Warnings over coffee

I warned the young doctor, the moaner

Striving to pay off his loaner

All of that debt

Just has to be met.

Please, never turn into an owner.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

Job offers cross my desk and invade my emails every day.  Most weeks include half a dozen calls from recruiters.  Just last week I got a flyer promising a strong six-figure base pay, with an available 66% upgrade for taking call.

I’m not in the market. Just trying to work reasonable hours takes up most of my time.  I forward some of the more interesting opportunities to a couple of colleagues who find themselves between jobs, a status that doesn’t last long for a doctor.

I sat down with one of them today, over coffee, to talk about an offer.  The email promised half the money a teacher makes, but would give the successful hire a chance to improve some skill sets. 

I informally counsel a good number of docs in the early phases of their careers.  If I talk about hanging up a shingle, I caution about the burdens of being an owner, and none of the cautions relate to the rapidly changing medical business climate.

The Affordable Health Care Act increases the regulatory burden on doctors.  With all the forms to fill out and reports to generate, few physicians can continue in small or solo practices unless they reject money from insurance and the government.  But that’s not what I warn the young docs about.

A medical business owner has to worry about overhead, and thus must be willing to fire less than stellar employees.  Few medicos have business training, even fewer have business sense, and most try to keep marginal staff in place, hoping they’ll improve.  If you’re kind enough to want to help people, you hate to fire a patient because they don’t pay bills.

I apply all these criticisms to myself.  Every day I go to work not worrying about management reminds me of how much emotional energy I spent on being a boss.

On the other hand, I finished med school with a mere $3,000 in debt (I had great poverty skills) and I didn’t face six figures of pay back.

More and more doctors marry other professionals and two good incomes decreases the drive to seek the highest paycheck.  At the same time, the physicians now coming out of training have had work hour limits, and hence have better leisure skills than my generation of doctors.

“Don’t get on the hamster wheel,” I cautioned my colleague.  “You’ll find it very difficult to get off before you burn out.”

Still the 40-hour work week, the ideal balance between home and work, eludes every doctor I know of, even the ones on salary.


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