Doctors without Dollars

The February 12, 2007 issue of Time magazine included an interesting article by Scott Haig, M.D. entitled Doctors without Dollars. As Dr. Haig illustrated, the traditional practice of medicine is no longer as lucrative as it once was, so doctors are looking for other ways to make a living. Some doctors have turned to cosmetic surgery and offer things such as laser treatments, Botox injections, and hair transplants. Other doctors offer alternative medical therapies that border on quackery, yet pay better than mainstream medical treatment. Many doctors have left the practice of medicine altogether, and are now stockbrokers, financial analysts, or realtors.

I discussed this topic several times in my www.ERbook.net site, beginning in 1996. I graduated in the top 1% of my class in medical school and was trained as an ER doctor, yet I would rather mow lawns or do virtually anything else than work as an emergency room physician. I know one surgeon who quit his job to become a bartender in Montana, another surgeon who now sells Amway products, a neurosurgeon who is a plumber, and a few doctors who are now artists. Then there's the internist who sells women's clothing in her home, a cardiologist who now makes furniture, and a doc who makes stained glass windows. I'm now making a robotic chef that will enable people to prepare meals by using a touch screen on the device as well as any computer or phone with an Internet connection.

Years ago, it was almost unheard of for doctors to transition to other careers. If you were smart enough and dedicated enough to become a physician, and you were lucky enough to pass all the hurdles that society imposes, then you generally practiced medicine until the day you retired. Medicine was perhaps the prototypical “great career,” offering respect, unsurpassed job security, and income that ranged from excellent to superb. Finding a doctor who was a millionaire was about as surprising as finding a cheerleader who is pretty.

Medical careers no longer offer such financial security. Some docs continue to rake in money, but many others now make less money than some real estate agents, salesmen, autoworkers, UPS drivers, and even teachers (I prove how a UPS driver can earn more than a doctor on my www.ER-doctor.com site on this page). Nothing against teachers, but becoming a teacher is considerably easier than becoming a licensed physician. Paradoxically, many people still harbor the notion that doctors are overpaid. The father of one of my ER patients mumbled something about “you doctors are paid too much,” and then demonstrated his resentment by leaving the emergency room to smash my car, much to the amazement of the security guard who witnessed this.

As I mentioned in my ER site and some of my books (Fascinating Health Secrets and True Emergency Room Stories), society has a vested interest in training and retaining the most intelligent, dedicated, and conscientious doctors. To get the best people, society must pay them very well and reduce the endlessly escalating hassles of medicine, such as dealing with unfathomable bureaucracy imposed by the government and insurance companies, as well as the ever-present threat of a malpractice lawsuit even when no medical errors were committed (a Harvard study revealed that over 80% of malpractice lawsuits lack merit). The more noxious a medical career is, the more likely it is that the most intelligent people will choose another profession. I made that prediction several years ago, and just after that the number of people applying to medical school dropped four years in a row—something that had never occurred before.

What is even more worrisome than the declining number of applicants is the fact that such a dwindling pool invariably reduces the quality of it. Consequently, many people who now get into medical school would never have been accepted two decades ago when I applied, when the competition was fierce. While watching ABC-TV’s The Bachelor with a friend who is a cardiac nurse, we were amazed that the bachelor, a young physician, had actually graduated from medical school. After listening to his characteristically unintelligent manner of expression, we looked at one another and simultaneously asked, “Is he stupid?”

His place in medical school could have been taken by someone with more brainpower, but as I mentioned elsewhere, many of those people with higher IQs who would have chosen a medical career years ago are now repelled by the realities of modern medical practice and therefore chose another career. Anyone smart enough to be a good physician has the intelligence to do countless other things. It is easy to find a job that pays better than medicine, requires less devotion, and does not require working nights, weekends, and holidays.

My mom died of cancer years ago, and I truly resent all the holidays and other family get-togethers that I missed because I had to work. Once those precious family days are over, they are gone forever. I was willing to make that and 1001 other sacrifices because I thought that I would eventually be rewarded for doing things that no human being should ever have to do.

How many of you have worked 40 hours in a row? I've done that numerous times with no sleep and no breaks, working at a frenetic pace to treat trauma and other patients who constantly poured into the hospital. Trying to cope with these impossible demands, some of my colleagues turned to amphetamines. I was offered speed but declined it, instead choosing to drink liters of Pepsi and chew caffeine pills as if they were candy.

My ER residency director once commented that I was the smartest resident they ever had, yet she also chastised me once or twice about how cranky I was. Gee-whiz, I wonder why? After years of sleep deprivation and running on so much caffeine that I shook like a leaf, it is no freaking wonder that I would be less than diplomatic when, for example, a nurse refused to chaperone me so that I could perform a pelvic examination on a rape victim who was very eager to get her evaluation over with so that she could go home and shower. In this case, the nurse was just standing around waiting for her shift to end, but I didn't want the patient to wait for the next shift, which could have imposed a delay of an hour or more.

