Would you go to a physician or psychiatrist if you knew they were in it just for the $money?

[jl lin]

I mean, even if you knew they were great at what they did? Just say you had overheard them talking with someone, and it was made clear that he/she was only motivated to practice medicine for the $$$$$.
Would it affect you in terms of choosing them as your doc?

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[Meeah]

Yes, I think it would.
A person who does things for money only, may have success, but in medicine I would expect even more.
He may have success, but he might be far away from being a real healer.
Just my opinion.

 

[Nasrudin]

Psychiatrists are physicians.

 

[Nasrudin]

Edit: I misread the premise of the question.

But I think it depends. Pure commercial interests might be dangerous in medicine. But if excellence was the commercial angle, like Apple computers or Mercedes Benz then sometimes you get what you pay for.

If you're up on a felony charge do you care about the financial motivations of your attorney or their ability. It's not always applicable to medicine but I like positioning myself as a criminal defense attorney wherever possible. And I aim to be clever in business. With clinical excellence as my angle. So...maybe you overhear me talking business strategy and assume X. Idk.

Give me specifics.

 

[ZedsDed]

Only for money? No.

 

[CognitiveNeuro]

No

 

[WinslowPringle]

If the person were clinically and ethically excellent, sure. People should be paid for their work and wanting to be financially secure can be a stronger motivator than innate curiosity about extracellular sodium levels or algorithms of airway management. If the physician were going to push me into additional unnecessary procedures/tests, no - but he wouldn't be 'excellent' at his job as a physician then.

 

[Mad Jack]

I generally just assume about a third of the physicians I deal with are mostly or entirely in it for the money, lifestyle, or prestige, but that they lie to themselves about that fact.

 

[Snakes]

I say who cares, as long as they are good at what they do. There are plenty of reasons why people go into the careers that they do, most of them are not for purity of heart. Some people start with purity of heart and end up jaded. As long as that isn't communicated to me personally ("you as a patient are only a dollar sign to me"), then I'm fine with it.

The only way I see this being a problem is if the doctor is treating me in an unethical manner, as @WinslowPringle suggested, or is rushing me out the door so he can maximize his profit (number of patients seen per day).

 

[AM508]

Honestly, a physician's personal motivations don't matter to me so long as they are providing appropriate top-notch quality care. I judge whether or not to go to a certain physician based on what is important, competence.

EDIT: spelling

 

[Nasrudin]

The better question is do they like what they do. Are they engaged in it. Trying to get better at it. Do they think about how they can do it differently. How they might get an edge. Are they curious about its developments.

Are they in it for the money or not....say...as opposed to are they in it to save planet earth. These are questions of charades that pre meds play with the people who like to play with them on the admissions side.

People who are into doing what they're into doing in medicine and who are interested in extracting satisfaction, independence, and creativity from it...are not concerned with the binary morality games of the admissions process where people advocate their potential amazingness based on the imaginary and for people who enjoy deeming the droves of seekers worthy. Or not.

 

[Goro]

Would you go to a mechanic or accountant if you knew they were in it just for the money?

I mean, even if you knew they were great at what they did? Just say you had overheard them talking with someone, and it was made clear that he/she was only motivated to practice medicine for the $$$$$.
Would it affect you in terms of choosing them as your doc?

 

[ZedsDed]

Would you go to a mechanic or accountant if you knew they were in it just for the money?

I would say the inherit difficulty of practicing medicine requires a compassionate individual that will go the extra mile. Otherwise you get a path-of-least resistance sort of doctor, who will not give his patients optimum care as it would cost too much money/time/energy. You do not face this dilemma with your mechanic and your accountant. Then again I'm just a premed, so this is just speculation on my part.

 

[IslandStyle808]

I would say the inherit difficulty of practicing medicine requires a compassionate individual that will go the extra mile. Otherwise you get a path-of-least resistance sort of doctor, who will not give his patients optimum care as it would cost too much money/time/energy. You do not face this dilemma with your mechanic and your accountant. Then again I'm just a premed, so this is just speculation on my part.

This is definitely true for both mechanics and accountants. The guys who cut corners to save money and waste time because they are paid by the hour. I would not want to hire them nor would I want a doctor who has a shift mentality (clocking out exactly after his hours are up because he/she is not paid to be there afterward).

