Yup. That is what I hear on a daily or at least weekly basis. I have new patients that will come in, fresh off of some bad experience with another physician, and accuse me of trying to order tests or procedures ” just to make money.” I also hear that all doctors are rich no matter what they do. They just get everything that they want. My first and most resounding response to statement like this is a resounding NOT TRUE! At least it is not true for me. Let me clarify a few things from an actual doctor’s perspective.
The first part about all doctors being rich. I can tell for myself that this is definitely not the case. You see, when it comes to monetary wealth, you actually have to have some in order to be considered rich. The average physician has to go through 4 years of medical school and then 3 years plus of a residency and sometimes an additional fellowship after that to finish training in his or her specialty. Keep in mind that medical school loans often tally up to the hundreds of thousands, unless you are one of the lucky few that had help from family etc. Then as you progress into residency and fellowship, those loans become due and the minimalist salary that you are being paid usually won’t cover the loan payments and allow you to actually pay your bills, so you end up deferring them as they steadily accrue interest for years and you ending up owing more than when you started. YAY! Then, you start looking for a job. The current trend nowadays is weighted heavily toward physicians seeking employed positions with hospital, which definitely helps with the past debt because they often offer to repay student loan debt and help with relocating expenses, plus you don’t have to worry about office expenses. For the rest of us rare-breed independent practitioner schleps, we need to come up a couple hundred thousand to start a practice, plus at least 6 months of overhead until the practice starts taking off. in addition to that, it may take about three months before your first check from any patient insurances is going to come in. So now, the debt is up to a solid half a million at least. On top of that, now you deferment of your student and medical school loans is now up and you have to start paying on those. The good news just keeps on coming.
To sum up, once you get to the point where you get to actually start practicing medicine on your own, count on at least a half million dollars in debt. Ok check. Now let’s talk a little bit about the realistic picture regarding what you can make as a doctor. Before we even start, let me be clear that I am not including the famous doctors on TV, high profile owners of regional or national practices or doctors that got to jump into an already well-established solo or group practice. I am talking about the rest of us who are still in solo practice who do everything ourselves. Let’s first deconstruct the idea that doctors just get handed everything. I do not know about other physicians but I did not just get handed anything. I covered my education with loans. I started my practice with loans. I worked hard. i went to school for 16+ years and I still have to attend continuing education conferences and earn online credits and renew my certifications yearly. i am on call 24 hours a day and 7 days a week. I worry about my overhead and my employees every day. I am always trying to pay attention to my billing service and make sure that what we are billing out is coming in at least somewhat. Speaking of billing, did you know that on average( a brief episode in the 90s aside), with Obamacare and other marvelous legislature, physicians get reimbursed 30 to 40% of what they bill on a good day? Did you also know that it can take three months or more for it to come in? So, 30+ percent, 3 months after you do something. That is some screwed up math. No one in their right minds would work for those rates right? I can understand the national trend toward trade occupations. It seems like almost every day I see some sort of advertisement for a trade school and the immediate job opportunities it offers. Who wouldn’t find that attractive? Not having to wait until you are 26 to 30 years old before you make even the smallest of salaries? Benefits right away? Shift work that you may be able to take a break from when you are not at your place of work? Don’t mind if I do. At least these hard-working jobs offer returns more quickly in terms of costs of living and even lifestyle. I am not saying that I am ready to throw in the towel and attempt a trade. I am also not implying that one scenario is better than the other. There are trade-offs on both sides. I am just saying that the impression that doctors have it easy and have everything handed to them is grossly incorrect.
Now let’s talk about the statement that doctors just order tests and procedures to make money off of patients. Here is where I am only going to speak for myself. I am well aware that there are office and practices out them that may emphasize quantity over quality or that there are certain things that every patient has to have. That is not the case in my practice. I do not order a test or counsel a patient about a procedure unless I truly think she needs it. I have nothing to gain by ordering extra labs for example. I do not have a contract with the lab or receive any volume-based kickback. It’s just not a thing. With regard to procedures, there are some diagnoses that I cannot adequately assess without more information. For example, when I perform a pelvic exam and palpate some fullness in the ovarian fossa, I suspect that patient may have a cyst or a mass. I cannot tell which it is, if it has septations or other concerning features, or measure the exact size without a pelvic ultrasound. I have to pay my ultrasound tech to perform the procedure. If a patient has a polyp in the uterus, I cannot tell if it is benign or cancerous unless I take it out with a hysteroscopy. I am not deliberately trying to sit down and think of more ways to get more money out of patients. I am not in it for the money. I am in it for the people. Have a fantastic day!
Dr. Katz
