[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!
There was a great black and white French movie “Le salaire de la peur”, “Wages of fear”, where several crews of desperadoes had to compete with each other to deliver highly unstable explosives to the oil well site.
In a way, we are getting paid wages of fear, too, esp. in the ED: trying to make diagnoses based on incomplete/unreliable info while keeping the flow going, dealing with irate/deranged/high and other miserable people on the daily basis, less than helpful and even less friendly consultants, the beat goes on…
I love FI/RE ideas, but in a way, for a lot of us it’s a bit of escapism, too , escaping from that grim reality while thinking of ideal future. A “downer” drug, if you will, pleasant thoughts, nirvana :))
And back to reality.
Daydreaming about FIRE is definitely a mental salve after a rough day at work.
We do high risk work and often meet scared, angry patients on the worst day of their lives. Somedays I think transporting explosives would be a nice break. Do they offer a 401(k) and HSA?
Via email:
Not much to add to your post but I just wanted to show appreciation for the amount of thought, dedication, and planning that goes into articles like this. It’s beyond informative and I want you to know that there are those like myself who genuinely appreciate your time and devotion to others. It truly means so much.
We all read Jim’s great posts week after week, year after year and take for granted how many hours goes into a single post.
I can only imagine the months or years of waking hours he has spent between the blog, book, forums, podcast, conference and answering our emails.
Great points on either side of a complex issue. I addressed the suicide issues as a reply a few comments above, and I really do think that that data is huge and telling and not to be blown off. Same with FIRE — if worked so damn hard for this job and sacrificed so much, and now we can make X money just by showing up to work, why do so many want to try doing other things with their time before they retire? There are a lot of other high earners out there who could retire early, but don’t.
One point I was surprised not to hear more about was the liability of doing our work. Lack of autonomy and respect suck, and having dumbasses without licenses tell us how to practice and suck up most of the health care dollars while doing it is outrageous…but there is something about knowing that despite working so hard to be the best and do your best and all the work you do and thought you put into your decisions that no one has a clue about, it can all be taken away (or at least threatened and strained and overtake your life for a number of years) because lay people decided something that didn’t go well was your fault, because your name was in a chart or you were on a committee during a time that something bad happened (perhaps on a patient you never even saw). It’s happened and it can happen. I can’t think of another profession where this can happen like this, where there are literally thousands of opportunities a day (every time you click past a lab or discharge a patient or prescribe/withhold a med or try to help someone in any way) where you are opening the door for that to happen.
Attorneys are so stuck on liability, but how often do they get sued for messing up a case? Financial advisors are a great example too (your job is to advise people on saving/making money, you knowingly do the opposite while making money off them – no consequence). Business owners may be forced to close their business, but can just open another business with a different name. And if one small decision makes your company lose out on something big and you lose your job/standing…no one takes away your “license” to do your job. Add to it that NONE of these people worked nearly as hard as we did for as long to get where we are, so emotionally it’s a whole different ball game to then be accused of causing someone harm. It’s never even happened to me (yet) and it infuriates me.
THEN add to it that the people you have to work for increase your liability several-fold so THEY can make more money, but they don’t have a license to lose if the fit hits the shan, only you do…but if you don’t follow through, you’re not “doing your job”. THIS is why people should want to get out of medicine — not the long hours and sometimes not the most amazing financial picture in the world.
If it weren’t for these points above, I think I would agree with the OP — medicine is not a bad gig if you want financial/job stability and you’re a smart driven person who’s not into starting businesses or running up and down (corporate) ladders. But these items above are not minor IMHO, and I can’t think of many/any other professions that have this type of unique situation.
And then there’s always this little calculation that shows that physicians could be at least as financially well-off, and in most cases moreso, if they worked in pretty much any other profession the way they worked in medicine (and most likely with a lot less stress):
https://www.kevinmd.com/blog/2016/09/doctors-wanted-wealthy-become-ups-truck-drivers.html
Agree with Snag
The lack of liability comparison is surprising.
Different jobs and different specialties matter.
I also agree with earlier comments As mentioned in xrayvsn and TPP disagreements with the blog entry.
When you deal in a high stakes world, and the amount of potential time you have to forfeit to be a witness giving depositions let alone the potential to be named on even frivolous lawsuits is a huge deal.
Money can’t buy happiness. I’m glad it is what it is or the extra 10 years of training missing out on many important things in life would not be worth it if not for the financial reward. (Do ER docs not understand this as much because for the most part they capped at 18 shifts a month in training and they are one of the highest paid specialties with shorter training time than most in a “lifestyle” specialty that is extremely customizable ?)
to just say “suck it up, others hate their jobs too” is a bit offputting and I’m diasaapointed in side hustle scrubs perspective. Exactly how are we in control of global picture of liability stress?
My family is in law enforcement. If I had to choose all over again I’d probably be a state trooper, make 6 figures and retire with healthy pension after 20 years (early 40s). Is their life stressful, sure. But there are some great fulfilling things about that job as well. In fact, I haven’t really met a trooper who didn’t love their job for the most part and are universally satisfied with their career paths. Of course they have some legit gripes and paperwork crap too.
PHysician Asst May be the way to go. Less lost years of training. Less likely to be on the other side of the law suit. Plenty of insulation and backup. And if you burnout in one field it’s easy to switch specialties and start anew. As a Doc, you are pretty much stuck.
Money is probably one of the only things not worth whining about as it’s paying for the delayed gratification. But I can tell you, the nicest homes in my neighborhood are not owned by docs. It’s amazing the amount of money people make in jobs that aren’t doctoring.
Could you become a state trooper now? Not being facetious, but it sounds like you’ve thought about it a lot and the perks seem good.
Getting a little old to start
Once I was in the muck , pot committed to the time expenditure to get here and the debt accrued that would be a tough pill to swallow to pay off med school without as big a shovel
That and my wife would kill me (if the crooks didn’t )
Good question though Sara.
I brought up the cop thing as it was mentioned earlier that , “hey, you are less likely to be killed on the job so don’t think that you have it hard”. A bit of an oversimplification without insight into that side of things.
I can understand the sunk cost feeling! But also I’m at the point (early 30s) where a lot of “reality” is setting in for me and my friends (read: “Why did we pick this career path when we were 20 years old?”), and there’ve been a lot of offline conversations about starting over in something new versus the real feelings of entrenchment.
Sara
My granddaughter has decided that she wants to be a doctor, a neurosurgeon or ob-gyn. There are no doctors in our family to advise. Can you suggest any reading for her, or do you have any other suggestions for where she might get advice to assist her in her decision? She is 11 going on 20.
