A young physician writes to Barack Obama

Ophthalmology resident Rachel K. Sobel pens an open letter to the President-elect in the Philadelphia Inquirer:

Where have all the primary-care doctors gone? Today’s young doctors are buried in educational debt. They have a huge incentive to skip poorly paid primary care and choose more lucrative, procedural-based specialties.
In the 1980s, the median amount of debt was $27,000 for private-medical-school students. Now that figure is $135,000.
It’s children who get hurt the most from our undervaluing primary care. Doctors who focus on pediatrics are among the least compensated despite the important role they play.
Wouldn’t you want the best and the brightest taking care of our children, the future of this country?
The average starting salary for a general pediatrician is $125,000; compare that to the average starting pay for a radiologist: $350,000.
What would you do?

Well said. And kudos to this specialist sticking up for her primary care brethren.

Comments

DR. MARY JOHNSON
“. . . kudos to this specialist sticking up for her primary care brethren.”
The brethren and brethrenettes could certainly use some help.
I’ve been standing up and talking back for ten years. I’ve also done my fair share of writing disinterested/disengaged politicians (a good many of them in Obama’s party). I’ve not exactly gotten “kudos” for the trouble.
But it will be nice to have some company.
To quote the administrator of a small-town “non-profit” hospital in North Carolina . . .
. . . “Good Pediatricians are a dime a dozen.”
JB
The sentiment is nice and the lofty goal is generous. However, simply writing a letter doesn’t help anymore. These politicians rarely even get these letters.
Obama has said he wants everyone to have the chance to make more money. While that claim is slightly counter-intuitive, GPs are one group who deserve some help, simply by the nature of the work and the numbers listed in this letter.
I’m a student preparing for medical school next year and it is terrifying to see the foundations of modern medicine (GPs) be neglected. As a student, I represent the future of the field. As a student, I know there is energy and drive to make the medical field better for all involved, doctors, patients, etc. I see it in my fellow students and those in the field who care enough to make efforts such as this letter.
My question is, what can actually be done about this problem? Beyond writing a letter or casting a vote every 2 or 4 years, is there anything that professionals and students can do to be proactive about bringing some light to this issue?
Robin
Well, $27,000 debt in 1980 is approximately equivalent to a $96,000 debt now. Not as big a difference as it sounds.
Anonymous
don’t feel so slighted mary johnson, to many a hospital administrator, all doctors are a dime a dozen.
Anonymous
If only the President could assign salaries to everyone in the workforce, but alas the marketplace sets compensation based on perceived value.
When government controls all health care spending through a single payer system there will be more equitable pay, lower pay for all but it will be more equitable.
DR. MARY JOHNSON
Chuckle. Exactly Anon 8:23. Some of us learned that lesson the hard way.
And Anon 8:59, I’ve done the dance with a federal program and I can tell you (from the sad experience) that (1) oversight is a joke, (2) whistleblower protection is non-existant, (3) the Feds cannot manage the programs they already have out of a wet paper bag, and (4) politicians DO NOT really CARE about good care or patients or (especially) doctors. All the hot air is about power (doctors don’t have any) – and buying votes.
Here’s a thought, maybe doctors could unionize (no, I am not talking about the AMA – as they say in NC, “as useful as tits on a boar hog”) and drive ourselves completely out of business in 10-15 years – just like the car companies. Then the government will own us anyway.
JB is right. Over the years, I’ve sent hundreds of letters and e-mails begging for help. Most of them fell on deaf ears and were never answered. Crimes were commited against a physician in public service – the public itself was ripped off in the deal – and NO ONE CARES.
I will not believe change until I see change – starting with my case. Paging Governor Bev Perdue and NCAG Roy Cooper!
It’s a mess. I honestly don’t know why anyone would go into medicine with things being the way they are.
Anon 8:59, do you honestly think that you are going to attract the brightest and the best . . . and they will work like slaves for the decade-plus it takes to become a physician . . . if all they can expect at the end of their training is “equitable” pay (as determined by some pencil-pushing nimrod that thinks they’re a “dime a dozen”) courtesy of a society/government that does not appreciate their hard work and sacrifice (I believe that was Obama’s word)?
Does it work that way for the lawyers and the administrators/business-school grads? I don’t think so.
But hey, you keep smoking that single-payer stuff John Edwards is passing around (may God help us, he’s back – WHY O WHY DOESN’T HE JUST GO AWAY AND STAY AWAY?).
Anonymous
We can help shape reform if they bring it up. There are alot of things we can do. We can march on Washington. We don’t have to outright unionize although with a much larger percentage of empolyed physicians that becomes possibility that wasn’t there 10 years ago. Simultaneous slowdowns can occur without an outright union. Simultaneous vacations can occur that are not called strikes. We could take the stance we will all go on Vacation if health care reform is not coupled with Tort Reform and do our best to ensure this doesn’t end up a onesided policy. Less they forget we are the volunteer soldiers. We are the boots on the ground and without us nothing happens.
