Squeezed By The Man And Closing Up Shop
A St. Petersburg neurologist is closing up shop. Why?
After 17 years as a neurologist and part-owner of a private practice in St. Petersburg, caring for patients with everything from migraines to multiple sclerosis to massive strokes, the bottom line showed that his earnings were half what they were six years ago. And he saw no signs of a turnaround.
This isn’t a problem unique to only neurologists, either.
An article in the Feb. 12 issue of the New England Journal of Medicine said the percentage of specialists in independent practice has declined 18.6 percent since the mid 1990s. Primary care doctors have also been migrating to larger groups or jobs as employees of hospital systems or HMOs.
The days of hanging a shingle and practicing independently are having the final nails drove into their dusty coffins as we speak. Now that Obama is in office and spouting “reform” everytime you turn around, I certainly see physicians making the transition from entrepreneur to (underpaid) employee in my crystal ball.
Dr. Franklin’s son speaks up in the comments on the article. I like what he has to say:
As Dr. Franklin’s son, I would like to speak from our personal perspective on his issue. Firstly, my father always wanted to teach. Secondly, he never cared about the money; we live well even with the pay cuts. This article is not about money.
Also, in reference to other doctors, this mass exodus of Florida’s healthcare is a byproduct of all of the legislation against them that YOU, THE PATIENT, supported. It’s a two way street whether you like it or not. Also, I’m becoming a lawyer.
Going to school for 8 years and another 3-7 years of postgraduate training to work for the government just doesn’t seem right.
But, I do think that’s where it’s headed.
Third Year
The following is contributed by Cousin Throckmorton.
When will it end?
Between the boredom
And bourbon
I haven’t much left
Empty
Hours
And hours
Of dry books and disappointed looks
Of diabetic feet and discharge sheets
Wading through patients
And patience
Knock kneed and faceless
From hackneyed cases
A doctor
Of guile
Hiding behind false smiles
Sweating away my soul
Into a day old shirt
I’m sinking
Gradually
Then suddenly
I haven’t much left
T-Shirt Hell Closes Shop
Way off topic, but this is one of the best goodbye letters I’ve ever read.
I’m done. I’m finished. I can’t take the stupidity anymore, so I’m leaving and I’m taking my website with me. As of Tuesday, Feb 10, 2009, T-Shirt Hell will be no more.
That’s the opening line from the letter from T-Shirt Hell creator Sunshine Megatron.
You’ve seen the shirts before here on MedSchoolHell. Definitely racey stuff, but the guy made a mint and had a good time doing it. Class act for not selling out and instead letting the site die. He’s opening up the Worse Than Hell collection for a limited time while he clears some inventory.
Why You’ll Never Get Rich In Medicine
Let’s assume that you’re a partner in a practice or an emergency medicine doc or a hospitalist somewhere. Let’s also assume that I own a pencil manufacturing plant. We’re also assuming that this is a scenario to illustrate a point. Thanks for playing along…
I get an order for 100,000 pencils. I fulfill the order and profit. I leverage my employees to create pencils for me and fill the order. If I need extra help for the order, I hire it.
You get an order for 100,000 patients.
You can only feasibly see 50 patients per day, so you tell approximately 99,550 patients to go elsewhere. You can’t hire extra help to see the patients because the extra help eats all of your bottom-line profit.
The Service Business
My point is that medicine is a service business. You can only do so much yourself when you’re serving others. If you want to progress beyond a certain income level, you’ll need to figure out a way to duplicate yourself. We can’t duplicate ourselves, so game over. Service businesses lend themselves to income caps. Income caps don’t play nicely with large (very large) incomes.
In other words, if you want to get rich, you need to get out of the service business. Which means, getting out of medicine. Sure, medicine will give you an incredibly “comfortable” life. I got tired of watching my parents be “comfortable” and decided to change. Will you?
There’s nothing wrong with banking a couple hundred thousand per year in medicine and living comfortably. But, you’ll never be rich so get used to that now. People all around you are making 5 times your income and working less than half of the time of your favorite attending. It may not seem like that or that cut and dry, but just trust me when I say that it’s true.
It’s all about passive income, and medicine alone doesn’t afford a passive income. You’ll always need to see patients or sign out a case to get paid.
And, that’s not the way to live. In my opinion, anyway.
Discuss.
MSH Forums
Awhile back I had requests to set up a forum. I never got around to it, but here they are now. Nothing fancy, hell it doesn’t even match the main site. But, I’m about to retire the old MSH theme and get a brand spanking new one, anyway.
So, here it is. I’ll try and answer questions as much as I can, but I’m pretty much leaving it up to you guys to get shit started. If it dies I’ll pull it, but hopefully it can be a decent resource once some solid discussions get going.