I gripe that I have a personal service business that I can’t walk off and leave without losing money, but then I also have to remind myself that I have a business with a nearly zero percent failure rate. I gripe about medicare, medicaid policies, etc, but then remind myself that I am still free and don’t have to play with anyone if I don’t like the rules–and have the guts to sell the value of my service to the customer like nearly every other business.

When the government just plains outlaw me operating my business freely and ethically, then I will have a legitimate gripe, but I am not going to allow myself that vice–instead I will emmigrate or find another line of work. I refuse to be a victim.

My father, grandfather, and great-grandfather were all doctors, so I’m well aware of how time-consuming and difficult the practice of medicine is. But it also taught me that doctors can have difficulty appreciating how time-consuming and difficult other professions and businesses can be.

I’m an engineer. I attended a top-ranked engineering school where I worked my ass off. Even so, while there I teamed up with a couple of other students to build a product. (Doing so didn’t exactly help my GPA.)

After who knows how many hundreds of hours of work, we eventually graduated and started our own business to sell our product. Of course there was no income to begin with so we all had “day jobs”. (Well, to be fair, one of us went on to get a PhD in mathematics. As if that’s an easier course…)

Fast forward six years. Our business was a complete flop and none of us had earned a dime, not because we didn’t have a well-built product (we did), but because we built the thing we were interested in building rather than something that lots of people actually wanted to buy. Oops.

We were forced to change directions, essentially abandoning all the work we had done (the documentation alone was well over 1,500 pages). It makes me sick just thinking about all that work swirling down the drain.

We got lucky the second time and built something that sold. Soon we all were able to quit our other jobs and work for our own company, but with that came management headaches. We were smart enough to know that we were out of our depth and managed to hire, with the help of an executive recruiter, a CEO. But all that meant is that instead of 100-hour work weeks running the business we switched back to 100-hour weeks doing the engineering work that wasn’t getting done when we were running things.

We eventually sold the company (by then with about 50 employees), but I still work on the product and I still work 80+ hour weeks 25 years after we began.

Other people I know who did the same sort of thing were not nearly as lucky as we were. There’s a guy who lives down the street from me who, after 20+ years of those 100+ hour weeks, still hasn’t managed to turn the corner with his little startup. But at least he’s still there – another friend was forced, after years of effort, to declare bankruptcy.

And to be fair, some were luckier. One friend sold his company at the top of dot-com boom. He’s set for life and then some.

Of course I’m talking about true startups here. Franchises are safer propositions in most ways, but as others have pointed out, the amount of up-front money required can be very large and even franchises can go bust.

From time to time now people approach me asking if I’m going to start another business. I always smile and say something polite but negative, but what I’m thinking is, “You must be freakin crazy! No way am I going to do that again!”

In summary, don’t confuse the ability of a few to be in the right place at the right time doing the right thing with the general ability of anyone who starts a business to succeed. A lot more startups fail miserably than succeed to the point of making their founders wealthy. And never, I repeat NEVER, underestimate the amount of time you’ll have to devote to a business regardless of type. It’s always more than you think it will be, and unfortunately it is sometimes more than you’ve got to give.

Our debt ain’t at 4% either, and is due and payable every month, thank you.

How much work do you think a motel owner or a new franchise owner does? And his debt ain’t student loan 4% debt that you can defer. It’s due and payable every month, at prevailing rates.

“With respect to your statement about the ease of dropping out of medicare, it is NOT easy. Besides the time requirement, the fact is unless you are a concierge PCP, dermatologist, or plastic surgeon, medicare patients are (almost) a necissary.”

No one said it is easy, but it’s still your choice. We all make them, in every job and profession, so get over yourselves.

Seriously, don’t leave medicine – you have no idea what you’re doing.

“When you train for so many years, most would agree that it’s reasonable to except to be (at least) upper middle class. “

I agree – that’s why I can’t figure out why you’re yapping about how poor you are since the average physician is upper middle class.

You are right, and this discussion shows just how little understanding laypeople have of actual medical practice now.

And, anecdotally, I have heard the average investment in a mcdonalds or dunkin donuts franchise is about $200,000. This is certainly less than than the time & money it takes to become a practicing primary care doctor (not to mention you don’t have to worry about acing endless tests). And I have heard (again I admit, anecdotally) that these franchises net the owner well into the six figure range.

I’m not saying that running a franchise is easy – it most certainly isn’t. But all the same hassles of running a small business also apply to a medical practice, as well as malpractice issues, third party reimbursement, on-call responsibilities, etc.

And as far as what the rest of the country earns, that doesn’t matter. When you train for so many years, most would agree that it’s reasonable to except to be (at least) upper middle class.

And I think you have no idea the length of training for docs. A doc spends 7-12 years after undergrad in training. The first four of which involve medical school in which debt now is greater than 100K (probably much higher than that if you throw out the rich kids whose parent’s footed the bill). Then add on the 3-8 years in which the resident/fellow works as essentially an endentured servent. The latest ACGME rules (2003) put the resident work hour limits at 80 hours/week (before that it was not unusual to see surgical/medical residents working over 100 hours/week. That’s the fact. With respect to your statement about the ease of dropping out of medicare, it is NOT easy. Besides the time requirement, the fact is unless you are a concierge PCP, dermatologist, or plastic surgeon, medicare patients are (almost) a necissary. A percentage of docs do anyways, but once this number drops over a certain percentage care for the medicare patients suffers. Besides, why would I drop the patient’s with the least access to medical care and the ones who need my expertise the most? The statement “just don’t sign” medicare contracts shows a total lack of understanding as to the number of patient’s under medicare.

Such as. . . ? I mean, a great salesman can make money doing anything, but which businesses do you think are so much easier and require so much little investment than being a physician, and still have average salaries of $150K a year like physicians?

Do you have any clue what the capital investment of buying or starting a gas station is? And the ROI? It doesn’t appear so.

“1- EVERYBODY makes you show participation with medicare/medicaid, from commercial insurers to hospital administrators to malpractice carriers.”

This is simply untrue – there are physicians out there who have completely dropped out of that game – I think Kevin’s even linked some of their blogs.

“2- “high standard”? if you are in primary care, you are SOLIDLY MIDDLE-CLASS after umpteen years of education making $100,000/yr starting in your thirties while everyone else was building a business/ spending their young adulthood having fun / etc. “

Do you really not think an average salary of $150K, or $250K for surgeons, is not upper middle class? If you don’t, then you need to take a hard look at what the rest of the country makes and how hard they work. I don’t think you’re in touch with reality.

Are you joking with the motel line? Seriously, I would encourage you to stay a physician – you have no concept of how the world that doesn’t get all its payments from large companies and the government works.