An Open Letter to Washington, D.C. From a Physician on the Front Lines.

-by Matthew Moeller M.D.

I am writing this letter because I feel that our leaders and lawmakers do not have an accurate picture of what it actually entails to become a physician today; specifically, the financial, intellectual, social, mental, and physical demands of the profession. This is an opinion that is shared amongst many of my colleagues. Because of these concerns, I would like to personally relate my own story. My story discusses what it took to mold, educate, and train a young Midwestern boy from modest roots to become an outstanding physician, who is capable of taking care of any medical issues that may plague your own family, friends, or colleagues.

I grew up in the suburbs of southeast Michigan in a middle class family.  My father is an engineer at General Motors and my mother is a Catholic school administrator in my hometown. My family worked hard and sacrificed much to enroll me in a private Catholic elementary school in a small town in Michigan.  I thought I wanted to be a doctor in 5th grade based on my love of science and the idea of wanting to help others despite no extended family members involved in medicine.  Winning a science fair project about the circulatory system in 6th grade really piqued my interest in the field. Throughout high school, I took several science courses that again reinforced my interest and enthusiasm towards the field of medicine.  I then enrolled at Saint Louis University to advance my training for a total of eight years of intense education, including undergraduate and medical school.  The goal was to prepare myself to take care of sick patients and to save the lives of others (four years of undergraduate premedical studies and four years of medical school).  After graduation from medical school at age 26, I then pursued training in Internal Medicine at the University of Michigan, which was a three year program where I learned to manage complex problems associated with internal organs, including the heart, lungs, gastrointestinal tract, kidneys and others.  I then went on to pursue an additional 3 years of specialty medical training (fellowship) in the field of gastroenterology. The completion of that program culminated 14 years of post-high school education. It was as that point, at the tender age of 32 and searching for my first job, that I could say that my career in medicine began.

Over that 14 year time period of training, I, and many others like me, made tremendous sacrifices.  Only now as I sit with my laptop in the dead of night, with the sounds of my children sleeping, can I look back and see where my journey began.

For me, it began in college, taking rigorous pre-medical courses against a large yearly burden of tuition:  $27,000 of debt yearly for 4 years.  I was one of the fortunate ones. Because I excelled in a competitive academic environment in high school and was able to maintain a position in the top tier of my class, I obtained an academic scholarship, covering 70% of this tuition.  I was fortunate to have graduated from college with “only” $25,000 in student debt. Two weeks after finishing my undergraduate education, I began medical school.  After including books, various exams that would typically cost $1000-$3000 per test, and medical school tuition, my yearly education costs amounted to $45,000 per year. Unlike most other fields of study, the demands of medical school education, with daytime classes and night time studying, make it nearly impossible to hold down an extra source of income. I spent an additional $5000 in my final year for application fees and interview travel as I sought a residency position in Internal Medicine.  After being “matched” into a residency position in Michigan, I took out yet another $10,000 loan to relocate and pay for my final expenses in medical school, as moving expenses are not paid for by training programs.

At that point, with medical school completed, I was only halfway through my journey to becoming a doctor.  I recall a moment then, sitting with a group of students in a room with a financial adviser who was saying something about how to consolidate loans. I stared meekly at numbers on  a piece of paper listing what I owed for the 2 degrees that I had earned , knowing full well that I didn’t yet have the ability to earn a dime. I didn’t know whether to cry at the number or be happy that mine was lower than most of my friends. My number was $196,000.

$196,000. That was the bill, for the tuition, the tests, the books, the late night pizza. $196,000 financed through a combination of student loans, personal loans, and high interest credit cards, now consolidated, amalgamated, homogenized into one life defining number for my personal convenience.

I then relocated to Michigan and moved into a small condo in Ann Arbor, where I started my residency. As a resident in Internal Medicine, I earned a salary of $39,000. All the while, interest continued to accrue on my mother-lode of debt at the rate of $6000 per year due to the high debt burden.  Paying down this debt was not possible while raising two children. My wife began working, but her meager salary as a teacher was barely enough to cover day care costs. During residency, my costs for taking licensing examinations, interviewing for specialty training positions, and interest on the large loan ballooned my debt further, now exceeding $230,000, all before I began my career as a “real doctor”.

Relatives and friends often ask me, “now that you are a ‘real’ doctor, aren’t you making the big bucks?” While I am fortunate to now be making a higher salary, some basics of finance make my salary significantly less than meets the eye (very in-depth article on how this is so). First, I was 32 years old as I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt. Also, as I did not start saving when I was younger, financially speaking, I have lost the past 10 years without the ability to save and invest to earn compounding interest.  In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide.
We do not “clock” the number of minutes as attorneys do when we talk with patients.  We do not hang up the phone as attorneys may do if they are not going to get paid. No, we listen to patients and answer their questions, however long it may take.  Even if it is the thirty-second straight hour of work, which happens very often, we listen, respond, and formulate a logical plan.  If it involves calling a patient at home after I just worked 30 hours in a row and just walked in the door to see my family, I do it. I never come “home” from work.  As physicians, we are always available, and have to respond in an intellectual way using the $230,000 rigorous education that we received.   And if we don’t do our work well, we don’t just lose business, but we can lose our livelihood through lawsuits.

You may ask why do we do all of this?  It’s because we have pride in what we do.  We truly care for the well-being of the human race.  We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America.  We are doctors.

In reading this letter, one may think that one has to sacrifice a significant amount to become a great physician.  You may think we face physical and mental stress that is unparalleled.   You may begin to think that doctors not only have to be smart, but they have to know how to communicate with others during very emotional times.   You may think that we must face adversity well and must develop very rough skin to handle all walks of life, especially when dealing with sickness and death on a daily  basis.

Now that you see this additional aspect to our career, you may think that we have a tough job to tackle several tasks at once, demanding much versatility.  You may think someone needs a great work ethic to do what we do.  You must think that not only do we have to know science extremely well, we also have to know other areas such as writing, history, math, even law given the multiple calculations we go through in our heads on a daily basis and conversations we have with families. And finally, you must think we know finance, as we have to try balance a $230,000 loan while making $50,000 at age 30.

Now imagine, if you would,  having $230,00 dollars in debt with two young children at age 30 and listening to the news with lawmakers saying that doctors are “rich” and should have their pay cut.  Or that “studies show that doctors lack empathy”.

Unfortunately, we physicians do not have much of a voice on Capitol Hill.  There are not enough doctors in Washington D.C. who can give the insight of this letter while you in Washington, D.C. discuss health care reform.   You may hear from leaders of the American Medical Association, but these are not the doctors on the front lines.   These are the older political voices who were physicians when the times were different, when doctors did get reimbursed fairly for their work, when student loan debt was not this high, and when lawsuits were less prevalent. Many of the loudest voices in the healthcare debate are those of lawyers and lobbyists for special interests. They do not care about the well being of patients; that is what doctors do.

I want to make it clear that this letter is not just another story about the difficulties of becoming a doctor and being successful in medicine.  I do not want you to think I am complaining about how hard my life is and used to be.  In fact, I love my job and there is no other field I would ever imagine myself doing.   My true wish is to illustrate the sacrifices doctors do make because I feel we are not represented when laws are made. These sacrifices include a lack of quality family time, our large student loan debt, the age at which we can practically start saving for retirement, and the pressure we face with lawyers watching every move we make. Yet we make these sacrifices gladly for the good of our patients.

I want to challenge our leaders to address the points I have made in this letter, keeping in mind that this is an honest firsthand account of the personal life of a newly practicing physician.  It is a letter that speaks for almost all physicians in America and our struggles on our arduous yet personally rewarding life.  It is not just a letter of my own journey, but one that represents most physicians’ path on our way to caring for America’s sick.
You may ask how I had the time to write this letter?  As I’m sure many of you do, I made time.  It is now 3:00 am on my only day off this month.  I considered this a priority.  I hope you feel the same.  I just finished my 87 hour week.  Time for a short rest.

Article by Matthew Moeller M.D. who is a practicing Gastroenterologist in Michigan.

Edited by Deep Ramachandran, M.D.

Followup Article: Another Letter to Washington, From a Physician on the Front Lines.

Related Articles:

5 Things You Don’t Know About Your Doctor,   Medicare and Generation X.

This entry was posted in The Truth About Health Care, Un-Sequitur and tagged , , , , , , , , , , . Bookmark the permalink.
  • NS Desi

    I feel like this article is disingenuous. Now as a practicing gastroenterologist said physician will be making approx. 250k a year. In 10 years, probably close to 400k. I don’t see why hes crying.