 

[ZedsDed]

This is definitely true for both mechanics and accountants. The guys who cut corners to save money and waste time because they are paid by the hour. I would not want to hire them nor would I want a doctor who has a shift mentality (clocking out exactly after his hours are up because he/she is not paid to be there afterward).

I was being generous. For the most part I wouldn't want to work with people who have zero passion for their job, in any occupation.

 

[Meeah]

Would you go to a mechanic or accountant if you knew they were in it just for the money?

No, if I knew it. Because I can`t see anything positve in this kind of attitude. But to me personally there is still a difference between a physician an the other occupations.

 

[deleted480308]

I call bull$&@$ on this implication that doing a job for the money somehow means that you aren't going to try and be great at the job. I further call out the idiotic implication that health care fields magically have some higher calling to not care about money.

We all want money and want more of it. There is nothing about that which makes any of us bad at our respective fields.

I want the best performance for the money I spend in whatever field or price range I am in.....if I'm buying a $2 burger, I want the best $2 burger in town. If i'm buying a $30steak I want the best $30 steak in town.

 

[Lord Boko]

If I had a problem and someone knew how to fix that problem and is willing to fix the problem then why does it matter what the motivation for fixing the problem is? Doc wants money. Doc knows he will attract more patients and get more money if he does a great job. Therefore doc wants to do a great job.

 

[jl lin]

Would you go to a mechanic or accountant if you knew they were in it just for the money?

Now come on Goro, you know it's no where near the same thing.

As a side note, one thing about my family lawyer is that sure, he wants to make a living, but he is totally NO shark. I've seen judges give him major respect, b/c it's clear he's not in it simply b/c of the money. I will add that he is private practice, so he doesn't have the same pressure that those in a law practice have.

Mechanic will charge what they can B/C THEY CAN. Same as most others in business and looking at the supply and demand curves. Same thing with accountant. But yes. At the end of the day, he or she better know what they hell they are doing.

Now, you can be good at something--know what you are doing--and lose your soul or perhaps never had it for what you are doing.
If you start out with the end game being financial gain, that is going to cloud the waters, and any soul-sense you had for what you are doing will completely evaporate. The sticking power comes from putting the financial gain as 2ndary to a commitment to helping others and a love for the field. Everyone is so scared financially speaking, and I think their fears are completely justified. . .to a point. Ultmately, like many things, it will come down to a philosophy. Sometimes people are just so pragmatic that they have no sense of interest, excitement, and joy about their lives. I'm definitely not saying be Mr. or Ms Fairydust. But I am saying you need a balanced blending.

And yes, at the end of the day, I believe you have to be someone that is willing to understand the sick person's point of view, as well understanding from someone's point of view that wants to have optimal health.

Many times, you can't do a whole heck of a lot unless you can get patients to partner with you in a plan of treatment. Sure, if you are doing pathology or diagnostic radiology, that may not be so much of a factor, but in general, it totally is. So, this means you really have to give a damn about patients, in my view, as a primary motivation for practice.

It is disconcerting to me when so much emphasis is placed on financial benefits of practice. And again I get the fear/concerns re: the high cost of the education and minimal salary through the training process. That is very real and must be taken into consideration.

Still, I believe a higher motivation for practice is what will lead to better success in the field, b/c patients will certainly pick up on that, and it will be the thing that is able to help the student-through-to-post-grad physician stay motivated and be happy in their career selection.

 

[ZedsDed]

I call bull$&@$ on this implication that doing a job for the money somehow means that you aren't going to try and be great at the job. I further call out the idiotic implication that health care fields magically have some higher calling to not care about money.

We all want money and want more of it. There is nothing about that which makes any of us bad at our respective fields.

I want the best performance for the money I spend in whatever field or price range I am in.....if I'm buying a $2 burger, I want the best $2 burger in town. If i'm buying a $30steak I want the best $30 steak in town.

Hence me qualifying my statement by saying if they are only motivated by money. By all means, pursue a larger salary. But there is something inherently creepy, even sociopathic, about a physician who couldn't care less about his patients and is only motivated to practice medicine so they can get a Bugatti. That being said, I think it is relatively rare.

 

[jl lin]

I call bull$&@$ on this implication that doing a job for the money somehow means that you aren't going to try and be great at the job. I further call out the idiotic implication that health care fields magically have some higher calling to not care about money.

We all want money and want more of it. There is nothing about that which makes any of us bad at our respective fields.

I want the best performance for the money I spend in whatever field or price range I am in.....if I'm buying a $2 burger, I want the best $2 burger in town. If i'm buying a $30steak I want the best $30 steak in town.

