Not even close...............Sunday, July 18, 1999
Copyright © Las Vegas Review-Journal
Doctor disputes notion of `greedy' profession
By Tony Alamo
Special to the Review-Journal
As a Nevada-born, University of Southern California-trained physician, I took great exception to the July 4 letter, "Doctors are obsessed with wealth." Ever since the AMA approval of the unionization of employed physicians (self-employed physicians are ineligible because of federal anti-trust legislation), numerous misconceptions and misinformation have been debated and discussed.
The letter writer discussed negatively (which seems to be in vogue) the current incomes of physicians. It described physicians as "Wall Street doctors" with their "seven-figure" salaries.
I think what America has forgotten -- or perhaps never knew -- is what it takes to be a specialty trained physician. The struggle starts as early as high school. Medical schools are extremely competitive, accepting only the best students. Thus, it is very important to succeed at the undergraduate level with excellent grades and national test cores.
My personal experience was very typical of the struggle. In high school, typical future doctors were students who took the most difficult classes, advanced placement courses and even college-credit courses. In college, again, the best students are competing for the few medical school seats throughout the country. Most pre-med students who are successful in achieving the few convenient medical school seats never have the opportunity to enjoy their high school social years. The normal fun of the college years (the fraternities, sporting events, social interaction, etc.) are luxuries experienced by others.
Those very few who proved themselves academically are accepted to medical schools. Many medical students do not have the chance to pick and choose what school to attend. Many students are uprooted from family and friends, finding themselves in various parts of the country not only facing demanding educational challenges but also emotional issues.
Once undergraduate students finally attain their college degrees and think they have put the fiercest academic challenges behind them, they land in medical schools, competing with the most dedicated, intelligent and hard-working students.
The academic challenges and intellectual curriculum in medical schools are very rigorous. Medical training in this country comprises four years of medical school and residency ranging from three to seven years (depending on specialty chosen). During this time, it is not uncommon to work in excess of 100 hours per week with call nights that require your presence in a hospital setting for 36 continuous hours with no sleep. This occurs every three to four days with typical 10 to 12 hour workdays in between. Depending on the chosen specialty and rigor of the residency program, these hours can continue throughout residency.
Typical private medical school tuition alone is approximately $25,000 per year, not including books, equipment and living expenses. Once out of medical training, the new doctors usually are in excess of $80,000 in debt, not including monies given by family.
Most of these physicians, myself included, required family help to co-sign for a small mortgage and loan to start private practice. Those physicians who are not fortunate enough to have friends and family who can help them financially are forced to take employment in potentially undesirable circumstances and/or live very meager existences for a long time. Because of the extensive medical school training process, many non-physician contemporaries have accumulated much more personal wealth than new physicians.
It is commonplace to say in editorials and articles that physicians make "more than enough" or "think of money before the patients." A cartoon caption in the editorial section of July 4 Review-Journal read, "What is the health care system coming to when my insurance company won't allow physicians to prescribe unnecessary tests that protect them from frivolous malpractice lawsuits?" Where did the idea come from that physicians simply order the most technologically and expensive diagnostic tests to protect themselves from malpractice? As physicians, we are constantly testing to discover hidden pathology and disease. When physicians fail to discover a potential pathology, someone's life is affected. This is not a question of money but someone's life.
Of course physicians will order whatever diagnostic or therapeutic tests are required for the benefit of a person's health and well being. It is not a "frivolous test" because even if the probability is low, it becomes 100 percent important for that particular patient.
The average physician in this country makes $156,000 per year for average 56-hour work weeks ($55.7 per hour). The average major airline pilot makes $101,000 per year with federally mandated maximum work hours of 100 per month (25 hours per week at $80.80 per hour). The average stockbroker makes at least $105,000 per year for an average 40 hours per week ($52.50 per hour or more).
The average physician training-sacrifice is 12.5 years after high school. For stockbrokers and airline pilots, assuming they have a college education (which is not a requirement), it is four years after high school. My computer software vendor requires $95 per hour to service the computer software required for billing, scheduling, medical supply inventory, etc. Have you ever simply looked at the cost of labor for a plumber, electrician, mechanic? If those who choose medicine as a career were doing so solely for financial gain, it is obvious there are other professions that would be more suited to their financial goals.
The physician has enormous responsibility in the care of his patient with large liability as well. Doctors work hard. They deal with difficult situations every hour and have sacrificed more than most to achieve their goals. The average life expectancy for a physician is less than a non-physician. I do not believe it is attributable to the stress of too much golf. I am very proud of my profession, and I hope my patients feel I deserve every dollar I earn.
This is a great country with the most comprehensive care, the most advanced technology, the best nursing staffs and physicians in the world. Many physicians, myself included, have had to place our careers and love of medicine first and any personal and family life second just for the privilege of becoming a doctor. A physician gives the ultimate sacrifice -- personal time, measured in decades. The days of Dr. Marcus Welby are gone forever. Younger, better-trained physicians with more technology and ancillary staff have replaced him -- for, perhaps, fewer financial rewards.
Dr. Tony Alamo is an internal medicine physician who practices in Henderson. |
