Back in the day, starting I would have to guess the early 50's, being a doctor really meant something. Don't get me wrong, being a doctor has always meant a lot, and the position a doctor holds in the community has since obtaining a license to practice medicine, i.e., being a doctor, usually meant a position of authority, respect, honor, and prestige. Today the same can be true, just that today's doctor doesn't quite hold the valor it once did, although it still should.
Back in the day when doctors first started to become doctors they did so because of their love of people, and their desire to better mankind one patient at a time. It wasn't about the money for them as they would often accept payment in the form of chickens, eggs, meat, or other such things. This was what was acceptable. People were dirt ass poor and out of respect for the doctors knowledge, time, and care, they offered up to him what they could, often times in fact, paying him with the only commodity they had, and sometimes what they themselves really couldn't even afford to give/pay, but did so again, out of sheer respect, and dignity on their own parts as well.
Then came along the 60's and 70's. Doctors in this country were still held to higher standards both professionally and personally. Their form of payment strayed away from the barter system as it had in the past and moved more toward monetary forms of payment, and so the money ball for doctors started rolling, and rolling fast.
I am giving you a very easy to understand and very watered sown version of a time line that may not be totally correct, but at this late hour will resemble most of the facts anyway. It was along this time, meaning the late 60's through the early 90's to even mid 90's perhaps that a great shift started happening in the medical community.
It started becoming more and more "business" oriented. Because of the quickly rising costs of both medical care in this country, and the cost of medical school, the price to even get all the equipment, staff, and whatever else it took and cost to start up a private practice, a bartering system just wasn't any longer an acceptable way to do business, and no longer paid the bills. That previous and more simple time in medical history would basically have to come to an end, because as willing as the doctor may still be wanting to accept chickens as payment, his school loans and landlord, and the electric company didn't work on a bartering system. So, things had to change and change quickly.
It was also along this time that more and more medical specialities started emerging. Medical advancements were coming at such an alarming rate there really wasn't a whole lot of choice in the medical community but to have doctors studly longer, go to school longer, and have intern practices to go on to be the specialists in their chosen field of medicine. Again here, cutting into the doctors ultimate bottom line.
It became more than evident in the latter part of the 1970's through mostly the late 1990's that specialties were the way to go if a doctor wanted to have a lucrative career. During this time, our regular MD's and their astute colleagues, along with the newest bandwagon to service was the scare that every patient could very easily become the family doc's worst court battle. So to avoid such action/sanctions, many of the cases that in a few back as ten years were being sent out to the "specialists", which may I add is where the money really was then and still is, if there is any to still be made.
By the time the years of the late 1990's to present this practice still is happening. You go to your primary care doc for a cold, and you are being referred out to an ENT, or to the cardiologist, or to the gynecologist for a routine pap smear, which (another of my biggest pet peeves and irk's) when your GP is more than qualified to take care of and would probably do a better and more through exam in the first place, not to mention a lot cheaper too. And as if that wasn't enough, your GP knows you as a whole person, not just our girlie parts, which in turn allows him to treat you as a whole, not just parts that have been put out on "loan" for someone else to examine, then relying on that doctors notes and finding out his findings a month or two down the road, then again, he has to add all the pieces together to once again get a handle on his patient, "is" key term there, patient/doctor relationship, which again in turn enables the doctor to once again be able to try and provide you, his patient, with the best medical care he/she can, given the medical findings from another outside source. And so that particular cycle continues without just about everything, and every part of your bodily symptoms. I personally have a huge huge issues with this. Personally speaking for myself, I prefer the "one stop shopping" method. Unless absolutely necessary will I accept or allow to be sent out to a specialist. There has to be something really wrong in order for me to allow this to happen, why you are wondering? Well again, most good GP's can handle most issues their patients are going to have, if they are just willing to revert back to their basics, trust their instincts, which again a lot of boils down to really knowing the patient, their whole patient.
All of this being said, really brings me to my main point at hand. I know, I have a tendency of getting way off topic, especially when my insomnia kicks in full force, as in now, lol. I agree with you age statement about play docs, and real docs being able and being comfortable with "practicing" well into their 90's, or until they are no longer safe to practice/play being a doctor.
Now finally, back to your statement that I wanted to address to start with. You were discussing with the board that your current real doctors all LOVE what they do, are PASSIONATE about what they do, and DEDICATED to their patients. I couldn't agree with you more there. As a nurse myself, I in fact feel the same way, or I wouldn't be doing it
Then your next statement is what and where I start to have my issues and is the entire reason for the long post leading up to this paragraph. We are talking about the old mighty dollar. And before I go on much further, I will tell you, ( and I hope I am not offending any of my fellow nurses or doctors, or any other medical professionals here when I say what I am going to say here...) Again, you are very correct that the monetary rewards is NOT what keeps them in practice.