Not what I am getting at. See my response below.

 

[jl lin]

If I had a problem and someone knew how to fix that problem and is willing to fix the problem then why does it matter what the motivation for fixing the problem is? Doc wants money. Doc knows he will attract more patients and get more money if he does a great job. Therefore doc wants to do a great job.

I call BS on this to some degree. Why? Because if you care, you will make it your business to do and be the best you can in practice. I have witnessed this for WELL over a decade. Comes down to that old saying--and it holds true no matter what you belief system is: "Where you treason is, that is where you heart is." And that spills out and people see it. Should you not be grateful you have a booming practice and have the benefit of sound financial gains?
Absolutely NOT! But it should flow out of the right motivation.

No offense to the Sharks on the show the Shark Tank, but man, they are completely outright with it. Their motivation is PRIMARILY PROFIT.
Of course no one wants to lose money. In medicine, to be like the people on The Shark Tank is not just bad form. I believe it's dangerous. It is also something that people: patients and families will ultimately pick up on.

If you truly care about what you are doing, you will make it your business to work to be optimal at it. If you care primarily about making a profit, this is ultimately going to lead to dissatisfaction, and often enough, less than optimal practice.
People mostly want to feel good about what they are doing, not just feel good b/c they can pay off their MS loans and have a better standard of living. That's the long-term satisfaction. And when it isn't there, I also believe it leads to a greater chance of burnout. Job satisfaction matters to people; and for patients, they will sense if you have satisfaction in the core of what you are doing.

 

[jl lin]

The better question is do they like what they do. Are they engaged in it. Trying to get better at it. Do they think about how they can do it differently. How they might get an edge. Are they curious about its developments.

Are they in it for the money or not....say...as opposed to are they in it to save planet earth. These are questions of charades that pre meds play with the people who like to play with them on the admissions side.

People who are into doing what they're into doing in medicine and who are interested in extracting satisfaction, independence, and creativity from it...are not concerned with the binary morality games of the admissions process where people advocate their potential amazingness based on the imaginary and for people who enjoy deeming the droves of seekers worthy. Or not.

Well, I was with you in the first paragraph, after that, I had to jump out of that car. LOL.
I don't know if you are projecting or have a general projection re: pre-meds and what they try to tell themselves or adcoms.
That really was not the point of my post; but, again, IF you are trying to project with what you "think" is my perspective, you are way off.

Read my response below openly without any sense of projection. People want to know you really care.
I've seen so much focus on some forums re: the financial component; and while I have already stated that it is a serious consideration re: debt, etc., there has to be much more to it than that.

Yes Nas. I AGREE that you have to like what you do. Since working with ALL KINDS OF PEOPLE is a HUGE part of what a physician does--I mean directly, even intimately, well to me primary motivation has to move well beyond financial. It has to move well beyond a sense of title, status, etc.

Yea. I wholeheartedly believe that and I will till I die. Sorry if that is too idealistic for some. IMHO, it really shouldn't be.

I know that I have, from a personal health standpoint, eschewed docs that just didn't consistently show that they give a damn and were focused on gain and patients secondarily. It doesn't mean they have to be super charming. My surgeon doesn't have to charm my socks off. S/he has to excel at what he/she is doing; but yea. They need to be able to demonstrate consistently that they really care. I have seen the difference as both a patient, advocate for family members, and as nurse for two decades. I personally have been lucky; b/c most of the docs I"ve worked with or had care for my family or me tended to meet the "really give a damn" criteria. As a patient/family member, I have more of an opportunity to self-select, and with the experience I have, I know what to look for. As a nurse, I may not get a choice in whose patients I recover or deal with, but I have to say, I have been really incredibly fortunate on that end. The few that I felt didn't make the mark, well, when I could get away with it, I didn't handle their patients; b/c I knew I would be hitting my head repeatedly against the wall in trying to advocate for their patients. When I couldn't bypass handling their patients, I did the very best that I could, and the patients and families 99.9% of the time knew it. Many of them also ultimately ended up choosing other docs.

Yea. Healthcare is profit-based too; but for the practitioners that are directly and intimately interacting with the patients and families, it's got to be about a whole lot more than that.

 

[deleted480308]

Yea. Healthcare is profit-based too; but for the practitioners that are directly and intimately interacting with the patients and families, it's got to be about a whole lot more than that.

it really doesn't. There is nothing wrong with your entire purpose being profit. Profit is not moral or immoral. It just is.

