of the most regulated countries and professions in the world. Capitalism is why we have it so good. Check out the great jobs Docs have right now in Venezuela.
Most reasonable comment yet. Let’s stop apologizing for making lots of money and recognize that many of us, especially in certain specialties , have given up 10-15 years of earning potential before we finally got these wonderful salaries. In other careers, where frugal and sensible people can start earning and saving early , the miracle of compounded interest does come into play. This should be acknowledged. Additionally, the extreme stress, and yes PTSD!! we endure in residency and sometimes fellowship, should not be ignored, as well as the other sacrifices we make, and which often lead to divorce, lack of love and passion in our lives, and other issues. It is not all about income, physicians sacrifice hugely and continue to sacrifice so much, and that is why our suicide rates and depression rates continue to soar. And what about the target that is continually focused on us by financials scams such as MOCA, malpractice insurance ( highest in the world), constant threat of litigation, and the fact that malpractice insurance does not protect us from venal lawyers who want to come after everything else we have ever earned or saved routinely?) And the stress of lack of sleep, long hours, life and death decisions etc. Most other careers at least acknowledge that pilots, nurses, teachers, firefighters etc need adequate sleep. As seems usual in this country, the writer of this article wants to make everything simplistic, and in addition, shame physicians (the victims) for complaining. The only point I agree with that of complaining. I have never endorsed that – change what one can change or move out, endless complaining never achieves much. Physicians need to band together, as with the MOCA scam, and protect all we hold sacred and dear to our profession. Lets fight for patient rights to have ethical physicians, not driven by bonuses and minimal time to actually listen to and examine our patients and deliver the kind of care we would want for ourselves and our families, and let’s fight for our right to deliver truly great care, our right to be the physicians we aspire to be without administrator and CEO interference and government interference ( which is all monetarily driven for the “medical industrial complex” ) and have the courage to design practices and lifestyles that we believe in, even if it means a little less income. That means addressing a lot of issues, and until we stop letting Big Pharma, Big Government and Big Corporate shame us into feeling we are just complainers and not the victims, we will never lead the way to solutions, which we should be doing, as the only truly qualified people capable of doing so, along with other clinicians like nurses, PAs and NPs.
I thought this was a good perspective article on the whole. The points made in the comment section about false comparisons were valid. Also, comparing the salaries of a us senator and a Supreme Court Justice is a little unfair. Those two professions typically have significant non-salary benefits (untouchable pension plan anyone?) and connections for life after the career.
What is important is that you can have a decent perspective while working towards changing your work. Feeling “stuck” because you are in a high paying job with a high debt burden? You can work to pay off debts and choose a different practice. Those nights and weekend work shifts not having the same attraction they used to? Start a side hustle and/or bring down your overhead so you can drop to 80% clinical work.
I would be in crisis mode if I suddenly had to settle for a US Senator salary. Even with a lifelong pension (~140,000/year) I’m not sure I would come out ahead. Not to mention the fact that I would have to spend my days with politicians instead of fellow ER docs.
No matter how miserable your situation, there is always room for change. The key is being willing to take the necessary steps to make it happen. I’m glad that WCI and other doc bloggers are out there showing us the way.
With that Senator salary, most Senators somehow have networths that miraculously increase to the millions. Must be all the other perks.
Doctors do live in bubbles. We make a lot and we have relatively stable jobs and we can change jobs more easily than a lot of other professions. We can build wealth just by living like a resident for 3-4 years and we can travel to a lot of places. We can cut down our hours and pick up extra to make more money.
Now this doesn’t mean we need to not fight against administrators and higher pay. I think my profession ER is one of the best in medicine. Money can’t buy happiness but it can erase a lot of stress.
Like WCI says – being a doctor is like being on the two yard line. All you have to do is not fumble the ball.
Being a physician should be an automatic path to wealth. I say should, because not everyone has heard the WCI message yet.
We can always fight to make things better for ourselves and our patients, but it is OK to admit that we have it pretty darn good.
Great Post! I’m exhausted by other physicians saying they are exhausted. I get the feeling that although you accurately described many wonderful benefits of being a physician many will still find something to complain about.
This is the main reason I don’t think I will attend physician wellness conferences in the future. I vividly remember sitting in a large room, less than a mile from the ski slopes, listening to people complain about how unhappy their lives are. Difficult for me to relate.
No one will care about your happiness more than yourself. You can attend all the conferences you want, but if you’re not willing to make the necessary changes in your career things will remain the same.
I’m looking forward to the 2020 WCI Conference, although it is mostly to put faces to the names of all my favorite physician bloggers and WCI forum contributors.