Anyone who wants the luxury of leaving on time should not work as a doctor or nurse. Practitioners must be sensitive to the needs of their patients, especially emotionally traumatized ones like rape victims. In my book, any nurse who thinks her expectation of leaving on time is more important than the needs of an emotionally shattered patient deserves to encounter a doctor like me who won't acquiesce to such an immature desire. Patients always come first.

A few days ago, a 14-year-old girl with aspirations of a career in emergency medicine wrote to me and asked various questions, one of which was if I would still go into medicine if I had to do it all over again. Emphatically, NO! I have written extensively on why going into medicine is now such an unwise decision that many medical students sincerely regret their career choice even before they graduate. I won't repeat what I wrote before, but suffice it to say that I apparently made such cogent arguments for avoiding medical careers that many people have exhorted me to stop dissuading people from choosing to be a doctor. Those people pleaded with me, saying things such as, “We need good doctors.” I agree, but I do not believe that the way to get the most qualified physicians is to give people a misleading idea of what it's like to be a doctor in the 21^st century. I am certain that I could sell more books if I did not have ethical reservations that precluded me from tricking or deluding people. However, I won't lie or even shade the truth to make a buck.

If society wants the smartest and hardest working people to choose medical careers in the future, it cannot do that by deception. However, politicians are too stupid to understand the nexus between careers with second-rate rewards and career applicants with second-rate qualifications. Lawyers and bureaucrats have no incentive to back off, so for the foreseeable future medicine will continue to be a career that is best avoided. The smartest students realize this and often choose alternative careers, leaving the spots they would have occupied in medical school to people, like the bachelor, who amaze me not with their intelligence, but with their lack of it. Society needs the smartest possible doctors, but we are not doing what it takes to get them.

Update: This posting prompted a teacher to send me a nastygram complaining about what I said about teachers. This person was so hot under the collar that I wondered if he were mentally ill with a chip on his shoulder. What triggered his outburst was my statement that "becoming a teacher is considerably easier than becoming a licensed physician." This statement is so obviously true that arguing about it makes about as much sense as claiming that walking in a park is more arduous than running a marathon.

The enraged teacher then rhetorically asked about the many teachers I had, whose tutelage enabled me to become a doctor. First, the best teacher I ever had was my mother, who had many jobs, none of which involved teaching. Second, only a few of my teachers were exceptional; most were decidedly lackluster. Bottom line? Most of the learning that propelled me to the top of my class in medical school (and beyond) was acquired from self-study, not from a teacher or professor.

If teachers and professors really knew how to teach, virtually every student could replicate my feat of transforming myself from dunce to doctor. Even the best teachers cannot do that because their antiquated teaching methods do not provide the necessary catalyst to fuel that intellectual metamorphosis. Bill and Melinda Gates, through their Gates Foundation, are spending a fortune trying to improve the educational process. They can burn money searching for the Holy Grail of boosting brainpower, or they can contact me to find out what it is. I was once so far down the bell curve of intelligence that my exasperated sixth-grade teacher called me “slow,” yet one of my bosses—not the one mentioned later in this article—said I was the smartest doctor he ever met. If I did it, you and others could do it, too. In fact, you would likely end up smarter and more knowledgeable than I am because most people would begin with a higher IQ baseline.

A high school teacher once took me aside and, almost gushing with stars in her eyes, asked me if I were John Denver. Umm, no. There were several reasons why that could not possibly be true:

I'm not named John. Or Denver.
I don't look like him (judge for yourself).
He was an adult when I was a kid in high school.
He was on tour and doing things that I could not have possibly done, given that I attended school five days per week.

Another person wrote to tell me how sick and tired he was of "greedy doctors" focused on money. Sorry, bub, but doctors are nowhere near the top of the ladder when it comes to greed; their lust for money is surpassed by lawyers, CEOs, gas and oil companies, actors, singers, assorted celebrities, software tycoons, professional athletes (most of whom refuse to perform unless they are paid far more in a year than most physicians make in a lifetime), and countless others. Second, that person totally missed my point that to get the best people in medicine (and retain them), society must be willing to pay for their brainpower and the many years of ungodly hard work and sacrifice that it takes to become a doctor. Make a profession less rewarding, and you'll simply divert the best and brightest into other careers, which is already happening: one of my friends recently tested a cognitively impaired medical student.

A question for teachers: If teachers are doing such a great job, why can homeschooled kids routinely trounce their peers educated in public schools? Students who attend school have a number of advantages that should increase their performance, yet their achievements are often disappointing and even embarrassing manifestations that public school teachers have not implemented simple and effective ways to augment learning.