    • http://www.facebook.com/richard.m.friedman Richard M Friedman

      Perhaps NS Desi has pointed out the problem here. People can read what doctors go thru and sacrifice, but the bottom line is, they still focus on the revenue, completely losing sight of the long years of training, the meager reimbursements from insurance companies, the long hours, the huge malpractice premiums paid, that there is a potential lawsuit out there every time a surgery is performed, the continuous need to keep up with latest developments. Doctors cannot afford to sit on their laurels. There is no telling how many times surgeons operate only to find out that the patient has no money, no insurance and with nothing to gain by suing the patient. How many people train for 10 or more years and have to put up with non-payment for professional services? The fact that NS Desi thinks the writer is “crying” is typical of a person who has no understanding of what physicians go thru. Instead of knocking the doctor writing this article, try opening your eyes and embrace what he is saying and put yourself in his place.
      (Disclosure: I am not a doctor, nor could I ever be one).

      • http://www.facebook.com/Ernie.More Ernie More

        Richard M Friedman, I agree with NS Desi. I think articles like this are best suited for high school students interested in becoming doctors and the American Medical Association which according to the author isn’t accurately representing the profession. It could be a good letter to congress and his representatives, “I want to challenge our leaders to address the points I have made in this letter” but he does not make any real points. He does not ask for anything specific. What does he want? Better health reform? They’re trying, be specific. A pay raise? An hourly cap? A sympathetic ear? A shoulder to cry on? What?!?

        Articles like this do not do the profession justice. They read like sob stories. I do not like how all articles like this start with, “Because of these concerns, I would like to personally relate my own story.” I don’t understand the line “while making $50,000″.

        What carries the most weight in this article is the line, “My wife began working, but her meager salary as a teacher was barely enough to cover day care costs.”

        (Disclosure: I am not a doctor or a teacher).

        • db4life

          The letter will be a textbook if he went into details with what is wrong with American medicine.

          (I am a new doctor)

          • Korba

            Well the good thing is that Obamacare will force many Americans to actually insure themselves and this poor doctor will get more patients!

          • flowereater

            Korba, unfortunately, many of the obamacare individual insurance plans have high deductibles, meaning that the insurance pays nothing until the deductible is met. So, a physician who is an in-network provider must first bill the insurance company, wait to get a denial notice from the insurance company, then bill the patient. and maybe, after paying their monthly premium, the individual will have enough left over to pay their medical bill, or maybe the doctor will never get paid for the visit.

          • Korba

            That’s the case with many plans on teh individual market before Obamacare came around. And it also depends on which plan you choose ( I assume you’re referring to the Bronze plans). The process of billing you describe is not new, not sure how that necessarily relates to Obamacare. Also, you neglect that the fact that all plans on the exchanges have essential benefits that the insurance providers must pay for. It sounds like you have some reading to do.

        • Kevin Williams

          He feels badly about his life. Just think of the guy who is holding a gun to his head to become an MD for 12 years? Now that guy has the harder job.

      • http://www.facebook.com/jared.jameson.10 Jared Jameson

        your opinion also is disingenous, for one simple reason: everything is relative. I’d expect a law student’s debt to be less than a doctor’s, and a journalism student’s debt to be less than a lawyer’s, etc, etc, etc. It’s all relative, and it rings of sour grapes by the doctor, if you ask me.

      • Nikki

        I completely agree with you. There are so many extra costs that people don’t understand, both monetary and not.

        While many people were out “partying at the bars” post-grad, these physicians were spending more time in the classroom and the library, missing out on the joys of being a young adult.

        • Guest

          Yes, Nikki, but that was their choice, wasn’t it?

          • Nikki

            Yes, it was their choice, but consider that MOST people choose to attend Medical school before they even start college, and once you’re in Medical school you can’t exactly quit because the loans are absurdly high. Just consider that as a 17-18 year old choosing to go into medicine, you’re generally not looking at all of the extra costs/sacrafices.

            You’d think it would be only fair to compensate physicians who make all these sacrafices, and on top of that, have to deal with idiots who don’t understand anything about the medical system. Just be thankful that there are people in the country who still choose to pursue medicine after all of this nonsense with people telling them that they are “greedy” and “only in it for the money.”

          • Kevin Williams

            So a 17 year old makes a stupid economic decision, don’t think I would want to pay 230,000. for HIS mistake. He can pay for it. I am so sick of MDs thinking they are God’s gift to the world and we need to worshiping them more and lick their boots.

          • Nikki

            If everyone thought, “Oh, Medical School is a stupid economic decision. Screw helping people, I’m going to work on Wall Street instead,” then we wouldn’t have any doctors and where would we be then? Honestly, any M.D. is TWICE as smart as you will ever be, so while I may not have to worship them, you sure has hell should. They’re the ones who clean up your mess of eating like a pig and being too lazy, trolling the internet, to get off your fat a$$ to exercise. Yes, when you are getting your knees replaced from all the excess weight and strain that you put on them for being a lazy piece of sh*t, then you SHOULD be worshipping them, for enabling your miserable life. Doctors are paid the big bucks because people like you are too lazy to do the preventative measures to spare yourselves the medical costs.

            P.S. if you knew ANYTHING about the health care system, is that you are not paying for “his mistake,” as you so eloquently put it. You are paying for everything single person that walks through a hospital that doesn’t have insurance and cannot afford to pay. So, instead of blaming physicians for the high health care costs, why don’t you go and yell at the local homeless person on the street instead. Please go educate yourself, and stop wasting my time, sweetheart.

      • BillikenHawkeye

        Despite those meager reimbursements from insurance companies, doctors (especially specialists like this guy) sure seem to make a salary that is significantly higher than the average American.

        • Nikki

          It’s because they’re doing work that is worth more than the average American. Have you ever gone into a random office building, and thought to yourself, “hey, this average Joe at his desk seems qualified to operate on me.”? I doubt it, and because they are more important than the average American, they should be paid as such.

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      Furthermore, he flat out lied in his letter. A quick, easy public search of his residency years reveals that, while perhaps he made $39,000 in that year, he actually was paid at a rate of $41,500 his first year, with a 9 percent increase his second year, and then an 8.8 percent increase his final year. Furthermore, Henry Ford, where he now works, is considered a top-rated payer for gastro; his region rates at a yearly average salary of $397,000. He might not be at that rate yet, but I bet he’s close, and I bet his starting salary was $250,000-$300,000 based on my interactions with my UM doctor friends, all of whom bought $200,000-plus houses in my sub BEFORE STARTING their residencies at Michigan. I suspect he needed to exclude some of the truths of his cirumstances in order to frame his ‘point’ in the perspective he intended. It’s disingenuous, if you ask me.

      • Katie

        I don’t know how in the hell your friends bought 200k plus houses before residency, but as someone married to a physician who is 260k in debt and finishing his 5th year of residency next June, I can say confidently that that is NOT the norm. We live in a 1200 square foot apartment, whose rent is 1280 per month and that is rough for us. My husband makes approximately 52k per year. Some day my husband’s salary is likely to exceed 200k, but the amount of debt he is accruing by way of interest (as he is in forbearance on his student loans) will make a huge portion of that salary go towards his loans for the next 25 years. We cannot buy a house and won’t be able to for many, many years, we cannot send our son to private school, we cannot even afford a fancy daycare center. Your friends are the exception, not the rule and calling this doctor a liar because his account doesn’t mesh with some second hand knowledge you have is ridiculous. This person’s account of his education and residency are absolutely in line with reality.

      • Arlene Lewis

        I think your post is disingenuous. The average physician salaries I’ve seen throughout my career have NEVER been accurate. And, you can say anything you want about what some friends of yours have done, but I and he and Katie here are people who are actually living it. Why in the world would anyone as busy as a doctor take time out to post just to make up stories. That’s just silly.

  • Ben P.

    Because he has missed out on 10 years of retirement savings and probably has a $2000/ month student loan note to pay. Take out 36% income tax , and he’s left with $136,000/ year. Sounds like a lot? At 80 hours/ week he’s only making $35/ hour! He is not merely skilled labor, he is the highest educated a human can be with years of training in dealing with medical , social, psychological, spiritual problems! I think the point he could make is that for some to endure and succeed in the extraordinary way he has had to, he should be compensated in an extraordinary way. Very few people alive can do (or even learn to do what he does). People who can’t appreciate what a doctor goes through and sacrifices have no value placed on education and hard work, and are usually the ones whining when they can’t get what THEY want. Its this lack of appreciation that is wrecking our healthcare system as intelligent people are going into business, computer sciebce , etc because they can make just as much without most of the debt and sacrifice. I personally think physicians should have their student loans forgiven after working several years. At least they are contributing to society through helping others, donations, free care given, and massive income tax payments.