Good post, great comments!
Agree especially with last two comments. The advances in all areas of medical care have been amazing. Current expectations very high among patients (and jurors.)
Unfortunately, the human brain can’t evolve quickly to keep up with the pace of medical knowledge and discovery. Smart phones and other apps can help with decision-support, but they are imperfect and a human still has to gather and interpret the facts and then figure out which decision support to apply..
We need adequate time to figure out the diagnosis. Patients want more time, administrators want less time, more volume.
Patients want more tests, insurance companies want fewer.
Practitioners are caught in the middle of this struggle. I’m sure other occupations face time pressures, but maybe it’s more acute in health care?
I agree that advocating for change in the name of better care is good, and “whining” is counterproductive.
But sometimes it’s hard to advocate without sounding whiney because of the stress and frustrations inherent in medical practice.
I wouldn’t say that the gist of the article was “suck it up”, but rather to give docs some perspective.
67% of the general population experiences some degree of burnout and at least 95% of them make less money than us.
The companion post that ran on my site gives concrete examples of steps people can take today to improve their job satisfaction. Don’t take my word for it – just ask White Coat Investor, Physician on FIRE, Passive Income MD, Crispy Doc, Vagabond MD, The Physician Philosopher, Xrayvsn and countless other docs who have shows their fellow physicians alternative paths to happiness.
To be fair, I was not unhappy before. I did not start The White Coat Investor because I was burned out and I had a plan to drop night shifts and to cut back to part time long before I started blogging. I did hit the point where I could do so earlier than the original plan, but that was it. I did not cut back to part-time because I was burned out. I did so to allow more time to do WCI stuff without stealing it from my family time and recreational time.
I suppose the reference to WCI is that addressing finances helps give options for FIRE, which is a very attractive prospect that many high earning physicians are lucky to have.
But my thought is that it’s generally not a good sign if the main recommendations for dealing with physician burnout (stress, suicide, etc) is to do things with our time instead of practicing medicine. I work with law enforcement, and these men and women are getting their first pensions (and healthy ones at that!) in their 40s because they started working right away. But they all come back as an “on call” and work over 1000hrs/yr doing the same job and/or change to a different organization and work another 10-20yrs for a 2nd pension (or 3rd). In theory, they could have lived off their first pension (esp if they were a higher ranking officer by the time of retirement), but they always come back to work near full-time. I don’t see us with the same enthusiasm for our jobs.
I’m skeptical most who take on a second career as a cop after retiring as a cop are doing so because they are enthusiastic about the job. I would bet most is driven by financial reality.
I would have thought so too. But the “O.G.” cops (yes mid- to late-40s is an O.G. for law enforcement) spend a lot of time chit-chatting about their houses, cars, kids they put through college, etc. They often live outside the cities on larger properties. They’re doing pretty good. Much of their new income seems to go toward feeding their hobbies, and some fancy dream-home they want to build somewhere. They’re not super-wealthy, but they are healthy middle class who got into the workforce and housing market early, and with little concern for running out of money since they get great pensions in addition to whatever they’ve saved along the way. Think GenX meets Baby Boomers. I wouldn’t want their job, but if you survive the streets it’s not a bad career.
SideHustleScrubs – I guess that is part of what sounds rather condescending and insulting in your post. Those of us who have been practicing medicine for a couple of decades don’t really need young docs in high-paying, procedural-focused specialities to “give us some perspective”! I would, humbly, suggest that younger folks typically need the perspective that those who have been doing things awhile have to offer (not the other way around!). And when you point out how a lot of you are managing the stressful situation by finding other things to do – most of the things you mention are outside of medical practice! That sort of defeats the whole thing, doesn’t it? Some of us have enjoyed medicine for years and actually, were reasonably happy and satisfied for much of that time. Not that medicine was ever “easy”, but it used to be very rewarding and it has never been boring. That part of the job is starting to disappear and the tedious, low-level tasks are exploding, putting a stress that has not been seen before. And most of us are not just sitting around “whining” – we’ve been wracking our brains to find new and more efficient ways to do things, trying to rebalance our daily tasks in a more satisfying way. But, we keep getting more and more heaped on by external forces- our own employers, CMS, etc. We are just experiencing and voicing what we feel. It does not sound like you spend HOURS of totally uncompensated time typing/clicking/signing/shuffling papers, that primary care and other less procedural/shift-focused specialities do. As I sit typing and plowing through hours of administrative (again, uncompensated) tasks while my children are home fending for themselves (granted,they are teenagers) -it is not sustainable for many. I work part time to make it bearable. Again, thanks for your “perspective”, but give us some credit. We are hard-working, intelligent professionals who just want a reasonable, sustainable balance; we know how our salaries compare to the rest of the world. Your graphs didn’t suddenly open our eyes. But thanks anyway.
I feel similarly–I didn’t start WCI to help people get out of medicine. I had hoped it would help them to be successful IN MEDICINE. I sometimes get lumped in as another FIRE blog, but I don’t plan to FIRE, at least the RE part.
To be fair to SHS though, there is a lot of whining out there from docs who don’t realize they’ve got a great job. That doesn’t minimize the very serious problems we have in medicine including loss of control, burnout, unrealistic demands, less time with patients, suicide, depression etc.
Well said WCI
Complaining doesn’t create change. Change creates change.
It doesn’t sound like you’re whining. It sounds like you have taken steps to make your job more satisfying. Cutting back to part time often makes a medical career more sustainable. It also sounds like you have identified other tedious parts of the job you wish you could eliminate. Is there a way you could hire someone to do these lower level tasks so you could focus on the parts of your job you enjoy? Even if it reduces your income, it might be worth it if it increases your career longevity.
I actually think older docs are less likely to be whiney. Many of them went into this field before the idea of work/life balance was even a thing.
I wish you the best of luck and many continued years of job satisfaction.
I think that the general confidence we, as physicians, have in the statement “I could’ve been just as successful in another field I chose outside of medicine” may be incorrect. We compare ourselves to our peers at the time, who went into tech, engineering, business, banking, etc, but may have had worse grades (or whatever qualification we choose to pick) at the time than we did. The problem is that the skills that predict success in climbing the medical ladder are a specific brand of “scholastic traits” and based largely upon memorization, multiple choice skill, compassionate disposition, and continuing to build a well-rounded CV that would make Mom and Dad proud. We are indeed very competitive, but these particular skills are the instruments of our competition.
However, in other fields where people become successful at a younger age, selection is probably based on combinations of different kinds of skills, like quantitative problem solving, or writing skill, or risk-taking, or straight up social sociopathy (for bankers). These things are not what many of us, as doctors, are actually skilled at. How many of us thought physics for biologists was the worst of the pre-recs?
