Is medicine really that bad?

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It seems like the majority of the posts on this forum have to do with the pitfalls of military medicine. Many of you, I understand, would not have gone the military route if you were given a second chance.
In other forums on SDN I've recently found quite a few posts from residents and attendings that state they would never have entered into medicine if they were given another chance.
Do any of you ( or your colleagues ) feel that you would not have chosen medicine if you could do it all again? or is it simply a milmed issue?

Is medicine really that bad?

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It seems like the majority of the posts on this forum have to do with the pitfalls of military medicine. Many of you, I understand, would not have gone the military route if you were given a second chance.
In other forums on SDN I've recently found quite a few posts from residents and attendings that state they would never have entered into medicine if they were given another chance.
Do any of you ( or your colleagues ) feel that you would not have chosen medicine if you could do it all again? or is it simply a milmed issue?

Is medicine really that bad?

speaking ONLY from a Family Medicine perspective.............medicine is very difficult today with ever increasing pressure to cut costs, decreasing reembursement, obesity epidemics, HMOs, medical school debt, lawsuits etc.

in my experience and in the numerous milmed docs I have known, milmed suffers from most of the same things civilian med suffers from, but multiplied times 2.

and in milmed, the physician has near ZERO control to fix the problems as they arrise, input to staffing issues etc AND in milmed, no matter how bad/unsafe/unprofessional things get, you aint going anywhere until DOS (date of separation). Its kinda like being the passenger in your own car while the driver (milmed) is weaving all over the road, at times nearly hitting pedestrians, sometimes actually hitting them, speeding, going through red lights and ignoring anything you say as the passenger. Believe me when I say most docs are releived when the "milmed ride" is OVER.

would I still go into medicine.....yes............primary care?...............maybe not, probably would specialize. Go into primary care milmed again? No Way!
 
It seems like the majority of the posts on this forum have to do with the pitfalls of military medicine. Many of you, I understand, would not have gone the military route if you were given a second chance.
In other forums on SDN I've recently found quite a few posts from residents and attendings that state they would never have entered into medicine if they were given another chance.
Do any of you ( or your colleagues ) feel that you would not have chosen medicine if you could do it all again? or is it simply a milmed issue?

Is medicine really that bad?

No.

I mean, yes.

Military medicine has its unique problems, to be sure. Much of that is presented on this forum by people with significant experience of those problems. But the problems facing medicine (at least as experienced in the United States) don't end at the base fence.

A lot of the general complaints about medical care are rooted in the inherent high costs of providing skilled medical services, from building hospitals to having well-trained doctors and nurses to work in them and the limited funds available to pay for the same.

Patients want someone skilled to provide care in a good facility, but they also want someone else to bear the substantial portion of the costs for that care. They are willing to pay for personal medical insurance and taxes to pay for Medicare, but only so much for either.

Politicians want votes and know promising better publicly-funded services is one way to get votes. They also know that getting services costs lots of money, and that taxes are basically unpopular, and increasing taxes are even more unpopular but that also cutting benefits is unpopular, too.

Insurance companies want to make profits for their shareholders. They need to build business to do that, by selling attractively-priced coverage plans to their subscribers and by not overpaying claims.

Doctors want to practice medicine, but also expect a reasonable economic return on the high costs of their education and on the opportunity costs of the length and rigor of their training and on the high stress and responsibility of their work. They want to receive enough to make them think the personal and financial investments they have made have been wisely made. That means they expect much more income than other people who have not made similarly costly personal investments are used to making. They want to get paid what they are promised, and on time. Who pays them is not as important.

Doctors also want some autonomy in their professional practice that balances the responsibility for their work placed upon them by their professions and by the law. They do not want insurance companies or the government dictating to them what they may or may not do but at the same time be held to account for practice standards that depend on what government or insurance companies will pay for.

Doctors also want their patients to be properly held to account for following advice and they do not believe that patients who neglect their health and the advice of their doctors should then be entitled to claim against their doctors when they suffer the inevitable bad outcomes of their neglect. Doctors also believe the civil justice system has been perverted both by tort lawyers, money-seeking patients, pliable hired-gun "experts" and uneducated, malleable juries of the public into making tort claims a bonanza of deep-pocket picking. Doctors believe that tort claims have become a poor and expensive substitute for disability insurance.