    • http://www.facebook.com/jared.jameson.10 Jared Jameson

      You and I both know that a doctor with a mortgage, and kids (his FB profile shows 3 kids), presumably daycare costs, and other tax-deductible factors is NOT paying that full rate of income tax. Hell, me and my wife were in the 25 percent tax rate this year, but after those deductions/credits mentioned above, our freakin’ ETR was a mere 3 percent! We made six figures combined. Considering the letter offers nothing in terms of wishes from gov’t, it is a letter of sour grapes, nothing more, nothing less.

    • Vicy

      This is why you only work for what you love. If you were in medical school for money, then you will regret.

    • Guest

      That is still more money than 90% of the population makes, and a lot more than physicians are payed anywhere else in the developed world, so quit complaining!

  • Will

    Why try to counter a bunch of mistaken notions about doctors by spewing a bunch about lawyers? Makes you sound immature and ignorant, which is the opposite of what I think you wanted to portray.

    • jlrc2

      Indeed, going into law is probably an even less advisable proposition at this point. Debt load can be similar and job prospects are horrible.

  • Neuro MD

    Give me a break, The story is a tired and boring harangue that so many of my colleagues have spewed out so often. The ideals underlying such stories reveal a self-inflated ego, but what would you expect from a profession where everyone has (viz: demands, expects) the same first name as ‘Doctor’? Being a physician is not the most demanding, most under-payed profession. The bottom line is that doctors made the the choice to become doctors. Diatribes such as this have little credibility to me as a physician, and much less to someone who may be out of a job or less fortunate.

    • db4life

      You must be an AMA admin, or worst yet, an Obama supporter.

      • Korba

        You must be another teabagger who would like to bankrupt our country by giving in to every demand by doctors.

    • Korba

      Agreed, dude’s a whiner. Probably just another teabagger who wants Medicare to bump up his pay so he can buy a bigger house.

      • Deep

        Hi. Perhaps you meant “tea party”?

  • Tana Benner

    I am an attorney from a modest Midwestern background. I have pride in what I do. I truly care for the well-being of the human race. Although I may “clock” the number of minutes that I talk with my clients, I do not hang up the phone on any of my clients ever, even when I am not getting paid. In fact, there are numerous cases where I end up writing off my bill. I listen to my clients and answer their questions, however long it may take, even if I am at home eating dinner with my family. I also have six figures of student loan debt and no retirement savings, but I will be lucky to ever make the kind of money that a physician earns. That’s that.

  • Matthew S

    No one doubts that doctors are well-educated, hard-working, and caring people. The problem with health care is not the high salaries of doctors, but the massively inflated prices charged by hospitals and insurance companies – the burden of which is carried by consumers. If the author of this article were truly humanitarian, he would not simply bewail the public perception that he’s an overpaid parasite, but offer some concrete suggestions about how to lower the overall costs of healthcare so that everyone in the system is paying, and earning, what they deserve. When a system is unequal, people naturally resent its relative beneficiaries.

    And he might gain some credibility by addressing some of the abuses perpetrated by less-altruistic doctors than himself (e.g. ordering expensive but unnecessary diagnostic tests to avoid malpractice, placate hypochondriacs, or get kick-backs).

    • Katie MacAllister

      … so attempting to avoid getting sued means you’re an abusive and non-altruistic doctor? Seriously?

  • http://www.facebook.com/profile.php?id=588265800 Dustin Pitts

    This show should support your sad case. http://www.bravotv.com/married-to-medicine

  • 21stCentMD

    To all of you who are not doctors and disagree with this view, go become one and survive the process then talk to us. While we voluntarily chose to enter this profession, what if we voluntarily decide not to offer you care even if you or your family needed it? Don’t hold doctors to a double standard just because of moral obligation (if such a thing even exists nowadays). We provide a billable service just like everyone else, but only difference it is your health and body. Imagine what would happen if physicians decide to simply see you as a client needing a deliverable rather than a human being in need of care and tender support? Just think how much happier we would be actually. ..

    • Guest

      Haha!! You were correct when you said you “voluntarily chose to enter this profession”, and if you think threatening the public to withdraw your services because you feel under-appreciated at a minimum salary of $15,000/year, then you shouldn’t have gone into medicine in the first place! Your profession “bills” plenty for services provided, which is why our healthcare system costs more than anywhere else in the world, and most Americans can’t even afford health insurance. You’re pretty ignorant for a “doctor”.

    • Korba

      Wow, you don’t sound like a doctor I’d like to receive care from

  • http://www.facebook.com/pjciam Paul J Coppola

    I just read your letter on Sermo and wanted to comment directly to you and say thanks.

    Here was my response on Sermo

    Great letter, I can easily relate as most all in our profession. I initially wanted to share with everyone I know who as ever said “you rich doctors have it made” and thought every lawmaker, insurance executive, and even patients so that they would understand what it is like getting to be a physician. I am nearing the end of my career and still love what I do and would not have changed if given another chance. I have great concerns for what the future generation of physicians will be like with computers, electronic health records, multilple layers of answering machines and staff before the patient gets to talk with the doctor and worst of all set hours as employees of hosptals or health care organizations. The real problem is that medicine has evolved to such a high level of technology that the cost is overwhelming and simply unaffordable. Noone, but the individual patient sitting with their doctor really listening, values the simple doctor-patient relationship, which in the long run is the most cost effective. However, that most important aspect cannot be maintained and is being sacrificed because of the technology costing so much. I am so thankful that I still have the privelage of spending time with the patients who have for so many years put their trust in me and in the end that is what makes getting there all worth it. Still great letter because it made me think about those years back in college, med school and residency training with all the struggles and yet they were good times. Thanks.

    paul.coppola@snet.net

    • Josh Bucher

      I think that most people here are missing the point of the article. The point is that he is graduating with over 200k in debt (like myself). Most other 1st world countries have education systems much more suited for encouraging people to go into primary care because they do not graduate with debt if they attend public medical schools.

      As someone who just graduated last year with > 200k in debt, making 50,800 a year as a first year resident (you can look up UMDNJ PGY 1 salaries online), I sympathize with him.

      The comment above that they know “so many people who bought $200k homes before residency” is totally irrelevant. I never worked, never had a full time job before residency and came straight from college. I borrowed money to rent apartments, and rent now. I drive a 10 year old Honda that I need to last me another 10 years. I am in NJ and pay some of the highest cost of living expenses. I make $500 a month loan payments. My assets are very low, and my loan principal keeps increasing due to compounding interest.

      If we were anything like the rest of the 1st world, medical school debt would be a different story. I am going into academic emergency medicine. I will start at a salary on the east coast of approximately 180k. I am not getting a maserati, nor can I purchase a 700k house. I am also inheriting another 100k in debt from my fiance.

      The point that I took away from this is that the system of debt needs to be changed. I am not complaining about my salary. I am not complaining I cannot afford a maserati. I am not complaining that I don’t make enough money. The point I will complain about is the education system has to change because there is a huge physician shortage, and students are discouraged from pursuing a career in medicine due to the way medical school and debt is funded in the US.

      • Vicy

        No.. trust me, in ten years you will be able to pay off those debts and afford a Maserati because you are a physician (as long as you don’t waste any money). Learn how to manage wealth and business. You will be thankful you were able to pull off this harsh time. One thing I can tell you is at least physicians are paid very high after residency. Unlike other professions there’s no guarantee that work for 5 years then you can get promoted to a position that pays you $300+k. You are already very lucky and smart because you are physician in training.

      • Guest

        Oh, get over yourself! You knew going into medicine would cost social and financial sacrifices, and nobody forced you into it!! If anything, your comments make you sound like an idiot for signing up for this! Normal people weight the pros/cons and benefits of taking a risk or pursuing a certain career before doing so… Don’t feel sorry for you at all.

        • Katie MacAllister

          So the point of his comment flew right over your head, I see.

