Thursday, August 28, 2008

Debt is a Shackle

This excerpt is from a letter by a physician printed in Emergency Medicine News, July 2008.

The letter makes a lot of sense.

There is a fair amount of paranoia at OSF amongst physicians and some feel if they speak out they will be punished. Many doctors know some policies at OSF are not ethical. And I think patient care in Peoria suffers due to physicians fearing for their jobs.

Debt Makes Doctors Miserable

I am a 30-something EP practicing for
five years in California. I also spent a
couple of years on the East Coast. It really
is a jungle out there in the ED “pits”
from coast to coast. The lack of control
most doctors experience is definitely
adding fuel to the general burnout.

I personally
make every attempt to limit and
eliminate debt when possible, which
gives me a degree of autonomy in my
practice. I do not need to work an
obscene number of shifts just to keep
up. There is also mental freedom knowing
I am not in jeopardy of losing my
income and home from an unpleasant
interaction, whether it is with a patient,
hospital administrator, ED staff member,
or fellow physician. If things ever get
rough, there is security in knowing I
have many options, including taking
some time off.

As a result, I find myself within a
minority of emergency physicians who
do not wish to bury their heads in the
sand and simply collect a paycheck. I
find myself one of the few voices present
and willing to speak up at monthly meetings,
even when there are grumblings in
the pit all month long. I believe in the
idea of right and wrong, and in not simply
looking the other way when one is in
the midst of wrongdoing, even when it is
too complicated to pinpoint precisely.

When physicians are scared to ask about
money billed in their names and not
allowed to collectively control practice
details, that just seems wrong to me. It
also seems wrong when we physicians
are more concerned about keeping up
with the Joneses than we are about the
details of our practice sites.

I strongly believe physicians have an
obligation to make choices carefully.
Even our personal life choices can have
an impact on the overall health care system.

For example, when we acquire massive
debt, we are no longer free to
express important opinions, which may
be distasteful to certain interested parties.
We are all well aware that certain
powerful individuals can immediately
reduce our workload without reason,
consequently controlling our income. As
inconvenient as our opinions may be,
they are important and should not be
silenced, which is something we do to
ourselves and our colleagues when we
have massive monthly overheads and/or
work for the highest bidder without
regard to company structure and process.

We all know the decades of sacrifice
and delayed gratification it takes to
become an EP. It’s only natural to enjoy
the income we experience after completing
residency. Many of us have families
to support, or simply wish to play
after many years of sacrifice. The more
money we make, the more fun we can
have playing, and we can buy better toys
as well. I only wish some of us didn’t go
so crazy with the extra zeroes we start
seeing on our paychecks after residency.
When I see a friend or colleague add
a high six- or seven-figure home to a six figure
education debt, I immediately
know that he will never be able to stand
up for himself or anybody else for that

Debt is the new shackle. There
are some great doctors out there supporting
groups that should not occupy
such an important place in our specialty
nor wield so much control over our lives
and livelihoods. I hope we will shift our
mind-set regarding contract holders.
They never call themselves employers
for legal and business/financial reasons,
and we should never consider them

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