“In it for the money” and a mini rant therein

So, there’s something that’s happening in Ontario right now that has been appearing on my Facebook feed that’s made me consider – and rant a bit – at this concept that doctors are only into medicine because they’re “in it for the money.”

The Ontario provincial government is cutting the fees that doctors can charge for services, and the totalled cuts this year are more than 4 percent.  And a lot of the public response seems to be totally on board with this, because well, doctors aren’t really working those long hours in stressful situations because they have a dedication to medicine and their patients, they’re just doing it for the money.

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Really?

So, it’s impossible that a doctor might have a sincere passion for medicine and helping people and also want to make a fair wage for the work and training they do and have?

Since when were these two ideas mutually exclusive?

“No, but we’re only talking about the people who go into medicine just for the money, not the people who want to help people and like the idea of money,” people who take this viewpoint often say.

So yeah, two things in response:

  1. No, you’re also judging people for whom one of their motivating factors for medical school is the ability to earn an income, i.e. everyone.
  2. Seriously, are there actually people who chose medicine just because they are “in it for the money?”

Now, I’ll come back to point 1 in a second, but as of point 2, I’m actually curious: are there people who actually think that medicine is just filled with people who want to make bank? Because medicine is kind of a terrible way to do that, from most viewpoints!  If you were motivated solely by income (and I’m not judging, having money is fine!) then would you look at 8 years of university, 100-200 thousand dollars in tuition and then 2-5 years of residency compared to say, 4 years of university, maybe 20 thousand in tuition and an income earning job after those 4 years like say a business degree provides and go, “oh yeah, medicine seems like a great get rich quick scheme!”

Any hustler who makes that trade is bad at hustling!

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You’ll note this movie wasn’t called “The Wolf of the Family Practice.”

Look, yes, doctors have an increased earning potential compared to many other professions.  But they also don’t receive pensions, or bonuses.  They have to pay malpractice insurance, wages for office staff if they are in private practice and they don’t have any kind of severance package.  There’s this image of the physician as this fat cat, rolling in all this money, and thus because of that physicians aren’t ever able to complain about spending cuts or long hours or the normal hardships of life that everyone else does.

And that image isn’t true.

Most doctors are just like anyone else: working to pay mortgages or car payments, to send kids off to university and to save enough away to retire.

When did the ability to earn money become such a dirty thing when considering a career path as a physician?

Because seriously, the potential earning power of a career is something that everyone considers, no matter the career.  When was the last time you had someone tell you, “Well I’ve practiced and trained on this musical instrument for years and now I’m going to audition for my dream job in the Wherever You Live Symphony Orchestra.” And you replied, “Yeah, but you must not have a sincere passion for music or you’d just give free concerts and busk for donations on the street.  You’re just doing that for the money.”

You’ve probably never had that conversation, right?

And yet it’s perfectly fine when someone when says, “Look, I’ve worked really hard and studied and volunteered to become a doctor,” to think or say, “Yeah, but you must not have a sincere desire to help people or you’d be a nurse or a paramedic. You’re just doing that for the money.”

As if nurses or paramedics don’t also work for money?

Look, the less romantic view of the world is that, it’s great that you have something that brings you passion and fulfilment in your life, but if that’s your career – and kudos if it is – it’s also going to have to make you money.  I have a sneaking suspicion if I told my landlord tomorrow that I’d decided to stop paying him rent, and instead was going to pay in free blood pressure checks and physical exams, I’d probably be without an apartment pretty quick.

I want to deliver babies. Personally, for me, one of the pros of medicine over midwifery or nursing was the ability to earn a greater income: to support myself, my future family, for necessities and yes, for indulgences.  Does that mean that I’m not going to also give my patients 110%, that I’m not going to work hard and enjoy my career?

No, of course it doesn’t.

But I’m going to take a stab at answer my own question from above, and say that when the idea of earning money became a dirty idea for physicians was right around the same time people started needing to cut budgets.  Because, if you look at the situation now in Ontario, and the public response to the cutting of doctors fees, you can see that governments and organizations benefit from this myth of doctors as entitled, Richy Riches. Because that way, when they go to cut fees, the public aren’t asking important questions like:

“Wait, how will this effect my quality of healthcare?” or

“Wait don’t we already have an thinly spread out healthcare system that needs more funding and not less?” or

“Is this going to make recruiting doctors to areas that are in desperate need of them – like rural or intercity areas – even harder now?”

Because those, and many, many more questions are the sort that need answering when funding for healthcare and doctors gets cut.

Not, “Oh darn, will this effect my doctors ability to make their BMV payments?”

Money isn’t a dirty word, and physicians, just like any other professional, aren’t sleezy for wanting to get paid for the work they do.

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*Also, apologies if I sound flip, and for any vitriol.  This is just a subject that kind of bugs me!*

7 Comments Add yours

  1. writingbolt says:

    Anyone in the medical field is in a hot seat because there is SO much “red tape” lingering in the shadows. All this insurance business, what should be free, who is abusing what and how do you prove it, etc. It’s a hot bed of controversy and trickery. So much legal jargon and paperwork, some people’s way of keeping warring folks at bey. Money is just one big root of evil that pops up even if it’s not right. If money wasn’t a concern, people couldn’t use that in their outbursts. Could they? And, who does seem to make more money than most? Doctors. Well, they and maybe TV stars who demand these ridiculous salaries and live in mansions they trade frequently between fire seasons.