  • nick

    I agree with the fact that doctors are not being paid enough but in this case I kind of disagree with my gastroenterology colleague as they are among high earners ( above 350K ) and actually under current system are being paid pretty well for what they do. Unfortunately doctors payment system in US is not fair at all. In current US health system you are not being paid for the time, energy, quality or level of stress you are dealing with and simply being paid for the number of procedures you do. For example in early 80s gastroenterologist were among least paid doctors no matter how much time they spent with their patients and Nobody wanted to do it. Suddenly after medicare started to pay for screening colonoscopy GI became a hot field and every medical students started thinking about it. Same story happened for Anesthesiology or some other fields. Procedural payment was the reason that many medical students decide to choose so called luxurious and less stressful fields ( such as Dermatology, GI,…) in recent years for the simple fact of work less and get paid more. I am not against the GI doctor who wrote this blog is wrong but I dont think he is the first one who should cry. Our primary care doctors, Hospitalists, surgeons, neurologist and even non procedural cardiologist have to tolerate far more and more pressure despite less and less pay everyday. I think Congress should come up with a system that guarantee a fair and sustainable pay for doctors and we as medical community should come up with fair and practical demands and work together to reach that goal otherwise our procedurists get paid less and less and our thinkers will suffer more and more everyday and nobody even patients will benefit from current situation.

  • Stephen Matics

    I’m sorry but CRY ME A RIVER. I’m a pharmacist and have a similar amount of school debt. Granted, unlike your profession, we do not need nearly as much post graduate training and so begin earning a large salary earlier. But let’s keep it in perspective here. The average salary for a gastroenterologist is $350,000 in the United States. No one forced you go to medical school or have two kids, or even pursue another 3 years of post-graduate training after internal medicine. In fact, you can argue that the reason you specialized was more for the money than anything else. Go on and admit it. Every other physician I’ve ever spoken with does. It’s the reason there are primary care doctor shortages.

    I see a lot of young attending’s who first start working, with their massive school debts, who pay them off very quickly and then proceed to buy maserati’s (true), BMW M3′s (true), $700,000 homes (triple true), etc etc. Go on and do a survey on every attending physician out there: Hey, if the money wasn’t so good, would you be in medicine? MOST of them would say no. People who go into health care should NOT have that much school debt. In fact, NO ONE should. But in exchange for providing a service and “caring” for people around you, you cannot gripe about not collecting an oversized salary. But physicians do collect oversized salaries. And the fact that while this continues while the biggest cause of bankruptcy in America right now is healthcare related costs should lead you to question how ALL of us are compensated and educated. The current model isn’t working. After all, if you were really into “helping” people, does that help involve causing them bankruptcy as well? I know as a pharmacist, and my fiance knows as a physician in training, that we wouldn’t feel very good about ourselves. And we are directly responsible whether we know it or not.

    • LawyersAreNotSmart

      I guess you were too dumb to go to Med School so you are whining about those who were able to make it?

    • Nikki

      I feel you because I’m in Pharmacy school as well, but your debt is NOWHERE near as much as a Medical student’s.

      • Ami Patel

        I don’t know about you, but I just did my calculations. I go to a six year program, so I cut two years of my total eight years. My total is $318,290 just for tuition and fees, plus dorming and meal plan. This is not including all the books, equipment, traveling fees, money for meals. I am only in my beginning of my third year and I have an almost $20k debt with only my undergrad fees, not my professional year fees. The only reason it is this low currently is because I have a merit scholarship, but soon my younger sibling also has to go to college and my parents will not be able to contribute as much as they have before. Also, Have you thought about how much the cost would be when you have to do your APPEs and IPPEs rotations? Those mid years and annuals that you are almost required to attend? Do you plan to go into residency? Our debt does go pretty high also. Plus all this information is coming from someone who is going for school for six years for my BS and PharmD. Talk to people who are doing there four years of Undergrad and then four years of pharmacy school.

        It might be true that we will be able to pay of our loans at a younger age, and doctors will have to go through more training for specialization. Thus they are postponing the amount of money they have to pay back.

        • Nikki

          The extra time it takes to pay back loans IS money, because the interest accumulates. I don’t doubt that you have lots of loans, but while we are going to be making a good amount of money right away to pay off loans, physicians will not be because they will be barely making enough money to live and make minimum loan payments. Also, Medical students have more rotations than we do, so yes, I have thought it through.

  • steve

    CRY ME A RIVER dude. Doctors aren’t in it to help anyone. IF they were, you really think they’d be okay with their profession charging prices that wind up being the number 1 cause of bankruptcy in america??

    Simply put, physicians and pharmacists (I’m one) are in it for the money. You said you spent 3 years in internal medicine. At that point you could have become a primary care doctor and actually worked to help reverse and prevent disease in people before it became something worse. But no, you specialized. They all specialize because that’s where all the money is at. That’s why you specialized in gastroenterology and now make on average $350,000. In my profession, when we specialize, get more training and do a residency or fellowship, we on average make FAR LESS than just being a local neighborhood pharmacist.

    In case we are still not understanding this, consider the most competitive fields in medicine (meaning the most difficult to get into with the smartest physicians applying) are: 1. Plastic Surgery. 2. Dermatology…LAST PLACE: Family Medicine

    Meaning: you want to see a smart doctor, go find your local dermatologist.

    • Nikki

      If you got your facts straight and studied the US Health Care System, you would realize that EMTALA is the law that requires Hospitals to treat people regardless of ability to pay, which in turn leads to higher costs for everyone with insurance because the hospital has to make up the difference somewhere. It is not the doctor’s fault for the increased prices, it’s actually the insurance companies and the hospitals themselves.

      Also, these high medical school debts are the reason WHY many physicians are starting to be “in it for the money” as you put so eloquently.

      • staup640

        This literally has nothing to do with this conversation.

        • Nikki

          It actually does, but I can see how a person such as yourself wouldn’t understand. Maybe you should leave this up to the adults, sweetheart.

    • Katie

      Spoken like someone who either a) has no friends who are physicians or b) has a really shitty doctor. I’m married to one and he doesn’t put up with crap like this from people like you because he likes money, he does it because he legitimately cares about the welfare of his patients. I really cannot imagine living with this level of cynicism.

      • steve

        http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html?ref=health&_r=0

        Ironically, I both am a healthcare professional and I’m married to a physician as well. The fact that we value specialized care in America at the expense of preventative care is appalling to me. That 80-90% of the medical problems we deal with in a hospital are the result of poor lifestyle choices. As a culture, we go out of our way to encourage these poor lifestyle choices as well.

        Physicians who provide procedures make more money because our system places an emphasis on interventions versus time spent with patients. A GI doc like above will make far more over 10 minutes with a patient than a primary care doc spending an hour counseling a patient on diabetes.

        Now specialized physicians are of course important and are required. But we place way too much of an emphasis and value on a dermatologists ability to do a Moh’s procedure (see above) when most of those procedures are unnecessary.

    • Wei

      actually, gastro is under the umbrella of IM, which is still primary care.

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  • http://www.caduceusblog.com/ Deep Ramachandran

    Followup to this article now posted at caduceusblog.com. Due to the
    tremendous popularity of this article as well as the controversy and
    questions it generated, Dr. Moeller has written a followup addressing
    many of these issues.

  • Edward Volpintesta MD

    March
    30, 3013

    Caduceuslog.com

    I appreciate the comments made by Matthew Moeller MD posted on the March 28
    Caduceus.blog. His willingness to speak openly and freely is admirable and I
    wish more physicians could muster the courage to do the same. For many if not
    most physicians suffer silently and to borrow a famous phrase of Thoreau’s lead
    lives of quiet desperation.

    My response to his blog however is directed not to the time and the financial
    burden but to the medical curriculum itself.

    I have been practicing primary care for almost 40 years. And as I look back on my
    years of education I realize how much of it was either redundant or
    inappropriate.

    For example, as I look back on courses like organic chemistry, physics,
    biochemistry, biology of vertebrates, and physical chemistry which I labored
    thorough because I was told medical schools favored students who took those subjects—and the time and worry I spent on them I am overcome with a sense of regret. For the
    time invested in them has contributed very little if anything to my capability
    as a general practitioner. Ironically a great deal of time is also spent on the
    so-called basic sciences in medical school as well.

    The basic sciences have their place in medical education of course. But, studying
    them with the intellectual exactness that is more appropriate for a career in
    medical research doesn’t makes sense. Some
    of these subjects I suppose are intended to weed out those students who do not
    have a superior aptitude for science. Unfortunately many students who could
    have made good general practitioners were either turned off from a career in
    medicine or refused admission to medical school because they were daunted by
    organic chemistry or biochemistry.

    My point is that perhaps the medical education experience doesn’t have to be so
    long and arduous. Certainly surgeons need their operating room experience to
    develop their skills but even their pre-residency education could be modified
    to be more practical. This would save time, money, and energy for those
    pursuing medical careers.

    Many believe that the Flexner Report of 1910 which set new standards for medical
    school is greatly responsible. Abraham Flexner undertook a study of American
    medical schools, identified their deficiencies and with the power of the
    Carnegie Institute and the Rockefeller Foundation supporting him set in place a
    new set of standards. They were inspired by the German medical schools whose
    main focus was on medical research. That focus has remained in place and has been
    the foundation of American medicine ever since.