If your desire for money or market share leads you to offer me the best value and skill in the price range I'm shopping. I hire you

This assignment of skill to altruism is illogical and ridiculous.

 

[ZedsDed]

it really doesn't. There is nothing wrong with your entire purpose being profit. Profit is not moral or immoral. It just is.

If your desire for money or market share leads you to offer me the best value and skill in the price range I'm shopping. I hire you

This assignment of skill to altruism is illogical and ridiculous.

There are quicker, easier, and less expensive ways to make a lot of money. That in and of itself is going to dissuade the "Wolf of Wall Street" types. This whole situation is extremely hypothetical I think. There isn't a one-to-one ratio between quality of care and salary of the physician. Is there a significant correlation? Absolutely. But that is not what the OP asked, and that is not what you are pushing. Nobody is assigning skill to altruism, what we are saying is that good doctors tend to be empathetic people, as well as highly payed. I can't tell if you are straw-manning us, or simply refusing to see subtly here.

 

[AM508]

it really doesn't. There is nothing wrong with your entire purpose being profit. Profit is not moral or immoral. It just is.

If your desire for money or market share leads you to offer me the best value and skill in the price range I'm shopping. I hire you

This assignment of skill to altruism is illogical and ridiculous.

Those of us living in Galt's Gulch get it .

 

[ZedsDed]

Those of us living in Galt's Gulch get it .

Ah. I didn't see the Ayn Rand reference. Things make a little more sense now...

 

[beebreezy]

Is it even possible for someone to go into medicine ONLY for the money? As in, there is literally nothing else that the person sees in a medicine career for him or herself, even if it's just something like respect or a way to fuel a competitive personality? I'm sure there is at least one person in the world who has gone into medicine seeing not a single other appeal in the path aside from the money, but I doubt it's even close to common. I think a scenario like that is only possible in the event of someone with a host of severe of personality disorders.

That said, it may not be fair, but it would depend on the type of physician for me. A psychiatrist? Probably not. A neurosurgeon? Yeah, I'd be okay with that if the surgeon had an amazing track record with successfully sawing people's skulls open and tinkering with their nervous systems.

 

[trev5150]

Is it even possible for someone to go into medicine ONLY for the money? As in, there is literally nothing else that the person sees in a medicine career for him or herself, even if it's just something like respect or a way to fuel a competitive personality?.

Maybe in the '50's it was easy to slipnslide in with good grades and a lot of family money to grease the way, but now the work is too hard, the time commitment too steep, far too much to know and the money isn't nearly good enough to make medicine attractive to anyone not it for altruistic reasons. I'm not sure how an adcom's BS-o-meter could miss someone that really didn't want to be. My understanding is that they are the best red-flag detection system there is.

If you were just in it for the money you can go to a school get an MBA (Master's of Bull****ting Arts), learn to play golf, and go work on Wall Street making insane amounts of money for Chase or Berkshire Hathaway or the Fidelity people managing my retirement (AKA med school fund) account.

 

[crazy87]

Let's say hypothetically that I am hooked on a drug.... Or I just use it daily and know it works. If I'm for instance hooked on adderall, and that's all I want to get, I don't care one bit about my psychiatrist's career motivations. I just wanna get my meds. No judgement here, but maybe you just wanna get in and get out if you know a medication works for you and you're not trying to change your regimen. Same goes for a pain management doc. If I have a problem (abuse of pain meds) then I just want a doc who will give me the meds I want. It doesn't even have to be a patient with an abuse problem, but drug dependency of any kind will cause you to act differently and care less about your provider so long as you get what you want. I didn't read the responses but just throwing this out there as a reply to the original question.

 

[Lord Boko]

I call BS on this to some degree. Why? Because if you care, you will make it your business to do and be the best you can in practice. I have witnessed this for WELL over a decade. Comes down to that old saying--and it holds true no matter what you belief system is: "Where you treason is, that is where you heart is." And that spills out and people see it. Should you not be grateful you have a booming practice and have the benefit of sound financial gains?
Absolutely NOT! But it should flow out of the right motivation.

No offense to the Sharks on the show the Shark Tank, but man, they are completely outright with it. Their motivation is PRIMARILY PROFIT.
Of course no one wants to lose money. In medicine, to be like the people on The Shark Tank is not just bad form. I believe it's dangerous. It is also something that people: patients and families will ultimately pick up on.

