Doctor Debt, CEO Salaries, and Taking Back the System

This article sheds light on a ‘physician stereotype’ that has been getting less and less true, although the momentum and the hate on docs for being “rich @**holes” (as my attending once said) shows no sign of giving way. I agree that pay for physicians “has remained flat or declined in recent years,” but that statement alone does not give the full picture. It doesn’t take inflation into account. It doesn’t take the rising cost of medical school into account ($90,000/yr + 8% interest). No one talks about these numbers. The real numbers. Always underestimated, always taken from less expensive schools, during less expensive years past. But from my school, some graduates had/will have $400,000 plus in debt AFTER residency. And that’s with sticking to a planned, conservative budget. How old are you after residency? Thirty years old if they went back to back to back with their schooling, and got every application accepted and passed every test. The first time. It’s absurd to think that physicians do it for the money. All physicians, on some level, do it because they want to help people.

The amount of debt, and delay in getting into the workforce, are shackles on the dreams of young physicians. What? How? Young physicians still get to practice medicine, don’t they? Sure, but what else can they do? Required to see four patients every hour, having to rush, no time to build rapport, 2/3rds of their time spent with the EMR, prior authorizations delaying care and hurting patients, decreasing patient satisfaction scores compound the moral injury that is inflicted day after day.  They want to care, but how can they? I’ve heard it referred to as indentured servitude. It’s not like they can join Doctors Without Borders and work pro bono (can they?). It’s not like they have a choice. They have to pay their debt. I debt incurrent for wanting to help people.

With that being said, I cannot ignore the fact that some medical schools have started implementing free tuition. This is AMAZING and will go a long way to improve the lives of future physicians. But it’s not enough. Free medical school tuition is only a small step. There are still thousands of freshly minted physicians who graduate each year, and don’t have a job. And it’s not because they’re not qualified or competent physicians, it’s because there aren’t enough RESIDENCY spots. There are plenty of qualified pre-meds competing to get into medical school. There won’t be a shortage of med students any time soon. Physicians are aging, working less, and retiring sooner. If we want more physicians, if we want physicians to have better work-life balance so they can better care for their patients, and if we want physicians to take ‘healthcare’ back from corporations and start practicing medicine again, then we need more residency programs.

How do we get more residency programs? Where could we possibly get the funding? What if the AMA could spare a bit of the 20 mill they spend each year lobbying? Or have they been putting that money to good use? Maybe hospitals could pay their CEOs less, and instead pay a few more residents the $60,000 a year they expect to get for actually caring for patients.

“According to one study published last fall, from 2005 to 2015, mean annual compensation for major nonprofit medical center CEOs increased 93 percent, from $1.6 million to $3.1 million.” That’s 12 times more than an attending physician. I’m just asking for a few more residents!

I’ve been at hospitals where each resident had 5 patients, and hospitals where each resident had 25 patients. The difference I saw was in the quality of care received. It’s not that the busy residents were bad, or harming patients in any way, but the residents with fewer patients, had time to care, and to show it to the patient.

And do we realllllyyyy need this much admin anyway?

“Between 1975 and 2010, the number of U.S. physicians grew 150 percent, in keeping with the nation’s population. Meanwhile, the number of healthcare administrators increased 3,200 percent. The cost of that administrative burden today accounts, conservatively, for 20 to 30 percent of our healthcare spending.”

WHY?

And to top it off…

“…despite spending about twice what other high-income nations do on healthcare, our life expectancy has declined for the first time in 100 years.”

What are your thoughts on this?

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Kailee Marin

Aloha! My name is Kailee Marin, I'm a DO student in California. I was 15 years old when I decided to go to medical school. I spent three years in Hawaii getting my bachelors, then I came straight to CA to pursue my dream. These three years have been a rollercoaster - the best and worst of my life. I've spent med school listening to, and participating in the complaining of my classmates. I've come to realized that it's all the same. It comes down to the common barriers that current and future doctors face - and it starts in medical school. Moral injury being disguised as burnout so that institutions can pretend they care... But moral injury can't be fixed by wellness Wednesdays, or fitness Fridays. I have realized, to heal moral injury, you have to treat the underlying cause. And there are so. many. causes. So I guess I have a lot to talk about! As an aspiring psychiatrist, I feel compelled to advocate for mental health. This includes the mental health of my colleagues, my future patients, and myself. 

