For a simple, but very insightful, sociology experiment, try googling “lawyer jokes,” and see what you find. Perhaps you’ll stumble upon Exhibit A:
A doctor told her patient that he
would need a heart transplant.
She said, "You can have a doctor’s
heart for $10,000, a Rabbi’s heart for $25,000
or I can give you a lawyer’s heart for $100,000."
The patient asked, "Why is the lawyer’s heart so much
more expensive than the others?"
“Well," replied the doctor, "we have to go through a lot
of lawyers to find a heart."
Ouch. Cheap shot; I know. But the point stands that any quick internet search will prove that lawyer jokes are ubiquitous, come in all shapes and sizes, often call upon other standard characters from the universe of one-liners (thanks Rabbi), and their thrust is generally the same. These jokes play on widely held public perception, fair or not, that lawyers are selfish and just take advantage of their clients and society. Lawyers are powerful because they know how to work the system, and people resent it when they abuse that power. I mean, why don’t snakes bite lawyers? Professional courtesy.
I’ll be here all night.
A more important observation however comes from the role of the doctor in my warm up act. She is at worst a benign character, potentially the man’s savior, and as such is starkly contrasted against the lawyer image. Indeed most doctor jokes spare the physician, and instead make light of the all our anxiety around health and aging or mock some scary aspects of medicine itself. See Exhibit B:
This theme is borne out in the realm of public opinion, where companies like Gallup have been asking people for decades how they appraise the “honesty and ethical standards” of various professions. In last year’s polling, and ever since they started this survey over 30 years ago, docs fare way better than lawyers in public esteem: Highly favorable (Docs = 66%, Lawyers = 17%); Very low (Docs = 5%, Lawyers = 35%). Nurses, incidentally, have the most favorable rating across all the professionals included in the study (81% of the public has a high opinion of their honesty and ethics).
And I submit that this is at least in part because, despite the regular failings of modern medicine and its practitioners, most folks still admire doctors for their altruism. Remember all those personal statements that you wrote to get into medical school about wanting to help people?
But I fear we may soon come to a major shift in public opinion secondary to out of control health care costs, particularly as more and more scrutiny falls upon doctors’ incomes in relation to the national debt. Physician fees make up 20% of the Medicare/Medicaid budget (our biggest entitlements), to the tune of over $505 Billion a year. And while we are well within our rights to look out for our own interests in the budget debate, we must be seen as part of the solution, not an obstacle to reform, lest we ruin the reputation that our profession has so long and painstakingly built.
Doctors have massive lobbying power in Washington. And like insurance companies we will be able to protect our high salaries until very late in the game – theoretically even as the US approaches a Greek-style bankruptcy – before there’s an effective public outcry. But if we let it get that far, we will find we’ve sold our professional integrity and public image only to become the butt of a bunch of rewritten lawyer jokes.
I recently attended a continuing medical education workshop put on by another physician, a man who hails from the good ole boy club of medicine that most zealously defends the right of the physicians to have more money than God, and enjoy as many perks and giveaways as they can get from the health care industry. This doctor had a chip on his shoulder about ongoing attempts at insurance reform, made evident by his frequent, gratuitous asides disparaging universal health care and his fretting that we doctors won’t always be so fabulously wealthy. Moreover, the workshop was generously sponsored by a medical device company, and its representative chimed in with the angst-ridden doctor – how in the good ole days companies like his could spend lavishly wining and dining doctors, but now are being made to divert resources to education and research. “Laws [limiting gifts from industry to docs] in Massachusetts and Vermont are bad for reps,” he said, and then with a wink and nod, “we’d rather have more fun with this money.”
With respect to my beleaguered colleague, this good ole boy mentality of medicine is the very avarice exploited in most lawyer jokes. Indeed, in the court of public opinion, we stand to lose more than our livelihoods if we don’t embrace our altruism and honestly come to the table for deficit reduction talks. The physician community at-large has a historic opportunity to fully get behind health reform, to ensure that everyone has a dignified, affordable standard of care. We have much at stake in this game, and we actually do ourselves no favors by being so afraid of a slightly smaller paycheck.
Even in the most heavily regulated health care systems in Western Europe, where physician salaries are much lower and taxes are much higher, doctors have always been comfortably reimbursed. They live in nice houses, drive new cars, travel frequently, and most of them are content with their share because they understand that they are not free market actors so much as mediators of a public good. If they wanted 7-figure salaries they’d go make money out of thin air on Wall Street. American docs should also expect to always be in the upper class by virtue of our rigorous education and unique skill set, but many of us could use continuing education on good citizenship, if only for our own sake.
I predict there will come a day when physician pay cuts will be an inescapable part of the tough treatment for reducing the deficit, and we should be prepared to not only make shared sacrifice but also seize the chance while we have it to negotiate and win other important concessions that won’t risk our prestige or the public’s good will. We could start with national tort reform, more subsidies for medical school tuition, more pathways for post-graduate debt forgiveness, or while we’re taking a cue from our European colleagues, let’s make medical school free to everyone that manages to get in.
Newly graduated American doctors finish school with an average debt of over $150,000. Increases in medical school tuition, like the cost of health care, outpace inflation. There are no comparable figures for our counterparts in Western Europe where the State pays for medical school. They know it is an essential building block for the public utility that is health care. Back in the US, what would a generation of debt-free of doctors mean for us as a political constituency? How might it accelerate the training of badly needed – but less well paid – primary care specialists?
We can choose to stand on the right side of history starting today, by supporting physician payment reform like that in the Affordable Care Act that is now under fire, instead of abusing our power as our lobby would have us do. Or, we can blindly cling to every penny, willfully ignorant of our contribution to the health insurance crisis until the average doctor joke reads like Exhibit C:
A doctor goes to his patient’s bedside to tell the patient’s family gathered around that he’s done all he can, but that their father only has a short time to live. The family asks that the patient’s lawyer be summoned to the bedside. Confused, the doctor asks why, and they reply, “Well we want Dad to die like Jesus – between two thieves.”