It isn’t exactly a broken contract. It isn’t quite bait and switch. However, I do believe there is an implication for those contemplating a career in medicine that isn’t being delivered.
After all, would any reasonable person expect to incur debts of $100,000 to $200,000, extend their education six to 10 years after college, sacrifice relationships, and work crazy hours under stressful conditions if there wasn’t an expectation of at least the ability to pay off one’s debts and operate a profitable business?
Most people don’t go into medicine for the money; I know I didn’t. I also don’t expect sympathy. As a group, physicians are still among the most highly compensated, but that seems to be changing. A former colleague told me his group’s income has decreased by 12 percent per year for the last two years. Another physician told me his group had a 10 percent greater volume of work for the same amount of income. The news headlines tell the story: We want more health care, we just don’t want to pay for it.
When I began practicing radiology back in the 1980s, the most complicated examinations had only 20 or 30 images and these weren’t exactly high information images. Nowadays, CT examinations may have a thousand or more images, each of which has more information than the sum of those 20 or 30 images on which I cut my radiological teeth. I work part time and the last seven day stretch I worked, I read more than 1,000 patient studies including a significant number of total body CTs. I remember hearing a few years ago that the average radiologist reads 12,000 to 14,000 studies per year. I guess I have never met or been an average radiologist.
The statistics say that more than half of physicians finishing their training are going to work for hospitals. There’s nothing wrong with this, but most physicians I know are stark raving individuals and this has to rub some of them the wrong way. The trend is for less and less autonomy and control for individuals who are normally control freaks.
At some point, the attraction of a career in medicine will lose its luster, if it hasn’t already. Then what?
One possibility is that society will assume the costs of medical education and consume the end products. In other words, in exchange for a state sponsored education, the physicians produced will become the property of the state.
There was a time in medicine when medical students and interns were not allowed to be married. That could happen again. We already have a shortage of doctors and recent articles suggest that as many as 30 percent to 40 percent of practicing physicians are threatening to leave medicine as a result of enactment of a certain, recent health care law. Why not force the ones left to live where they work without the distractions of family or friends, similar to cloistered monks — funny haircut optional?
It is already clear that the normal rules of a capitalistic society do not apply to medicine. Monastic medicine may be coming. A former partner of mine once called me a Cassandra. In Greek mythology, Cassandra was a mortal who was cursed by the gods to see the future but to never be believed. I hope this Cassandra is wrong.
Douglas G. Burnette Jr., MD, CFP®, has been a practicing radiologist for more than 30 years. He also started a second career in wealth management and continues to practice radiology part time as an independent contractor.