Deron Schriver
Dr. Johnson – You’ve done a lot of writing about unfair treatment, but what is your solution? Simply complaining about unfair pay will not get anyone anywhere. You need to orgnanize and come up with an actual solution. For example, you could fairly easily show how the focus of the RVU system is a major culprit of our high cost healthcare system. You could then propose a realignment of the values to achieve the results that our system needs. I’m behind primary care physicians 100%, but simply complaining could actually be hurting your cause.
Anonymous
Anon 8:59…if only physicians’ salaries were market-based. They are not (except for those providing uncovered cosmetic procedures). Physicians’ salaries are effectively set by CMS, which uses an administrative payment system known as the Resource-Based Relative Value System (RBRVS…google it!). While you’re at it, consider also reading about the RUC (the AMA’s RVU Update Committee). If you still believe physician’s incomes are market-based, I have some nice credit default swaps to sell you.
So let’s see. CMS is in the executive branch of government. Therefore CMS works for the President. So yes indeed…Obama can in fact determine physicians’ salaries! (and fix the primary care/specialist disparities in pay)
DR. MARY JOHNSON
Deron, due respect, you’ve popped up here before – telling me that I should not be so “negative” – or that I need to develop “a plan”. You sound like some of the (left-leaning/John Edwards-loving) journalist-bloggers in the Greensboro, N.C. area (where I got my start) who, for a while, had had me jumping through every hoop (writing short version and long versions of my story) . . . in order to snare that elusive “hook” that might compel them to take action and actually report a story right under their noses.
I would submit that at some point, it becomes the responsibility of the politicians and journalists getting the letters and the (damning) information to treat me (and others) like something other than a warm body to be stepped on/over on their way to power and prestige.
I am not just complaining about “unfair pay” and if that’s what you think, you can’t have spent even a few minutes on my blog. Go back. Read and learn. That’s what someone who is “behind primary care physicians 100%” would do . . . and they’d do it BEFORE they comment.
(Anon 9:14) I’ve done some “extensive” writing on how useless our medical lobbying organizations are – they sold out the younger generations long ago. Health care reform and tort reform are joined at the hip. You cannot have one without the other. It IS a mixed/complicated message – and actually accomplishing anything is going to have to be about more than painless, politically-correct sound-bites.
Fixing a wound hurts.
In my own situation, it is very sad that a town can be held medically captive for well over a decade by two WAY OVERPAID hospital executives – operating with virtually no checks or balances . . . while Pediatricians are driven out of that same town (in this case, my hometown) for doing the right thing . . . and/or go bankrupt/lose their homes if they stay.
Deron, you do not seem to understand is that what I am asking for is relatively simple (you could call it a “plan”). Enforce the laws we already have – fix the ones (like whistle-blower protection/blanket peer review protections for hospitals) that do not work. Hold hospital executives accountable in the same way doctors are held accountable (it would be nice if that profession could acutally admit it makes mistakes).
And here’s a big one: Don’t create MORE Federal programs until you address what isn’t working in the ones you have.
Oh, and do something – ANYTHING – to get us some tort reform. Soon.
It’s not just about pay. It’s about a mentality in this country that wants the best of everything in medicine for nothing – and is literally killing off the people who provide the service.
So, as I see it now, the BEST thing I can do is write about my experience (that could STILL be fixed/made right if some politicians and law enforcement officers in Raleigh and Washington – you know, the ones promising “change” – got off their duffs and simply enforced the law as it is written).
The second best thing I can do is jump up and down and SCREAM at the journalists worshiping at the altars of power and profit (the tactic doesn’t seem to be working too well for them . . . as most newspapers are barely hanging on by a thread . . . for people are tired of of the sucking up and the biases . . . they want MORE).
Obama (your guy apparently) said to “get in their faces”. He was not my man. But I am going to take his plan of action to heart.
Anonymous
“Health care reform and tort reform are joined at the hip. You cannot have one without the other”
Nonsense. All the caps in the world won’t put an extra dollar in your pocket, and distract from your real issue – getting paid more. When you go running to the government for solutions you get what you asked for – more government. How’s that working out for you now?
However, you are right you need more effective lobbying agencies. I can’t tell who the AMA works for because it isn’t the individual doctors. Liability carriers maybe, hospitals maybe, but doesn’t appear to be doing much good for doctors. It’s amazing that the world’s wealthiest profession is so politically inept. I guess when you sold your souls to the govt. 40 years ago you sold your ability to think outside the govt. as a solution to all your problems as well.
For goodness sake, hire someone to write some legislation to untangle you from the govt.’s clutches, educate your fat and happy members on why they won’t be fat and happy much longer (or at least fat), and start organizing for YOURSELVES instead of waiting for hospitals, insurers, etc. to prod you along.