On a related note, many of the gripes that we have about the loss of physician autonomy in the medical ecosystem probably stem from the incursion of business folks who have honed skills that we never learned to defend against.
Those are some fair points, but skills are refined through practice and those skills you mention are things we as physicians just dont spend much time doing. Could they have been better honed if we invested as much time into them as we did medicine? Who knows, but I would like to think than you spend enough time doing something you will get better at it.
Every side job I ever had on the road to med school (and during med school) offered me to work with them full time. They had other temp employees before me. I’m not tooting my own horn, but I realized that intelligent people with common sense and problem solving skills (and a touch of work ethic) is useful in ANY work environment, and not as common as we might assume. I think we could have done a lot of jobs that would pay us well — how much would we want to do it every day for decades though?
I absolutely agree with that. I would be an awesome employee for many businesses.
Yes, but that’s just what I’m talking about – our perception is flawed about what is required. The “best employees” in fields outside of medicine aren’t the folks we think we’d be better off as. People who are hardworking team players are foot soldiers in the non-medical world, making 80k, working for people who, by in large (I believe), have different skills than those we were selected for. Medicine should be cherished in some respects, because it actually rewards the cultivation of good qualities. My observation of other fields has been that they only do this up to a mid-level point.
Soni – with all due respect, I suspect that the side jobs one could get on the Med school route don’t lead directly to the kind of careers people on this thread are wishing they’d pursued instead of medicine. Also, my observation is not that we were chosen for “common sense and problem solving skills”, but rather for beast-level work ethic / determination, outlier memorization skills, and talent for multiple choice tests, wrapped in with agreeable personalities and a breadth of extracurriculars. These are great things, but it I’m hypothesizing that the jobs many are lusting after go to different outlier skills than we, as doctors, are generally selected for. This doesn’t mean that some of us don’t have some of those skills, but I’d posit that our success scaling the MD gauntlet wouldn’t predict success in scaling the tech gauntlet in any simple way. Spending time in the Bay Area let me see many examples of doctors trying to make that jump – there are some who really made it work, but most took a pay and prestige cut.
Also – WCI, you actually have made it in a different arena (which we’re in now!). I’d bet the skills to do this were tangential to your MD skills, but you’ll have better insight into that than I do 😉
My group is looking for a full time nights guy. I think you’d be great!
Ok, so I haven’t had time to read all comments yet, but I wanted to throw out there the fact that my best friend (and best man at my wedding) is an investment banker with Citi and there are some important elements to compare there, as well…
They work a lot – probably more than most physicians, but Investment Bankers consider “Client Dinners,” sitting in first class on transcontinental flights, and transportation time to be a part of their “worked hours.” Most of us don’t consider “drug dinners,” and destination conferences part of our “work.”
I’m not saying they don’t work hard, in fact, I think they probably work harder than most physicians, but to claim 80+ hours a week is a bit disingenuous. My friend will readily admit that his internship and early residency were more taxing than what he does today. Part of that is also the nature of the work. He doesn’t find the social interactions, meetings and report writing to be as strenuous as staying up all night making critical clinical decisions.
The reimbursement seems similar based on the “averages,” but the structure appears to be different. From what I’m told, salaries in Investment banking tend to be very pyramidal, with top earners taking home tens of millions (think CNBC contributors) and the lesser research analysts making about $150k. I think it’s fair to say medicine has a more bell-curve shaped reimbursement pattern with few making over 600k and few making under 150k.
Lastly, most investment bankers didn’t have to suffer through residency or medical school for essentially no reimbursement at all until the age of at least 30. Becoming an attending physician is something which must be earned. On the whole, I’m probably happier to be an attending physician than an investment banker.
I agree that not all work hours are created equal. Flying first class and wining/dining clients is not the same as coding a child while their parents watch.
Even within the house of medicine not all work hours are created equal. The entire concept of a lunch break is completely foreign to an ER doc (as is the concept of working 48 hours straight on weekend call).
At the end of the day, what all these work hours have in common is time away from my family. I wouldn’t want to work 80 hours a week as an investment banker because those are hours I wasn’t home with my wife and kids. The work may be less stressful, but the time away from home is equally stressful to those you leave behind.
There are legit gripes about medicine and burnout is an real issue. However, I also feel that some have a harder go of it in medicine than others. It seems their mental makeup just isn’t suited for medicine or at least their particular specialty. I’ve had colleagues, who go thru the same things I was, have a much much harder time coping, dealing with stress, the weight of our decisions, etc. I don’t think just any smart person can do medicine, it takes a certain personality, at least for some specialties. I can certainly think of very smart friends not in medicine who could find it challenging.
Having said that, I worked outside of medicine for a few years prior to med school, and my spouse isn’t in medicine either, and that, along with an open mind, has helped me keep a healthy perspective. We do have it pretty good. After 4 tough years of med school I’m nearly guaranteed at least a 3yr job paying above average US income. It’s a tough job, but I work indoors, it’s not physically taxing, I don’t sit in a cubicle all day, I can live in any city I want, and I have nearly bulletproof job security, all while honing my skills in a protected environment. As an attending, a lot of the same applies, my responsibility gets increased as does my salary, but I can still work pretty much wherever I want and it’s well-paid work. Well paid that I could conceivably retire in 10yrs. I don’t have to work multiple minimum wage jobs. I was out-earning my engineer friends in residency w/ moonlighting. I can find a well paying job anywhere I want unlike my lawyer or tech friends. I have much better job security and low risk income source compared to my business friends. All the while providing a very vital, meaningful service to society, which can’t be said of most jobs. The grass isn’t necessarily greener elsewhere, and those of my colleagues who think that often have no idea what they’re talking about or keep a very small particular social circle.
Those doctors that say they could make more money doing something else, I highly doubt. Certainly I know some brilliant doctors who could succeed in anything, but many of the others, like myself, who maybe could do just a good job at some other thing, but unlikely to outearn my job as an MD and certainly without all the perks mentioned above. I personally wasn’t very good at anything else in college. Forget math, engineering, business and I highly doubt I could do better as a lawyer. Most of my MD friends are the same.
That stuff is all true…but I think the complaints about money and being able to do something else are not really about money (which means the money being the big “pro” is not really as valuable).
I think it’s about what we give/gave up and endure(d) for this. Was it worth it in the end? A whole lot of resources piled into delayed gratification…that ends up not being as gratifying as we thought – that seems more the issue.