Patients want to have their doctors available to them, but they also want to exercise what they see as consumer "rights" in obtaining services but also, they want to pass the obligations to pay for those services to others, in fact they would want to pass off the entire responsibility for satisfying their obligations to others if they could. They would prefer to consume without thinking about costs or payment at all.

You could see why there might be some problems with all of this.
 
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speaking ONLY from a Family Medicine perspective.............medicine is very difficult today with ever increasing pressure to cut costs, decreasing reembursement, obesity epidemics, HMOs, medical school debt, lawsuits etc.

in my experience and in the numerous milmed docs I have known, milmed suffers from most of the same things civilian med suffers from, but miltiplied times 2.

and in milmed, the physician has near ZERO control to fix the problems as they arrise, input to staffing issues etc AND in milmed, no matter how bad/unsafe/unprofessional things get, you aint going anywhere until DOS (date of separation). Its kinda like being the passenger in your own car while the driver (milmed) is weaving all over the road, at times nearly hitting pedestrians, sometimes actually hitting them, speeding, going through red lights and ignoring anything you say as the passenger. Believe me when I say most docs are releived when the "milmed ride" is OVER.

would I still go into medicine.....yes............primary care?...............maybe not, probably would specialize. Go into primary care milmed again? No Way!

I appreciate your response and I have a couple of questions I would like to ask you. From what I gather across different forums on SDN, many civilian residents complain about being underpaid and having to deal with ungrateful/disorderly patients. Both of these aspects, it seems, aren't as much of a problem for military docs. I know that there's a huge piece of the picture that I may not understand until I enter medicine - which leads me to my last question.
Now that you're out, are things so much better (pay/hours/quality of life)?
 
Hmm, perhaps I'm just bitter b/c I'm in the middle of residency, but I don't think I'd do either medicine or the military if I could go back in time.
 
I appreciate your response and I have a couple of questions I would like to ask you. From what I gather across different forums on SDN, many civilian residents complain about being underpaid and having to deal with ungrateful/disorderly patients. Both of these aspects, it seems, aren't as much of a problem for military docs. I know that there's a huge piece of the picture that I may not understand until I enter medicine - which leads me to my last question.
Now that you're out, are things so much better (pay/hours/quality of life)?

Mind if I jump in here, USAFdoc?

OP:

I'd take residency out of the equation. All residents are low-wage, long hours, treated-like-dirt worker-bees who are paying their dues until graduation. Also, most residency programs are in larger cities, and the inner city population engages in many social pathologies that can make those folks unpleasant to encounter. It's once you clear residency that the punishment really begins, and it's not just in the military (the myriad problems with MILMED have been hashed out many times in this forum... I won't revisit them).

The bottom line with medicine is that despite the personal rewards, the satisfaction of helping others, the "prestige," the job security... it's really a lousy business.

Many of the problems with the business end of medicine result from the actions of third-party and government payors. Far from the fee-for-service model of medicine, where prices for services can be adjusted up or down based on local supply-and-demand, the insurance model allows third-party payors to control your revenue stream.

How? By only reimbursing a set amount for a given procedure code or encounter level, regardless of how much it costs you to provide that service. You might bill 200$ for a new patient visit, but the insurance company is only going to pay you sixty bucks. Depending on your overhead, that sixty-dollars-per-patient may or may not cover your "cost of doing business." Many insurance companies set their rates based on medicare rates (some give you a percentage of your billed charges), so everytime medicare cuts reimbursement, so do all those payors. Why do you think there's such a bitter political fight every time congress attempts to balance the budget by slashing medicare reimbursements? That's money that comes right out of your practice's bottom line. Note that we're not talking about keeping up with inflation, or the increased cost of doing business... we're talking about cuts.

"Fine." you say... "I'll just charge more, or make the patient pay the difference."

Nope. Read your managed care contract... most managed-care, insurance company, and govt. payor contracts prohibit any sort of "balance billing"... a practice wherein a physician charges the patient the difference between what the insurance pays, and what it actually costs them to perform the service. As an out-of-network provider for some insurances, you might be able to balance-bill some patients... but NOT the government (tricare, medicare, etc). In the case of medicare, tricare, etc. you get what the government pays and that's it.

If all this is sounding like wage/price controls, you're right... you payed attention in ECON 101.

And while you technically have the ability to negotiate your own contracts, asking for more money than your colleagues will cause the insurance company to drop you as a provider. Your patients are then forced see you as an out-of-network provider, which results in a greater cost to them, and they go elsewhere... and voila! Your practice dries up.