So you’re not coming to WCICON20?
Probably not but that is not meant to be critical of the conference. Your website has literally been life changing for me and many of my colleagues. I have tried to ensure all interns entering my residency have a copy of your book because I agree that financial literacy is both lacking and very important.
Obviously lots of providers struggle with job satisfaction, burnout, and worse. Wellness lectures may be very beneficial for them. Personally, I find it difficult to relate and not helpful to commiserate in that setting. I’m not sure if that means I have a more enjoyable professional scenario or a different perspective. Either way I thoroughly enjoyed the skiing.
There’s no skiiing in Las Vegas. 😉
Hopefully we’ll pick up enough spa, show, shopping, rock climbing, and gambling enthusiasts to make up for the loss of the skiers.
SHS,
If I had to define whining, it would be “loudly and repeatedly pointing out problems that I am waiting for other people to fix.”
The onus is on you to create and live your best life – that includes finding a way to create your best job out of the (potentially mediocre) one you currently have.
The system depends on us to accept crappy jobs with little work-life balance on poor terms that lead to burnout. And we continue to take them.
A bit of creative problem-solving and unconventional living can allow docs to avail themselves of the many valid options you explore in the companion post on your site: achieving FI; subtracting the aggravations from the job; cutting back (my personal lifeline); diversifying income sources via real estate and side hustles so you no longer depend on medicine alone.
I love this post, because (echoing Wealthy Doc) regarding medicine with a sense of gratitude and perspective is not incompatible with wanting to change the job and the profession for the better.
With apologies to Churchill, “Medicine is the worst kind of job…except for all the others.”
Fondly,
CD
Change is scary. It’s easy to settle for the status quo. Luckily for all the people reading this, there are people like you who have blazed the trail and left a roadmap for the rest of us.
There are so many different ways to practice medicine and earn a decent living using your skills and knowledge. Overcoming the fear and taking that leap are necessary to achieve career satisfaction. You’re living, crispy proof.
I think this is a really good reminder about perspective and to especially remember that a lot of us live in a bubble of people similar to us. When you live in that bubble, it’s easy to think that the things in your bubble are normal and that everyone is living the same way as you.
The important part is that last part – stop whining and start changing. I see this so often with lawyers who constantly lament the state of their profession, yet take no steps to change it. I’ve been guilty of that too, although I’m working on changing that now. You gotta take action if you want to make changes.
The bubble is real and it can sneak up on you. Most professionals spend more time with their coworkers than their friends or family.
Anyone who continues to complain year after year but doesn’t do anything to change their situation must just like the sound of their own whimpering.
After the birth of my 3rd kid, my eardrums no longer have the capacity to tolerate anyone else’s whining.
The ‘my non medical professional friends make a fraction of what I make aside for some unicorns’ schtick only highlights an ignorance of what other people make. Plenty of the hardware reps calling on hospitals are knocking down more than the majority of the non-surgical docs working there, plenty of attorneys in any big city knock down 7-figures, etc. Go to your local high end country club and you’ll find the percentage of docs there is trivially small.
I kind of agree with that. My second job is kind of unicorny, but I make an awful lot more than I ever made practicing medicine. I can think of at least a half dozen other businesses I could have been successful at that would have paid me more than EM.
Zzz- I think saying plenty of reps make bank or plenty of big-city attorneys bring in 7 figures (and I’d caveat this one by saying a 25yo starting today with a prestige firm has a *much* tougher road to partner and 7-figure salary than her parent did 30 years ago) is like saying plenty (literally the median according to mgma data) of Mohs surgeons make 7 figures. It may be true, but you’re talking about a subset of a subset of a subset.
I feel very lucky to be where I’m at so maybe I’m an exception, but I don’t know many white-shoe attorneys or high-powered reps getting 40-50 PDOs off a year. While nearly all our specialists are getting 40-55 PDOs/year (yes, they also have significant call responsibilities). Heck I just had a coworker leave for a MW job, 45 PDOs, no weekend call, 2 weeknights/month, for mgma median-level salary.
WCI, you’ve obviously been a successful entrepreneur, but for many people I would think it’s hard to beat a dr who goes straight through training and is making 350/yr as a 29yo EM attending right? The ceiling is *much* higher but most business-school type people aren’t bringing in anything close to that under 30.
This is a good post shs. I’m happy most days but certainly acknowledge that healthcare is squeezing more and more on providers.
And totally agree to whoever posted about the single-mom scrub tech! Be kind to your support staff everyone!
Success can be earned in any field though base-income levels are more “guaranteed” in medicine. Most businesses fail. WCI, what are the 6 higher paying alternatives that come to mind?