The stress, expectations, liability, and disparity between our integrity and how we’re treated is what causes a lot of the questions about if it was worth it.
I think if we currently make 20-50% less than our predecessors (relatively), we’re much more than 20-50% less satisfied.
But I agree, when I think about it…I don’t know what else I could do as well as at, or that I’d want to do on a daily basis and not want to shoot myself. Even on a boring day, our job’s are challenging and interesting. Flip side to everything.
There is no other career path I could have pursued that would have worked out as well for me. Sure, I could have been an attorney, dentist, plumber or engineer, but I don’t think I would have found any of those as personally satisfying. The money is great, but I suspect I would still rather be an ER doc than a lawyer even if it meant taking a pay cut.
I did not have time to read all the comments, but I am tired of physicians being labeled as “whining” as they react to changing job pressures. Most docs are not “whiners” – lets start with that. You don’t delay gratification, put in the hard work studying and training all those years if you are someone who just wants an easy way out. My initial thoughts on SideHustleScrubs is that he’s a young guy in a high-paying specialty. Which I think is correct assumption. I am a primary care/IM doc who has been practicing for 25 years! I love medicine. I’m part of a dual-physician couple, so in all honesty, money has never been my primary concern or even motivation for my working. But, I can tell you, medicine has changed over the past 20 years. Doctors continue to lose autonomy, authority, and are being asked to do more and more repetitive, low-level tasks. I have a huge interest in efficiency, job productivity- it is a KNOWN FACT that increasing these low-level, repetitive aspects of a job leads to burnout. Asking high-level workers to “click boxes” all day is a recipe for burn out. It has nothing to do with the fact that, yes, we make more than the average American. I have a patient who is a leftist, retired economics professor-when he hears a bit about what our job now entails, he pointed out immediately – doctors have become the new PROLITARIATE! and that describes us exactly. We are a new “working class” who just provide a service; with little autonomy or control. and are just paid a wage. It is a recipe for burnout, not good for our society. Just look at all the “side hustles” “FIRE” thoughts – doctors working hard, jumping out of practice, trying to find anything else but clinical medical practice to earn some money. This is NOT what medicine was or should be. It is an interesting and rewarding enough field that it should keep us all happy and satisfied. this would be good for society as a whole – maintaining a highly skilled work force makes economic and social good sense. That is not what is happening here.
Exactly this!
Well said LisaH…fellow internist/data entry clerk.
Totally agree that physicians shouldn’t be wasting their time and skill on repetitive menial tasks. Aside from the fact that it increases burnout, it doesn’t generate revenue. The only thing that brings in money is caring for patients. Docs need to focus on the parts of their job that they enjoy and puts food the table. That might mean hiring scribes, medical assistants, NPs or PAs. It might mean outsourcing all your coding and billing. The happiest docs I know are the ones who have figured out how to eliminate as much BS from their day as they can (even if it hits their bottom line).
My final word-I’d like to give SideHustle and other younger docs some “perspective”. I don’t sit here thinking any other field has it better, easier, is more lucrative OR that I wish I had gone into tech, finance, etc. I realize my husband and I make decent salaries. What I see – the balance of medicine has shifted dramatically with explosion of low-level, tedious tasks. We are now almost “line workers”, selling our analytical skills, but having little autonomy or authority – things that used to make this a very enjoyable field. The perspective is also that when us “old timers” started practice, and well into our 30s and 40s, we did not constantly focus on how we could “side hustle” or FIRE. We enjoyed our jobs and looked forward to many more years of the same, building our practices, becoming better and better at what we did. Believe it or not, when we’d get together with colleagues and friends in our 30s, we NEVER sat around and thought of ways to get out of medicine! We liked our jobs! I totally get it that the world changes and that may be all this is. But, I can’t help feeling that doctors actually do provide some necessary function to society and it is sad, if nothing else, to see how many docs want out.
Hey Lisa
Side hustles – for me – aren’t to get out of medicine but rather a way to take advantage of my knowledge and skill in other venues
Even in your response above you have a defeated mentality – ‘limited autonomy or authority’ – hey you gave up – ceded control. Cut back your FTE and live the life you want. You are in control unless you give up that control!
Its a very – when I was young – the good ‘ol days story.
And this isn’t meant to be young v old – its about finding satisfaction at all stages of your career.
Lastly – think of the side hustle as a parachute because one never knows
JustSayin
Going part time is, by definition, getting away from the job that used to be satisfying. I don’t know anyone who went into medicine with plans to go part time, actively work on FIRE, and find side hustles.
I agree I didn’t go to medical school with the goal to go part-time, but from very early in my career (it was baked into the financial plan I wrote up as a resident) I decided I wanted to at least have the option to go part time in my 50s. I also decided at least within 4-5 years of leaving residency that I was interested in a way to cut back on/eliminate night shifts from my life ASAP.
The side hustle idea showed up about 5 years out of residency for me. Mostly because I found myself sitting around the house on a lot of weekday mornings with my kids in school, my wife busy, my friends working etc.
WCI – you’re on point….I also do shift work and as young hospitalist was off too many M-F to just sit around – so I found things to keep me busy …now known as Side Hustles!
The random weekdays off definitely gives you time to explore alternative opportunities.
I don’t think I would have been as interested in side jobs if I worked banker’s hours and my time off aligned with everyone else’s.
Eliminating night shifts seems like a natural evolutionary habit. I can’t wait to have a consistent sleep cycle.
Fair statements…however times change and doing the same job and expecting same renumeration or ‘happiness’ level decades later is IMHO a setup for the opposite.
Also going part time is opening up time to do other things – you assume its less medicine- maybe yes maybe no. For me its many things: med device development, real estate development, moonlighting at a higher rate, legal case reviews, travel, etc.
Build the life you want!
JustSayin
YES! YES! YES!
Sick of hearing this ‘we’re all burned out’ narrative – its slightly pathetic
Scarcity vs abundance mindset – and suspect we are lumping a bunch of different things into ‘Burned out’ bucket
Everyone is in control of their own lives – though far easier to say ‘it’s the system – it’s the government’
take personal responsibility – hourly – daily…create the life you want!
JustSayin’
We are all responsible for our own job satisfaction. No one else is going to stay up at night worrying if you like your job.
We can either wallow in self pity or do something about it. I am glad there are so many physicians out there who have set good examples of rejecting the status quo.