If you truly care about what you are doing, you will make it your business to work to be optimal at it. If you care primarily about making a profit, this is ultimately going to lead to dissatisfaction, and often enough, less than optimal practice.
People mostly want to feel good about what they are doing, not just feel good b/c they can pay off their MS loans and have a better standard of living. That's the long-term satisfaction. And when it isn't there, I also believe it leads to a greater chance of burnout. Job satisfaction matters to people; and for patients, they will sense if you have satisfaction in the core of what you are doing.

This is a fair point, but, in the OPs scenario, we know that this is a great physician. If we know it is a great doc then why does it really matter to the patient what their motivation is?

 

[jl lin]

it really doesn't. There is nothing wrong with your entire purpose being profit. Profit is not moral or immoral. It just is.

If your desire for money or market share leads you to offer me the best value and skill in the price range I'm shopping. I hire you

This assignment of skill to altruism is illogical and ridiculous.

I'm a capitalist too, but yea there is an inherent wrongness if it's number 1 for motivation. Saying otherwise is BS. There is a reason that is supposed to be called health CARE.

 

[jl lin]

Is it even possible for someone to go into medicine ONLY for the money? As in, there is literally nothing else that the person sees in a medicine career for him or herself, even if it's just something like respect or a way to fuel a competitive personality? I'm sure there is at least one person in the world who has gone into medicine seeing not a single other appeal in the path aside from the money, but I doubt it's even close to common. I think a scenario like that is only possible in the event of someone with a host of severe of personality disorders.

That said, it may not be fair, but it would depend on the type of physician for me. A psychiatrist? Probably not. A neurosurgeon? Yeah, I'd be okay with that if the surgeon had an amazing track record with successfully sawing people's skulls open and tinkering with their nervous systems.

I wished the world worked that simply. It doesn't, and people do go into medicine for money and beliefs of high prestige. Such things are the major motivators for this path. Some number of that percentage will burnout or become bitter all the sooner. Money, pride, perceived power, are all major motivators for people. It is b/c the GP raised the "liking" and "status"of becoming a physician as so high. As that sense of status drops and salaries decrease and tuition costs and interest rates rise, the applicant pool will certainly drop. When that will be deemed enough to make a dent will depend on how fast and how much the former motivators drop and how fast and how much the less desirable aspects increase.

 

[deleted480308]

I'm a capitalist too, but yea there is an inherent wrongness if it's number 1 for motivation. Saying otherwise is BS. There is a reason that is supposed to be called health CARE.

It's called lawn CARE too, I don't believe my lawn guy altruistically just wants the best for my lawn. He's a hard worker that wants the best for his family. He wants money. He knows it and I know it. He offers me the most convenient value for the proce range I'll spend on my lawn and as long as he continues that, I am a revenue stream for him. He's a vendor and I'm a customer. It isn't remotely required that either of us particularly cares about more than that for us both to get what we need out of the transaction for years to come. The best plumber I ever met didn't care about plumbing or buildings...but he cared about retiring early so he was great at his job.

One of my preceptors told me she refers to surgeon often who has terrible people skills and admits he is in it for the money. Will literally tell her patients, "you won't like him but he's the best. You don't need a new best friend though, you need someone to skillfuly cut you open and remove exactly the right stuff. He's that guy"

I'll repeat that being in it for the money does not at all mean you'll be bad at it, and being in it for the "feels" doesn't remotely mean you'll be good at it.

 

[jl lin]

NO, it is called and truly is landscape contractors and lawn & landscape maintenance. You keep getting the basic stuff wrong.

Yes dude, I've acknowledged that. Hell I have worked surgical recovery for a very long time. I already stated elsewhere that a physician doesn't have to be Mr. or Ms Charm and your bestie.

This is not about that--reference being to the other thread, where I indicated the very thing you are trying to use as an argument against my position. Hilarious.

You can repeat what you want. No one said that at all. It's about making money and/or title as it a dense and long number 1 in priority that it is the problem.

If you were to be honest, you'd want someone to give a damn,. You'd want them to like working with sick people and like what they do as a physician. This will naturally move people toward being better physicians. Die out and/or soul death follow when people's true, number 1 motivation has to do with money, power, and prestige. Sure some folks can live as automatons all the way to the bank; but it really isn't that easy is this particular kind of role.

 

[deleted480308]

NO, it is called and truly is landscape contractors and lawn & landscape maintenance. You keep getting the basic stuff wrong.