    Clearly the medical schools of the time needed the improvements in standards that
    Flexner promulgated and no one would doubt the benefits that have accrued
    because of medical research.

    But the overriding attention to research encouraged the training of specialists and
    did all but ignore the training of general practitioners.

    This unintended effect of Flexner’s report is responsible to a great extent for the
    primary care shortage that is constantly reported in the media. Perhaps if
    Flexner were a physician his approach might have been different. He was an
    educator not a doctor.

    One of his contemporaries, Sir William Osler MD a celebrated physician, teacher, and
    author of a highly regarded medical textbook disagreed with Flexner’s ideas. He
    preferred that medical research be done in institutes and not in medical
    schools attached to teaching hospitals. He was also against full-time teachers
    in the hospitals because he thought that not being directly involved in private
    practice in the community did not give them the exposure to the practical needs
    and problems of patients outside of the hospital environment.

    Be this as it may, some leaders in medicine are seriously taking a second look at
    the changes that followed in the wake of Flexner’s report with plans to correct
    any unintended consequences.

    If they do a good job future physicians may be spared some of the stresses and
    adversities that Dr. Moellers aptly described.

    Edward Volpintesta MD

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  • guserson

    What’s your salary now? you don’t mention it in the article.

  • AP

    I’m an incoming med student. Although there is the potential to do very well down the line, and I understand that, looking at raking in $350,000 to $400,000 in student loans at the age of 24 scares the living crap out of me!!!!

    I’d like to note that perhaps we would all be less interested in subspecializing and lining our pockets if we would not have those loans in the back of our minds through the next four years of medical school. It frames how we think about the profession, doesn’t it? PCP, for example becomes very appealing when you have $0 debt. Perhaps not for everyone, but perhaps for enough that it may make a substantial difference in the way we see health care in the US.

  • Jano

    Dear Dr. Moeller,
    I did take the time to read your letter and appreciated it very much. Being one of the few in our population that do not just assume all physicians are rich, your story gave me new information and I am so glad you stuck to the goal you decided on in elementary school. I am sure you are a fine physician and helping many patients. If I lived in Michigan I would use you myself! I spent my whole career in health care from being an office nurse to auditing oncology practices across the country before becoming very ill with a disease called Pulmonary Fibrosis…..we all know the probable outcome of that, but I have and continue to spend alot of time in many Specialized Physicians’ offices, including GI. My spouse is an Attorney and probably gives away more of his hours than he bills them for, but that is why I love him….it isn’t all about the bottom line, it is about helping someone.
    I think it is awful that our physicians do not get paid more that they do from the insurance companies, you are held up to the highest standards and are asked some questions that no one has the answer to, as I know you have learned by now too in some cases.
    Please find time to enjoy your career and do put your Faith first (I didn’t see that mentioned in your letter!), then your family and you will have a wonderful life helping the people you set out to help.
    Good luck and help mentor those coming behind you in the field of medicine. Do not pay attention to responses criticizing your letter….it sounds like some I have written while “awake” on Ambien, but I am sincere when I say I appreciate your letter and what you have done.

  • Threehills

    I’d like to hear from everyone what they think I doctor SHOULD be paid, in a net hour hourly wage. What do both sides think a doctor should take home in his pocket for an hour of his or her time? Saying this or that salary is too much or two little, doesn’t mean anything, as one can’t appreciate the hours involved in that salary since it varies so much. I have a number that I think my time is worth, and I am curious to see where it falls in the range of opinion.

  • Brian

    Why are you complaining to the government? That’s not the entity that set your tuition rates. Maybe instead of enabling the sentiment that allows capitalist measures of business success to govern our education system, the public should hold the private sector accountable for immoral and selfish practices that take advantage of the consumers/students/people. It’s easy to complain to D.C., but we have a much larger cultural paradigm to tackle if this issue is ever to resolve.

  • Baby Tarlow

    Take your 350k/year salary. Live like a student for 2-3 years, rent an apartment, drive an old car. Retire your 230k debt. Continue making 350k/year for 25 years.

    Agree with other posts–this seems to be written from the perspective of a doctor’s union like the AMA.

  • Ed

    Tthink you’re special regarding challenges in completing med school? – it too me 16 years after high school, and I did 12 of those training years in a wheelchair, with paralyzed fingers, no assistant, and lived alone with occassional aide assistance. So don’t be so quick on the draw, bitching about your travails.

  • tabitha.bluelady haney

    I want to cry you have it so right. I am the wife of an anesthesiologist, and change the location to California and this is our life. Not easy by far and although we are grateful all the backlash and snarky comments from even friends about how we “have it made” or “doctors make too much” is really starting to wear on me. I fear for our future and the future of healthcare in general.

    • staup640

      You’re uninformed. You’re married to an anesthiologist who will easily make 4-8 million dollars during his lifetime and you’re complaining about 250K in debt? Granted, it would be better if there was no debt, I agree, but people have it much worse in this world. If you want to own estates and have ten luxury cars (which you could probably still do as an anesthesiologist in some states), go into investment banking, not medicine.

    • Arlene Lewis

      Tabitha, the only remedy I’ve found that helps with people like some on this site is to IGNORE. That can be very hard to do, but at the end of the day their opinion really doesn’t matter. I practiced much longer than I wanted to worrying about what people would think. Fortunately with inevitable age comes wisdom and I just no longer care. Each of us has to do what we need to do in our own lives to be happy and what anyone other than our family and closest friends (and maybe not really them) thinks just really doesn’t matter. My close friends all know the reality because I’ve told them. Maybe they think like some of these people on here but they know better than to say it out loud if they want to remain good friends. As far as we know we only get one life and it’s no one’s responsibility other than ours to make sure it’s a productive, happy one, especially not some random people on a website who would never say the things they say if face-to-face.

  • jlrc2

    This seems, primarily, to be an issue with college education in the USA. It affects more than just doctors. We have by far the most expensive higher education in the world; unfortunately, it is the best as well. The money isn’t buying us the better education, though. The better education is there and the money buys us administrative bloat, presidential salaries, overseas campuses, etc. State governments have abandoned their flagship universities, making their tuitions skyrocket and abandoning the goals of an academic institution, which aren’t to make money. American government at all levels do not subsidize our education; look at Canada, where an international student can pay around 10,000/year at their top institutions.

    The story told here would be almost completely fine if you didn’t have to hamstring yourself with unbelievable debt to receive the education necessary to become a doctor. Doctors are being paid too much! But they have to be. If you leave medical school with 200-500 thousand in debt, you need to get paid a whole lot of money for it to be remotely worth it. I think prioritizing the cost of education at the policy level would be a huge first step in lowering the costs of medical care as well as being a huge boon to our entire country, culturally and economically as others get education in other fields without soul-crushing debt.

    Unfortunately, I fear that the “solution” will be online courses, continuing to slash professorial pay, increased use of substandard methods in the name of the dollar, and other financially-motivated reforms rather than addressing the administrative problems in higher education and, more importantly, having the state and federal governments restore their investments in education to pre-Reagan levels.

  • staup640

    This article is nonsense. I am a practicing generalist (who usually earn a lot less than gastroenterologists). I had about 270k in debt. With my first job I earned 170k/year and my wife earned 45k/year at her job. Between my wife and I, after taxes and paying my 2k/month loan payment, we cleared 10-12k a month. So difficult for us! We could only afford a million dollar mortgage and still be able to live a normal life. At least for the next ten years, then the majority of my loans are paid off, and we can really start clearing 14k or more a month.

    • Nikki

      The fact that you’re a practicing generalist means that you weren’t able to get a better residency due to your lack of good grades and mediocre board scores. Did you go to D.O. school? Someone in a DIFFICULT specialty would like to have the extra money someday to make up for the fact that their entire 20′s was lost to studying in a library (something you obviously never did), to travel and have some fun. I’m sorry you can’t comprehend wanting a little extra room to play with, especially if you plan on wanting a family.

      And funny, I noticed your previous comments to people and it’s hilarious how you couldn’t call me “uninformed” in reference to my argument on the US Health Care System.