And forget collectively bargaining with your fellow physicians to get a reasonable reimbursement... that can get you busted under anti-trust laws.

This is only a basic overview of why many physicians get fed up with the business side of their practices, or farm out those functions to billing or managment companies (which costs yet more money).

It's not necessarily medicine that's difficult... it's the business of medicine that frustrates many docs.
 
A lot of the general complaints about medical care are rooted in the inherent high costs of providing skilled medical services, from building hospitals to having well-trained doctors and nurses to work in them and the limited funds available to pay for the same.

Patients want someone skilled to provide care in a good facility, but they also want someone else to bear the substantial portion of the costs for that care. They are willing to pay for personal medical insurance and taxes to pay for Medicare, but only so much for either.

Politicians want votes and know promising better publicly-funded services is one way to get votes. They also know that getting services costs lots of money, and that taxes are basically unpopular, and increasing taxes are even more unpopular but that also cutting benefits is unpopular, too.

Insurance companies want to make profits for their shareholders. They need to build business to do that, by selling attractively-priced coverage plans to their subscribers and by not overpaying claims.

Doctors want to practice medicine, but also expect a reasonable economic return on the high costs of their education and on the opportunity costs of the length and rigor of their training and on the high stress and responsibility of their work. They want to receive enough to make them think the personal and financial investments they have made have been wisely made. That means they expect much more income than other people who have not made similarly costly personal investments are used to making. They want to get paid what they are promised, and on time. Who pays them is not as important.

Doctors also want some autonomy in their professional practice that balances the responsibility for their work placed upon them by their professions and by the law. They do not want insurance companies or the government dictating to them what they may or may not do but at the same time be held to account for practice standards that depend on what government or insurance companies will pay for.

Doctors also want their patients to be properly held to account for following advice and they do not believe that patients who neglect their health and the advice of their doctors should then be entitled to claim against their doctors when they suffer the inevitable bad outcomes of their neglect. Doctors also believe the civil justice system has been perverted both by tort lawyers, money-seeking patients, pliable hired-gun "experts" and uneducated, malleable juries of the public into making tort claims a bonanza of deep-pocket picking. Doctors believe that tort claims have become a poor and expensive substitute for disability insurance.

Patients want to have their doctors available to them, but they also want to exercise what they see as consumer "rights" in obtaining services but also, they want to pass the obligations to pay for those services to others, in fact they would want to pass off the entire responsibility for satisfying their obligations to others if they could. They would prefer to consume without thinking about costs or payment at all.

You could see why there might be some problems with all of this.

I just thought that this needed to be posted again.
 
Medicine... yes. This took quite a while to think over, as things aren't so rosy. See the eloquent posts above for the reasons why. However, I still feel that the positives outweigh the negatives for me.

Military medicine... no way in hell! I threw away 4 years of my life by when I made this mistake. These were young productive years and they are gone. If you decide to do anything with the military, whether infantry or medicine, you will be giving up these years. I would rather work at McDonald's and have some autonomy.
 
heh, linky:

http://news.aol.com/health/story/_a/medicare-to-stop-pay-for-hospital-errors/20070819074009990001

"Medicare to Stop Pay for Hospital Errors"

"Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder."

So Medicare is going to stop paying for nosocomial infections, and how long until the other insurance companies follow suit? Yikes.

Ya, I'm most likely out of medicine after my civvie internship and 3 years in the AF. So I'll be starting a new career at 30 having tossed away 8 years of my 20s involved in getting and using the MD for not-nearly-enough wages. Boohoo. Wahwah. Welcome to the wonderful world of sunk costs. Everyone is definitely entitled to their period of griping, but eventually you gotta decide whether or not you want to get out of Dodge.

The one fringe benefit of my AF time is that I'll have a few years on the sidelines to watch where medicine goes unlike my colleagues who will have committed to full residencies and careers. So that's kinda nice.

But it's just become too fudged up a business, despite the great nurses and docs I've had the opportunity to work with. I think I could enjoy myself a lot more elsewhere, and I plan to give it a shot, and hopefully I can parlay some of the karmic mojo I've been banking recently into financial rewards at the same time. Someone somewhere owes me big :p
 
Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder."

Right.

And they're also going to pay for the extra staff to turn debilitated patients, or pneumatic beds that automatically turn them?

And they're going to loosen the restraint rules so that demented/wandering patients can be kept from getting up in the middle of the night and falling?