Yes dude, I've acknowledged that. Hell I have worked surgical recovery for a very long time. I already stated elsewhere that a physician doesn't have to be Mr. or Ms Charm and your bestie.

This is not about that--reference being to the other thread, where I indicated the very thing you are trying to use as an argument against my position. Hilarious.

You can repeat what you want. No one said that at all. It's about making money and/or title as it a dense and long number 1 in priority that it is the problem.

If you were to be honest, you'd want someone to give a damn,. You'd want them to like working with sick people and like what they do as a physician. This will naturally move people toward being better physicians. Die out and/or soul death follow when people's true, number 1 motivation has to do with money, power, and prestige. Sure some folks can live as automatons all the way to the bank; but it really isn't that easy is this particular kind of role.

You couldn't be worse at reading me

 

[Nasrudin]

Your reference to reading resident forums as your impetus for the thread is a bit off. The resident forums are one of the few places where residents can learn the financial aspects of the career. Something that never gets taught to us during training. So the curiosity is there. And the conversations focus on that a lot.

You're using that and what you overheard to broach the subject. Also, yes, this is somewhat of a fantasy in the premed imagination. The factors that go into a quality interaction with your doc do not typically cluster around their relative financial focus.

That's nursing anti-doc narrative surfacing from the subconscious.

Hahaha. I'm only partially serious.

 

[Esquire]

I mean, even if you knew they were great at what they did? Just say you had overheard them talking with someone, and it was made clear that he/she was only motivated to practice medicine for the $$$$$.
Would it affect you in terms of choosing them as your doc?

You're setting up a false dichotomy because it's hard to be great at something if money is the only motivator.
The opposite can be true: those who aren't motivated by money can be the worst docs. The nicest, most normal people in my class don't care about money. They don't care much about medicine either, and consequently are at the bottom of the class. The combination of don't care about money and medicine means most of them gravitate to, wait for it... psychiatry.

On the other hand, some of biggest a-holes are classmates interested in competitive specialties (and money). But they work hard and know their stuff, and I wouldn't hesitate to refer my future patients to them.

In any event, you're not being fair to psychiatrists. The reason psychiatrists have to talk about money is that psychiatry tends to be a huge financial loss for insurance companies, who in turn, reimburse psychiatrists the lowest among specialties that train for 4+ years, in order to discourage utilization of psychiatric care. To keep the lights on and pay student loans, psychiatrists need to go into private practice more often than other specialties, which requires them to learn more about the financial aspects of medicine. It's not ortho or GI, where hospitals will treat you like a demi-god and throw buckets of money at you because you are generating lucrative facility fees for them, and allowing an army of bureaucrats and nurses to suckle on the teat of your work, by treating your patients at their hospital.

Free market economics means that psychiatrists should be at top of the heap in compensation due to heavy demand for psychiatric care. However, 3rd party payors, in order to maintain their profit margins, have uncoupled demand from compensation and artificially depressed psychiatry income. Hence, talking about money is a necessity for psychiatrists to provide viable care and keep insurance companies from eroding the quality of psychiatric care even further. Hell, insurance companies have already screwed evidence-based standard of care in psychiatry, which is meds + talk therapy, by paying peanuts and refusing to pay for more than a few therapy sessions.

To pretend that money doesn't factor into healthcare is magical thinking.

 

[jl lin]

OK?

You're setting up a false dichotomy because it's hard to be great at something if money is the only motivator.
The opposite can be true: those who aren't motivated by money can be the worst docs. The nicest, most normal people in my class don't care about money. They don't care much about medicine either, and consequently are at the bottom of the class. The combination of don't care about money and medicine means most of them gravitate to, wait for it... psychiatry.

On the other hand, some of biggest a-holes are classmates interested in competitive specialties (and money). But they work hard and know their stuff, and I wouldn't hesitate to refer my future patients to them.

In any event, you're not being fair to psychiatrists. The reason psychiatrists have to talk about money is that psychiatry tends to be a huge financial loss for insurance companies, who in turn, reimburse psychiatrists the lowest among specialties that train for 4+ years, in order to discourage utilization of psychiatric care. To keep the lights on and pay student loans, psychiatrists need to go into private practice more often than other specialties, which requires them to learn more about the financial aspects of medicine. It's not ortho or GI, where hospitals will treat you like a demi-god and throw buckets of money at you because you are generating lucrative facility fees for them, and allowing an army of bureaucrats and nurses to suckle on the teat of your work, by treating your patients at their hospital.

