Payment is how this society values goods and services. That doesn’t mean that anything not paid is not worthwhile–but it does think that others aren’t putting much value on it. If what you are doing is serving society, and they will not pay you for it, then they obviously don’t think much of the value of your service.

I grew up poor and am fine with making an average income–as long as I do it with an average work ethic, the average privelege of calling in sick to go to the beach, provision of average benefits, pension, and sick leave. The average privelege of being left alone when the whistle blows at the end of the shift, average levels of personal responsibility, and an average educational and training time and energy. But the practice of quality and ethical medicine demands much much more than average.

I earn near the bottom of the typical income for physicians and am happy with that. But were I unable to earn at least in the general income range of other professions, like accounting, engineering, and law, which are much less personally demanding, I would quit and do something else, something more “average.” If I were a firefighter or a policeman, I would have been saving lives and helping people, with benefits, paid vacation, and a great pension. In fact, I would already be retired instead of looking at another 20 years or more.