And of course they're going to pay for the additional triple-lumen kits, procedure charges, pneumos, and other complications that all those frequent central line changes in the ICU will require?

I doubt it.
 
Lol, of course not.

Doctors, nurses and hospitals need to do more with less. It's the solution to every problem in medicine.

And remember, those extra line changes, etc. are complications, which of course Medicare isn't going to pay for now. So what's the problem for them?
 
I appreciate your response and I have a couple of questions I would like to ask you. From what I gather across different forums on SDN, many civilian residents complain about being underpaid and having to deal with ungrateful/disorderly patients. Both of these aspects, it seems, aren't as much of a problem for military docs. I know that there's a huge piece of the picture that I may not understand until I enter medicine - which leads me to my last question.
Now that you're out, are things so much better (pay/hours/quality of life)?

as a civilian FP:
1) PAY: last year I made 180K doing ONLY outpt work.
2) moonlighting at the local urgent care prn about 70/hr before taxes
3) I work 4 1/2 days per week in clinic. NO WEEKENDS
4) 37 days off year total (includes CME, vac etc)
5) Staff is way way better (nurses with 10-20 years experience vs 18 yo USAF techs). I say that as no disrespect to my previous 18 yo techs.
6) the treatment of docs/staff etc at my clinic/hospital is much better than in the USAF by those in Admin.

having said that, there is still some "not great aspects" of being a salaried physician for the hospital in terms of red tape, but USAF red tape was 2 feet thick and laced with barbed wire, making it a bit more toxic to staff and patients.:eek:
 
in my experience and in the numerous milmed docs I have known, milmed suffers from most of the same things civilian med suffers from, but miltiplied times 2.

"Miltiplied"? Is that the military version of "multiplied"? :D

In general, I take all those "half-of-all-doctors-wouldn't-do-it-again" stories with a grain of salt. My working life (which includes a long time in the non-medical, non-military world as well) has taught me that at least 50% of everyone hates their job, so what else is new? I like what I do, that's pretty much all that matters.

X-RMD
 
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My working life (which includes a long time in the non-medical, non-military world as well) has taught me that at least 50% of everyone hates their job, so what else is new?

The main difference there is that most people in other fields didn't sacrifice 10 years of their life to do it. I'm sure I'll enjoy my job a lot more once I finish residency and especially once I get out of the military. But there is no way that it will be worth the training process and all the personal life sacrifices.
 
The main difference there is that most people in other fields didn't sacrifice 10 years of their life to do it. I'm sure I'll enjoy my job a lot more once I finish residency and especially once I get out of the military. But there is no way that it will be worth the training process and all the personal life sacrifices.


"Sacrificed" is a relative term. If you feel you're "sacrificing" something (money, time, whatever) then you probably just have priorities that are not compatible with the process needed to become a physician.

I left a nice secure career to go the med school/residency/fellowship/military route, which totalled about 14 years, but I don't feel that anything got "sacrificed" in the process. In fact, I gained a lot of great things along the way (education, wife, kids, friends, etc).

And, no, it's not just physicians who "sacrifice" 10 years of their life before hitting the finish line. Just ask anyone who's gone the PhD/post-doc route, or tried to become a steadily employed (never mind "successful") actor/entertainer, or busted their butt in law school and the DA/public defender's office before becoming a bigshot lawyer, . . .

Success is not easy, friend.
 
"Sacrificed" is a relative term. If you feel you're "sacrificing" something (money, time, whatever) then you probably just have priorities that are not compatible with the process needed to become a physician.

I left a nice secure career to go the med school/residency/fellowship/military route, which totalled about 14 years, but I don't feel that anything got "sacrificed" in the process. In fact, I gained a lot of great things along the way (education, wife, kids, friends, etc).

And, no, it's not just physicians who "sacrifice" 10 years of their life before hitting the finish line. Just ask anyone who's gone the PhD/post-doc route, or tried to become a steadily employed (never mind "successful") actor/entertainer, or busted their butt in law school and the DA/public defender's office before becoming a bigshot lawyer, . . .


Success is not easy, friend.

great statement

my issues with milmed is not that it requires sacrifice. My issue is that no matter how much one sacrifices, things are so far gone that you still end up with a crap clinic. Currently it is taking tremendous effort of our docs just to barely keep things going (all the while Surgeon General had been touting how wonderful things are while his head was buried in a computer screen full of metrics).

as one of the many "ex-milmed" docs, I was willing and did all I could for the team, but when the "owner of the team" is bent on ensuring another last place finish, it was time to enter "free agency".

