Doctors owe a debt to society
I am often told, usually by an experienced doctor, that some doctors owe something to the public, usually to cover the cost of their education. This is in response to various situations. It can be:
- A person who retires early
- A part-time worker
- DoC has a child or “continues with the parent of the parent track”
- Someone who is hot and changing technology or being a stay-at-home parent
- A doctor who is taking parental leave, or recently
- The doctor chooses a Concierge or direct patient care business model
Here is an example of how it is said:
“I just finished listening to the description of your Concierge video. The fast line for general care or the next specialist is why the waiting list is so long right now. This explosion seems to be the Conciction of five medicines or the concierge, and I see people who have done Training in the Concierge seems to be an injury that we should discuss with open minds.”
The Hippocratic Oath?
I’m not sure where this idea comes from. Perhaps it comes from the oath that several young doctors repeat, that is, another version of the hippuc oath. This is one of the older versions:
“I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, acting as my witnesses, that I may do this from this company.
Holding my teacher in this work of art equals my parents; to make him participate in my livelihood; when he needs money to share with him; To think of his family as brothers, and teach them this art, if they want to learn it, without money or indenture; Passing orders, oral orders, and all other orders to my sons, my teacher’s sons, and students who see the opponents who healed the healer, but no one else.
I will use those methods of diet that will help my patients to the best of my ability, and I will do no harm or injustice to them. And I will not administer poison to anyone when asked to do so, nor will I recommend such courses. . . . But I will keep my life and my art pure and holy. I wouldn’t use a knife, not even, really, really, on rocks, but I’ll give things like this a risk there.
I enter any house I enter, I will enter to help the sick, and I will avoid doing everything with the intention of doing evil and harm, especially in hurting the bodies of man or woman, bound or free. And whatever I will see or hear during my work, and outside of my work in sex with men, if it is something that should not be published abroad, I will never be preached, I will protect such things to be sacred secrets.
Now if I fulfill this oath, do not break it, may I always get their reputation because of my life and my art; But if I break myself and I’m hungry, it might go astray.
As I read that, I see nothing that binds a doctor to work for many hours, for many years, or for free without teaching the children of those who taught me medicine. So, maybe there is an obligation to teach medicine for free, but there is nothing there that says I have to do it for free or that I am responsible for the health care issues seen in our modern health systems.
Do doctors owe the public their education?
Who pays for a doctor’s education? In the case of many doctors, they do – to the tune of hundreds of thousands of dollars. Sometimes that credit is done well at work in the middle and beyond. This is in stark contrast to today’s top doctors, who may have faced the Simple Learning Bill. If they went to a state school, the State probably subsidized the education in some way, usually in the hope that the doctor would choose to continue living and practicing in the state. But if the government actually wanted to get a doctor to stay in that state, it should have done that. Those contracts do exist, but they usually pay more than the difference between in-state and out-of-state tuition.
Maybe a doctor paid for their medical education the way I did – through a contract. I have a contract with the US military. The military paid for school, and I agreed to work there for four years, no matter where the military sent me or what I asked to do. The soldiers fulfilled the contract, and therefore. The same applies to the National Health Service Corps, the Indian health service, or the MD / PHD contract program. Yes, if you signed a contract, you need to fulfill the terms of that contract. But that’s not the case for most doctors.
What about staying, you say? Hospitals that offer fellowship programs receive a large amount of money through Medicare, which is paid for using payroll taxes. The most recent data I have seen is that Medicare pays $150,000 for each year you live. My first question when I heard that, “what the heck? Where is all the travel?” Most of them will not actually go to a resident. Even a well-paid resident has a compensation package that can be offered no more than $80,000.
Now, I’m not going to argue that a PGY1 resident costs $80,000. But the super resident is worth a heck of $80,000. Heck, over $150,000. On average, the compensation is likely to be good for the given amount. What is a doctor supervised? It’s easy to see, given the increase in advanced practice physicians (APCs such as PAs, NPS, CRNAS, etc.) in our system. They are paid more than a resident, even a senior resident. In any case, there is no contract, and there is nothing in the hippocral oath or its contracts that requires doctors to work longer – under more relief – less because Medicare helps pay for the last places.
Docs don’t owe anything for their resident training. And even if they do, doctors and high earners alike suffer greatly under the Progressive Tax Code. The higher your income, the lower your tax rate. No reps condition for treatment. No medical interest. There are no stock options in medicine. Everything you earn is taxed regularly at the regular income tax rates. And every little bit of income (barring a CORP involved) is taxed at 2.9%-3.8% for Medicare.
We all pay for those residents. A doctor making $800,000 pays about $30,000 a year in Medicare tax but no more than someone who pays $1,500 a year in Medicare tax. It doesn’t take many years to pay off the cost of your Medicare stay.
More details here:
Are doctors retiring from early trauma with a program that has made them rich?
How to retire early as a doctor
Why is this argument limited to doctors?
For some strange reason, I have never heard this with any other work. No one is saying that lawyers should work 80 hours a week to 75 because society taught them. No one uses this for engineers, astrologers, expert drivers, teachers, judges, or anyone else who helps in teaching. I don’t hear about nurses. Only doctors. And interestingly, it is almost entirely doctors. Maybe it’s time to stop bullying each other in the workplace.
What about Emtala?
As long as we’re talking about obligations, let’s talk about fake legal doctors, emergency treatment and staff treatment (Emtala). This is the anti-wallet biopsy rule. While it works primarily in the Emergency Department and in labor and delivery, it includes any doctor who is legitimately poor doctors, many doctors are bad.
Basically, you cannot ask a patient to pay for their medical care until you have established their emergency medical condition. I actually have no problem with Emtala. I think it’s a good rule of thumb. My problem with Emtala involves financing. It is true that there is no money. It is an inappropriate command. Unlike anyone else in America, emergency physicians are empowered to work for free. And yes, patients benefit from that. Uninsured patients are technically paying to “pay for themselves.” In fact, if you don’t raise money upfront, paying yourself is the equivalent of paying. The self-pay rate in the emergency departments I’ve worked for is about 3%, which is 0%. If you are given an unrestricted rate of 20%, that basically means I work every Friday for free. And I have it right. Most emergency departments have a dismal rate of 40% or 50%.
No, I don’t owe it to society. And if I had, it would have been led long ago with all the free care I’ve given to every fifth patient over the past two decades.
Workforce and Patient Access Issues
Of course, there are career issues involved when doctors work part-time or retire early. Yes, there are issues with patient access when doctors decide not to see seven patients for an hour or adopt a concierge model. These are real, complex issues. But they are problems for our entire society to solve, not problems that can or should be solved by doctors alone. Anyone who thinks these problems are easy to solve doesn’t understand the problem. But doctors cannot take the entire medical system on their shoulders and carry it to the Promised Land. They may try, or – or which explains the rates of 37%-63%, depending on the specialty.
More details here:
What are the most popular medical skills?
What urgent documents can make you hit burnout
Bottom line
If you want to travel the distance, have a baby, start a Concierge practice, take Wednesday afternoons off, cut back full time, retire early, or quit medicine altogether, go ahead and do it. You shouldn’t feel guilty for doing so. You owe nothing to society. You did not steal someone else’s place in medical school or residency. Give me a break.
WHAT DO YOU THINK? Do you think doctors owe anything to society? Why are doctors the only ones who feel guilty for not doing enough?