Landscaping/snow removal (picture running a dozen trucks/crews not a 15 year old with a lawnmower)
Online entrepreneurship- blogging, drop shipping, affiliate marketing, online courses etc
Direct real estate investing/landlording/property management/realtor etc.
Financial advisor
Insurance sales
Running medical conferences
I’m confident I could get all of those up to “doctor money” in less time than it took to get through med school and residency. I see lots of other smaller businesses all the time and I suppose I could string a few of those together too.
Then there are the trades- plumbing, electrical etc. That would require some training but in those businesses just showing up and doing what you said you would do goes a long way toward a successful business. And before long, you’ve got a dozen trucks running around the city.
I think there are many docs with an entrepreneurial streak who are “cursed” with a high opportunity cost of doing anything other than practice medicine.
When you can make 2-3K just showing up for a day’s work, it makes it harder to justify doing anything other than work a bunch, save most of it and funnel it into low cost index funds.
One of the reasons I’m looking forward to achieving FI is to satisfy my entrepreneurial interests without the worries of paying bills or needing to continue to save.
Jim – before FI and the financial boon of WCI would you have pursued any non-medical side businesses?
If WCI didn’t become profitable after a couple of years my next plan was to do direct real estate/landlording. So yes.
I agree. I think I have w skills to be able to do all of the above except running medical conference
WCI, is running a medical conference profitable venture ? Just wondering what the numbers are like. Similar to WCI conference ?
If done well, yes, it can be profitable. Not my favorite business line, but if I’d lost money I wouldn’t be doing it again. All of CME is pretty much a racket though. Kind of like MOC.
Money comment.
100% agree. Most well to do folks I have met are business owners not doctors. Doctors live in bubble and think they earn more than their peers. Reality is different if you look around carefully.
One important lesson I learned was from an attending who was buying a new house. We were scrubbing at the sink before a case and he said something along the lines of “I am buying a new house, its huge and will fit the whole family, we are buying it from a plumber.” I was caught off guard about the plumbing comment and he went on to give me some education in finances. This plumber was moving to a bigger house in a nicer neighborhood. This plumber, due to an ability to scale his business up and make money while he was not physically working, was able to have a bigger house than my attending surgeon. I will always remember him saying “every day I want to make money I have to come to work”.
I agree with that. Most people smart and hard-working enough to get through medical training can make a lot of money doing something else. That said, medicine still pays pretty well and better than most things.
I’ll concede that being an entrepreneur can bump you from being in the top 1% of American incomes into the top 0.01% of American incomes. I would also concede that joining a high end country club is on my short list of stupid doctor tricks.
Medical jobs are not as scalable, although there are certainly opportunities to make money in your sleep. Owning part of a surgicenter, owning your own billing company and employing mid-levels who earn a fraction of what they generate are all ways to make money without breaking a sweat.
I’m 1 of 12 owners in a group that employs many mid-levels and non-owner part timers. Every time I see an ambulance on my days off, I know 1/12 of the profit is coming my way. Not as nice as owning a chain of gas stations or the WCI empire, but it still puts money in my pocket while I’m on the beach.
With reward comes risk. The risks of working in medicine are much more acceptable to me then entrepreneurship.
You are exhibiting the classic physician mindset (I know …cuz I am a physician).
But
https://www.youtube.com/watch?v=MZ0iCu_-Q0M
This is such a complicated topic. Are there truly toxic physician jobs out there? Sure, but probably not most of them.
Something that has been eye opening for me is listening to Katrina Ubell’s podcasts (it’s primarily about weight loss but talks a lot about other life things too). She talks about how you get to decide how you think and feel about everything. Patients showing up late? Overbooked? Patients refusing what you recommend? You can either choose to have a pity party, or choose to just deal with it and move on. Even in an “ideal” physician job, these things WILL happen. Learning to be okay with things not going how I’d like has really helped change my perspective- I leave work pretty happy most days.
You can’t always control how your day goes, but you always have control of how you respond to it. Everyone has that one co-worker who is a living, breathing Eeyore. No matter how well you think your day is going, they always manage to see the negative. Much of career satisfaction boils down to your outlook on life.
While I agree with many of your comments, your comments on suicide data are I believe incorrect.
Most in the mental health profession these days agree that physician suicide rates are higher than any other profession. All the studies and references I have seen have quoted female physicians attempt suicide at 2.4x the rate of the general population and male physicians attempt it at 1.8x the general population. The table you refer to has females at far lower rates (half as much as men) which would lead me to think your data reference in that regard is flawed. Perhaps the data you refer to combine all healthcare practitioners to include nurses, techs, or other allied healthcare practitioners?
