Is anyone else frustrated with the business of medicine?  I guess that’s a stupid question.  But really, when you were training to become a physician, what were your goals?  For me, I wanted to have a career that was meaningful, interesting, and at the same time provided a good living for myself and my family.  Growing up, I was always told to strive to become a doctor or a lawyer.  Neither of my parents were either of these, but it was touted as the ultimate in success.  So that’s what I did.

I went through the brutality of med school, internship, nuclear medicine residency, and then radiology residency.  When I passed the boards and began practicing radiology, I felt like all of my wishes had been granted.  But as time went on, Medicare cuts (and the generally bad economy and higher unemployment rate ) were starting to have a huge impact on our bottom line.  In fact, since 2007, our revenue is down over 30%, and with no definite end in sight.

I also realized that a large number of the non-medical people we would meet through my children’s school were in business for themselves.  They lived in bigger houses than us, drove nicer cars, and did not have any of the financial concerns that we did.  They didn’t have to pay back any of the school loans that I owed.  They went on great family vacations that I could not offer my own family.  They could send their kids to more expensive schools than I could.

I don’t mean to sound ungrateful.  I still make a better living than most, and I am able to help people while doing it.  I am also able to do something I love, something that is interesting.  But from a financial and business perspective, it is not really what I had envisioned.  And speaking of business, try explaining the business of medicine to someone who is in real business.  Give it a try.

It goes something like this.

I work a job where I am the boss, sort of, where I can tell technologists what to do, but I don’t employ them.  So I can’t hire good ones and I can’t fire bad ones.  I am the expert on what is best for the patient, but I don’t make a lot of the important decisions.  I am paid for the work I do, but I am expected to provide a cost-effective, minimalist approach (crazy, right?).  I am required to provide care, even if the patient can’t pay for the service.  Oh, and the doctors who are on the medical staff must serve on the various committees, but they don’t get paid for the time, other than potentially in political capital.

Needless to say, I get extremely blank stares from others who know how to run an actual  business.

So maybe medicine isn’t really a business after all.

Geoffrey L. Fey is a radiologist who blogs at Radiology Review.