Free market economics means that psychiatrists should be at top of the heap in compensation due to heavy demand for psychiatric care. However, 3rd party payors, in order to maintain their profit margins, have uncoupled demand from compensation and artificially depressed psychiatry income. Hence, talking about money is a necessity for psychiatrists to provide viable care and keep insurance companies from eroding the quality of psychiatric care even further. Hell, insurance companies have already screwed evidence-based standard of care in psychiatry, which is meds + talk therapy, by paying peanuts and refusing to pay for more than a few therapy sessions.

To pretend that money doesn't factor into healthcare is magical thinking.

I have previously written on the fair relevance of money in medicine. I stated it more than once above. That is a factor--a thing. When it is or becomes THE THING, watch out.

What often goes with such extrinsic motivators such as money is pride, some sense of power, and prestige. These are enough, with the deferred hope of a greater income, to allow a bright person to prove that he/she can do it--do the work. When the realization comes that it is not as prestigious, powerful, and laudable to have gotten through it and hold the title, after a time, people become, shall we say, less than inspired--to be euphemistic. In the beginning of that phase, it is then in particular that the nicer income can keep you going, at least for a while.

Have you never read Thoreau's quote, "Most men lead lives of quiet desperation and go to the grave with the song still in them."? Do you really believe physicians are not included in that group? They sure are.

People settle in. People become chagrin. Some make the best of it. Some become bitter. Some drop off eventually from the long-term pursuit and commitment to excellence--go through the motions, or b/c of the lifestyle to which they become accustomed, churn out the work and then find a dog to kick somewhere--displacement. Really, what these people really want is to take the title and a sweet retirement ASAP. And you know, I think that is OK for the person that sadly found out too late that doctoring didn't turn out to be what they thought it would be--if they can swing it and still provide great care until they can happily retire. This is why I want to scream when people talk about not needed all that much relevant clinical experience. This is completely bogus to me. It's just too costly of a path, and there is just too great a need to put the patient first--and be there for them--to easily miss the importance of getting a lot of clinical exposure. Some folks can no earlier on if there is enough clinical exposure that no matter how smart they are, it's not necessarily a good career match for them.

When someone really loves what they do, though they may need to leave it at some point, there is a huge piece of them that is leaving it in protest--kicking and screaming--at least inwardly. It's not about it being a means to an end to them.
It's about the meaningful means. For these folks, while it may not always be so, for no work is always ideal, for the most part, it's something that is contentedly incorporated into one's life and purpose.

Here's another good one from Henry David Thoreau:

"It is not enough to be industrious; so are the ants. What are you industrious about?”

 

[jl lin]

Your reference to reading resident forums as your impetus for the thread is a bit off. The resident forums are one of the few places where residents can learn the financial aspects of the career. Something that never gets taught to us during training. So the curiosity is there. And the conversations focus on that a lot.

You're using that and what you overheard to broach the subject. Also, yes, this is somewhat of a fantasy in the premed imagination. The factors that go into a quality interaction with your doc do not typically cluster around their relative financial focus.

That's nursing anti-doc narrative surfacing from the subconscious.

Hahaha. I'm only partially serious.

I never said anything about a reference to resident's forum. ????? I mostly avoid going there as well as the MS forum, unless something is particularly intriguing to me or there is something compelling there. You are assuming too much from post 24.

What I have seen at SDN, IN GENERAL and over the years is that some people almost become absorbed with the financial part as well as other things that indicate a sense of earned or entitled pride--you know the "glory" of the title deal, etc. I am certain this is not everyone of even most. What is disturbing is the trend of being OK about such motivators as being primary.

But No. There was never any one thread to which I read and thus the impetus for this thread came. People make A LOT of assumptions. I have NO problem with MSs, residents, attendings, or whomever discussing financial issues and sharing about sound investment and retirement plans, managing debt, or anything of a financial nature. etc. There is NOTHING wrong in my mind with looking at and sharing about various financial aspects of becoming of working as a physician--or anything else for that matter. Again, assumptions. Everyone forgets Gen I Chem. First thing you learn is not to ASSUME b/c then you know what happens.

And re: your latter comment ....I don't get and generally never have gotten sucked into the nursing anti-doc narratives. Got/Get along with physicians over many years. But hey, the fact that I didn't want to be part of such a narrative probably never garnered me favor with a certain percentage of nurses.

