How Being a Doctor Became the Most Miserable Profession

[eridani]

http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html

Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?

By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.

Simply put, being a doctor has become amiserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize withphysicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

[A HERETIC I AM]

1. Ehhh...fuck it

Last edited Tue Apr 29, 2014, 04:44 AM - Edit history (1)

[Warpy]

2. Calling, schmalling

The problem is that the MBAs and bean counters have done to doctors what they've done to the rest of us, put them on an assembly line that keeps speeding up, only the risks to doctors legally and emotionally are so damned high this sort of thing should be criminal.

Docs are lucky to spend 5-10 minutes with their patients, then another 15 minutes reviewing their labs and 5 minutes dictating the chart entry. Patients are left feeling shortchanged by a doc who won't stay and chat and the doc knows full well that staying and chatting for a few minutes turns up problems beyond the initial complaint.

MBAs and bean counters have made it nearly impossible to function at any level in medicine. The MBAs are the ones who really need to go. They're OK at running supermarket chains but utterly dismal at health care.

[Rod Beauvex]

3. No.

They're not ok for supermarkets either. They're not ok for anything.

[Warpy]

6. Well, they have a lower risk of killing people when they run supermarkets

so let's leave it at that. They just treat employees like something they scrape off their shoes.

At my last job, we jokingly put together a plot where we nurses would accuse one of the docs of sexual harassment, have him throw the case, and then we'd all split the take and get the hell out of medicine.

And it's getting far worse for everyone at every level of the system, from hospital housekeepers and home health aides all the way up to MD specialists.

[pipoman]

25. The group usually left out of these lists of oppressed

Health care workers are the billers, coders, and registration people. These people know what it takes to get paid for the work done by everyone else, but are treated like the enemy, or worse, like know-nothing peons. Doctors, nurses, PAs, and APRNs refuse to listen to or act on requirements for billing without top administrators involvement. ICD10 coming down the pike is projected to deny 50% or more of all medicare claims for lack of documentation. Providers like to pretend it isn't coming or will have no effect on them. Peon billers and coders know better...but alas. ..

[dionysus]

9. maybe that's why my "dr" was such a jerk to me... literally walked out of the room without

saying a word when I was talking, describing symptoms of an issue I was having.. comes back a minute later "I needed my laptop charger cable"

I was stunned.

[Warpy]

12. At least my docs say "hold that thought a minute"

when they have to get some piece of gear.

But yes, all docs are rushed now unless they're concierge docs prepaid by a handful of rich schmucks to tell them to quit smoking and cut down on the booze.

And yes, that's why your doc was a jerk in that regard. They're now working an assembly line.

[Lonusca]

60. New requirements

(I don't think they are ACA related - started prior).

I got the same thing with my doc, and have a relative who is a doc. The new requirements for electronic records are throwing a lot of docs off their game. They are used to taking mental and written notes. Now after all these years they need to fill out form after form after form electronically.

Mine looks totally perplexed with the computer. Not the technology part but the new forms, records, etc. My cousin doesn't like it - takes away a lot of time he would normally spend with patients.

[hfojvt]

11. the doctor should be so lucky

when I made $5.40 an hour at a factory, one that paid piece rate, I had a welder tell me he made $10 an hour.

But, he added "I bust my a$$ for that".

And I thought, well you always have the option of relaxing a little bit and still making $9 an hour which is 167% of what I make.

The GP who makes $170,000 a year has the option, do they not, of spending a little bit more time with their patients, and still making, say $140,000 a year.

Well, they would, I guess, if anybody could actually live on a mere $140,000 a year.

If they don't do so, then they basically seem to be saying "another $30,000 a year in income is more important to me than the health of my patients".

But hey, considering that I would clean puke out of a drinking found or excrement off of a wall for $30,000 a year, who am I to criticize?

[Warpy]

15. The average doc is looking at $250,000 in school debt

and more if he decides to specialize and undergo extensive training at low wages at a teaching hospital. Most of them now have to work for HMOs because there is just no way to pay that kind of debt while setting up and building a practice. If he doesn't slog along and see 3 times as many patients as he can safely see, he can get fired because he's not generating enough revenue.

Janitors don't have to worry about missing something and having somebody die and their relatives sue him. Part of the reason medicine is such a pressure cooker is because it's the one area where mistakes aren't tolerated.