At the end of the day, medicine is an awesome job. All careers have their downsides, but we are lucky to do what we do.
refreshing to find like minded colleagues on this site
JustSayin
SideHustleScrubs, WCI – glad to see we are more on the same page on many things! I am in total agreement that the main goal is to be satisfied at our jobs. Also that, bottom line, we each can only be responsible for our own job satisfaction as nobody else will do that for us. I have loved the practice of medicine – it’s a great field! I appreciate all flow of ideas and information. The world in general is changing, and medicine undergoing some significant “growing pains” – I do think it will take some younger physicians, who are very computer savvy, to help reshape medicine to a more provider-friendly balance. Right now, it is a slow and somewhat painful process. I’m just hoping to hang in there for awhile and see how things develop! In the meantime, am enjoying WCI and others advice on how to make sure we’re FI along the way.
I think the EMR thing is an underlying cause of much burnout. It is so depressing to see how much an EMR can help us and then see how little it actually does! But I am encouraged that every 2 or 3 years when we switch from one to another that the next is better than the last. Maybe a decade from now, the good will outweigh the bad.
I hope so, but don’t know. Our medical organization has been using EPIC in the outpatient setting for 20 years! I kid you not. We started on EPIC in 1999. And I was right in on it. It started out as “not so bad”, once we all got used to the format. Not as many other institutions on it then, so not as much connectivity between institutions as now. BUT, the additional “quality” monitoring and check boxes for billing levels has exploded over the past 7 years. And has added complexity and “busy work” with really no clinical consequence or benefit. Unless the docs that really use the system get much more involved and become the drivers of this technological tool, it will not work “for” us and will continue to hinder and burn us out. I read one high level clinician noting that a new technology takes “10 years” to fully implement and work out the kinks to point where then helpful, which initially gave me hope. But as mentioned, we are at a solid 20 years of use. Things are worse. And no relief in sight. A lot of it falls under “quality” and CMS thinking they can reliably measure how well things are going, when clinically many of these “measures” make no sense. And docs start to buy into it and think we are measuring “quality” too (ie, patient experience, etc etc). We all know these are not measuring true “quality” but we seem to be helpless to change it. It’s a very complex problem.
Wow, 142 comments!! That has to be near the top for the past twelve months.
I wonder where politicians fall nowadays on the Trusted Professions chart. Or maybe they’ve just been in last place since Vietnam.
If our public opinion polls ever dip below politicians, we should just hang it up.
Hells Yeah! Finally. Someone else who thinks all this “boo hoo” burnout is a load of $hit too. We’ve got it great. Stop being wimps, all. Fantastic post.
Strode, you sound like you shouldn’t be in medicine. No sympathy or insight.
The suicide rates article by profession has been retracted by the CDC for Incorrect information and the one that has succeeded it includes several disclosed errata.
Interesting. Does the new data show docs on top?
I wonder how much of it is docs being more suicidal or docs just being more effective at suicide.
I’m curious too. I know the completion ratio is higher in physicians, and for female physicians their rates of “attempt” are lower than the general population (but that may be due to how suicide attempts in the general female population may come along with other co-morbidities more prone to “gestures”) — but I believe the absolute values and ratios are still not good for physicians compared to other educated professionals, even when corrected for psychiatric co-morbidities. Would like to see more clearer analyses in this area, but tbh I don’t think much more convincing is needed for a call to action.
Did my old hospital administrator write this??? This article bothers me. I appreciate the call to action vs. whining…100% agree. However:
1. Physician suicide and burnout is no joke
2. Teachers can form and join unions, doctors can’t legally. Lawyers don’t have legal “fair market” caps on their salary. I venture to guess most senators and judges have other forms of income.
3. BIG ONE that is almost always overlooked. Lost retirement savings! Many docs don’t have means or guidance to start retirement as early. Don’t be fooled by a “higher” salary. Compounding interest is hard to overcome when you don’t start retirement plans until your early 30’s and have much more student loan debt than other professions.
Why would you think doctors can’t form unions?
http://www.doctorscouncil.org/our-history/
How quickly you forgot the title of the article – some people love to be a victim – you are 100% in control of your life and decisions …with that
Burnout is a basket term and likely lumps many issues together.
Unions are not going to be your savior
Physicians – despite late start can easily build nest egg very quickly – that’s what this site is about
I’m 40 and will have 8m in assets by 50 without anything crazy – stop complaining and find a solution
Plenty of success here – I choose to focus on positive
JustSayin
(message was for Cameron)
Hopefully, it does work out that way for you in ten years. But I wouldn’t be too dismissive about other people’s experiences who’ve already reached or passed that milestone without the matching portfolio. I’ve met countless investors over the years with pro forma spreadsheet wealth that never turned into reality.
$8M by age 50? That sounds amazing!
That’s more than twice my goal; though I chose a lower-earning field and haven’t always practiced full-time. $240K/yr ($8M x 0.03) is significantly more than I’ve ever earned practicing, even full time (I don’t miss those bad old days of168 hr hospital call weeks.)
On the bright side, there are several other careers where I could replace/nearly replace my physician income were I to retire from practice. I’m still young & healthy enough for an encore career, and feel sympathy for younger grads with such high student debt burdens who might feel trapped despite the higher salaries available the past 5-10 years.
Anyway, I would enjoy learning more about how you have/are reaching your goal.
Guest post, perhaps?
This is awful and you’re contributing to the problem. I’d love to see where else I should be working – my salary is well below average. Hours worked is misleading because of CME, unpaid admin time, etc, AND we shoulder life or death burdens in care and emotional weight. Your use of numbers strips the humanity aware. I’m disgusted you view things in such a sterile way.
If your salary is well below average (and you are willing to change jobs in order to have a higher one) there should be a long list of places you could work and make more. The further below average, the more jobs there are that pay more.
WCI, you make it sound much easier than it really is to shop around for another job! That is part of the problem! Vast majority of us are now under restrictive covenants and our employers have locked us out of any similar job in a fairly broad geographic radius. Also, in primary care (and probably most other specialties), it is a huge work effort to start all over. Getting to know ALL your patients again from ground up is massive, slow buildup. And part of the wonderful satisfaction and enjoyment of primary care is establishing long-lasting relationships and knowing your patients (often whole families) for many years. For most of us, even if we were “allowed” to switch jobs, all the general systems employing physicians are very locked in same structure, so you won’t improve your situation by working for different organization. And, yes, you can really go outside the box and consider DPC, etc, but those have sig limitations and lower guarantee of success due to the bigger health care organizations controlling most local care. In fact, this is a huge contributor to “burn out” – feeling limited options. Many of us have gotten to a point where we contemplate, daily, weekly, at least monthly- “I want out of where I am now, what else could I possibly do?” And the burnout is the feeling that there really are no better options.
