As I sit here today, I think about the future and how life will be ten years from now. There seems to be an illusion that when you finish your residency and you start to be an attending that your life magically becomes better and that you have a lot higher quality of living. However, what I have found going through this process is that the dream may not be true. As a fourth-year medical student I have had the opportunity now to talk to many physicians and what I have found is that from their perspectives, the quality of life really doesn’t change. In fact, as our bodies age, the quality of life may become independent of personal economy.
Last year I had the opportunity to delve into simple living and the mindfulness campaign of the mental health fields. What I realized is that we don’t need the vast majority of material possessions to get through life. What we do have a lot of the time is extraneous materialism. Why do we need whole closets full of clothes that we never wear?
Much research has been done on decision fatigue, the phenomenon by which users who must make too many decisions become fatigued and eventually burned out. I propose that by eliminating unnecessary decisions, we may become better able to project empathy to our patients. Over the last year or two, I’ve had the opportunity to see if I can make my life simpler and see how that affects me.
I began at the end of third year when I had to move out of my apartment to pursue clinical rotations. I started by donating most of the clothes that I had as well as my kitchen equipment and appliances. From there I realized that I had a greater ability to absorb my medical education, because I was avoiding being overly fatigued. I also cut out toxic relationships and set forth on learning who I was. For the first time in my medical career, I was able to concentrate properly on what I was doing and think through a difficult physiological question from a physician. For the first time, I was being “present” instead of thinking about the future or five other things simultaneously.
Now two years into this process of decluttering, I have realized that a lot of the appliances that we have are not necessary. There’s an old saying that, the more you have, the more you have to take care of. My parent’s generation believes in having huge property and nice houses, but I don’t want one. This holds true in my life. Now that I can fit everything I own into the back of my car, I don’t have to worry about buying Renter’s Insurance, because what I own isn’t worth much. What little documents I have are backed up to the cloud, and the small number of physical items I have wouldn’t be damaged by water and can be replaced if stolen. I did not have to put my extra belongings in storage, because I had none.
Earlier this month I was on my rural medicine rotation, and one of the physicians I was working with took the opportunity to educate me on physician salaries. What I realized was shocking. The attending told me that he made quite a lot less than what I thought attending physicians make. He told me that in reality, over half of a physician’s earnings are withdrawn for taxes, loans, insurance, and other hospital fees. I couldn’t believe my ears when he told me that hospitals charge physicians to admit patients and do not pay loan repayment directly. All this salary talk was a huge shock to me, given that I had been investing in “the dream” for so long. His true after-tax earnings were at the level of a lawyer or a computer scientist.
On another rotation, a non-rural physician told me that because of all the stress associated with having a higher-paying job in health care, he decided to voluntarily take a lower salary to see fewer patients. This physician was happy and had a good life and a good family balance, and this was someone who I saw as a role model for me. He was earning less than a nurse practitioner or a physician assistant, yet he was the physician. The high stress and burnout of bureaucracy was what he stated caused him to reconsider.
Physician salaries are on the logarithmic curve of taxes, so the $400,000 salary after taxes leaves you with $250,000 and from that, you pay your loans, insurance policies, business fees, malpractice premiums, and other fees. There is a logarithmic limit with how much you can earn, and the end salary goes up as you pay in life years. The higher length of training can correlate with higher earnings. A cardiologist salary of 350,000 seems high, but that is 14 years of education, compared to the family medicine salary of 220,000 with a training time of 11 years.
In conclusion, what I want to point out is that the happiness doesn’t start when you begin making the attending level salary. Too many times I have heard med students say that they work hard now, so that they can be happy later. But, the happiness is now, there is no guarantee to the future. A recent brilliant neurosurgery PGY-7 was diagnosed with terminal illness; he never got to the “dream,” but he ended up accepting the life that he had, and I respect that. We need to be happy with what we have now, and not rely on delayed gratification. When you realize that you have everything you need in this world, you then realize that having money could not make you happier. This is the power of perception.
Omar Bukhari is a medical student and author of the upcoming book, Perspectives from a 2018 Graduate.
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