Cleaning somebody's cut plug out of the drinking fountains is just a perk.

[Bazinga]

19. And that doesn't even consider...

The almost 2 decades worth of opportunity cost associated with such extensive training. Docs are definitely on the wrong side of the time-value of money equation.

I saw an infographic the other day comparing a doctor's hourly wage after debt, training, and working hours to a high school teacher's hourly wage. The teacher's salary worked out to $33.06/hr while the average doctor made $33.03/hr. This is not meant to be a cut at teachers and obviously this was no randomized control trial, but even if they are half right, consider the attitude we have towards teachers vs the one towards doctors.

The days of the rich doctor up the street are gone. Those who still choose this profession, like myself, do so not for a huge paycheck, but for science and service to the suffering.

[Warpy]

50. It was late, or I'd have pointed out

that there are plenty of professions out there that don't require being on call every third night or so and which generate greater returns far more quickly than being a doc does.

I watched the speedup from the vantage point of a hospital RN as our own "assembly line" was undergoing the same thing.

[hughee99]

54. If I understand correctly, Doctors who work for certain medical groups are often expected

to see "x" number of patients (or have an "expected" workload). If they can't handle the workload, they can be fired. Doctors that hang out their own shingle have more control over their patient count, but they also have the overhead of running their own practice.

It sounds to me like a factory that pays piece rate, but if you don't make enough pieces, they'll fire you and find someone who will. And if you go into business yourself, you have to make enough pieces to cover your wages PLUS pay for your workshop and materials.

[hfojvt]

55. okay, not all doctors are self employed

but the ones who are NOT self employed are still making a median of $170,000 a year.

THAT is one reason why their employers are pushing them to see more patients - to cover the cost of THAT salary.

Theoretically a doctor could ask to spend more time with patients and also ask to be paid less. If the HMO loses $30,000 in revenue, but also loses $30,000 in expenses, then they have not lost anything.

And sure, the self-employed doctor has to cover overhead, but the median GP income is still $170,000 so apparently they are covering overhead and then some, because the $170,000 is what they get AFTER they pay all their overhead.

True, 50% are making less than that, but it is also true that 50% are making MORE than that.

Seems to me that a skilled worker (the doctor) who can command a six figure salary (or make it on their own by being self employed) has more options than the average worker like myself who just goes begging for an entry level job.

[hughee99]

56. Doctors certainly have more options than us. Isn't that what the op is about?

Doctors getting out of the "doctor" business and doing something else.

[hfojvt]

58. they also have more options

IN the doctor business.

Assuming they want to use all their education and training to help sick people, rather than just using their talents to make more money and have less stress.

No, the article in the OP is about having EMPATHY for people who make $170,000 a year and presumably have less social status than worm excrement, er, I mean janitors.

[hughee99]

59. From the article, it sounds like doctors who want to use their education and training to help

sick people are instead spending their time processing claims for insurance companies, rushing from room to room to see multiple patients, knowing that they're not able to spend enough time with some of them, and knowing that their performance is largely based NOT on how much they actually help the patient, but how much the patient likes them.

Yes, I understand that they make, on average, $170,000 a year, and that seems to be your issue with the whole thing, but making a lot of money doesn't turn any job from a bad one into a good one, it might just make it worth putting up with.

[hfojvt]

61. actually it generally does

because minimum wage jobs are usually not without their sturm und drang.

My issue is that it seems to me, like the $10 an hour welder than they could make their jobs better in exchange for a little bit less money.

They CHOOSE not to, because they want to have their cake (their high salary) and eat it too (with very little stress). Just like the welder making $10 an hour complaining that he is "busting his a$$".

I am working pretty hard for my $5.40 too and don't have the option that he does - to slow down and STILL make decent money.

[hughee99]

62. You seem to have it in your head that doctors are "paid by the piece" and get to set

their own schedule. If they don't want to see more patients, they don't have to, they just don't get more money for doing it. I don't think this is how it works. Perhaps this is why the author starts out early on saying that it's hard for anyone outside the profession to understand what it's like.