  • GWong

    These arguments have gone on forever and will never stop. Sorry to say this, but if anyone in the public wants to go out and do a laparoscopic appendectomy, then be my guest. But in a nutshell, despite the world wide internet of not necessarily truths about health and our ability in using evidence based medicine and experience to make a decision, a regular person cannot do many of the things physicians is trained to do. So yes, we are paid a lot, but we also do put aside a lot of earning potential in our 20-early 30′s to try to achieve what we wanted to do. And if you slacked off in your 20′s and didn’t get a real job until your late 20′s or early 20′s then that’s not my fault either that you also missed the earning potential of a non-physician. Like many other of those “pension and benefits seekers” very few physicians have jobs that provide pension plans or even retirement funding advice. It is well known that physicians (esp the older ones) suck at finance. And let’s not jump the gun here thinking they spent all their money on cars and homes and travel. But it is probably true for a lot. It’s like when a college student gets their first credit card and they have fun with it. They later learn their consequences and these such physicians have and will also learn the consequences. And like the general public, a lot of us also pay for our own health insurance. In fact, one of my friends doesn’t even have it because of the costs and he just started practicing this year. So not all groups (hospitals or university based systems are different) offer these things as part of the package as a job.

    I am annoyed by people placing blame one another. I only briefly skimmed the comments and while I will not sit here pointing out one comment over another, I will say that not every has a primary interest in primary care. If you always wanted to operate or feel your best operating vs being a GI doc or vs being a pediatrician/IM then so do it. Should the government also use the financial incentive to make you choose a field you’ll be miserable doing your whole like so you don’t have debt? I always knew what I wanted to do, and people continue to be surprised at that. I ended up going right into the subspecialty i wanted and I didn’t even know they earned what they earned. I just wondered about how it all worked and found I really liked it. Does that mean I’m not stressed out everyday knowing the patient is entirely in my hands? Of course I am and I take pride in giving the best care I know how to give. Does it frustrate me when others don’t have the same pride? Yes. Does it mean I was number 1 in my class and graduated from some medical ivy league? No. But it does mean that I care about my patients and do what I can to give them the best and safest care even if that means not following what they, the patients, are demanding. Does that also mean I spend an extra hour that I can’t bill (Because insurance cap what I can bill for certain things) making sure the treatment is working and they are improving? Yes? Does this also mean that the choices patients make put them more at risk than those who aren’t like them and I’m the one that experiences the added stresses of someone who’s an alcoholic, or drug user, or morbidly obese, or uncontrolled diabetic, or ______(fill in the blank with whatever uncontrolled, noncompliant patient that exists)? And if something goes wrong because of their previous issues, then I am at fault? YES! Because I apparently am not a miracle worker and can’t cure their morbid obesity when I have to move them from a gurney to a different table. Yes, I will OF COURSE give myself back strain and a hernia just to make sure these patients are moved safely. Etc.

    So to the public, yes we chose to do this for different reasons and a large majority of us coming out are jaded. Not only because of money but because of the attitude of the general public. Many of us are in here because we chose to be. I don’t have any family in health care and now, don’t recommend it to any younger family members i know. I also have had several family members completely screwed by my fellow physicians. I’ve played both sides of these story. And I still love what I do. But Imagine when I’m taking care of really sick patients, and there are drug shortages of core medications we use daily and we have to ration them…knowing that if someone who’s truly on death’s door comes it, we may not have enough to help them. Even physicians are fighting and lobbying the government to do something with drug companies who are creating drug shortages for us and putting our patients at risk. If you think we have control over drug companies, then please wake up from the dream.

    I also want to say that it’s not even always about the money. It is about the hours we put in. Many of us aren’t the type of physicians who have only clinic hours M-F. Or secretaries with 9-5 jobs. Or even customer service reps with their version of a 9-5 job. Some have wonderful gigs out there as any type of physician but there are some that work 80+ hours a week.

    I’m just going to say this. sometimes that quality of life we have stressed to patients (esp terminal ones) is the one thing that is now important to many people and it’s just as important to your physician. So many of us don’t find time to see our own doctors (sadly because a lot also work 9-5 while some of us, are working 7-7, etc) or dentists. Some of us work in practices so stretched and tight, we don’t call in sick. We cannot call in sick. But more importantly, we miss big things in life. Unlike this author, some of us are forced to move across country and back and across again to gain the experience we want. And going back to our childhood home (or newly designated location of our choosing) can be near impossible. I have given up ever thinking I will live near my mom because the competition is so strong with two major highly ranked university hospitals in that area. So who cares about family? Who cares about that lifeline that I was forced to move away from? THESE are the things that are important to me. I would take a pay cut to live in the same city as my family. But that’s not even an option because someone without those ties but better connections will get that job before me in that area. THESE ARE the things I gave up when I decided to be a physician. Yes, there are many jobs just like this but very unlikely is someone’s life actively in your hands when you’re negotiating a deal or ringing up a purchase. And yes, for me, someone’s life is ALWAYS in my hands. I’m not looking at eyeballs or skin lesions all day. And when a family member dies, like a parent, some of us, if part of a program or group that doesn’t realize life happens, are forced back to work a day or two after they bury their parent. Are forced to repay the time that others did for them when they were busy planning a funeral (in those two days). And aren’t even asked how they are doing or if they want time off. This is the stuff that makes me mad about medicine and training in medicine. These are the things I gave up. So you can comment all you like, but unless you live it, you’ll never know what it feels like to give have a discussion with a patient’s family about taking their loved one off life support while your own parent is on life support and dying and you can’t be there because the schedule doesn’t allow for it. To hang up the phone on your own family because you are having the most important discussion of the moment with your patient’s family and their loved dying when that’ is the EXACT SAME CONVERSATION YOU ARE ABOUT TO HEAR over your own phone. IT’s ABOUT THE SACRIFICE OF MY OWN LIFE to make other’s better. And the fact that many don’t realize this is what we do.

    • JimBob

      You could make the same arguments about any profession. Try repairing your own plumbing or preparing your own tax returns.

      • GWong

        I do prepare my own tax returns, thank you very much, and if your profession requires you to take a chance at putting a 500 lb person under the knife, and all the risks associated with it, then you can say something about it. Until then, you should be quiet. And i never complain about the asinine amounts of money i pay to have my car fixed, my plumbing fixed, etc because i understand they are trained to theoretically fix what they fix. i comment on the amounts, but i pay and understand. so you can take your comments elsewhere. and i don’t want to hear about people calling in sick just because they can so they can use up their PTO and sick time and take a day off to do whatever instead. or complain they don’t get enough bereavement. or they called in so they can go to the doctor. I was only trying to explain that we do sacrifice family (if you hate your family, so be it, but i love mine and want to be there to take care of them) and distance and life events. In fact JimBob, i will stop now because i’m wasting my time on you. and others that think like you. People like you are ignorant and can’t think about both sides of the story.

  • DoctorG

    Thank you Dr. Moeller for your words. The need for your article is proven by the misinformed comments that I have been reading. I understand why people have misconceptions about our lives as doctors. For one, doctors’ lives were different many years ago when insurance companies didn’t run the show and doctors’ salaries were higher. Additionally, there are a wide variety of doctors in medicine, of whom, some still do make quite large salaries. Lastly, TV shows and media have routinely portrayed doctors in a false light that leads to vilification and skepticism- only now have some TV shows started to film the reality of our lives. Let me tell you the reality of my life and give you my quick opinions on this subject.

    I am a first year family medicine resident who plans to be a primary care provider. I make 50k before taxes yearly. I am 200k in debt. My salary in 3 years will increase to about 125k depending where I work. I could make closer to 150k if I decide to work for a larger group. I am also engaged to a first year pediatric resident. She also makes 50k, has 200k in debt, but will make slightly less than me in 3 years as insurance companies pay less for her specialty. We live in a 900 square foot apartment yet never see each other. We don’t vacation, see friends, or sleep. But I am not complaining about my life, because I knew this was waiting for me all along.

    Yet, I do worry about the effects of this life on you. Let me explain. I went to a medical school in NY where I was an average student, in no way was I blessed with impressive intelligence. However, many of my classmates where blessed. They had both the intelligence of House and the bedside manner of JD. And do you know where these students are practicing? Dermatology, ophthalmology, radiology, ENT. Because those fields pay the most and have easier work hours. The brightest minds of our nation’s medical schools are choosing to stare at the pimples of our nation’s youth and the sun-colored backs of our nation’s old. Preventative care is, as most agree, the most practical and cost-effective treatment in medicine, yet most preventative doctors were just average students like me. Seems that we are allocating our resources in the wrong place?

    Doctors’ salaries have zero effect on healthcare costs. Read about the costs of medical equipment, or prescription medications, or malpractice suits and you’ll realize how inconsequential doctors’ salaries are in comparison. I don’t care if you pay me more. Honestly, I don’t have enough time to spend the 50k that I make. I could sleep in a box outside the hospital and feel no change to my current life. But you should be worried about quality of your medical care if things don’t change. The smartest doctors need to be motivated to go for primary care positions or else medical care will fail to progress. The average medical student/future doctor is not a saint. 99% of us are just people who can work hard, sort of like science, and couldn’t find anything else to do with our lives except become a doctor. Don’t expect medical students to choose primary care fields just because they are good people- money is always going to play a role.