  2 comments for “Doctor Debt, CEO Salaries, and Taking Back the System

  1. Dave
    May 5, 2019 at 10:02 am

    For several years now, I’ve been firmly convinced that this graph (https://bit.ly/2VcYW18), the data of which is referred to in the essay above, represents *the* problem with medicine today.

    • Steve O'
      May 5, 2019 at 12:10 pm

      I looked at the informative but horrible link you offered, and read the article. The pitiful and embarrassing truth, Dave, leaks out of the executives’ brainwashing about the explosion of administrators to explain the graph. To me, every reform in medicine over the last 30 years can be compared to the growth of a cancer on healthcare.
      “Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. “
      The “changes” brought on by the “new healthcare” are dealt with as though they are unquestioned regulatory mandates of God, and we are just encouraged to accommodate them, as unavoidable as a plague or drought.
      If a carcinoma could speak, it might say something like we naturally are going to see an increase in rules, regulations and management procedures related to that “triple aim” that hospitals like to talk about – improved patient experience, overall population health, and reduced cost of healthcare. The carcinoma simply discusses its role in “disruptive progress.” Cancer, too, is a natural thing, and causes a sort of progress – disruptive innovation, as it were.
      “Improved patient experience” is just so much verbal bathwater. It means comfort measures for the victims of a dying healthcare system.
      The embarrassing shock to the system is laid bare by Direct Primary Care. All the crap that these and other administrators ladle out is destroyed upon excision of the tumor, leaving no margins of the burgeoning administration, regulation and quality-assurance neoplasm. DPC is cheaper and more effective than quack administrative remedies.
      One malignancy in a suit states, “If we’re saying the sheer number of administrators is compromising relations between physicians and patients, I disagree. I don’t believe the number itself is a key factor. The key is for [physicians and administrators] to come together and deal with that complexity.” The patient’s body and the cancer must work together to deal with the new eventualities, that is.
      Here’s a howler from another Tumor-in-Chief: “Bintz: The growth in healthcare administration should in some part be a tool to help relieve physicians of administrative and clerical burden, which detracts from patient care and contributes to physician burnout.
      Beyond that, the best way to improve the quality of care that patients receive is to have a strong partnership between physicians and administrators so that both understand the complexity of how “quality” is defined and reported, and both understand the real-life details of high-quality care at the bedside.

      And get this:
      “More and more we’re seeing an enhanced push toward physician-administrators, with more physicians going into administration through MHA and other degrees. Doctors have a greater sense that an administrator understands their concerns and is focused on the clinical side of patient care if that person is a physician-administrator rather than a lay administrator.” No, we don’t. In prisons, the Kapo was a position filled by a member of the incarcerated population who was more likely to swing the truncheon on his brothers. Having an MD on the list of letters after the name doesn’t make the humiliation any less.
      We have deserted independence, principles and honor, and have substituted rules, quality-kapo’s and factory-floor medicine; and as things get worse and worse, the more aggressively the Leadership of New Medicine backs up and rams the iceberg again.
      The Buzzword Bandits demand MORE oversight, MORE rules, MORE intrusive quality auditing. They imagine that the ideal of managing every business enterprise simply the same as working the floor at Wal-Mart, Amazon or Wendy’s.
      Deming, in his TQM, aspired to: Drive out fear. Eliminate slogans, exhortations and targets for the workforce. Remove barriers that rob people of pride of workmanship, and eliminate the annual rating or merit system. link
      This stuff used to be standard, Ohio-Republican-banker management strategy. How come it now sounds like revolution? Who changed??

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