Thursday, October 23, 2014

Dear American Medical Association,

Thank you for the brochure I received from you and Mercedes-Benz, making me aware of the great car deals available to physicians.





I'm glad to see the AMA is still living in some sort of fairytale land where doctors have money trees growing in their yards. This sort of stereotype only fuels the already crappy image the public has of us.

Here's the reality: In 2013 (my worst year ever, due to several factors) Dr. Grumpy's solo practice salary came out to $99,354. That's working 60-70 hours per week, with 4 weeks of vacation.

Now, I'm NOT (emphasize NOT) complaining or bragging. I'm just stating this as a fact, to make a point. I know there are MANY people who'd be grateful to be able to make that. I'm thrilled to have a job I like that allows me to support my family.

But the reality is this: I drive a 14 year-old Nissan Maxima with the passenger door smashed in. Sending me a booklet telling me that, as a "qualified physician," I can save $1000 off a $92,000 S-Class sedan, $3000 off a $72,100 CLS-Class coupe, $4000 off a $116,000 CL-Class coupe, $3000 off a $114,200 G-Class SUV, or $3000 off a $106,700 SL-Class roadster... just shows me how fucking incredibly out-of-touch you guys are with the reality facing today's doctors.

Granted, I'm not a member of your organization. Honestly, I'd rather spend the $420 annual fee on my kids. To the best of my knowledge, an AMA membership gets me a journal I don't have time to read, discounted admission to an annual meeting I won't go to, and, obviously, a token discount on a car I can't afford. In fact, if I was a member, I'd be pretty pissed to find out this is what you were spending my annual fees on: getting me a deal on an imported car that costs more than I made last year.

American medicine is in a serious crisis right now. I'm not going to take political sides, as there are plenty of blogs for that. But my point here is that you guys are obviously clueless as to how much docs are really making.

Not to mention medical students. The next generation of docs are coming out of school $200,000 in debt. Residency pays maybe $40,000 a year, and they're at the ages where they're starting families, buying first homes, etc. Then they get to go earn practice salaries that (like mine) are dropping each year. So realistically the only "luxury automobile" they'll get to ride in... is a hearse.

Note to medical students- if you're doing this thinking you're going to get rich, just stop now and cut your losses. In fact, I'd get out regardless of why you're doing this.

But, I'm glad to see you AMA guys are on the ball. I'm sure there are SOME doctors out there who can blow that kind of money on a car (likely all on your board of directors) and it's reassuring to know you're doing something to benefit them.

The rest of us hard-working docs trying to practice ethical front-line medicine will stick with our old cars with the sides smashed in.

40 comments:

BluenotesBb said...

I used to get these darn things when I subscribed to the APA as a student.....gave me high hopes. False hopes, really really false hopes.

My 7 yr old SVU gets me through the snow when I have to go out to attend a client emergency in the ER. I've hit a couple of guardrails with it....not worth the insurance claim.

Daughter mentioned she wanted to follow in my footsteps and go into mental health, those words struck fear in me...told her she would be better off as a music major....lol

There is no Mercedes in my future.796

BluenotesBb said...

Oh, and our local hospitals CEO makes $750k a year.....while PCP physicians are high tailing it out of the area because they can not afford to live here in CT.

Sad

Anonymous said...

If it makes you feel any better, the same thing is happening with veterinarians and the glorious (*sarcasm*) leadership of the AVMA.

RehabRN said...

Grumpy:

Just like the average for nurses.

Unfortunately, we have RNs who do make well over that and are slaves to the paycheck (and its variability, since OT is never guaranteed). They work lots of hours then complain about what they have.

I have a fourteen (soon to be 15 year old car) and one 2012 (because the 15 year old car died). I am not replacing the 15 year old until it drops dead.

I'm not complaining, I'm happy. But you will not get rich in any medical field anymore, unless you invent something they sell a lot of units. Be careful of that says my husband's cousin (an attorney who deals with medical stuff). You need lots of insurance for lawsuits.

Just my $0.02...not much for the little guy anymore. Corporate CEOs have to make too much.

Anonymous said...

To be fair, though - Mercedes pays the AMA a pretty penny for the privilege of giving members a discount. This is what is referred to in the Association world as "non dues revenue"

Shellye said...