For some of us it's a fulfillment of a life long goal, or a passion for our fellow man to somehow make a change, or a difference, even a small one in someones life whether we are aware of it or not. I have said many times here that being a nurse was what I believe "God" if you were, put it in my soul that this is what I was born to do. People, and I believe in all walks of life who are pushed into jobs/careers that they don't want to do, are not cut out to do, simply don't make it, can't cut it. And if by off chance they do, it's usually painfully obvious they hate their jobs/life. At least in my profession, those are the nurses who are nasty and mean to both their co-workers, patients and disrespectful to the doctors, the families, and to their superiors. They are the ones who would rather go smoke than sit down with their patients who are dying and hold their hands so they know they are not dying alone, or who won't take an extra 5 minutes out of their already way way way too busy day to stop and talk to the family just to tell them a cute or funny story about their mom that might make them laugh or smile, or just let them know that you care about their mom as a person, not only as a patient. Thats' what making a difference is all about, not how quickly you can get your job done so you can get that smoke break or get out on time.
So yes, I agree with you, no matter what the age of a doctor/play doctor is, Love for and of their jobs, the passion they exhibit, and the countless minutes, hours, day, months and even years sometimes is what keep us medical professionals going and continuing do what it is that we were deep down probably born to do.
Now, the problem with that same statement, of....."sure they all enjoy the monetary rewards. That's what keeps them in practice. It just happens to be a lovely fringe benefit", could NOT be any further than the truth than saying something along the lines that "I'm running for President was the wild card and will be winning the election in a landslide."
Without getting into too much political BS here, and trying to break this down as easily as possible, I will do my best. Now again, before all of this gets said, please keep i mind that I am talking about America here and it's current state of the health care system as we know it. Okay, so bare with me please yet again.
There have been many and too numerous changes already thanks to "Obamacare". My political views don't matter here either way, facts are facts and here is the strait crap. Last year, my little 81 bed facility had to cut cost of over 400,00 dollars in about a 6 month time frame. We are one facility out of probably a thousand in my state alone, now times that by all the homes in my state, then add in all the other states as well. First of all, cutting that much from on facility was very very challenging and almost to the point of impossible. We were forced to take a pay cut, only 2 percent, but I know a lot of places in our state were legally allowed to up up to 9 percent, and they did. Talk about a huge OUCHY! Even at 2 percent, and the promise of all wage increase freezes for the next 2 years, well, it was quite devastating.
Now as if I haven't mentioned it at least a gazillion times, my boyfriend Doc is a real doctor who owns his own private practice where he practices family medicine. Now Doc is a different sort of a doc in the way he practices and runs his business. I always describe him as sort of a "country" doc. He doesn't even employ a nurse in his office. He loves the hands on approach as much as possible with his patients. In a nutshell his office is run accordingly. When a patient is in the waiting room he walks up to the front desk and gets their chart. He then turns the corner and goes to the waiting room and picks up his patient from there himself. They then walk back to his exam room and he gets started with their patient. Now, he has all the modern amenities for every normal modern day office, but he just wants to do thing himself. He believes that his patients receive better care, and complete care when he does things himself from start to finish. If a patient needs to be weighed, he puts them up on the scale and weighs them, if they need an injection, he prepares the shot and he gives it to them himself, temp needs taken he does that too. On average he spends about 30 minutes with each patient, sometimes longer. His patients almost never have to wait in his waiting room longer than maybe 5 minutes to be seen, and when they do get seen by him they never feel like just another patient, or cattle rushed in to the slaughter house. They walk out feeling like they got their monies worth of his time, and they feel they got all of their questions answered, and they feel like he really cares about them and are not just a number, and that's because they are not numbers or dollar signs to him, they are people, his patients with real problems that he can and wants to be able to fix.
Now my doctor here has a totally different mode/style of practice. He schedules 3 patients every 15 minutes unless your issue is going to require more time, then his schedulers schedule accordingly. You are probably given 10 minutes instead of 5. So it goes without saying that my doctor is pulling in probably 10 times the amount of money Doc is, but again, it's all relative once you start crunching the numbers. Doc probably employees 3 full time office staff, and my Dr. John probably had close to 20 if not more. So money-wise, it's probably about equal.
However there are countless other factors to consider here as well. Also depending on state, these guys have to pay for their malpractice payments. Now I as a nurse pay about 2 grand a year, and I am not a "specialized" nurse. Doctors are paying, and this is a complete guess, although I am sure I am in the ballpark, but they are paying a minimum of 40,000 a year just in malpractice insurance, which they have to pay by law. This also doesn't include their student loans, which again about probably someplace in the ballpark of 3-6 thousand a month. There is the cost of their board certifications, which if I remember correctly is like 5-7 thousand every 5 years or so. Then they have their payroll expenses, and along with the employees comes their insurance payments which also add up into thousands a month, also thousands a month for unemployment they have to pay into, "just in case". Next you have rent on the office space, which I know for a fact is also thousands a month, then all that entails, water, trash, sewage, electricity, gas. And that list can go on and on and on, little stuff you don't even realize, all the mail that goes out and it's postage, the envelopes and all the other office supplies, printer ink, ream after ream of paper. Internet services, business class on multiple servers isnt' cheap either. A cleaning service. Equipment upkeep, state inspectors their fees and the license's that go along with all of that. All the medications they have to buy and keep stocked either by law or by choice. Not all the samples you get at your docs are free samples you know, many of them are bought. There are tons and tons and tons of more hidden costs that most people just have no idea about.