I miss wearing the uniform, I miss the troops, but I will never miss the ADMIN friendly fire, and recklessness of a USAF Primary care clinic. EVER. :thumbdown:
 
I'd pass on medicine.

I'm pretty sure I would leave out the military on a mulligan.

I got accepted to a bunch of dental schools. Some days I think should have gone that route. Mostly it's those days when my friends that graduated with 300k in debt 4-5 yrs ago tell me that they paid their loans off and now it's all 'their' money.

I don't really care that military residents make "so much more" than someone in a civilian residency. You are likely spending most of it on books, food, pda, haircuts, shoe polish, uniforms you will wear once per year, and other things that you would not encounter on the outside. Prolly doesnt add up to 20k, but it's still a lot of cash.
 
I appreciate all of your responses. If you have anything else to add, (ie the good & bad of medicine), please do.
Seeing as the bad of milmed has been fairly well documented - here, at least - maybe the downside of medicine (or it's specialties) should be brought to light. For those of us who are interested in the medical field, yet have no experience with it - the honesty may be enlightening.

Thanks again.
 
The things that irritate me about medicine are worse in the military, namely hierarchies headed by incompetent/rank-seeking leadership, loss of freedom without good cause, and administrative BS. I entered the military first, so when I saw them in medicine I tolerated it much better. If I had never joined the military, I would probably be cursing them in medicine. Instead, when something silly happens at the civilian institutions I work at, I think 'Hm. At least I only wasted 1/2 hour instead of 2'. When I work 80+ hours, I think 'I'm working on patients and learning things... much better than getting ready for an inspection or going to another briefing...'

I never planned on private practice and am content with my current wages and living conditions, so I don't think about the reimbursement issues. If I make over $50,000, I'll be fine (that's because I don't have loans). I do miss my fiancee and family, and there's no amount of money that will replace that.
 
Luckily, my first attempt at this post didn't load for some reason. I'm glad b/c is was pretty strident and bitter. Amazingly what follows is the "positive" version so it gives you some insight into the earlier post.

Medicine as a career... Well, it isn't what it used to be, and unfortunately the future isn't so bright. Between the lawyers, insurance and medicare execs, and a demented legislative branch, we are pretty much screwed. Who would go into a career which offers the potential to see ones income decreasing annually, despite increasing work and hours? And do you expect any appreciation or understanding from the public or assistance from the AMA, the most impotent professional organization in America? Of course not, you are a "rich" doctor (regardless of your pay). If you are a spine surgeon, you have seen your medicare reimbursement decrease in many cases by 50%, that's right a 50% paycut. It's called bundling. Try to plan a business with no idea what the future value of your product will be..

So how does the military factor into all this?

Well, since I don't get paid by volume of patients seen, I don't have to see 80 people a day and provide substandard care so I can stay on my 10 minute/patient schedule. I have no ethical conflicts regarding insurance or ability to pay. I spend whatever time I need and if I can't accomodate enough patients - too bad, I'm not going to degrade care. As the military needs me far more than I need it, there isn't much pushback from the powers that be.

There is so much military specific bs, but at least I know what my income will be whether I see 4 or 400 patients. I have some security in that there is a retirement albeit paltry for physicians, and health insurance and disability insurance (kind of). So long as I don't catch a bullet I'll probably do ok, and then.... can work in the civilian world on my own terms.

I have done both systems military and civilian and my experience is that I make a more tangible contibution to the military.
 
why am I a "new member", and more importantly, why are residents and medical students "attendings"... Oh yes,,, who do I pay to become a senior member?
 
Try to plan a business with no idea what the future value of your product will be...
Sorry, I had to jump on this one...

Please point me to a business that has an unshakeable knowledge of what the future value of its products will be.
 
Oil companies
:laugh:
I'm going to assume you're not serious...
Drug Cartels...
The price of cocaine has fluctuated significantly since the 80s. I doubt El Padrino knew that the price of blow today would be a fraction of what it was at the beginning of the '90s.

Undertakers: this varies based land values and cultural shifts. An undertaker with significant land holdings for burials is going to find it tough sledding if there's a widespread shift to cremation.
 
I'm going to assume you're not serious...

Undertakers: this varies based land values and cultural shifts. An undertaker with significant land holdings for burials is going to find it tough sledding if there's a widespread shift to cremation.

