This excerpt is from a letter by a physician printed in Emergency Medicine News, July 2008.
The letter makes a lot of sense.
There is a fair amount of paranoia at OSF amongst physicians and some feel if they speak out they will be punished. Many doctors know some policies at OSF are not ethical. Patient care in Peoria suffers due to physicians fearing for their jobs.
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Debt Makes Doctors Miserable
I am a 30-something EP practicing for five years in California. I also spent a couple of years on the East Coast. It really is a jungle out there in the ED “pits” from coast to coast. The lack of control most doctors experience is definitely adding fuel to the general burnout.
I personally make every attempt to limit and eliminate debt when possible, which gives me a degree of autonomy in my practice. I do not need to work an obscene number of shifts just to keep up. There is also mental freedom knowing I am not in jeopardy of losing my income and home from an unpleasant interaction, whether it is with a patient, hospital administrator, ED staff member, or fellow physician. If things ever get rough, there is security in knowing I have many options, including taking some time off.
As a result, I find myself within a minority of emergency physicians who do not wish to bury their heads in the sand and simply collect a paycheck. I find myself one of the few voices present and willing to speak up at monthly meetings, even when there are grumblings in the pit all month long. I believe in the idea of right and wrong, and in not simply looking the other way when one is in the midst of wrongdoing, even when it is too complicated to pinpoint precisely.
When physicians are scared to ask about money billed in their names and not allowed to collectively control practice details, that just seems wrong to me. It also seems wrong when we physicians are more concerned about keeping up with the Joneses than we are about the details of our practice sites.
I strongly believe physicians have an obligation to make choices carefully. Even our personal life choices can have an impact on the overall health care system.
For example, when we acquire massive debt, we are no longer free to express important opinions, which may be distasteful to certain interested parties. We are all well aware that certain powerful individuals can immediately reduce our workload without reason, consequently controlling our income. As inconvenient as our opinions may be, they are important and should not be silenced, which is something we do to ourselves and our colleagues when we have massive monthly overheads and/or work for the highest bidder without regard to company structure and process.
We all know the decades of sacrifice and delayed gratification it takes to become an EP. It’s only natural to enjoy the income we experience after completing residency. Many of us have families to support, or simply wish to play after many years of sacrifice. The more money we make, the more fun we can have playing, and we can buy better toys as well. I only wish some of us didn’t go so crazy with the extra zeroes we start seeing on our paychecks after residency. When I see a friend or colleague add a high six- or seven-figure home to a six-figure education debt, I immediately know that he will never be able to stand up for himself or anybody else for that matter.
Debt is the new shackle. There are some great doctors out there supporting groups that should not occupy such an important place in our specialty nor wield so much control over our lives and livelihoods. I hope we will shift our mindset regarding contract holders. They never call themselves employers for legal and business/financial reasons, and we should never consider them employers.
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Comments in 2021--
1. I remember being a medical student and resident physician and hearing my attending physicians complaining about how hard they were working. And they had conversations with their wives on the phone and argued with them about how they would be late for dinner again due to work in the hospital.
2. I did not want to live like that when I grew up.
3. Something that did not occur to me back then was the fact that these docs lived in big houses and needed to work hard to pay their bills. They were trapped by their lifestyles. And this probably led to some burnout, too. I didn't think about stuff like that back then.
4. So due to the fact that some were owned by the medical center, and they needed to keep their income, their ability to dissent against hospital policy was limited. And patients can suffer when their own doctors cannot advocate for them.
John A. Carroll, MD
www.haitianhearts.org