Then moving on to the health care reform bills/actions currently going on. Your doctor may charge you for example 100 buck for your hour long physical. Lets say you have insurance. Your insurance will pay 35 bucks for that physical, your co-pay is 20 bucks, now some doctors offices will make you pay the difference, others won't, and I also believe that depends on state laws and regs as to whether or not they can do that. But for the sake of argument we will say that your state doesn't allow your doc to require the difference. That mean that in total, your doctor just made a whopping 55 bucks for your hour long physical. I know, most of you wish you could make 55 dollars an hour, but do you have all of the other overhead these doctors do? I highly doubt it. He will be lucky if his paycheck will even see 5 dollars of that visit.
Please also don't forget the other health care cuts in the government programs too. And again, the figures I am spouting off here are probably not even close to accurate, just using them as an example. But 2 years ago Medicare/Medicaid would pay 75 dollars for that same physical, now they are paying 32, but you doon't have a co-pay at all, so he gets shorted another 43 bucks. So for that visit he will see about a buck of that visit on is paycheck.
One of the last perks we had as medical professionals were the fantastic thins the drug reps would bring us, the cool toys, the medical props, and my personal favorite, the pens, and even better than all of that, the food and once in a great while a dinner party where we got to dress up out of our scrubs and put on big girl and boy clothes where we could go out and mingle with our peers, enjoy fantastic food, usually free drinks (which neither of us every drink, but still, it was usually an open bar) and we would talk about the product being represented, then we could mingle and talk the lighter side of shop, or better yet, catch up on our peers social lives that didn't have anything to do with medicine. Hahaha, like we have a life outside of medicine, lol. Sadly now however, even our drug rep perks are all gone now too.
Which brings me to the only, last, and final perk/fringe benefit we medical professionals have left, and even that at times can be and like for example in Doc ad I's case is even being now questioned is that after the hundreds of thousands in medical school debt, 10 plus years of medical school and residency, the many many many hours we have been up for days on end, answering the on call phone at all hours of the day and nights when our patients call us for "important" things at 2 AM for example, "my son just stepped on a Lego in the the middle of the night and he split the skin between his toes, what should I do, should I take him into the emergency room? Oh Doctor, I am so scared he might get an infection or something. I think he's going to need IV antibiotics or something." And we are thinking, really? Please, it's 2 AM, unless hes' bleeding to death, slap a band-aid on it along with some TAO, smack his ass and tell him you told him 6 times to clean up his room before he went to bed, make him pick up his toys and put the kid in bed and then go to bed too. And for the love of Mylanta, 2 am, really? Come on now use some common sense.
Now, as a nurse it's even worse. We may not get as many phone calls in the middle of the night but we also get EVERY kind of bodily fluid slung, flung, spat, thrown, ejected, and squirted onto us almost on a daily basis. We risk our own health immunity-wise, we risk being permanently injured and sometimes paralyzed, kicked, punched, bones broken, needles, dirty might I add, being punctured with them, not to mention being bit. When someone stops breathing we, or I should say I, because I can't speak for everyone, but I am responsible for knowing the code status of 38 people at all times so if by chance I have to know in a split second if I need to crack their chest or let them die on their own. I get to call the families after whatever event just happened, I call them for every single new or changed order the doc wants to write, no matter what time it is, and again, I don't really want to bore you even further with a nurse crazy life.
But seriously, in closing finally, "sure they all enjoy the monetary rewards". What monetary rewards? Yes, there are a very very very select few doctors who are leading the good life, but you will sadly see a goodly portion of this fade and fade quickly as more and more doctors are being forced to file for chapter 7 and close because they just can't simply afford to stay in business anymore with all the budget cuts mandated by the government and or insurance companies, or both, and sadly, many nurses are headed in the same direction just as quickly. Then as far as the "lovely fringe benefits" you talk about, hahaha, you are kidding right? The only fringe benefit we medical professionals sometimes get, and I stress the sometimes, is that we once in a while will get special treatment within the health care system itself. For example, a lot of places will move us closer to, or actually to the head of the line if we have to get an x-ray, or in the pharmacy line, or we can get in quicker to see the doc. Sometimes depending on the doc, we can just tell them what's up, tell them what we want and we can get out the door a lot quicker. This can be a double edged sword though because they often think sometimes that we are drug seeking.
So I can safely tell you that most of us medical professionals have to love what we do, are very passionate about what we do, and are 100 percent dedicated to what we do because the hours suck, if we are even lucky enough to have a relationship it usually sucks, then crashes and burns in a firey death, or is just plain non-existent, so that leaves us to be completely dedicated, to the love of our jobs, the "love" of our patients, and the "love" we have for their families.
And that's my 5 bucks worth and a bit more this evening. Sorry for rambling.
Mashie.