Full disclosure: I consider myself in the “younger” doctor category. The experiences and sentiment expressed in this entry are derived from what I’ve encountered during my training and now current job.
There, I’ve said it. My attending physicians said it to me when I was a medical student, resident, and fellow. My coworker who is 30 years my senior doesn’t openly call me a wimp, but we both know what goes on in his mind when I whine about taking call. It gets worse. When I was teaching my medical students, they seemed to elevate apathy to the next level—imagine combining laziness, entitlement, and cleverness together. You end up with someone who will only do what it takes to get the grades and advance to the next level. No more, sometimes less.
Maybe subsequent generations are always wimpier. Doctors in the 1970’s and 80’s were mostly men who belonged to single income households. Many surgeons operated from dawn to dusk and rarely saw their families. These doctors also generated serious amounts of income compared to doctors today. The incentive was good for them to work hard; you put in the hours and the money rolled in.
Times Have Changed.
Economic and social shifts in medicine over the past two to three decades have molded the experiences of doctors.
Economics of Being a Doctor
Reimbursements for professional services have either decreased or lagged behind inflation rates. Some surgical procedures in the 1980’s actually paid three times more than surgeries performed today (not even taking account of inflation). We are constantly pressured to see more patients to keep up with rising overhead costs while the complexity of documentation and regulations have made medical practice much more challenging. I make about forty mouse clicks and type several lines in the Electronic Health Record for every patient that I see in the office—thirty years ago the same could have been documented using one side of a 3”x5” index card! The very technology that was designed to improve communication and quality of care not only slows me down but also digs into my checkbook. There are plenty of physicians who actually bankrupt their practices when they are unable to adapt to the changing financial aspects of medicine.
In some ways, the increased restrictions on how we practice medicine have led many doctors to limit the number of hours they actually spend working. Twenty to thirty years ago, internists typically ran outpatient clinics and saw their patients who end up being admitted into the hospital. A typical week may entail 35-40 hours of outpatient clinical care, another 2-3 hours of managing the business, and 2-5 hours caring for hospital inpatients. Now, the role of caring for inpatients has transitioned to that of Hospitalists—doctors who strictly work on a shift basis caring for inpatients. The doctor who was able to handle his business, hospital patients, and his clinic in 50 hours a week may need 60 hours to do the same thing AND get paid less. From an economic perspective, it is a no brainer to actually put in fewer hours. Yes, the healthcare system is way too complex to be explained solely by this reasoning, but from a practical sense, working less actually makes sense. Ironically, by working less, the new-age doctor by default becomes “wimpier”.
Social Changes in Medicine
One significant social shift in medicine is the increasing number of FEMALE doctors. Most medical schools enrolled nearly a 50/50 distribution of male to female students. What this also means is there has been an increasing number of dual income doctor households. A dual income doctor household confers two advantages: (1) higher earning potential and (2) diversification of income. If one spouse’s job ends up being horrible and he loses his job, the family isn’t going to starve. A dual income household allows flexibility in how much each spouse needs to work. Instead of one spouse working 78 hours a week, you can have both spouses working 40 hours a week to generate an equivalent income. With an easier cash flow, neither working doctor spouse actually has to put as many hours in. With social change, there is now a higher potential to have two wimpy doctors in a household.
Wimpy Doctors Come Ahead Financially
Yes, younger doctors who put fewer hours are wimpy compared to prior generations of doctors. The earning power of younger doctors will unlikely ever compare to that of prior generations due to the nature of the healthcare system. However, the new generation of doctors are savvier. We are resourceful enough to learn the basics of managing our finances and know where and when to seek assistance. Our hours of work will be less, but we can take advantage of increased freedom to broaden our fund of knowledge, prepare ourselves financially, and have more time to our families. Dual income doctor families have an even greater advantage. With appropriate division of earning potential combined with an intelligent savings rate, a dual income doctor household can have a diversified means of building net worth and a higher likelihood of achieving financial independence.
Being wimpy wins.
What have you done to take advantage of the changing face of medicine to improve yourself financially?
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