Maybe if President Obama took a pay cut, he'd only have to do half the work. If Rex Ryan took a 50% pay cut, he'd only have to coach half the games. In many cases the job has set requirements. If you can't meet them all, you go somewhere else. It's not a matter of having the option to do 50% of the work for 50% of the money.

Apparently, though, doctors now make a lot more than you did when you were working at a factory making $5.40 an hour (a fair comparison, given that they are similar jobs with similar requirement, responsibilities, and pressures ), and I can't make any argument to change that.

[Tracer]

27. 5 - 10 minutes?

I'm not so naive as to think that there aren't doctors who spend that little amount of time with their patients, but I haven't run into any.

In fact, the first time I went to see (a particular specialist), he spent MORE THAN TWO HOURS with me.

And just two weeks ago, another doctor spend close to an hour with me -- not just regarding my diagnosis, but also pleasantly chatting about this and that.

Above Dr.#1 has mentioned that his practice's major stress is money -- not time, or fighting insurance companies. In order for his group not to fail financially, they found it necessary to join forces with a major city hospital.

[A Little Weird]

29. 5-10 minutes is normal from what I've seen

I have finally found a doctor that will let me finish a sentence and will spend more than 10 minutes on me. But it has taken years and several doctors. Most would send in a nurse to do almost all of the work and then come in - they were basing everything on the notes the nurse took so they wouldn't have to spend much time talking to me.

Specialists do spend more time than primary care docs. I don't think they generally have the same problem in that regard.

I have a great deal of respect for (most) doctors - it's not a job I would do for any amount of money. The whole medical system is messed up in this country. We shouldn't treat medicine like an assembly line job. It shouldn't be a for-profit industry.

[riderinthestorm]

36. 5 - 10 minutes is about average for me too.

[raccoon]

57. Who are you, Victor Newman? nt

[uppityperson]

46. Those are the only ones I want to have as my doctor for sure. Assuming they are knowledgeable and

able to figure out the puzzles involved.

[Douglas Carpenter]

4. Physicians are a LOT more polite and respectful to both patients and to non-physicians healthcare

workers than they used to be. In the 32 years I have been a Respiratory Therapist I have noticed a profound improvement in that area. On the other hand - The problem of student loan debt which affect almost all new graduates in almost all categories these days is compounded dramatically for physicians who start practicing already buried in mountains and mountains of debt from day one. I dare say primary care physicians do have it a lot worse than advanced specialist - I suspect even an experienced and well established primary care physician is fortunate to make $180,000 to $200,000 per year - while an experienced and well established neurologist or orthopedic for example almost certainly make well more than $500,000 per year in the United States.

[snot]

5. That's what they get for ignoring the highest aims of their profession.

They should have been the first to advocate for single payer; and still could be.

Instead, we have clusterf*ck.

[fbc]

8. I agree

Screw them. Where were they when our manufacturing jobs went overseas? Where are they when they try to increase H-1B visas to cut the tech jobs available to citizens?

They enjoyed getting rich off our shitty healthcare system and have never, with a very few exceptions, stood up to improve it lest providing care for more people might take a dollar out of their pockets.

Let their jobs go to immigrants willing to work for less like the rest of us.

[uppityperson]

47. Many were protesting, contacting those in power, etc. I disagree with what you write as I know few

who fit what you are saying here. The exceptions do, but the majority do not. I think you have it backwards, from what I have experienced.

[eridani]

53. Indeed--some even got arrested n/t

[Tuesday Afternoon]

37. yes.

[uponit7771]

42. +1

[hfojvt]

7. very funny Daily Beast, very funny

"being a primary care physician is more like being a janitor—but without the social status or union protections."

Really? When did I miss the huge social status promotion of janitors?

Let's just see about those union protections too.

Median income of a general practioner is $176,530.
http://www.bls.gov/OES/current/oes291062.htm

Okay, sure, that IS $140,000 less than I make at least if today is OPPOSITE day does anybody remember when we used to have opposite days?)

Median income for a janitor - $22,590. http://www.bls.gov/oes/CURRENT/oes372011.htm

Okay, that is a teeny, tiny bit less than a GP makes, but thank god for the higher social status of the janitor. Why janitors are held in such high esteem that their occupation is regularly used in articles like this one - as an example of a job with fuking LOW status.