Again, while there a many good points here about perspective, the ‘pressures’ from wherever (family, group, admin, etc.) are enough to have our co workers end their lives and sometimes that of their families at the same time. As someone who has had a colleague commit suicide, it can be devastating.
Perspective is good, and we all lead incredibly privileged lives, but your data, at least on the suicide part, may be incorrect.
Thanks.
Agree with this. I’ve been researching this a lot lately and it’s eye-opening. There are a lot of theories as to why there is this disparity between other professions (including dentists, attorneys, etc), but those can also be explained away. People with underlying mental health issues do not disproportionately become physicians. Many of the suicide cases are NOT people who were suffering from mental health issues, nor even desperate/serious life circumstances — in other words, for some it was literally the stress from their work that they could not reconcile with themselves.
Is it that other professions with similar stresses of seeing humanity at its worst on a daily basis, death, destruction, tragedy, and feeling powerless while the world expects all from you (police officers, military, firefighters, to name a few) have protective mechanisms that we don’t? A “brotherhood” and comeraderie that we don’t share, or that they have benefits and/or “off” time enough to compensate for the stresses of the job that we don’t as much? I’m speculating, but you have to wonder why.
Some say it can be financial, the expectation of having a certain type of life and it not working out (both with job/life satisfaction as well as financial issues) — but that seems less likely with the higher female rate since female physicians tend to join the lower paying specialities more, tend to be primary caregivers (meaning not defined only as breadwinner in the family), and just overall seems that finances wouldn’t stereotypically be a reason to drive female physicians to suicide.
Regardless, the statistics are telling and worth pursuing. If for no other reason than it’s a cause for 1,000,000 Americans to lose their doctor every year — who would have thought that *suicide* would be such a large cause of health care access issues!
Phenomenal post.
Please post this to the WCI Forum too.
WCI, this post should be run every year here. Heck, maybe every 6 months.
I’m glad you enjoyed it. I will try to submit more fun guest posts in the future that can stir good debate in the WCI community.
I am not a physician so will never understand the stresses involved with making decisions that could impact a person or their family at the level you all do everyday.
I can only imagine you don’t get a lot of gratitude from patients as you may be seeing them in desperate times and high stress situations. FYI- some of us hate needles so a flu shot becomes high stress in the moment. Don’t get me started on a cavity fill….bring the nitrous.
I want to say thank you all for the work you do, the attention you give all of us as patients and for taking on the responsibility to shoulder hard decisions and harder conversations with patients and their families.
Wow. What a great comment Darren. Wish more people felt the way you do.
Thanks for the acknowledgement. Most docs hear more F* you’s than Thank You’s. This is a great job to have, but not without its stressors. Caring for patients is a privilege, even on a bad day.
Via email:
Brief feedback on the latest article (2/6/19), “Despite the fact that
we should presumably be experts on how to die, we’re getting shown
up by a lot of people. I would expect some creative solutions from
engineers, but artists?? Color me surprised.” As a psychiatrist, I
must say this discussion of suicide went from blassé to tasteless in
a hurry. Physician suicide is a huge problem and this author somehow
thought listing all health care professionals and comparing it to docs
was the same thing? We have better financial situations, substantially
lower divorce rates, yet much higher suicide rates and the date on
this is overwhelming at this point. I will exit my soapbox now, but
just know that how suicide is described in media DOES matter to
individuals struggling with these issues.
I am not a doctor, but I do find this article very interesting. As the article states, society does highly respect doctors, and this is well deserved. This high level of respect is the reason “you make more money than everyone”. It is politics and not the market forces of supply and demand that determines your income. US citizens have decided that you deserve twice the income of doctors in all other wealthy countries. I have no problem with this current decision, but all doctors should be aware that the politics might change; for example, if the US adopts universal healthcare, as have all the other wealthy countries in the world. https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557
An American physician would be foolish to assume this gravy train can continue on this trajectory. I think the odds of us continuing to make double the salary of other wealthy countries’ physicians while delivering worse outcomes is low.
People would be wise to take WCI’s advice and live like a resident, treat debt like an emergency and create a system that makes wealth building automatic.
Time to make hay while the sun is shining!
I also found the discussion of burnout, regret, etc. very interesting, though sad. That led me to further reading on the subject. What I found surprising is that these problems were much less pronounced in those countries with single-payer or other forms of universal health care. Maybe there is a silver lining to increased socialized medicine.
Often overlooked is that other countries’ physicians have no debt, shorter schooling, make a lot more $ as trainees, receive paid pensions, and also have a slower lifestyle with less hours worked per week. Don’t forget the litigation differences that we need to account for in this country.