How magnanimous of them to offer...well...a journal and two discounts. I'm surprised people aren't taking advantage of this deal!

In all seriousness, I am impressed by your "tell it like it is" eloquence. You possess a colossal amount of integrity.

Anonymous said...

This happens to lawyers too. When I was admitted to the bar, I immediately started receiving brochures for million dollar property in Hawaii. My first "legal" job paid $600 a week (gross, before taxes).

Packer said...

And to take that salary, you probably needed to gross 4 times that.

If you think 2013 was good, just wait until 2014.

I think I told you that you needed to branch out into cellulite reduction therapy, it is a freaking gold mine.

Many people are amazed when they hear that the economy is improving overall.

Anonymous said...

Dang, Grumpy. Your finances look like mine, a solo family doc. Makes you wonder sometimes.

Anonymous said...

i am not saying you are a rich doctor, but it's not fair that you mentioned your worst year only, i am sure you had some best years too, right?

awesomesauciness said...

Well, in all fairness doc, a yak herder's (as you claim to be) salary seems pretty good.

For a doctor, maybe not so much.

For the millions unable to put food on the table, a fortune.

It's all about perspective.

If you wanted to get rich, perhaps plastic surgery might have been a better choice? I don't know, I'm not a medical professional.

As for vehicles, every financial guru will tell you that putting money into a fancy-schmancy new car is a huge waste of assets.

You're just being fiscally responsible.

D(ea)r Abby said...

To be fair to the AMA, I doubt they paid BMW for this. More likely, BMW paid the AMA for the opportunity to advertise to it's members (or others on their mailing list.) AMA dues would actually likely be higher without things like this.

This comment is not meant to excuse the fact that the offer is somewhat tone-deaf to the current state of physician finances...

Anonymous said...

I second the comment about veterinary medicine and the AVMA. I don't know if it makes me feel better or worse that the AMA is the same....

peace said...

Unfortunately it is the case in many countries.

Ms. Donna said...

Go Grumpy! Go Grumpy! PLEASE stay in regular medicine. We, your pts. (speaking metaphorically) need you and your brothers and sisters in medicine.

Just an aside (stop reading if your mental health is feeling low) a guy I graduated college with was going for a masters in public health, with an eye to hospital administration. All I will say, he makes more than you. With less education. And far less responsibility.

It's like having accountants (!) in charge of newspapers. News is not a "profit center." (oops, rant coming on. Need Fuckitall.)

Regarding my college acquaintance -- I would not trust him to take care of me, even going to a hospital if I broke a bone.

Holly said...

My doc drives a beat up pickup truck... 1990's style. I have his beat by 10 years.

He's happy, his wife is a kick in the pants, his kids are weird, but whose aren't? I know he's not in it for the money. There isn't any.

It's funny how people ass-u-me so much.

PediNP said...

Dr Grumpy, did you know the AMA wants to restrict NP practice? And now I see why...we might be taking some of the $$ that could be used to buy a Mercedes!

It all makes sense to me now. Thanks for this! :)

Don said...

You'd make more if you had an MRI machine in your office :)

/not an MRI salesman

Anonymous said...

Thanks to Dr. Grumpy for sharing his common experience. I'm a recent residency grad (specialist). Husband has own practice in the same field and did not take a paycheck in the last 3 months in order to pay practice expenses / employee salaries. He spends somewhat more time with patients than many docs in our field and treats comprehensively but reimbursements are declining.

To make a lot of money by just providing clinical care (and not relying on mid-levels), I think one probably would have to commit fraud.

Anonymous said...

You need to own shares in a PT clinics like my EX neurologist, and do botox on the side (cosmetic). Oh and how could you not have a CT and MRI scanner in your office.

No one makes money in health care (animal or human) any more.

SkullCandy

Anonymous said...

Right there with you. My health system can't even afford to advertise me (new provider) or provide business cards. Because that would be logical and like promote more business or something...Hang in there. The people need you.

Candida Gomez said...

I've noted that as increased government regulation (not always to protect the patient) and lawsuits have increased, overall doctor reimbursements and pay have decreased. So idiots have a lot to do with doctors having to cut corners in their personal lives in order to continue providing good care.