    But, if doctors really care, they’d be treating people directly and not handing over the job to assistants. Of course, then we’d need more doctors and a better way of training more people to be them. Well, let’s face it, the whole practice is a mine field of internal and financial stress. How can one be a good doctor when so many have their hand in the patient…er, pot?

    1. dellaliz19 says:

      I agree with you in that the systems of compensation we have (fee for service or salaried) are not perfect, and that they certainly need oversight and review (especially in the USA, where no centralized bargaining means that hospitals can set their own prices and charge wildly different prices for the same service). However, I’m going to respectfully disagree with you on a few points. I have no idea what you mean by “handing the job over to assistants” and I desperately hope you don’t mean nurses. But anyone who doesn’t think doctors don’t care hasn’t seen a doctor agonize over a potential cancer treatment on their way into work, spend 20 extra minutes in a full clinic day explaining chemo to a weeping spouse or stay behind late to talk about soccer with a hospitalized, homesick patient. I’ve watched doctors waive fees and ask their patients to make food bank donations instead, and try to counsel patients against things like buying glucose testing strips that don’t have the evidence to support them.

      Additionally, conflating physician salaries with that of hollywood movie stars is a bit dishonest. According to Stats Canada, Specialists (13 average years of university) made an average of $350,000/year and General Practitioners (10 average years of university) made $180,000. That’s a substantial salary, but its certainly not millions, and in my opinion its comparable to Judges ($260,000/year), Senior managers corporate/industry ($225,500-$205,000/year), Dentists ($175,000/year), Lawyers ($165,000/year) and Actuaries ($155,000).

      Is what we’re paying doctors appropriate? I don’t know, that’s a question for a free market economist. The point I was trying to make in my post is just that a high salary and true empathy for patients are not mutually exclusive. That doctors wishes to have fair negotiating power regarding salaries doesn’t negate their passion for helping patients.

      But thanks for commenting and sharing your view! Differing opinions are how we expand our horizons.

      1. writingbolt says:

        Nurses may be one title they are given. All I know is I hear the word “assistant” more than any other word. Nurse seems archaic when I think about it.

        I didn’t even know/think about the possibility of hospitals acting like retail outlets and making/adjusting their own prices like grocery or clothing sales.

        Oh, I didn’t say NO doctors care. I wanted to come back and make that clear. Besides, I wasn’t totally siding with your opposing argue-er, either. I know that much. Sure, some doctors care (if not most). But, because of the financial aspects of the job, I imagine some “new recruits” will look forward to the pay. And, others who start out wanting to be the good service professionals may find themselves “turning to the dark side” (looking at the money more than anything else) if the job gets them down. I am merely stating the odds of possibility. It’s possible doctors could care more about the money than the patients/job due to any number of variables/influences.

        I don’t have the salary/pay stats, but I suspect pointing fingers at doctors and celebrities is more common/easier because those are seen more often than judges and lawyers.

        …Dentists ARE a type of doctor.

        I don’t know if any pay rate is fair/accurate. I think the whole system–if there is such a system–is screwy. I keep saying the economy was created as a means of separating people into groups and invoking some form of control (the alternative to chaotic theft and violence of ancient times, I suppose).

        I think some doctors probably don’t get paid enough for their kindness. What dollar sign do you put on a good person? I don’t think there IS a right price or a way to rate that in a book of business jargon.

        I just don’t like all the paperwork and money matters attached to someone I should feel good about seeing once in a while when I can’t treat myself. [And, what happened to people treating themselves for minor things? We’ve lost the old way of doctors teaching people to do that and NOT clog up waiting rooms with minor coughs and whatnot.]

    2. dellaliz19 says:

      *Sorry, I’m trying to reply to your latest comment but wordpress seems to think its mine apparently, because I can edit it but not reply?*

      You make several fair points (although I think if I called one of my classmates who did nursing as their first degree a “doctor’s assistant” I might suddenly find myself needing a doctor!). But yes, the balance of compensation must always be weighed to make sure that it isn’t attracting the wrong kind of people to the profession (though going through medical school now myself, I can say that if you don’t have even a little bit of passion for it, you’re going to get eaten up and spit out!). And yes, doctors are definitely more visible, which is why I’m sure they are mentioned in these cases (also more publicly funded then the other professions).

      I agree with you 100% that we should be trying to get people not to go to doctors with minor problems, but I kind of feel this is a societal problem. Most family docs I’ve been placed with really don’t like patients coming in with little things and try to teach them how to deal with it themselves, but as a society will have become accustomed to the idea that we should go to the doctor with every little thing (and often with a WebMD diagnosis and recommended treatment, and boy do doctors love that!) And yes, putting a dollar value on the price for caring for someone is an incredibly hard thing, but it does need to be done sometimes. What that amount is, I think we can both agree, needs to be the subject of more review!

      Thanks again for sharing your view!

      1. writingbolt says:

        As soon as you say it’s a problem for someone else to solve (blaming society), the buck is passed, another line of red tape appears, and more hassle abounds, weighing even greater upon everyone’s psyche.

        I hate to sound racist, but it seems certain nationalities go to the doctor for minor things more than others. I have spoken with people around the world, and certain cultures would tell me so often they went to the doctor because they had a sore throat, sniffles or a cough. I gave them remedy instructions. They told me they had to see a professional. When they returned from the doctor, they said I had given them the same advice. How stupid is that???

  2. joeythebuddhist says:

    I just wrote on this subject too

    1. dellaliz19 says:

      I went and browsed your blog and although I couldn’t find that post, I absolutely agree with your one on Daraprim. Now there’s an example of corporate greed blotting out human decency!

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