    I wish I could have found something else to do with my life. Unfortunately, being a doctor is the only thing I can do – so for now I will close my eyes, keep my head down, and keep my ear to the stethoscope for the sound of change.

  • Liam

    Plenty of law school grads have equal debt burdens. I am $200,000 in debt from law school and make a fraction of the salary of this column’s author. I can’t even afford having children, let along having a relationship. I can’t afford a car or really an independent life. I have a law degree from a top 20 school and I am impoverished. I will most likely be poor until I die, so it’s hard for me to feel sorry for this person.

  • BillikenHawkeye

    This could be Exhibit 1 for why doctors are the most insular and whiney profession in the United States.

    Where to start?

    “I’d have fewer loans if I had gone to law school.” Actually, probably not. He would have maybe only slightly less in student loans, but if he had gone to a middle-ranked law school like he did a middle-ranked medical school, there’s a 50% chance he might not even be practicing law because he couldn’t find a job or would have had to hang his own shingle right after graduating. Even if he did get a job where where he’s actually practicing law, unless he was one of a handful of students who graduated at the top of his class or is lucky enough to have some family connections to get a job in a firm that will eventually pay out the big bucks, he wouldn’t even be making anywhere close to enough to pay those loans off for a very, very long time, if ever. (Like this author, I also graduated from Saint Louis University. But I graduated from the law school, where a large percentage of my class has struggled to find full-time legal employment.)

    “Waaaah! I have to work so many hours each week doing a job I love.” You knew long hours were part of the gig when you enrolled in medical school. Oh, and you shouldn’t have been working 87 hours per week either, since resident hours were recently capped at 80 hours per week. Deal with it. You know who else works lots of hours? It’s not just medical doctors. Lawyers, accountants during busy season, single mothers, 3 minimum wage jobs, business executives, the list goes on. Deployed soldiers often work that many hours, and they get shot at during their day. Last time I checked there weren’t too many doctors in Americans hospitals dodging bullets or IEDs while making their floor rounds. . .

    “I didn’t get paid much during my residency, but now that I have finished I am fortunate enough make a pretty good salary.” This guy throws a lot of numbers around, such as how much he got paid as a resident and how much his student loans are, but he neglects to say how much he gets paid now. Why? Probably because as a GI specialist, he’s actually now making quite a bit of $$, and disclosing that amount might hurt his pathetic argument. It’s hard to have too much sympathy for a guy who is 32 years old and pulling down between $200-$400k per year. Did he make have to work for a low salary for a few years? Yes, but there is a nice pot-o-gold at the end of that residency that makes it well worth the low salary for a couple years. Making monthly payments on a $230k loan isn’t going to keep him from feeding his family on his current salary.

    Speaking of salary:

    “We don’t have enough representation in Washington.” Bull crap. Washington recently passed a law that completely overhauled the health care payment system. Washington just required every American to purchase insurance, which means that every American now has an incentive to use more of your services. Other than perhaps Agriculture, there aren’t too many industries that the Government really incentivises every single American to purchase. And guess what that does to your pocket? That’s right, it keeps you busy, and makes it easier for you to make a living. This is the only industry that the Government is now indirectly forcing people to buy your product.

    Despite this huge change, guess what Congress didn’t do in the ACA? They didn’t do much of anything that would actually lower the cost of health care? What could they have done lower costs? Lower your fees. All of them, not just Medicare/Medicaid reimbursements. Washington could have created a single-payer system and put a cap on physician reimbursements so that every physician is basically on the Government pay-scale, which maxes out at about $180k per year.

    As a trade-off, Congress could simply pay off the student loans for every medical doctor out there. So instead of getting paid $350k when you are 35 years old with $200k in student loans, you can get paid $135k per year and have no loans. How many of your colleagues who are complaining about student loans would take that deal? Probably not too many.

    I tend to lean more on the conservative side of politics, so I don’t look too favorably on the ACA at all and I’m not a big fan of a single-payer system, but a more collectivist/liberal/socialist perspective this type of policy actually makes a lot of sense. Cutting physician pay would go a long way on help cut down on health care expenses.

    But despite the fact that the same folks who pushed through the ACA might favor this type of policy, no one actually seriously proposed this. I guess it’s because doctor’s don’t have a big enough voice on Congress.

    Cheer up dude, now that you are finished with your residency you can spend the next 35 years of your career enjoying your money and tormenting the next generation of medical residents.

    • JimBob

      CPAs work longer hours than physicians.

  • Peter Torberntsson

    As a physician myself there are some red flags in this person’s letter that are a bit disingenuous and exagerated. I personally do not know of any gastroenterologist that has no days off a month. They are specialists with normalized office hourse and call schedules. It is ture that medical school debt is a huge problem along with all of the other things that nickel and dime you to death like licensing fees, DEA fees, continuing education fees, malpractice premiums etc in the context of deminishing reimbursement from Medicare and Insurers. This physicians attemp to protray himself as a martyr on the front lines is a bit over the top especially conidering how many others have it much worse than we do.

  • LawyersAreNotSmart

    Interesting to read the negative comments. Most do not realize where the root cause is – special interest groups, crooked congressmen/women, the lobbyists, and the millions of lawyers available for pennies. Instead they focus on the 350K/year salary of a specialist. What about the salary of a lobbysist, congressmen/women, special interest group members, and their cronies? It is exponential to say the least. Well written article.

  • JimBob

    This writer, like many physicians, is wrapped up in his own ego. 99.99% chance that he isn’t even intelligent enough to prepare his own tax return each year – but his CPA or Tax attorney is (today it costs about $300,000 to become a CPA or competent tax attorney). Those people earn far less and put in far more hours each week than most physicians.
    The REAL reason that healthcare is a luxury that few can afford is because of the obscene amounts physicians are paid. In our little town, there are more than 100 physicians reporting earnings well north of $800,000 each year. Insurance insulates them from market forces which would otherwise keep compensation at reasonable levels.
    Doctors have a license to steal. In the past, there was enough honor in the profession to refrain from using that license. Today, that honor is long dead.

  • Ami Patel

    I would also like to make a comment that doctors are not the only one who go through a lot of schooling, rack up debts, and don’t get paid for a lot of their services. There are fields that go through 8 years of school, then go through a residency (if they want to, but becoming more common recently), perhaps fellowships, on top of getting other certifications. I think this problem is prevalent through out the entire medical field.

  • Sarah

    I was quite interested while reading this article. I found
    myself agreeing with a lot of the points then I made it to the section differentiating
    attorneys (who doesn’t love to vilify an attorney). The article deals
    with the same problems that all professionals are facing due to the rising
    costs of education, long training periods, low starting salaries and expensive
    testing. These problems are not relegated specifically to the medical
    community. In case it isn’t obvious, I
    am an attorney. I have a nearly zealous
    level of respect for the medical community, but I also realize that both
    professions are in the same boat and, in case the author wasn’t aware, there
    are other professions on this boat with us.
    In only three years of school I accrued over $110,000 in student loans
    from a modestly priced law school. I worked
    to try to help and my grades suffered, impacting my future earnings. Post-graduation for myself and my fellow
    graduates has been a frustrating existence to say the least. We are unemployed
    for more than 6 months after graduation, we have an average loan at 8.5%
    interest, we work between 60-90 hours per week and often work 6-7 days a
    week. I worked 2 jobs my first year to
    try to make ends meet. Attorneys operate
    largely the same as doctors: you have a fee, the client/patient comes in and
    pays whatever the fee is, you do what they need. Also, compare most starting salaries for
    attorneys and physicians to their ending salaries. I think you’ll find that by and large
    physicians end up well above their attorney counterparts despite having similar
    loans, education, and experience. Most
    attorneys I know don’t “go home.” We go home
    and read updates on the law (similar to reading medical journals), watch news
    programs to see if that proposed law is making headway in the public, volunteer
    at workshops and within the community to provide free legal advice, answer
    emails and take calls at 11 pm because our client expect us to be available
    24/7 which is different than many physicians (not OBBYN of course, those poor
    guys never have a break). Physicians,
    attorneys, educators, etc: we’re all in the same boat. We all offer something important to the
    society we live in. Physicians
    heal. Attorneys protect. Educators shape the future. Instead of trying to put down a profession,
    we need to stick together to try to change the access to affordable education
    in this country.