Update: The impact of ObamaCare

Hidden in the ObamaCare legislation are so many nasty surprises for doctors that anyone who now considers going into medicine must be a masochist or ignorant to how Obama is waging war against physicians and patients.

Patients will pay the ultimate price

Medicine is becoming such a noxious career that many of the brightest people reject that occupation or leave it. Patients will pay the ultimate price for this diversion of brainpower and dedication.

I was one of those nose-to-the-grindstone perfectionistic doctors who devoted his life to giving the best possible care. After I realized that society looks the other way as good doctors are whacked around like a piñata, I left the field of emergency medicine.

Big deal, you say? There's always another ER doc to work a shift, right? While working in a busy ER that handled codes (cardiopulmonary resuscitations) every day, I've gone over 18 months without losing one patient while other ER docs put patient after patient into the ground. The vast majority of codes are not successful, but my “batting average” (so to speak) in saving those patients was substantially better than average, so in the years since I left, the ER docs working the shifts I WOULD HAVE WORKED have filled a cemetery with patients I could have saved.

In my next book of ER stories, I will present a case that I still find shocking. When I arrived in the ER to begin my shift, I found it empty, except for a clerk who told me everyone was in Room 4. When I opened the door, I saw something I never could have imagined: a child who was critically ill and near death, and a group of medical professionals, including my boss, who were standing so far from the patient that one might have thought the kid was radioactive. You didn't need to be a rocket scientist to realize this child needed help, stat, but my boss and the others stood in place with their arms crossed. I thought, “WTF?”

They said they tried to intubate him (insert a “breathing tube” into his trachea, or windpipe), but couldn't, and tried to start an IV, but couldn't. I knew these were pathetic excuses, because an ER doc should be able to intubate and obtain intravenous access on anyone. I knew they were just waiting for the patient to die so they could go lie to his mother how they did everything possible for him.

“There's no tragedy in life like the death of a child. Things never get back to the way they were.”
— Dwight D. Eisenhower

Intubating and obtaining intravenous access were child's play. To make a long story short, I did what they should have done and saved the patient's life. This case was super-easy for me but so challenging for my boss that he gave up. If he couldn't handle this case, I wondered how many other patients he had killed with his incompetence.

I discussed this case in another article.

I could tell many other horror stories to illustrate how patients are penalized by second-rate doctors: the child who lost an eye, the man who lost a finger, the teenager who lost his life, and on, and on, and on. Want even more second-rate doctors who harm patients? Make medicine less rewarding and more noxious. You get what you pay for.

I'm going back to work—on my robotic chef.

Notes:

When people speak of greedy doctors, I think of what I did: treat many thousands of patients free, dispense expensive antibiotics from my personal stash, make free housecalls, buy or make presents for patients, including handcrafted “Get Well” cards and personalized coffee mugs, scratch-n-sniff stickers, stuffed animals, flowers, bread and other baked goods. When the ER was slow, I'd buy pizza and throw an impromptu party, inviting hungry patients to join me, the nurses, and police officers I'd summon for a 3 AM snack. I also gave some books (usually not ones I'd written) and my home phone number so patients could call me at any time if they had questions. Other doctors have done even more by, for example, traveling to foreign countries to treat patients.
In the first paragraph, I mentioned how some doctors are offering alternative medical therapies that border on quackery. I think some alternative treatments have merit. My sentence may have led some readers to think that I oppose all alternative therapies, which certainly isn't true.
I wrote another article (one of my more entertaining ones, I've been told) that included an illustration of the rich doctor myth in action.
UPDATE 1-5-2012: Doctors going broke (CNNMoney article)
Mamas, Don't Let Your Babies Grow Up to be ... Doctors?
Doctor: 'I gave up on health care in America'
How could any teacher be daffy enough to think that I am John Denver? This excerpt from an American Thinker article provides a clue:

“For two generations now, public school systems have been bottom-fishing. Most grade and high school teachers come from the dregs of any class of baccalaureates. And many of these underachievers are credentialed with "education" degrees, an admission that such teachers have little or no substantive knowledge. And many of those weak teachers are now principals or administrators. In short, K through 12 has become an affirmative action program for unionized nitwits.”

The views expressed on this page may or may not reflect my current opinions, nor do they necessarily represent my past ones. After reading a slice of what I wrote in my various websites and books, you may conclude that I am a liberal Democrat or a conservative Republican. Wrong; there is a better alternative. Just as the primary benefit from debate classes results when students present and defend opinions contrary to their own, I use a similar strategy as a creative writing tool to expand my brainpower—and yours. Mystified? Stay tuned for an explanation. PS: The wheels in your head are already turning a bit faster, aren't they?

“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”
— F. Scott Fitzgerald

Reference: Imagining dialogue can boost critical thinking: Excerpt: “Examining an issue as a debate or dialogue between two sides helps people apply deeper, more sophisticated reasoning …”

Kevin Pezzi, MD