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Sara Germann's avatar

As a nurse practitioner with 25+ years working in healthcare who went into nursing due to a “calling”, I don’t really want to ever hear that we do the work as a calling ever again. Pretty sure the pandemic soured many of us as we were treated very poorly (at least in the red state I live in currently). Work is work-we deserve to be paid for it and paid at a level that reflects our experience, education and risk. And it is very risky. I was punched in the face as an ER nurse and suffered a concussion due to a patient high on PCP. It was the first time I was hit in my job and sadly probably won’t be the last.

I make less than my brother in law who is a business professor and my brother who is in marketing. And I have 4 degrees and the experience listed above as well as multiple certifications. I’m also someone with multiple chronic conditions and have experienced the frustration navigating the system that my patients experience.

Surgeons spend anywhere from 7-10 years training. They literally open up our bodies and work to fix non working parts. Why do they deserve less money than an executive or attorney?

As I cited in the past, reading The Social Transformation of American Medicine by Paul Starr is enlightening. It’s a hefty book but can be broken into parts. In addition, illness is part of life. I don’t love the multiple autoimmune conditions that I have nor the reliance on medications to survive BUT I do think it helps me as a provider but with increased empathy and navigating a broken system.

Last, there is implicit bias and moral judgement against those with chronic illness. People judge any lifestyle choices and if the person battling the conditions doesn’t present as a “perfect” patient, they are judged and “had it coming”. Everything from their dietary choices, stress management, etc. I think that is the elephant in the room that needs to be addressed in order to get to universal healthcare.

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Katherine Cartwright's avatar

I'm an OB/GYN. While I know this conversation was more nuanced than a single comment and I acknowledge I have a hard time not being insanely defensive when it is implied we should/would do our jobs for less compensation, I have to just say how demoralizing it is that discussions of healthcare costs so quickly turn to physician salaries. Physicians (and multidisciplinary teams- NPs/PAs, nurses, medical assistants, imaging and respiratory specialists, pharmacists etc)- are the only ones in this massive convoluted system who are actually providing CARE. For-profit insurance companies and massive hospital corporations are intermediaries who have injected themselves into OUR care relationship to get theirs, diverting money that should go directly to care. There is this idea that doctors are overpaid (we aren’t) and therefore the problem. Physicians just took yet another CMS fee cut this year and are paid less in just gross salary number than our mentors from 30 years ago. Adjusted for inflation I already make almost 40% less than partners in my practice did in the 90s. And they didn’t have loans or malpractice anywhere near what we have now.

The reality is that on a Saturday night I am charting and catching up on labs and results for patients I squeezed into every possible second of my days and nights, consistently working well over 80 hours weekly. This is significantly more than 2 full time jobs and is more the norm than the exception in my field. At least half of this is uncompensated work. Just this week I spent hours trying to get insurance companies to cover things like pelvic and breast MRIs, a second opinion for aggressive breast cancer treatment in a young mother, a very needed hysterectomy, and the RSV vaccine in pregnancy which United continues to deny despite FDA approval an insistence they'll cover it(!). There aren’t enough of us and the amount of patients waiting for care is daunting and endless.

I see and appreciate comments on how many other professions have long hours or risk of bodily harm etc, for too low wages. Firefighters are up all night and risk their lives, they should be paid more. Teachers have become heroes to me in so many ways and I'm SO grateful for them. So many people deserve better pay. At the same time, you'd be hard pressed to find a profession that has the combination of hurdles and challenges that medicine does. I spent 14 years, which is ALL of my 20s and into my 30s in class rooms and clinical settings 80+ hours a week, going half a million dollars into debt, while chasing my passion and “life’s calling” (not sarcastic- I absolutely love my work and would probably do it for free to the financial ruin of my family if they let me). I continue to work hours that leave me missing my kids and woken at all hours of the night. I have to pay ungodly malpractice premiums and ALSO worry that I would be a felon for doing my job ethically in half of America today (and who knows what tomorrow will bring). I do not seek pity here- I chose and love this life and I'd choose it again every single time. But honestly, I don't want my kids to choose it. And the idea that without MASSIVE reform of education costs, length of training, physician pay schedules, physician liability, etc, we would just do all the above out of the goodness of our hearts alone is so disappointing.

I worked in public health on my road to medicine and have long advocated for some kind of universal program that cuts out our private for-profit insurance model entirely. But unless the money that is poured into private insurance gets poured into this theoretical universal program, it doesn't work. Medicare For All doesn't work at current CMS rates- I would have to close my practice immediately if the Medicare rates were the rates for everyone. I wouldn't be able to pay my front desk staff and my rent let alone make a dollar of my own to keep. And there remains an issue of limited resources- government "rations" care while private insurance "denies your claim"- these are two sides of the same coin. We certainly have endless problems in healthcare with only painful and complex potential solutions. But physician salaries are NOT the problem. Our endless moral injury and the speed with which we are leaving our life's work may add to it though.

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