    • Deep

      You should have a look at the follow up that Dr. Moeller wrote, (link at the bottom of the article). He backs away from his statement about attorney ;)

  • Arlene Lewis

    It’s been awhile since I read this type of posting. I’m a physician who practiced OB/GYN for 11 years before deciding I’d had it with feeling like I was going to work every day with a target on my back, and I fortunately found a non-clinical position that still utilizes my medical training. However, reading the comments is still disheartening. The amount of sacrifice it took to become a practicing OB/GYN is not something I’d choose to go through again because it’s not worth it. Even with salaries above $100,000 (I never made over $150,000 practicing OB/GYN due to the region of the country I worked in) it’s NOT WORTH IT. I’m not sure any salary would make it worth it unless it was enough to work for only a year up to 5 years and then be able to quit and never have to work again. That would require way more money than most doctors will ever make. I even heard a neurosurgeon, probably the highest paid specialty out there, say he would do something else if he only knew what to do. Money is never enough by itself to make sacrifices like missing out on family time, having to constantly worry about lawsuits and keeping up with regulations that no one can keep up with AND practicing medicine, the lack of sleep and ability to attend to your own personal needs, deal with the uncaring entitled attitude of many in the public, etc., etc., etc.

    I think the doctors of old made even more sacrifice but there were a lot of benefits back then. They made way more money than now, they didn’t constantly feel the threat of lawsuits, they didn’t have to fight with insurance companies to get paid for work they’d already done, people seemed to respect doctors in the past and they didn’t have near the regulations that doctors face now. They had to do more rigorous training than even we do now, but they did it knowing it would be for a limited time and then there would be substantial payoff. Why the public thinks that doctors are supposed to behave any other way than as a human being where sacrifice is weighed against benefit is beyond me. I decided that to continue what I was doing which I’m not exaggerating to say was killing me for $100,000-$150,000 was foolish. The public can be snarky and say doctors are complaining all they want, but there is really going to be a problem when there aren’t enough doctors to care for them. With Obamacare potentially introducing many more people into the system, that problem is only going to intensify. You can make up some of the difference with nurse practitioners and PAs, but they can’t take the place of MDs and DOs. They can’t do surgery or manage very complex medical conditions.

    The comments about this author or any other physician who tries to explain the mental, emotional and financial place MANY doctors are in right now is dismissed as a sob story. More power to you for telling your story and I hope everything works out for you no matter where your path takes you.

  • Druff

    What is your salary now? If you were to live within your means and make $150-250K per year, how long would it take to wipe out $230K of debt?

  • Kaj

    Whine whine whine…You don’t like it, get another job that you like. You were in it for the money and not for the reason you mention:”because you have pride in what you do. you truly care for the well-being of the human race”. Philanthropists do not whiny doctors like you. The same goes for whiny lawyers who complain about their college loans…they are in it for the money. At least be honest about it instead of telling the world a bunch of howeys

  • shanealbritton

    I’ve read this letter twice now, and I’m still not sure what the author wants. Clearly his thesis is that becoming a doctor is expensive, time consuming and arduous – but what exactly is he asking lawmakers to do about it? Make medical education less expensive? Keep healthcare expensive – to protect doctors’ abilities to eventually become wealthy – thereby justifying the sacrifices they made? Or some other unnamed option that eludes my deductive reasoning?

    “I want to challenge our leaders to address the points I have made in this letter, keeping in mind that this is an honest firsthand account of the personal life of a newly practicing physician.” – To what end?

  • Guest

    I
    totally agree with this article, except the author’s statement “Had I
    invested my
    talents in other pursuits such as law school, I would not have built up
    this level of debt.” The author clearly hasn’t talked to law
    students/recent law graduates about this. We’re in the same boat. Law
    students work endless hours at unpaid internships, while taking full
    time classes. We have to pay thousands of dollars in fees and for prep
    courses for the LSAT, MPRE, and the bar. And law school itself is
    ridiculously expensive. Then, after accumulating all of that debt, it’s difficult for new attorneys to even find a job.

  • http://www.caduceusblog.com/ Deep Ramachandran

    Hey guys, Dr Moeller (who wrote this post) has done a radio interview explaining some of his views, listen to the podcast here: http://www.wor710.com/media/podcast-john-gambling-johngambling/john-gambling-dr-matthew-moeller-111113-23957941/

  • College Student

    Unfortunately, we physicians do not have much of a voice on Capitol Hill. There are not enough doctors in Washington D.C. who can give the insight of this letter while you in Washington, D.C. discuss health care reform……

    Even if you think the rest of the letter should be dismissed because it is “full of sour grapes”, this point (and the rest of that paragraph) should not. Many have said that the author didn’t ask for anything, but this sentence implies it: Physicians need better representation. Most laws falling under the heading “healthcare reform” relate to money and health insurance, not the actual care being provided. As such, those involved with making those policy decisions are usually health insurance companies, “career politicians,” and hospital administrators. Rarely are private-practice physicians considered in those calculations. Now you’re going to say, “well they can if they want,” and my answer is that it’s tough trying to help a large volume of patients AND try and get involved on capitol hill when in your mind, based on the good work that you do, those on capitol hill shouldn’t have such a negative feeling toward physicians. Unfortunately, they, and people in general do, because some how it seems okay to give the person trying to improve your health a hard time when he/she asks to be compensated for it.

    In fact, it seems that the effects of these laws upon the care that is provided is not even taken into account. Sure, it’s great to make “care” more affordable, but what happens to that “care” when the person providing it has to take pay cuts, deal with threats of lawsuits, and deal with the unbelievable stress involved with trying to get money owed to them from an insurance company, all because people in other professions are just jealous. And lets be honest, most individuals in other professions aren’t jealous of the money, they’re jealous of two things: the fulfillment a physician gets from his/her work, and the reverence people have when speaking about their physician. At the end of the day, more often than not, that physician, who you feel makes too much money, did their best to help you feel better and probably did actually make you feel better. Just because, at your job, you don’t get to do the same kind of work, don’t think it’s okay for physicians to deal with pay cuts and underrepresentation.

    What the author said is completely true. If a physician is making, so called, “unfair amounts of money” it’s usually because that individual is working extremely hard. It’s easy, when you don’t know a physician personally, to overlook the fact that many are available at off-peak hours to take calls or to visit a patient who has been hospitalized. And most physicians are completely okay with it. They don’t really mind, because they want to help their patients. People stop believing that when they get a bill afterward. Physicians are full of sour grapes because the negative focus is always on them, rather than the real culprits responsible for the high cost of healthcare, health insurance companies.

    I’m unsure which comment said this, but it said something about how physicians charge so much for an individual visit…that is only the case because one of the biggest problems with private insurance companies is the fact that they (individually, no less) have the ability to define how much they will actually pay (percentage) for a given service. So you might receive a bill for a service that, for example, says $150. Your insurance will only “allow” maybe $50-75. Then depending on your plan, the insurance company will cover it and you will be good or the insurance company will pay a portion and you will be responsible for the remainder.

    But people will focus on the fact that the service costed $150 when they actually didn’t pay nearly that much. They will say, well why doesn’t the physician charge less? Because if they charged less, the insurance company would pay them EVEN less.

  • Katy

    Cry me a river. Dude, that student debt amount sounds like a shocking amount of money, I agree. But everyone who attains an advanced education emerges with a large amount of debt, and most won’t earn anywhere near what you will earn over the course of your lifetime to pay it back. If your lament had been about how ridiculous the cost of education has gotten, you’d have a lot of people on your side. But your lament was about how rough you poor little rich doctors have it. The only people moved by your lament were other self-entitled physicians.

  • Danielle

    You know, I am a firm believer that higher public education (like healthcare) should be free, and malpractice law needs a firm overhaul, but it’s really difficult for me to sympathize with doctors complaining about their lot in life. Don’t get me wrong – $230,000 of debt is unacceptable, and time with one’s family is invaluable, particularly when children are young. And as someone going into the medical field, I understand that there is sacrifice involved. HOWEVER! If I read about one more doctor saying how they only make “minimum wage” I might hit something. I would like you, dear doctor, to ACTUALLY TRY TO LIVE on what people who really make minimum wage live on. And then you can complain about how hard your life is.

  • http://www.nile7.com jaklin badr
  • Carl

    You are deluding yourself if you think that you would not have the same debt if you went to law school. Most law students graduate with close to $200k of debt.

  • Ash Patil

    very well said, Dr Moeller.

  • jaki

    What is your salary now? If you were to live within your means and make $150-250K per year, how long would it take to wipe out $230K of debt?

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