On the car issue, in the US the law is that cars that have been leased and returned have to be as close to new as possible before they can be resold. But thanks to depreciation (which starts as soon as the vehicle is first driven off the lot), such vehicles are much cheaper. My dad bought a leased and resold truck 7 1/2 years ago for a combo business/personal vehicle, and that thing is still going like gangbusters. Something at least worth looking into.

Sadly, I'm on Medicaid, since I don't make enough to get private insurance. (The way it works in this state is Medicaid contracts with a selection of private companies and pays the premium and copay, which means if I ever do get a better job, I can just take over the existing account.) But this certainly explains why my doctor is willing to treat for every problem I discuss with him or that shows up on my labs. (sorta joking) He is an AWESOME freaking doctor, though, if slightly deaf. But he listens in the important way.

Anonymous said...

The car wouldn't be of any use to you anyway. Judging by the white cliffs in the background, it is Dover, UK.

Rodrigo said...

Dear Dr. Grumpy – We at the AMA hear you loud and clear! While the auto discount you reference is among the top visited items www.ama-assn.org, the AMA understands the challenges you and so many other physicians are facing as the health care system continues to rapidly evolve. That's why the AMA is focused on addressing issues like practice sustainability, ending type II diabetes and cardiovascular disease, and reinventing medical education. In fact, the AMA recently unveiled principles for the top 8 EHR challenges physicians are facing and we are now using these principles to lead EHR improvements to advance the delivery of high-quality care and improve the health of the nation.

officercynical said...

Can you loan me $200 for these cool shoes I saw on Zappo's?

kasey said...

I'm a therapist and my agency is ALWAYS looking for a psychiatrist (do you know one?! we do telemedicine!!) because ours sucks and clients hate her. Whenever a client asks me why we can't just hire a new one, I explain that there's a psychiatrist shortage because it is a poorly-paid specialty compared to oncology, etc. I explain college + medical school can cost up to half a million after interest, and malpractice insurance is expensive. They never care. "They still make more in one year than I'll make in five or ten!" But their outgoing expenses are ten or twenty times what yours are ... they still don't care, or don't get it, or both.

And they all assume I'm loaded with cash, too, because I have a Master's and a professional job. Meanwhile, I can barely afford rent or the gas to get to work. And I live in Ohio, not NY or CA. The NASW - my field's equivalent to the AMA - costs $190 a year. How many social workers can afford that? For some crappy magazine and a generic promise that they are working on improving wages across the country. Right.

Anonymous said...

What I want to know is WHO is making the money (beside wall st, CEO's, etc)? I'm a Pharmacist and as my husband (engineer) and I drop our kids off at the YMCA for before school care $650/mo and head to work in our 2003 Dodge Minivan (that has manual roll windows and more than its share of rust (Just this am, I realized I was driving in neutral---hmmm...that can't be good and we were hoping to get another 10 years out of the old girl), we pass sparkling new SUV's, BMW's, etc. WHO are these people??? Between the two of us, we have two bachelors, 3 masters and a doctorate. What do you have to do to make a good living...because I would LOVE to let my kids in on the secret!

warmsocks said...

My plumber took your advice (okay, maybe a bit prematurely). He's an MD, but part-way through residency said it wasn't worth it. It took just as long to get all his credentials to be a plumber, but he's much happier and making more money. Medicine is in a truly sad state of affairs when cleaning up the mess and replacing broken septic/sewage pipes is better than dealing with patients all day.

Library-Gryffon said...

Speaking as someone who lost their hospital, non-clinical, position to corporate restructuring in CT, the CEO and several of the EIGHT vice presidents of a small/medium size community hospital are making into 7 figures. However staff raises didn't even meet inflation for many years.

Some years back, at least 6, my hematologist walked into the room at my annual visit, shook his head, and told me to never let my children become doctors. (I'm assuming he'd just written a check for either his malpractice premium or his kid's pre-med or med school bill.) I replied, half joking, that I kept asking mine didn't they want to become plumbers. He paused and said wistfully that his neighbor was a plumber. The plumber got to repaint his house every few years, had a new car, and owned a boat.

Anonymous said...