Sorry for your struggle – just think completely different than you – so much opportunity in this world
You are 100% in charge of your life
Burn out is a manifestation of many issues – but ceding control to someone else ensures you will never find a way out
The answer lies within – not without!
JustSayin’
Agree that starting over in (employed) primary care is tough. You see a lot of new patients who have fired or been fired from other clinics, or their old clinic no longer will see them for insurance reasons.
Your employer’s hospitals and EDs need someone for handing off uninsured/Medicare/Medicaid patients who haven’t found a PCP.
These patients can have challenging socioeconomic situations or complex medical/psychological needs, or both. That’s probably why health systems offer high (initially guaranteed) salaries to recruit primary care, and yet there is still a shortage of primary care.
We do not “treat em and street em” in primary care. The patient is referred to a “your” patient, although you can not own a fellow free-willed human being.
I suppose one can open their own primary care practice and have greater autonomy, in exchange for lower financial security. For how many new, heavily-indebted physicians is that option feasible?
Dude. The jobs that need us pay less. I could jump into a concierge practice and make more BUT THAT IS NOT THE POINT. The people that work in most needed areas don’t get recompensed. And saying “just change jobs” is totally tonedeaf!
Pretty sure you’re oversimplifying ‘people that work in most needed areas don’t get compensated’
And ‘jobs that need us pay less’ – certain that market forces (supply/demand) don’t exactly work that way.
(I’d be more specific if I were you)
Just saw oncology in rural Alaska for 600k / year
And Neurosurgery….def in high demand and paid as such
Heck BS – I could do this all day….Just Sayin’
PS BS – I know what you mean – but using old paradigm to solve current healthcare issues wont serve the population. We certainly have a workforce distribution issue, though best to not use yesterdays solutions for today’s problems. As an example – maybe everyone doesn’t need a PCP.
JustSayin’
I disagree that changing jobs is somehow a solution that cannot be considered. If you’re in a job that abuses you and pays you at the 10th percentile, I think looking around at your options is a very good idea.
Sounds like you need to find some more productive ways to find job satisfaction.
May I suggest: https://sidehustlescrubs.wordpress.com/2019/02/06/wci/
We do have hard jobs. We deal with life and death decisions and often see people on the worst day of their lives. We often do thankless jobs at odd hours and we aren’t the only ones who sacrifice – our careers often leave a trail of civilian casualties (friends and family) in their wake.
When you step outside the doctor bubble, you realize no one else is throwing us a pity party. A little perspective helps you remember how the rest of society sees us. No one is sitting around their living room talking about how poor Dr. Jones has increased regulatory obligations and doesn’t get reimbursed for charting at home.
You are the master of your own destiny. You can take an active role in improving your job satisfaction, or you can blame the world for your problems. Dealer’s choice.
No one asked for a pity party. Stop speaking down to us. We’re saying we don’t necessarily have the control and your experience isn’t universal. Besides, WCI and SHS seem to have side jobs anyway. Regardless, this post is tonedeaf and I encourage you to watch ZDoggMD’s video about the same.
A friend just forwarded this post to me.
I see so many things wrong with this post. I never post on message boards but I feel like I should contribute.
Immediatelely, the condescending (bordering on hostile) tone lost me as a reader. If I were to come to this site looking for help, should I feel defensive and weak? Will that help me? Has anyone felt happy just because another person said, “Shut up and be happy!” You lost most of your readers with the title of your post.
Like you, I am in Emergency Medicine. Before that, I worked for years in the finance industry, even through the beginnings of the Great Recession. I assure you that telling a client, even a wealthy one, that such and such investment instrument underperformed does not compare to sitting with a mother as she wails at the death of her only daughter. Losing money is not losing lives. My hours were longer in my past career but my job was easier. You cannot compare investment banking, primary education, or dog walking to medicine. I would have a hard time even comparing specialties within medicine. Every conceivable job may push a person to a limit.
What you can measure is population based data and job satisfaction in medicine is absolutely tanking. This trend isn’t because doctors are whiners or we’re all millennials who don’t know how to work hard. If we were patients with these same symptoms, why would you assume that something is wrong with every one who is sick?
The core premise of this article is comparing hours worked and money earned to other professions and as asserting as a logical conclusion that applying rudimentary formula somehow invalidates or even lessens the immense wave of physician unhappiness. This is obviously false but, for arguments sake, even if your comparisons were somehow valid the happiness (or less unhappiness?) of another in some different profession in some different situation does not negate the unhappiness of many physicians. One can always try to soften the current situation by imaging one worse… “My department chair is cutting my bonus because my Press Ganey is below average but at least I’m not a refugee!” No, the human condition does not work like that or otherwise we could convince everyone, everywhere to be happy.
One could go through your data and deconstruct it based on regional salary/cost of living differences, litigation rates across specialties as well as compared to other professions, shift work vs traditional schedules, clinical time vs administrative time, delayed earning potential vs years worked, hours invested as residents vs hours invested in other internships/entry level jobs, rote administrative burden vs creative and deductive thought, and on annd on and on … but I don’t think this matters because many people are unhappy and telling them that they are not allowed to be unhappy accomplishes absolutely nothing.
If you are to make comparisons, perhaps the family medicine doctor who has a 2:1 paperwork to patient ratio has every right to be upset. Maybe he or she would like to have the time to maintain a finance blog and write a book about basic, prudent savings strategies but he or she just can’t climb out from under the paperwork. Your roughly 36 hour workweek might be much different than the pediatrician or the general surgeon.
In full disclosure: I don’t feel burned out. I am grateful for my experiences and my profession and my patients. I feel deeply privleaged to enter into people’s lives in such vulnerable, fragile moments. I fight burnout through the human connection and striving to be good to my residents and coworkers.
I have had times where I have felt burned out and other doctors telling me to suck it up only hurt more. Doctors need to stop eating doctors and this article is pure cannabilism. Recognize each other, our good and hard work,sa and support each other.
Thank you for this perspective, you bring up some very good points.
If you read this entire post from top to bottom and thought the theme was “shut up and be happy” you’ve missed the point.
I admit the title is effective click-bait (as evidenced by you clicking the link your friend forwarded to you). The theme of the post (and the sister post on SHS) is take a step back from the doctor bubble and remember that our problems are not unique to medicine. If you’re not happy with your job, do something about it.
The job satisfaction fairy is not going to improve things for you while you sleep.
What? There is no white knight riding to my rescue? The cavalry isn’t coming?
Answer these 3 questions:
1. Do you like yourself?
2. Do you like what you do?
3. Do you like how you do it?
If you answered affirmatively to all 3, you are likely to feel successful and have job satisfaction per a Harvard study. I answered affirmatively for numbers 1&2, but not for number 3.