The author chose "janitor" out of all the occupations in all the world, to be funny. A way of saying that, ha ha, doctors are worse off than worm excrement. They are so low EVEN janitors are above them in social status (and, of course, those awesome union wages of $11.75 an hour.)

But maybe fewer janitors are committing suicide than doctors - (although which profession is in FIRST place.)

Why would that be?

Perhaps "Great Expectations". Perhaps most janitors did not expect all that much, so they are fairly satisfied with $11.75 an hour and some benefits.

Whereas the doctor making $175,000 maybe expected to make $300,000.

And heck, maybe $175,000 is NOT all that compared to their Mt. Everest of student loan debt. Their student loan debt is bound to be at least twice as high as that of the median janitor.

But this author pleading for empathy for the poor abused doctors, isn't showing a hell of a lot of it for janitors.

But we are used, as a retired school janitor put it, to being treated as "scum of the floor".

[dionysus]

10. no shit, talk about hyperbole!

[reformist2]

13. This is one profession that would benefit from more workers, lower pay, and fewer hours.

The "medical school cartel" that limits the number of physicians that come out of med schools in the US is
a major cause of the overwork and overscheduling - and shortages - that we all see today.

[pangaia]

31. Glad someone mentioned that little fact..

[Sgent]

40. That's changing

the "cartel" was imposed by Medicare, not by the schools / AMA (which have very little power in this regard). From 1996 until the ACA passed there was no funding for new physician slots, but the ACA changed that. Since then there are at least 8 new medical schools in various stage of opening, plus additional slots in existing ones.

One problem you have is that there are a limited number of slots due to a limited number of learning opportunities in regional hospitals. Even for primary care, they need to be at a teaching hospital or at the top of the food chain in a large community hospital.

[GeorgeGist]

44. Not quite ...

The Balanced Budget Act of 1997 capped the number of available slots for residents coming out of medical school as part of the law’s reduction in spending on Medicare, which largely funds residency programs.

[Alkene]

14. Boo hoo. n/t

[Ex Lurker]

16. Academic medicine is a good deal

One of my friends is a med school professor. Regular hours, regular salary, no hassles of trying to run your own business. It's pretty much like a single payer system would be.

[My Good Babushka]

17. They are just like every other worker

in that they have kept their mouths shut for too long and let things get as bad as they are. They have more prestige and social standing than janitors or fast food workers, if they spoke up, people would listen. I see janitors and fast food workers taking to the streets, where are the doctors?

[Bazinga]

20. The snarky answer...?

They're in the ERs and ORs saving the janitors' and fast food workers' lives.

[My Good Babushka]

21. Why should we save doctors

and expect everyone else to save themselves? They certainly have more agency in society than people at the bottom rungs of the economic ladder working two or three jobs. How about some solidarity? How about pulling in the same direction?

[Bazinga]

22. I agree, all boats should rise.

I was just walking through an open door, tongue planted firmly in cheek.

[My Good Babushka]

26. I didn't mean to lash out like that

It seems like there has been a glut of news stories that find a deep well of sympathy for people who are actually quite well off, but very little of the same for people in very dire straits.

[sendero]

18. My doctor and I...

... generally talk at least 20 minutes when I visit besides the medical stuff. We talk about politics and about his job. What he says echoes much of what this article says.

The system, while allowing "specialists", surgeons, anathesiologists, hell almost everyone involved except the primary care physician and nurses, to make out like bandits, buts the squeeze on them. And the primary care physician is the linchpin of the entire system IMHO.

A decade ago my doctor told me what he was earning (not much and I believed him) and at the time I was making more than he was. I think he is doing better now, but no way that is right, he is a very good doctor and sees a lot of patients.

Another opinion he shared with me is the belief that everyone visiting the doctor that is not destitute should have some sort of out of pocket expense, he said that he does have a fair number of patients that abuse the system because it is "free". I believe him on this also.

Also, he told me that he does not accept new Medicare patients as he loses money on every visit. He said that since I had been a patient of his for a long time that he would continue to see me when I went on Medicare though. I have moved and it is not convenient to visit him, but I continue to do so because I have a lot of confidence in him, it can be hard to find a good primary care doctor.

I really don't know the answer except to say that we should not treat our primary care physicians so poorly, they have a very difficult job that takes a lot of training and they deserve better.