Most undertakers do not buy or sell burial plots; that is done by cemetery companies and associations. Funerals vary in price depending on location, services purchased and materials. As you say, if there were a widespread cultural shift toward simple body collection with immediate cremation, perhaps there might not be such a demand in the future, but cultures don't generally change that quickly without cataclysms (plagues, etc.).

As to burial space, cemeteries are just another form of neighborhood. If you want a place in a desirable one, that costs.
 
The price of cocaine has fluctuated significantly since the 80s. I doubt El Padrino knew that the price of blow today would be a fraction of what it was at the beginning of the '90s.

I'm sure the "Colombian Coffee Business" continues to generate great returns for its investors...:laugh:
 
Sorry, I had to jump on this one...

Please point me to a business that has an unshakeable knowledge of what the future value of its products will be.

Would you take a loan to start a new business with the reality that you can't control the price you sell your product for, and the government arbitrarily can just decide you will receive half of what your business plan predicted? To date the government hasn't forced Exxon-Mobile to sell gas for 50 cents a gallon.

At least in industry you can make reasonable prediction that if you run a tight ship and outcompete your peers you will do well. Medicine doesn't work that way. You sell a commodity which even if it is the best one on the planet, your buyers (patients) don't have an option of purchasing it if you are too expensive for the HMO plan, tricare or medicare/medicaid.

Please don't try to compare the price fixing and insane regulation of medicine to the free market economy.
 
Would you take a loan to start a new business with the reality that you can't control the price you sell your product for, and the government arbitrarily can just decide you will receive half of what your business plan predicted? To date the government hasn't forced Exxon-Mobile to sell gas for 50 cents a gallon.

At least in industry you can make reasonable prediction that if you run a tight ship and outcompete your peers you will do well. Medicine doesn't work that way. You sell a commodity which even if it is the best one on the planet, your buyers (patients) don't have an option of purchasing it if you are too expensive for the HMO plan, tricare or medicare/medicaid.

Please don't try to compare the price fixing and insane regulation of medicine to the free market economy.
Some examples of the exact phenomenon you suggest:
- Rent controlled/stabilized housing
- Public utilities
- Telecommunications (until recently)

Further, we all know a whopping portion of the price at the pump is composed of taxes: federal, state, and local. Contrary to what the layman likes to think, there IS an affordability index to gasoline. As taxes increase on gas, oil companies are forced to cut the proportion of revenues due to them in order to maintain volume (a critical metric in an industry with high fixed costs). Obviously, we're in an era of constrained supply so this hasn't neccessarily been the case, but we've also seen increasing tax loads on gas, so yes, the government has de facto controlled the price of what an oil company can sell gas for via taxation and affordability.

If there's one thing doctors do better than dispense medical advice, it's compain how rough it is to be a doctor. :)
 
If there's one thing doctors do better than dispense medical advice, it's compain how rough it is to be a doctor. :)

This coming from a guy with zero personal experience with the practice of medicine in any capacity. Let's remember,,, he is here b/c girlfriend was in HPSP and his goal was to figure out how to weasel her out of her committment which apparently he was successful at.

I guess Exxon really wasn't the most profitable company in the world last year. Last I checked they had record earnings.
 
Would you take a loan to start a new business with the reality that you can't control the price you sell your product for, and the government arbitrarily can just decide you will receive half of what your business plan predicted? To date the government hasn't forced Exxon-Mobile to sell gas for 50 cents a gallon.

At least in industry you can make reasonable prediction that if you run a tight ship and outcompete your peers you will do well. Medicine doesn't work that way. You sell a commodity which even if it is the best one on the planet, your buyers (patients) don't have an option of purchasing it if you are too expensive for the HMO plan, tricare or medicare/medicaid.

Please don't try to compare the price fixing and insane regulation of medicine to the free market economy.

Really good point!
 
If there's one thing doctors do better than dispense medical advice, it's compain how rough it is to be a doctor.

You might want to stop that. It just makes you sound like an ass.

Also, adding the "smiley" after a sentence like that does nothing to blunt the condescension, and arrogance of presuming you are in a position to dismiss the concerns of a profession that you've never practiced.

Your GF may be a physician, but sleeping with a doctor is a far cry from being one.
 
Your GF may be a physician, but sleeping with a doctor is a far cry from being one.

I thought he was sleeping with a med student. Yep, clearly an expert on this issue.
 
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