To put patients’ interests first, we have to put our own aside

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my undergraduate economics major entering lucrative jobs in finance, investment banking, and consulting, I knew I’d spend years falling behind them financially. I’m inspired by his continued commitment to treating patients, as that’s why I decided to go on this path too — and I’m glad to see that the rough times ahead of me don’t stamp out that desire.

But I have to say, I was a little disappointed with the piece after reading it, especially considering how much attention it continues to receive. Don’t get me wrong, I think we absolutely need to do something about the way we finance medical education in this country — it gives physicians and hospitals a set of incentives that run counter to the things we want.

But to say that physicians aren’t rich is misleading. Yes, we have debt in bunches. We also have an unemployment rate under 1%. Take Dr. Moeller for example, who’s now a practicing gastroenterologist. According to data provided to medical students by the Association of American Medical Colleges, gastroenterologists in the beginning of their career make an average of $390,000. The average gastroenterologist regardless of experience makes over $520,000 a year. That puts the average physician in your specialty in the top 1% of earners. By any reasonable definition, that makes the average gastroenterologist rich. Quite rich, in fact.

I’m not saying this to deny Dr. Moeller’s story, or to say there aren’t real problems to address. My point is that, in the end, we’ll do just fine. The beginning of our career is incredibly difficult, yes. But it pans out — which it often doesn’t do for some of our poorest, sickest patients. I appreciate that as a profession, we want to ensure lawmakers know what it’s like to become a doctor. But we don’t have problems recruiting people to apply to medical school; in fact, more people want to be physicians than ever before.

If we’re a profession that really, truly, wants to put patients first — and let’s be clear, that involves placing our own interests second — then we’ll spend more time telling lawmakers about the patients bankrupted by hospital costs, the patients on food stamps so stingy they only buy horribly unhealthy food, or the poor elderly suffering from dementia but with no place to turn.

If we’re to care for these people — by providing insurance, or better access to nutrition, or universal long-term care — then we’ll need money. If we want to make it more attractive for physicians to enter primary care, we’ll have to pay them more. The money has to come from somewhere. Some of it will come from specialists, and wealthy physicians. Make no mistake. Specialists are by and large rich, and they’ve become so on the backs of a system designed to make them so.

If we’re in this for the best of intentions, to sacrifice our own good for the good of our patients, then we need to put them first. And that includes in how we talk about our jobs, our pay, and our priorities — especially when we talk to lawmakers.

Thank you to Dr. Moeller and so many other doctors for setting a wonderful example of patient-centered healthcare. Years from now, I hope I’ll be able to say that I, too, put patients first for 24 hours a day. Let’s hope all of our colleagues do so too.

Allan Joseph is a medical student who blogs at Project Millennial can be followed on Twitter @allanmjoseph.

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