[pipoman]

28. Who that isn't destitute doesn't have to pay?

There is no such thing as a no deductible/no co-pay, nor low/no premiums even when employers offer insurance. And even when there was, people still either paid for insurance or worked for it.

There is dignity in all human labor. What makes physicians so special? Why doesn't all labor "deserve better"?

[grasswire]

52. Medicaid, I think. nt

[99Forever]

23. This isn't from The Onion?

Seriously?

Do rich people ever stop fucking whining about how "tough they have it?"

[WinkyDink]

24. I've never met a poor doctor or doctor's wife. (P.S. Note it says "profession" and not "job.")

[pipoman]

30. Yep...High student loans..

Maybe if they lived in a reasonable rent district and drove reasonable used cars like the rest of us for a few years they could knock those loans out a little quicker. I have yet to see a doctor who finished internship who doesn't add to their debt by living beyond their means by anyone else's standard. ..

[bullwinkle428]

45. My brother is a family practice physician - he's been out of school

and employed full-time in his profession, and still drives a beater 1999 Toyota Camry. He's definitely a cheap bastage in a lot of ways (and I mean that in a good sense - I'm the same way), and his drive to pay down his loans is the primary motivation for his fiscal restraint.

[LynnTTT]

33. Oh, Boo-Hoo

Doctors so miserable they have to join hedge funds? You want a miserable job? Go to WalMart. Dig ditches.
Recently I checked out a similar rant. Medical school admissions are back to where they were before the recession and doctors salaries are still sky high. Yes, primary care general practitioners still make the least, but as I recall it's still about $ 150,000 or so.

[sorefeet]

34. I trust no doctor

way too many personal experiences that tell me they could give a fuck less about me. It's more on a profit, expense, insurance, no insurance, rather than my medical problem. Even the VA is concerned with expense like, they will deny a MRI until it is absolutely the last option, knowing they could find the problem now. But we also know if it were say a 3 star General, his options are totally different than an NCO. I have been told "why don't you people just go away", referring to me as a medical marijuana user. A month ago I seen her for gastric pain, she said I got an ulcer (zantac), 3 days later I'm in the emergency room nausea big time, ultra sound, cat scan = cyst on kidney. Says don't worry about it. Still got pain and high BP(new). Got an appointment for May 20 same doctor, guaranteed same bullshit. After 6 hours in emergency I was sicker than when I went in with nausea. He gave me a script but I could not get to the second floor to fill it because I was heaving so bad. I heaved and staggered to my car where I promptly smoked 3 puffs of cannabis, which in 5 minutes I was not heaving or sick and was stabilized enough to make it to the drug store. Why didn't the assholes at the hospital give me a pill in those six hours??? The nurse watched me heaving and trying to get dressed. Would Rush Limbaugh or any other muther fucker with money crawl out of the hospital that God Damned sick???? Fuck no. I am losing more and more respect for doctors every day. WHY, because they are spineless puppets and won't any of them speak up for my rights or theirs. They won't say shit if they has a mouth full. Don't make waves, just ride it out for 20 or so years and it will be over, you can retire comfortably.
I have been mistreated a heck of a lot more than I have been treated. They work for the corporates, not the people, just like a politician.

[n2doc]

35. I live in a community full of medical doctors

They don't seem too miserable to me. Busy, yes. Lots of nice houses, boats, fancy cars, private schools for their kids. Maybe it is just a facade.

[nolabear]

38. Another side.

Mr. Bear's family is full of doctors, surgeons to be precise. His father was a pioneer in surgeries that you are glad exist today. They make an excellent living and have considerable perks and social position, after many years of school and work. But they work, and worked, trauma. Family stories are rife with leaving holiday dinners to try to save the people who piled up on the highway, or whose Christmas trees caught fire, or who just plain got drunk and shot one another, and coming home and pacing and calling repeatedly to find out if they had helped someone's child not die. Long term relationships with patients frequently end with death, terribly altered lives and the alternate gratitude and rage of patients and families. They know more than anyone that they are human, and imperfect, and can just do the best they can.

They also teach, work to pass legislation, deal with constant changes as they try to keep up with research advances, manage staff drama, and did I mention that people often die?