Main point is that it's not a problem for the financial benefits and such to a be a thing of importance. The problem comes when it and other extrinsic motivates become THE MAIN THING.

 

[Nasrudin]

Yeah ok. But I just don't buy the moral moral simplicity of your point.

If I'm motivated by money and seek to own and operate a smooth running clinic or practice and I take the strategy of treating my clients well and earn their referrals to the people they know, then what am I doing wrong?

Or if I use my physician salary to become an entrepreneur or an investor and that becomes more exciting to me than seeing patients after 15 years of seeing the same problems does that mean I'm morally corrupt and my patients suffer bad outcomes?

You're also presuming that motivations are discreet and distinctive. And then on top of that the financial one I particular produces poor quality of patient/doctor interactions.

I don't know how you would go about concluding that. A checked out, phoning it in doc may be working 20 hours a week in a urgent care joint by the interstate. And maybe he's motivated to go after redfish on the salt flats and intercostal water ways, but cares nothing about his work. One, I don't find him morally 1-dimensional, two, he may suck at his his job and have no motivation whatsoever towards making more money.

These answers just don't track the moral questions you're asking as easily as you're suggesting they might.

 

[Beargryllz]

Yes, professionals tend to get paid money

 

[Nasrudin]

Also font changes...


...not necessary.

 

[Rouelle]

Would you go into medicine if there was no money in it?

 

[deleted480308]

Would you go into medicine if there was no money in it?

No, i have financial goals for my family

 

[AM508]

Would you go into medicine if there was no money in it?

Heh, nope. I am not investing years of my life and going ~$350K in debt just for charity, and neither are most other med students.

 

[jl lin]

Would you go into medicine if there was no money in it?

That's an entirely different question.

And a fair salary w/o all the burden of debt, yea.

 

[jl lin]

Yeah ok. But I just don't buy the moral moral simplicity of your point.

If I'm motivated by money and seek to own and operate a smooth running clinic or practice and I take the strategy of treating my clients well and earn their referrals to the people they know, then what am I doing wrong?

Or if I use my physician salary to become an entrepreneur or an investor and that becomes more exciting to me than seeing patients after 15 years of seeing the same problems does that mean I'm morally corrupt and my patients suffer bad outcomes?

You're also presuming that motivations are discreet and distinctive. And then on top of that the financial one I particular produces poor quality of patient/doctor interactions.

I don't know how you would go about concluding that. A checked out, phoning it in doc may be working 20 hours a week in a urgent care joint by the interstate. And maybe he's motivated to go after redfish on the salt flats and intercostal water ways, but cares nothing about his work. One, I don't find him morally 1-dimensional, two, he may suck at his his job and have no motivation whatsoever towards making more money.

These answers just don't track the moral questions you're asking as easily as you're suggesting they might.

First, huh?

Second, yea if I try to understand and know what I am about, this is not complicated.

What makes it complicated is that it's a lot of pain and work to get completely REAL with oneself.

Third, I like the the font features. They are fun.

Lastly, people will hopefully, eventually figure it out---but by then let's hope it is not too late.
And it's amazing what intuition can tell you. It's led me well. No offense re: the MD FP guy that my family members and I used to see; but it became evident that he did not give a real damn. Fine for him for now, I guess. Not so fine for his patients. (As a nurse, I've seen this with some other physicians--from a surgeon or internist here and there, to a couple or more of shrinks. People that are genuine will continue to show it over the long haul.

The docs that want to put money and "prestige" as main motivators can do that if they want. It will reveal itself in time. It amazes me how often medical people just assume that most patients are terribly stupid. They may not be geniuses, but they learn to interpret nonverbal as well as verbal behaviors. They will figure out how much their doctor or nurse may care.

 

[Rouelle]

That's an entirely different question.

And a fair salary w/o all the burden of debt, yea.

Sure. But my point, though, is that at the end of the day it's a job. Various things motivate us to work. Money tops that list for many people. That doesn't necessarily say anything bad about those people.

 

[jl lin]

Sure. But my point, though, is that at the end of the day it's a job. Various things motivate us to work. Money tops that list for many people. That doesn't necessarily say anything bad about those people.

But it doesn't make it great for the long haul. Something like this, with the cost of time, effort, and money. Shoot to me you had better have at least strong like for it. Money makes you get up for the alarm. Love makes you forget about having to wake up for it again.