How about you?
1. Yes.
2. Yes.
3. Yes, but I’m still looking forward to cutting out night shifts like Dr Dahle.
via email:
n reference to the article above –
As we are both physicians, I presume you have had experience in
hearing administrators go on and on about how we need to do better
documentation, and create more rules every year about how we go about
our business. The core of many complaints is – how is it right that
administrators, who know nothing about medicine, should demand that we
document a certain way, or demand that we deal with ever more complex
EMR, or ever more complex rules, which ultimately take time away from
our families and personal time? Why were there no comments on taking
back our profession from those who simply earn money off our backs and
produce no patient care?
It’s not fair that admins make money off our backs and constantly increase their demands. There’s a lot of things in life that aren’t fair.
Taking back control of your practice is one of a hundred ways you can increase job satisfaction. That might mean changing practices or even moving to a new town. There’s also the option of paying someone else to deal with the P.I.A. aspects of your job – hire scribes, outsource billing, use more midlevels.
[Removed at comment author’s request. ]
I’m glad to hear you’ve taken active steps to improve your burnout. If you are still trying to find a way to enjoy the practice of medicine more, I’d suggest taking a page from some of my favorite physician bloggers. https://sidehustlescrubs.wordpress.com/2019/02/06/wci/
They seem to have a good grasp on making the best of a (sometimes) bad situation.
I don’t know where this three week old article got picked up today, probably a Facebook Group somewhere or something, but I’m getting all kinds of fresh hate mail from it. Thanks a lot Side Hustle Scrubs! 🙂
At any rate, I think people are struggling to understand what the phrase “guest post” means. It means I didn’t write it.
I saw your updated editor’s note above. I would recommend seeing if there’s a way to make original author info (in general) more clear (larger, bolded, different color) at the top, exactly for reasons like this. 😂
It’s not that big of a deal. But it does demonstrate that people don’t read on the internet, they skim.
If one works for someone else then they will always be making money off our efforts.
Become an owner or seek out another institution (hospitals are slow moving beasts so not worth waiting it out)
Nobody is forced to remain in their current role/job but so many act as if we arent in a free society.
JustSayin
I work for a hospital group and feel the pressure of the increasingly burdensome structure they have put in place. My husband owns and runs his own private practice in a surgical subspecialty and works right next door. We both feel the strain on a daily basis and BOTH would love to find something different. Being one of the very last private practice groups in this city dominated by hospital based conglomerate systems is definitely not easy and quite stressful. CMS-required regulations leave him with the same documenting and reporting structures that add hours of “paperwork” to his days. He’s 57 years old! He does not want to start all over somewhere! He’s hanging on for 3 more years and then getting out. And we are not sitting around bemoaning our lives to anyone else. We don’t expect other non-physicians to feel sorry for us or wish someone else would solve our own problems. We do plenty of other things besides medicine. Raising three now-teenagers has been my “side hustle” for years. We are looking forward to the next phase of empty nest, travel, maybe do other things in medical or other, etc etc. It’s just too bad that the daily reality for at least another couple years is as unpleasant as it currently is. Again, all of this is what defines “burnout”
[ad hominem attack deleted] Where to start………..
1.) Many, Many, Many physicians and surgeons enter the profession because of an expectation. That expectation is not financial windfalls, private islands, [inappropriate comment removed], mountain sized piles of cocaine, and private yachts with their own helicopter pads that are too large for any but the largest harbors. No, those fantasies are for WallStreet/Corporate [inappropriate comment removed]. Most doctors want professional satisfaction, the feeling that they make a difference, the idea that because of their effort the world is filled with just a little less suffering and death. As a surgeon, there is simply no feeling in the world like reaching into the icy blackness, grabbing the patient by whatever is available, and prying him from the wings of the dark angel just as she is taking him permanently into the dark. That, in its purest form, is what attracted me to surgery. As an aside, while having an arguement with a nurse who refused to clean up a patient who was post CABG, demented, and rolling in her own feces, I asked what I felt was a simple question; What does the word ‘patient’ mean? No one, not the ICU nurse, the PA’s, the NP’s, nurser manager who was suffering a severe case of FNS, the residents, nor the attending could come up with the correct answer. Priceless…………….
2.) The article, like most articles [ad hominem attack deleted], forgets to ask the most important questions around physician compensation:
a) How much should someone who gets good to great grades throughout highschool, takes challenging courses throughout college (Princeton, in my case) also with good grades, is accepted to a top 20 medical school (number one by some metrics), gets good grades throughout, participating in independent study on the cardiac surgery service, takes a residency that includes a year of research with awards and publications, solves a crisis involving a universally antibiotic resistant bacteria terrorizing the ICU, be compensated? How much is someone who spent the prime years of his life undergoing the most rigorous training in the world (when I went I was working 100-120hrs/week, and as a chief I was always on call for my own patients and on some rotations just always on call) worth? How much is having that level of expertise available when a real health crisis arises (colon cancer involving liver metastasis, say) worth? If you said $300,000/year you are missing the point entirely.
b) How much should someone who is expected to get out of bed in the middle of the night (after years of school and poorly compensated post graduate training), correctly diagnose a potentially immediately life-threatening condition, assemble the necessary personnel, intervene competently, manage any post-operative ‘fun and games’, and see the patient home in good health (ideally), be paid? If your answer is $70/hr (the current average compensation for general surgeons), you are [ad hominem attack removed].
3) My buddies from college, some of whom went straight to wall street, don’t experience burnout because they did not base their career choice on some ill-defined idea. They based it on the promise of riches, [inappropriate comment removed], the finest that life has to offer, and an early retirement on a private island. They didn’t ‘burn out’ because there was never the expectation that ‘career satisfaction’ would factor into their compensation package. Stock options, sweet heart backroom deals, front running clients, shaving nickels, [inappropriate comment removed], private yachts, yes, absolutely. You can keep the ‘career satisfaction’, these guys simply don’t need it on top of all of the other tangible compensation. Doctors are the only fools who accept intangible compensation for very tangible work. Always beware the MD/MBA in your hospital/medical group/insurance company/HMO who is constantly trying to convince you that your job is so rewarding monetary compensation is secondary. He is looting the place and most of the financial benefit he is putting in his offshore account is a direct result of the middle of the night, early in the morning work referenced earlier. It isn’t all wine and roses, sometimes someone gets fired, or the market tanks and a couple guys jump out of windows. Less risky than dipping your hands into HIV/HEPC infected blood several times per week in an attempt to save someone’s life.
