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To the 1%

By Dr. Brandon Green
.

So I’m having a Warren Buffett moment.   And no, I haven’t been finding spare $100 bills in my couch cushions, I’m not considering hiring a maid, nor am I embarking on any big venture capital enterprise…but I am volunteering to make less money. 

Sure, as a resident physician living in Boston, I currently make a very average income, about $50,000 yearly before taxes.  Money is tight sometimes on account of my educational debt and the cost of living in this town, but I live comfortably enough, and life is about to get much easier.  Upon completion of my residency in two and a half years my income will go up to the tune of 3 to 5 fold…and I’ll be working fewer hours!  That’s just for rehab medicine.  If I had chosen a different specialty (say orthopedic  surgery), my salary bump at the end of residency might have been ~14 times my resident’s salary (>$600,000).  

Obviously most of our neighbors are not so secure, and indeed the economy of the past decade has been firmly on the side of the few wealthiest citizens but against the middle and lower classes whose salaries have only decreased.  Add in bank bailouts, followed by major corporate windfalls that still don’t help unemployment, and  a full court press in Congress to slash the deficit on the backs of the poor who depend on government services, then you start to understand what the protesters from Occupy Wall Street to Oakland have been so riled up about. 

Meanwhile, the bipartisan Congressional Super Committee is running day-by-day up against its November  23rd deadline to present to their colleagues in the House and Senate a $1.2 trillion deficit reduction package for an up-or-down vote by year’s end.  Though their meetings up till now have been ostensibly secret, some leaks, gossip, and speculation have emerged that have the medical community backing into a defensive posture.  Will the Super Committee freeze physician compensation under Medicare? Might there even be a 5.9% reduction in federal compensation to specialists? I have even heard worries from my own Graduate Medical Education office that resident salaries might be cut back or positions eliminated altogether.

And so our lobbyists, like all the others on Capitol Hill, have been busy vying for Super Committee consideration in defense of our own special interests, claiming that cuts in just the growth of physician salaries will result in the nation’s poor and elderly being barred from care.  Well, I am sorry, but I can even put my bleeding-heart liberal altruism aside when I say, our lobbyists and professional societies are full of fecal matter.    

The truth is, the average physician cannot afford to quit seeing Medicare/Medicaid patients, hospitals are utterly dependent upon them for census volume, and we specialists in particular cannot afford to pick and choose which referrals from primary care we accept, lest those referral sources get fed up with us.  On the other hand, even if you’re one of those rare and brave docs from the small private practice days, chances are that your personal take-home salary could stand to go down a few percentage points to help make up the losses in the operating budget that generates your generous salary.  We are not public school teachers being asked to buy extra paper and crayons on a $40,000 salary.   We are doctors, and we still make a lot more money than that.

So forget about the greater good, to hell with societal responsibility, and never mind that most Americans haven’t seen a raise in over 10 years, while we insist that ours be a sacrament.  I don’t need pie in the sky chanting about fairness to make this point.  Health care costs are set to bankrupt the country that made us all rich, and as government contractors through Medicare and Medicaid, we are going to be a part of bringing down those costs one way or another.  Period.

Of course we can work within our own practices, like the National Physicians Alliance recommends, to reduce wasteful prescribing.   But no single measure will restore our fiscal house.  In more personal areas like our own reimbursement physicians are making a big mistake (and missing an historic opportunity) if we don’t come to the table to negotiate in good faith.   Let’s use our considerable clout in Washington and put our lobbyists to work gathering votes for a deal that accepts a freeze in reimbursement in exchange for other elusive agenda items. Want comprehensive malpractice reform, student debt forgiveness, or an end to the sustainable-growth-rate policy? If we can be seen as sincere negotiators in these debt deals, we can come away with real concessions in exchange for just a few percentage points off our already above average salaries.  Indeed, even as a resident, I would volunteer to forgo my raise next year if my support for that paved the way to sustain all current resident positions and helped protected some fiber of the social safety net.

During the crafting of the Affordable Care Act, Republicans refused to come to the table, and as a result got no concessions in the final bill.  Nowthey stand shouting at the rain, making empty threats of repeal that will simply never come to pass.  They could have gotten something in exchange for cooperation, for participating in our democracy which has always been forged out of compromise.  Let not the same be said for us, while our profession and livelihoods are on the line. 

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