And then there's the kind of generalized hatred that people who, for some reason, fire shotgun-like at them. They do read, you know. They do see how much the competent and incompetent (and they crusade against incompetence) are viewed all together, and how much people seem to believe they are inhuman, money-grubbing machines even as they work stretches that would put ME into a state of mild psychosis.

My f-i-l used to throw a party every August on the first day his income wasn't going for taxes.

I don't dismiss any criticisms leveled, but believe me, the reasons for doctors being stressed aren't new, and the people who go into the profession thinking it's an easy buck are quickly disabused of that notion or genuine are hacks who should get out. But it's hardly the majority. Even for hacks, it ain't that easy.

[rock]

39. MBA

Ewwwww!

[Aristus]

41. They must have front-loaded their polling sample with congenitally unhappy providers.

I love my job. I consider myself happy and fulfilled.

Sure, it's stressful. Most jobs are. I have good days and bad days, like everybody. I have patients I love and patients I'd just as soon throw through a window if I hadn't taken an oath against that sort of thing. I have patients who seem to love me, and patients who curse me and my descendants even unto the seventh generation. I've had bosses who view patients as numbers which exist to generate profit, and bosses who assert that more time spent with the patient is the key to good medicine.

There's good and bad.

I earn what in my estimation is a generous salary. I don't own a mansion, a limousine, or a yacht. But I live comfortably. The stresses I undergo in the course of an average day in clinic are well-compensated. I feel like I'm making a difference in a difficult field, with a difficult patient population. The feeling I get from that is a treasure beyond price.

My last comment is to all those who think all medical providers are rich whiners; sure there are those out there. But I believe them to be in a minority. Most providers I know love what they do, study diligently to become better at it, and would do it regardless of what they get paid.

[lumberjack_jeff]

43. First, let's accept the author's premise that this is an actual problem.

What would be some solutions? If doctors are overworked, overstressed and can't spend enough time with patients then perhaps we need more doctors, which implies lower pay and more med schools. If $176,000 annually is not worth the stress, do something to change the situation.

The AMA won't have any of that kind of talk.

So take it up with your own union - the AMA.

[Blue_Tires]

49. My father was a doctor

and his absolute biggest gripe at the end of his 35-year career was the skyrocketing cost of malpractice insurance...He wasn't even breaking even his last 2-3 years on the job...

[hunter]

51. How many times do I have to say it, Jeff. The AMA is a dusty old fart.

They've sold their soul to the big pharmaceutical corporations.

Think of an older minor celebrity on late night television hawking incontinence products and "ask your doctor" prescription medicines. That's the AMA. They pump up their numbers by giving free and steeply discounted memberships to medical students, residents, and retired doctors.

Most doctors these days are not members of the AMA. They throw AMA mailings in the trash with the rest of the junk mail.

[hunter]

48. All the "altruistic" professions are being screwed.

Helping others is seen as a waste of money by those who control the money.

Teaching, medicine, social services... all these professions are suffering.

First, it's the "Social Darwinism" of big money that believes only the "strong" deserve to succeed, even though many of them were born in privilege.

Second, the oligarchs know that altruistic people will tolerate higher stress working conditions for fear of letting their students, patients, etc., down.

It's past time for pitchforks and torches. The oligarchy needs to be disbanded. The extremely wealthy ought to be taxed out of existence before they kill the rest of us.

One problem with doctors is they always thought they were part of the upper classes and thus would be protected. They were wrong. They are now feeling the same screws that have been clamping down on teachers, nurses, social workers, etc,. ever since smiling puppet Ronald Reagan convinced the ignorant masses that oligarchy was good.

Younger doctors and other medical professionals tend to be strong supporters of single payer and other "liberal" causes. The oligarchy is treating them the same way they did high technology workers, by outsourcing their work, where possible, and by importing workers (including doctors) who will accept lower wages and more stressful working conditions.

We are all in this together but, reading some of the responses above, it's obvious that the oligarchy is very good at setting us upon one another so that maybe we don't notice who is really pulling the strings, who really has ALL the political power.

It's not people like your family doctor, or even the specialist doctor who enjoys a very comfortable income by your own standards.

The people who actually run this nation, the people who are putting the screws on you, are the sorts who can move around billions of dollars, our dollars, to further increase their political power and unspeakable personal wealth.

Our nation is corrupt.