4) Hard work. Sure the investment banker guys work hard. Please remember that many of these guys are millionaires multiple times over by the time an MD leaves specialty training. This point is more important than ‘The White Coat Investor’ believes which is weird because successful investing requires an understanding of the time value of money. [This commenter, despite all those years of training, apparently hasn’t yet figured out the author of this post is not The White Coat Investor.] This understanding is critical in a fiat money system where income forgone today (or money you borrow in the course of pursuing education) is much, much, much more valuable than money received at some point in the future. In fact, properly discounting future cashflows is THE skill required to properly value any asset be it a bond or an MD with an American Board of Surgery Certification. Please also remember that the access to deals, paper investments, and potentially valuable stakes in their own companies leads to incredible wealth. When leaving Leeg-Masson, Goldman, JPMorgan, or any of the firms you mention, a huge pile of money/assets and valuable skill comes too. A retiring doctor leaves practice with comparatively little, and no understanding of managing money or other assets, something he will surely need. In the not so distant past, before hospitals devalued physician services through political maneuver and consolidation, a physician could sell his practice to an up and coming young doctor who was just getting started. The stream of income would help with retirement, and being available to answer questions was very valuable to the young physician or surgeon just getting started. Now, doctors who build practices and referral networks leave with nothing as hospitals, HMO’s, insurance companies, and other vultures have stripped independent practice to the bone leaving nothing but employed positions. The idea that it is more efficient is quickly countered by the observation that administrative costs increased 32 fold (3200%) between 1970 and 2009. In the past 10 years it has gotten exponentially more expensive. Having nurses with clipboards looking over everyone’s shoulder, and armies of MD/MBA’s with bucketfuls of bad ideas only serves to push costs up and quality down. All one need do is enter any hospital and see how large the administrative wing is in comparison to spaces dedicated to clinical practice. Shocking, isn’t it. The smart guys (MD/MBA’s are the smart guys, sociopathic tho they be), take the financial advantage up front knowing that the average, financially ignorant, ‘job satisfaction seeking’, altruistic MD will simply say ‘yes’ without doing the math. That is why they are the guys double parking their chartreuse Lamborghinis with enough ‘bling’ to make a drug dealer blush in the handicap zone in front of the hospital, and the average physician is hiking to the front door after parking his beat up Subaru in the resident’s parking lot. Physicians and surgeons sell themselves way, way, way too cheaply. This is not my opinion. Looking at the average value a physician represents to a hospital or HMO during his career and the income forgone during training discounted/compounded suggests that physicians are grossly underpaid.
5) Comparing doctors wages in other countries to the US is incredibly disingenuous and, again, ‘White Coat Investor’ knows better (should?).
Medical school at the Royal College of Surgeons in Ireland at Dublin costs about 8,000E/year or about $9120. If you are Irish, it is almost free. Also, you go to medical school straight from high school and this cuts 2 years off of your undergraduate/graduate education.No interview travel expense, no interview clothes expense, no expensive tests and tutors, just high school to med school. Again, using cashflow discounting modeling the savings is millions of dollars over a lifetime at average rates of return. Why use RCSI Dublin. I used to play rugby against them in college and marvelled that none of them seemed particularly stressed out about anything, much less how to pay for all of it. Then, get this, your hours as a surgeon are limited by budgetary constraints. The surgeon is paid an annual salary, and when the system burns through the annual budget, no more elective surgery is performed until the following calendar budget period. A buddy (no names locations or identifying information) said that it was not infrequent for elective surgery to stop in March or April. Think about that. Imagine what the waiting periods are like. Imagine needing elective surgery and having to wait for years. As a surgeon, you receive your salary no matter what. So sure, it is a fraction of the salary one could make working 80-100hrs a week in the US, but it comes with benefits, retirement, a lot less work, and a ‘devil may care’ attitude about less than excellent outcomes. This system is in no way comparable to the US system of education, medical education, medical/surgical practice, or being a patient (did you find out what ‘patient’ means? No! Shame on you!). Here is another way to see it. The average cost of med shcool (we will forget about the [inappropriate comment removed] wages being paid to residents, and we will also forget that the average hospital contract gives the sponsoring hospital about three times the money paid to the resident in salary and benefits) is now $180,000. Let’s imagine the good doctor invested $180,000, went to med school for free, and put it in an investment fund that paid 9.8% annually (average return of S&P 500 over the last 90 years). We will ignore that fact that accounts exist in other jurisdictions that pay 20%(this is why wallstreet and bigwigs offshore as much as possible, let’s not even think about the tax savings). The difference is (conservatively) $18,000,000 at retirement (age 18 to 65, average rate of return of S&P 500 last 90 years). Please bear in mind that all of the money the average physician making $200,000/year can expect to earn in a lifetime is about $8,000,000 assuming the MD starts at age 31 and works to age 71. This calculation ignores little inconvenient facts like getting paid $200,000 to start is going to be impossible for all but a few specialties, and ramping up is going to cost a lot of blood, sweat, sleep, and treasure. In short, using math, physicians are woefully underpaid. This calculation leaves out the blood, sweat, and tears of medical school, residency, starting practice, MOC, Boards, getting privileges, being sued, being called a ‘ni99er’ to one’s face by hospital administrators, working with drunk, incompetent, backstabbing nurses and physician extenders, and all of the other ‘wonderful’ experiences modern medical and surgical practice have to offer. I wonder how much ‘career satisfaction’ one might be able to purchase with the missing $10,000,000?
If you don’t mind, please skip the ad hominem attacks against someone who didn’t even write the article and especially the objectifying of women next time you leave a comment. You’ve got to be REALLY careful about that stuff when posting using your real name and profession. I’ve seen docs lose their job for doing less on social media than you did in that comment. I think I cleaned it up enough that it won’t be going viral, but be careful online for your own sake.
Jim, you’re a spoilsport. 😉
You’re reposting a guest, so you clearly must support their POV. Or are you distancing yourself realizing you’re wrong?
Would you like a list of guest posts I have run where I do not support their POV?
As mentioned above, I think SHS makes some good points and that this is a topic worth discussing. Would you prefer that all points of view you disagree with be suppressed on the internet? Like any blog, take what you find useful, leave the rest.
Way to cherry pick the data. “What, you think you work hard at 58hrs per week? What about the INVESTMENT BANKER?”
“What you think you’re underpaid? What about Obama?!”
That was a dumb article. There are actors and actresses arguing they need to get paid 10,000,000 or more for such and such reason. Its not about about money or time anymore….its just about feelings. Feelings rule the roost now. So well…if everyone else can whine…..so can a doctor. Times are changing
Edwin, agreed.