The “deceptive” income of physicians

One perennial topic of profuse internet discussion, ranting, and general circle-jerking among medical students, American medical students in particular, is the idea that doctors’ incomes are “deceptively” high, and that really, when you take all the cost and effort of training into account, physicians don’t really make any more money than [insert some other “humbler” profession of your choice]. This is a topic that pervaded blogs and forums back when I was a bright-eyed pre-med seeking advice for my med school applications, and it continues to be a popularly repeated topic now, as I near graduation. Most recently, this article has been making the rounds on reddit, and to be honest, I’m really sick of it. Yes, medical education is expensive. Yes, the training is long. Yes, you have to work hard. And no, you probably shouldn’t decide to go into medicine if money is your only objective. And I do think that we probably deserve the high salaries that we’ll eventually get. But what’s this need to compare ourselves to everyone from high school teachers to nurses in order to “prove” how much “worse” we have it?

We were the ones who, of our own free will, decided to put ourselves through this. Because, after careful consideration, we thought that it would be worth it. Few of us came into this blind. Most of us could have succeeded in any number of other potential professions. And if we really thought that it would have been better to become high school teachers, dentists, and nurses, we would have picked a different path. Can we really not just be happy with our career choices without trying to convince everyone else that we’re all a bunch of self-sacrificing martyrs who have dedicated our lives to the thankless service of humanity?

I think the real reason that these kinds of discussions keep happening is that we’re afraid. With all the recent talk about runaway healthcare costs and “bending the curve,” many members of the lay public have looked at doctors’ salaries as a potential place cut costs. And so we’ve become defensive. We’re afraid that by the end of our grueling training (and I do agree, as anyone who has done 24-hour call or worked an 80+-hour week will, that the training is grueling), after we’ve all worked so hard to be worth what we thought we’d be worth, that by then, our salaries will have been cut to pieces and the journey wouldn’t have been worth it at all anymore. So we make ridiculous claims about how we should have all just become high school teachers instead (since no one could ever accuse a humble high school teacher of making too much money), not because we actually believe it, but because we want to convince everyone else to sympathize with us. And somewhere, deep down, with the smallest tinge of guilt (because most of us did go into medicine, at least in part, because we had some selfless notion of wanting to “help people”), maybe we do wonder if doctors might just be a little tiny bit overpaid after all. But as soon as that thought surfaces, we drown it again in another wave of facts and figures and comparisons.

Teaching hospitals

A few days ago, I overheard a conversation at work. One of the other medical students was speaking to my research mentor’s secretary, and the gist of the conversation, to which both the medical student and the secretary seemed to agree, was this: “I try to avoid going to teaching hospitals for my medical care because I don’t want medical students and residents to ‘practice’ on me.”

I’m not going to pretend that medical students, residents, and other trainees know what they’re doing, and I acknowledge that people have the right to choose who takes care of them. I concede that health is an important thing, and that it shouldn’t be entrusted to just anyone; healthcare isn’t something to be toyed with or taken lightly. Even still, this sentiment doesn’t quite sit right with me, especially coming from someone who is, herself, a medical student.

First of all, teaching hospitals (especially those at major academic medical centers) tend to be at the bleeding edge of medical technology and to offer the most advanced techniques and therapies available. These are places that worry a great deal about their reputations and have the resources to attract the most prestigious, most top-of-their-game staff members. This is why the rich and famous tend to seek out these academic teaching hospitals for the various surgeries and other procedures that they may need.

Secondly, while there will be trainees running around who will have some responsibility in your care, nothing is done without the oversight of a full-fledged attending physician. It’s true that medical students or residents may be given the opportunity to “practice” on the patients, but the attendings will do their best not to put you in any real danger. In fact, many patients volunteer for trainees to practice simple procedures on them (for example, drawing blood or taking a blood pressure), because they want to give back to society for the wonderful care they’ve received. Furthermore, with so many trainees around, there will be more people looking at and talking about your case. Attendings are human, too, and sometimes they miss things just like everyone else. At a teaching hospital, medical students and residents are around and can potentially catch their attendings’ mistakes.

Lastly, and perhaps most importantly, you’re a medical student! You’re going to be poking and prodding and practicing on hundreds of patients before you feel like you know what you’re doing! How can you expect other people to allow you to practice on them, when you’re not even willing to have it done to you?