DR. MARY JOHNSON
Now who’s talking “nonsense”? My real issue is NOT getting paid more (although it IS an issue). It’s about being treated fairly . . . like a human being . . . as opposed to some pawn on a chessboard being poked from all sides.
Again, there’s a blog. Click the name. READ it.
I wasn’t around “40 years ago” when medicine “sold its soul”. Morevoer, I’m not asking for the government to solve all my problems . . . it would be a tall order anyway given that the government won’t even acknowledge I had/have one.
Tort reform is not just about caps and insurers. It’s about the responsibility to do a better job of policing our own. It’s about getting back to the basics of medicine without the lawyers lilving on our shoulders. The reform you poo-poo might keep some of us from getting sued in the first place . . . it might allow us to focus on our lives and our careers and our patients . . . rather than hunkering down for the 1-10 year ride of our lives courtesy of some ambulance-chaser. It might cut down on defensive medicine . . . as well the cost of providing medicine.
I honestly don’t know what to do about the AMA and our state medical societies – or the “fat and happy” members of our profession (who generally are content to sit on their fat butts as long as they’re happy). Right now they’re all part of the problem.
“Hire someone to write some legislation.” Many of our current problems now are mired in badly written legislation. Doctors may start things – but by the time something gets passed it’s morphed into something unrecognizable.
OBTW, that also put us back to the lawyers solving our problems. For money, of course.
JB
Reading this exchange, I don’t know if I should continue toward med school or go back to law school.
Dr. Johnson, you touched on the media. There must be a way to get this message out through the media. This past election was greatly swayed by the media (whether that be bias or the fact that Obama had a billion dollars to occupy all the media outlets or both). America has become a place where the loudest voices lead, oftentimes regardless of the message.
What are your thoughts on pursuing a media outlet to voice these concerns? Obviously, they’ve been voiced on some level repeatedly, but a voice that will be heard more clearly?
DR. MARY JOHNSON
JB, honestly, if I could afford to do it, I’d go to law school. And right now, I am not encouraging anyone to go into medicine. It’s a profession that eats its young.
As for my thoughts on the media, they’re not printable. I’ve been trying to get in the door – first via a website – then via a blog – since 2004 (I think it was 2004).
The local media has buried this story – because it embarrasses the very important people in power . . . and that line stretches all the way from Raleigh to Atlanta to Washington.
In classic “Catch 22″ fashion, the national media has pretty much blown this off as a “local story”. I’ve contacted everyone from 60 Minutes to Oprah and have gotten nowhere. Again, the sad saga of a lowly Pediatrician in public service who saw her practice/life in her hometown destroyed (after standing up to threats and saving a newborn’s life) does not seem to strike a cord with the media. It’s not for lack of trying.
It does not fit an agenda I suppose.
One of the biggest problems I have encoutered is the mindset of folks like Anon 11:56 . . . who seem determined to peg all doctors as self-interested, greedy/”rich”, souless, and politically inept “providers” . . . as opposed to dedicated professionals who have already sacrificed much to get where they are – only to see their profession raped and pillaged by outsiders (that would be the lawyers and business-school grads) skimming off the top, and their patients transformed into “customers” who are always right even when they’re wrong.
Good luck with whatever you decide to do.
wheels
guys it’s not a letter to the editor. it’s a column that runs every two weeks on the front page of the philly inq’s health and science section.
http://www.philly.com/inquirer/columnists/rachel_sobel/
Anonymous
The average starting salary for a general pediatrician is $125,000; compare that to the average starting pay for a radiologist: $350,000.
What would you do?
……become a community organizer……..
Deron Schriver
Dr. Johnson – I suppose I could have chosen my words a little better in my previous post. Let me put it a different way. You would make more progress if you did not sling blame and insult entire professions of people. That is a sure-fire way to lose credibility. The ONLY way we will solve our healthcare problems will be if we check blame and selfishness at the door, and be prepared to give a little in the name of the system as a whole. Physicians, patients, insurance companies, “overpaid administrators” have all gotten us to where we are now. I happen to agree with many of the problems you highlighted, but are you prepared to acknowledge that you have contributed to the mess we’re in now?
By the way, I’m not a left-leaning journalist. I am a right-leaning “overpaid medical group administrator”.
DR. MARY JOHNSON
I’m very sorry you’re feeling “insulted”, Deron. But I have a (sincere) suggestion for you:
Perhaps your profession could admit that, for the last 10-15 years or so, some of your kind have gotten away with PROFESSIONAL MURDER. I’ve yet to see a hospital administrator admit that they were wrong – about anything – and I’ve seen them do some fairly horrific things to doctors.
Sometimes just for the giggles . . . to prove that they could . . . to get one over on the doctor.
