Imagine this: Two attending surgeons undertake a surgical procedure on a patient. The surgical residents have draped the patient; the surgical tech and the circulating nurse are ready to begin the operation. The surgical attendings enter the OR, scrub in, and move to the next order of business: “How are we going to bill for this procedure?”
Often, there is an unspoken—and spoken—consensus that the medical field is a lucrative one. However, this viewpoint is typically and conveniently held by those not burdened with the profession. Needless to say, the “next order of business” should be about achieving a successful operation and avoiding possible complications to ensure proper postsurgical recovery. Thus, are the attendings to blame for their mindset, or is this the fault of a system that has placed a financial yoke around the neck of physicians? In the coming paragraphs, I will highlight a few financial struggles of the medical profession and applicable solutions.
Let’s start with Charles Darwin’s principle of evolution. Regardless of its polarity among all peoples, there is a baseline level of agreement that humanity has reached—the foundational principle, which teaches that humans and all living things evolve to accommodate the conditions of their environment. We see it today and in antiquity: how those near the equator possess more melanin and how the sickle cell trait is prevalent in malaria-endemic countries. The Darwin principle still plays a part in the micro-environment of the medical profession.
What does it take to be a physician? Debts from undergraduate years plus debts from medical school plus debt from residency because you barely make enough to stay afloat, plus miscellaneous debt from life. These debts do not simply disappear when you become an attending physician. What, then, can the life of an attending physician in need of malpractice insurance and possessing all these debts look like? Getting paid based on how much one works, not based on a fixed salary. From the outside looking in, this may seem reasonable, even fair, until you examine how much work is required to justify the pay in this system.
Therefore, like all of nature, all humans bend to the foundational principle of Darwinism. A system that is primarily money-minded creates physicians who are equally business-minded, concerned about coding and billing instead of the vulnerable patient before them. Are the physicians to blame? Of course not—when, as nature has taught us, it is a basic matter of survival. It is the system that must change if we are to expect better outcomes.
My proposed solution is that there should be more hospitals—teaching and nonteaching—that provide a fixed salary to their physicians. This should not be a license for mediocrity, as there should still be an evaluation system. Nevertheless, it will create a different system where physicians are less concerned about how much they are paid and more about the quality of their work and education if they supervise residents.
This system has the added benefit of a work-life balance for the attending physicians and, by extension, the residents. In addition, I would be remiss if I did not address medical school tuition. It is quite exorbitant. The reasons, while complex, do not vindicate the system that they create downstream. Medical school tuition, by all means, must be reduced. This is possible—after all, man has walked on the moon.
Sarah Fashakin is a medical student.