The oversimplification of this problem as “double the salary of other wealthy countries’ physicians while delivering worse outcomes!” (like this https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557) is disingenuous because its not a true attempt to solve the problem. These are very complex problems that require complex solutions. The answer is not to just turn down the lever of physician salaries and expect everything to be fixed — if anything that is the fastest way to hurt healthcare in the US.
Of course healthcare in the US is enormously complex, and simply cutting physician salaries would do more harm than good. However, It seems to me that all doctors should study the main types of universal healthcare adopted in other countries and decide whether some such system would be good for this country. Perhaps more importantly, they should decide if universal healthcare would be good for themselves and US doctors generally. I always thought doctors would uniformly object to any form of socialized medicine, but, based on some of this discussion, I’m now not so sure.
Great article.
I totally agree that most doctors live in an echo chamber / bubble. Once we take a step back and gain a little perspective, most will realize that it’s not quite as bad as we make it out to be. Just like you, I have a lot of friends who are non-physicians and not nearly as well-off as I am. My wife is not a physician either (she’s a lawyer) and many of her former classmates are struggling financially or not very happy. Traveling to developing nations and interacting with the people brings a different outlook on the world too. We in the western world have it pretty good. All of this gives me perspective and keeps me grounded, humble, and grateful.
The comments on the article are thought-provoking. I can see TPP and Xray’s points in that burnout / job dissatisfaction are rampant and big problems. It’s true. But like you said, many of us can do something about it. To every problem, there is a solution that we can come up with that tailors to our needs. It’s up to ourselves to find or create that solution.
Suicide is so complex. The rise in anxiety, depression, suicide, and mental illness is a big societal problem that extends beyond physicians. The fact that suicide is among the top 10 causes of death is appalling and something I have no explanation for. Maybe it has something to do with the depersonalization and lack of empathetic relationships that is becoming more pervasive in today’s society. I’m not sure. I would like to think having more gratitude, living more in the present, and understanding what truly makes us happy and fulfilled would solve this. But I know it’s not that simple or easy.
It’s hard to go wrong staying grounded, humble and grateful.
You are right that it is up to us to create a solution to our problems. We’re lucky that there are many docs out there who are blazing trails and showing us different paths to higher job satisfaction.
I don’t pretend to have the answers to physician suicide. I meet a lot of suicidal people in the ED and the one thing they all seem to have in common is a feeling of hopelessness. It’s not how strong or resilient they are. It’s not about their support structure. It often boils down to the feeling that there is no escape from their current situation.
Doctors need to know that there is always an escape that doesn’t involve self harm. Even if it means quitting your job, declaring bankruptcy, defaulting on your loans and moving to a Caribbean island (this is actually the extreme solution my hospitalist friend took) there is always a way out. The worst kind of handcuffs are the self-imposed ones.
While I agree that complaining and whining are not useful, I think there is more to this problem than is being addressed here.
Stressful jobs happen when your responsibility outweighs your authority. Doctors may think money or prestige is important, but ultimately the vast majority of us really want to take excellent care of our patients more than anything. The stress points are when we are stymied in these attempts by things out of our control, such as an EMR that doesn’t let us put in the orders we want, a lack of adequate support staff, administrative expectations that take away from our time with patients, etc. There are literally lives on the line, and the buck stops with us, yet our hands are often tied. This does not mean that we don’t have good jobs, but recognizing that does nothing to eliminate the inherent stress in such a system. No amount of money fixes this.
We need to continue to work for a more physician led system to decrease these stresses and improve patient care. Whining won’t fix it, but neither will ignoring it.
Ignoring the problem is definitely not the solution. It’s OK to vocalize concerns and advocate for a better, more humane healthcare system. As physicians it’s our duty to fight for ourselves and our patients.
If all that vocalization isn’t met with actions, nothing changes.
Money definitely doesn’t buy happiness, but if that money allows you to cut back or escape the very things that drive you nuts about your work environment it may be able to buy you some sanity.
Thanks for the Side Hustle shout-out in your companion article! You definitely stirred the hornets nest with this one. It is good to read a different opinion now and again. I agree that we make a ton of money and our jobs can be super awesome.
But I also think there is so much more we can do to make medicine better and to better serve ourselves and our patients. Being a complantsypants is the first step to making things better!
Glad to highlight the steps you’ve taken to improve your job satisfaction and family life.
I think I punted the hornets nest across the yard and it landed on a rabid pit bull!
There is plenty we can do to make the healthcare system better for ourselves and our patients. You know what’s better than being a complaintsypants? Being a solverpants.