The 'word' was, going in, that pharmacists would be paid over the top; not so much (relatively speaking) after 25 years in the business, and I don't even own my own shop. (Very few pharmacists are owners, anymore.)

We live a little precariously. Because I am still paying medical-related bills (from before ACA), the large bank at which we've done business for past quarter of century refused a home equity loan so we could pay for a new roof. The automobiles have started to make ominous noises and the repairman just shakes his head when he's asked to perform another miracle on hubby's vehicle. We could still toss college textbooks into the fireplace if necessary if the heating bills are too much this winter!!

Am not discontented in my world so long as there's a chance karma is involved. I sometimes work 60 hrs in a week or longer and get home by midnight when working out of town. I'm a pharmacist and obtained BS in the '80s and worked on the PharmD over next two decades.

When a beloved family member became ill and required tertiary medical care and expensive medication, even though I KNEW what was going on, I was helpless to make things easier for his recovery or the 'hit' of low-tech, but outrageous prices of medication. That's the kicker.

As students, my husband and I 'made do' with the years of living at what might be considered a poverty level, working numerous low-wage jobs, day-care for kids, walking, biking everywhere, and long hours at the university library and in class.

When there is a certain level of education involved, and good health, and motivation; 'they' cannot take that away. With all that, that sort of wealth can never truly be called 'poverty'.

I think what Dr. G is commenting on is the phenomenon of the increasingly huge disparity between poverty and conspicuous consumption of assets.

pharmacy chick said...

if you figured out what your hourly wages were based on this figure, you'd be depressed doc...

no wonder its hard to get people into medicine now.

Anonymous said...

Our NURSE ceo cleared almost 2 MILLION last year. MULTIPLE senior docs leaving: FP, Dev Ped, Neuro, GI, all replaced by newly minted fresh NP. More than 100 patients a week, constant harassment from the 'never practiced clinically' RN 'care delivery supervisor' grosses me less than $120 if I don't look too closely. I have paid down HALF of my graduation debt of $150,000. Living the dream. Keep me off the bridge. Friends don't let friends become Docs.

Anonymous said...

Where I practice, in rural/suburban Indiana, NP's and PA's get about $100K to start. So, that is more than OP made last year. And I suspect that OP had many more years of training than a new NP/PA has. So, that is the point. We owe thousands more in student loans, don't start earning money until we are nearly 30, which is something a nurse can do with a 2 year degree from a community college, so probably age 20 or so.

OldRPh said...

Interesting car talk. In a business layout much like McDonalds, my pharmacy serves up drive thru prescriptions. If you don't work and live off of the taxpayers, there is about a 99.9 % chance you drive a nicer car than your neighborhood pharmacist. I make my way to work in a 1998 4 Runner or my newer 2004 Nissan pickup.

rapnzl rn said...

The nurse who drives a rusty '97 Sentra with manual everything (trany included) curtseys in respect to Ibee and his ethics (those thingys we lose when the almighty dollar becomes more important).

Anonymous said...

I met a physician the other day who was positively giddy over the fact that she had just paid the last installment of her medical school loan. Her loan was more than her mortgage, both in total and in her monthly outlay.

She was 54 years old.

I'm sure that she could have paid the loan sooner had she gone into some high-paying specialty, or if she had grown up wealthy, but she had grown up in "the projects." She decided that when she became a doctor, she would serve the impoverished and under-served community of her youth; she now works as a family practice physician in its neighborhood community health center.

54 years old - not so far from retirement age. Yup - these doctors have it made. TCG, RN

The Patient Doc said...

I am so sick of the image media gives us. My husband and I are hard working people. We don't own a house , drive 12 yr old nissans, and have just enough to pay our bills. My loan repayment eats up more than 2/3 my paycheck. Where do people get the idea all focus are rich?

Anonymous said...

Uh the person who thinks NPs and PAs have a two year RN degree is grossly mislead. Both require specific graduate degree programs, a four year degree isn't even enough.

Anonymous said...

Maybe the ad is trying to convince you that you would make more money as a salesperson of luxury cars?

Anonymous said...

Cheers, from a veterinary counterpart, whose professional outlook is equally bleak, and has a medical association advocating for more veterinary schools.

 
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