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Doctors, Know the Power of the Dollar

I haven’t been completely honest about why we decided to get out of student loans in such a hurry.  Yes, I like numbers. But there was more.

Turns out being an attending wasn’t as glamorous as I imagined.  When I was in medical school, I pictured being an attending would go like this: I would leave my beautiful, large, well decorated house on a hill in my Jaguar.  I would pull into a doctor’s spot and strut into the hospital. I would go door to door, making brilliant diagnoses and touching lives. 

As I would walk down a hallway, nurses and staff couldn’t help but give me a high five… so many high fives.

Yeah.  That’s NOT how it turned out.

As a hospitalist, I would rush over to the hospital after prying my children from my legs.   I would park in a doctor’s spot, but then get chased down by the parking attendant, “You’re not allowed to park there, miss.  Doctors only.”

Guess I wear a badge with an MD just for kicks and giggles.

I would hurriedly go over charts and try to identify anyone that may need attention right away.  Then, I would “round” with case managers and hospital administration and they would tell me exactly how many more days insurance would cover in the hospital for all my patients.

 “That older lady that almost died 2 days ago has no one to care for her at home? Someone will be there tomorrow? Ding, ding, time is up. She doesn’t qualify for nursing home and her medicare days are used, so you’ve gotta get her out today doc.”

“No,” I say.  “I’m concerned about her.  She needs one more day.”

Running around from room to room, talking to patients, keeping it quick because I have charting to do! Lord knows if I spent more than 10 minutes in a room, I would not get home to my children before their bedtime.

Gotta get it done. Somewhere in there, I’d have to find time 20 minutes to pump.

Then, run, run, run!

Afternoon conference to “learn” how to document better so someone else could get paid. “We are losing money,” but administrators are getting paid millions and we are getting sold like commodities to private equity.

A code here, a rapid response there and the afternoon is gone.

Pump again, and then sit down with the charts. So many words to put down what I saw in 10 minutes. “Oh I’m sorry do you need the chart to see what’s going on with your patients? You’re just a hospitalist. Someone more important needs it right now.” The specialist comes back with some condescending words and, thankfully, the chart.  

Call from case manager, call from hospital admin. “Get her out, she has no more days.” Discharge, discharge, discharge.

Not what I imagined.  

Finally, one day, I had enough.  I walked out. I told my boss, “I quit!”  It felt good. I called my husband on my way out of the door.  He said, “Yes baby, good job. I know you were unhappy.  We are here at the mall buying the kids some clothes. I’m just going to put it back and we’ll meet you at home. We’ll figure it out later.”  You see, I was the primary breadwinner. Without my paycheck, we still had to clothe my children, pay the $2400 student loan bill, the mortgage, and other living expenses.  How would we do that? We had an emergency fund but we would burn through that fast.

Reality Hit.  What had I done?

I walked back in to my boss’s office… ate humble pie… and returned to the ranks, until I could find a smoother way to exit.

I NEVER want to be there again.  I never want to have to be in a workplace because I need the job.

When physicians graduate residency, we are sold this big ol’ dream. Big house, big car, big life… you deserve it. You’ve gotta have it. If you don’t, everyone will think you are a failure.  At this point we are a million dollars behind our peers. We have lost over 10 years of earnings while studying and training, over 10 years of retirement savings, and have racked up an average of a quarter million dollars in student loan debt that has been accruing interest.   

And then, we buy a huge house, big furniture to fill that house, a big car. How do we pay for it? Financing. We take our future dollars earned and promise them to someone else, with interest. We handcuff ourselves to a job. If the job goes, our whole lives fall apart.  Because what else is going to pay enough to cover all those bills? So when something comes up at the job that we may not agree with, we have no power to speak up. We can’t lose our job. We have to feed our children. Inadequate supervision of physician extenders? Unethical treatment of staff? Illegal kickbacks being received for referrals?  Healthcare is rife with inefficiencies and third parties trying to make a buck.   Our patients depend on us to speak up for their interests.  How can we speak out when our children’s wellbeing is on the line? We won’t. We don’t.

This is the problem with medicine right now.  Doctors have given up the Power of the Dollar.  We are in a business. We are the driver of the business, the cash generators.  But we have no idea where the money is going.   We have given up the dollars to MBAs, insurance companies, and big pharma.  We have no idea what our patients actually get billed because “that’s between them and the insurance companies.” We have no idea what they are having to pay for the medicines we prescribe them.

How did we get here? How do we get out?

We have to take back control of the dollar.

To do that, first, we have to clean our own house.

Shed the chains of debt. Get out from under the thumb of financing.

TAKE BACK control of the dollar.  Know where the dollars are going and where they are coming from.   Then, we can begin fixing this broken system.

Oh, and if you know a hospitalist, please give them a hug today.  They need it.  #hugahospitalist

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Standard Disclaimer: For Entertainment Purposes only.  Not meant to be personalized financial advice.  Do your own research and consult a financial planner and account prior to making major money decisions.  Views are my own and do not represent any employer.  Images from by Ani Kolleshi and Luis Melendez.


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