I repeat. Horrific, life-destroying things.
Now that some of it is finally bubbling up to the top of the cesspool, I’m sure your profession would love mine to “check blame and selfishness” at the door.
It’s called cheap grace.
Moreover, after THE HELL I’ve been put through for doing the right thing by a patient over a decade ago (in case you don’t get it, the wounds are still raw), I don’t feel the inclination to mince words in order to make progress.
I’m also WAY sick of the “credibility” jab. Again, point and click. Read the following links on my blog (in the sidebar):
http://drjshousecalls.blogspot.com/2008/06/dogs-and-ponies-one-does-not-even-get.html
http://drjshousecalls.blogspot.com/2008/08/well-now-i-guess-i-dont-have-to-sue.html
Then tell me I have no credibility.
In terms of choosing one’s words a little better, I’d love for you to explain how I personally have “contributed to the mess we’re in now”. Because I am most certainly NOT prepared to acknowledge that.
In fact, I’ve spent most of my time living with or cleaning up somebody else’s messes and just trying to survive.
Instead of lying down and taking what was dished out (like so many doctors are forced – for one reason or another – to do), I’ve decided to take it all back to the people who made the mess.
I refuse to live in fear anymore. And I won’t be patronized. Please be advised, that I know all the smooth administrator moves.
As an aside (WHEELS), and speaking of Pennsylvania newspapers, the Pittsburgh Post Gazette did a stellar piece several years ago on the abuses of medical peer review (by you guessed it – overzealous hospital administrators trying to silence medical whistle-blowers). Alas the story/series did not really take flight:
http://www.post-gazette.com/pg/03299/234499.stm
Anonymous
“who seem determined to peg all doctors as self-interested, greedy/”rich”, souless, and politically inept “providers”"
Actually, I do no such thing. Putting aside the fact that by all objective measures you are “rich”, which you should be based on your training and the value of your skills.
What I am saying is that if you don’t do something other than hitch your wagon to your insurers, you’re going to be govt. employees. By all means, study how they get tort “reform” passed (which, whatever you want to call it, they mean caps on their liability exposure regardless of fault). They hire good lobbyists, they hire good pr people, they write the legislation, and they get someone to put it up in state legislatures. Then they get you guys to do their dirty work and demonize the other side for them.
Do it for yourselves! Stop whining about how much you’ve sacrificed, for starters, because everyone feels like they’ve sacrificed, and 90% of Americans aren’t renumerated nearly as well as you. Start talking about the value you give to the patient.
You can pretend that it’s not a business, but you have to earn a living. You’ve had the luxury of not pretending it’s a business because you didn’t get paid by your customer for decades, you got paid, and well, by the govt. Well times are changing, and the govt is cutting costs, so you better start getting your head around that unless you want to become a full time employee of the federal govt. or states.
I’m trying to give you a wake up call, but you seem determined to resist it out of unwillingness to recognize your own role in getting your profession to where it is. Admitting physicians have made mistakes doesn’t preclude you from changing course.
DR. MARY JOHNSON
Anon 8:22 (whatever you may be), I’m trying to give you a “wake-up” call too.
I did not go to business school – or law school. I went to medical school. And I went to medical school to practice medicine. And there are only so many hours in the day. And FYI I’ve already dropped a small fortune on lawyers (fighting hospital executives) – only to be swindled by perjury, contempt and fraud that NO ONE in a position of oversight seems to give a rat’s tail about. I don’t have another small fortune to spend on slick lobbyists – and the big bad “physician advocacy” organizations that do have the money and are supposed to have my back stopped listening to the little guys on the front lines long ago.
Hitching the wagon to insurers is a two-way street. Patients hitch to have their bills paid. And the government is in the equation because so many Americans think that medical care should be free. It’s like trains crashing into one another.
Many Pediatricians might as well be full time employees of the federal government anyway – because a good portion of our reimbursement is not from private insurers, but Medicaid.
The general public has got to get it’s head out of its butt where doctors are concerned.
Politicians have got to start answering some of these letters – both the open ones and the real ones. And they’ve got to offer more than lip service if they want this “valuable” profession to survive and thrive.
Alas, with a hospital administrator in the White House, I don’t have a lot of hope that anything is going to “change”.
sarah
there are several government programs that pay medical student’s school debts if they work in rural communities for a couple of years. loans are a poor excuse to have a high payout.
i think doctors are overpayed- take a look at the doctors in Europe, they make about a third of what US doctors make… and their healthcare system is better!!!!
most US doctors get into the field for the money, i mean you should listen to medical students some time, this is literally all they talk about. i heard one resident tell me that he wanted to work in a spa and do botox therapy because it’s not covered by insurance – forcing people to pay in cash. he was calculating how much he’d make… i mean what happened to getting into medicine to help people. medical students need to take more ethics courses, all they think about is money.

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