Me, I think people should have quotas to meet, and so long as they meet
I wish I had a nice cushy government/union job. Preferably one that would allow me to work remotely, and work on other personal projects.
The reason I moved to DC back in 78 was sort of the luck of the draw, GW was for me the best place to go to medical school. After that, another luck of the draw put me in Baltimore for my residency and that is how I wound up staying in the DC area all this time.
An explanation of the economics, or rather the nature of medicine in the US which is really a business requires far more time than I have at the moment to discuss. What i can say is that there has always been a large disparity between how much a cognitive physician earns and a specialist that does procedures. If anything, it should be the other way around.
If you look at an Oxford dictionary that is perhaps 15 years old, you would see that there are only 3 professions...the clergy, law, and medicine. The reason is simple. A profession is supposed to be a calling, you do it not for money but because you really want to help people...period....nothing more. In fact, it is probably best defined by being a little bit nuts because a calling is about self sacrifice. Traditionally, up until relative modern times, European physicians were highly respected professionals but from an economic perspective belonged to the middle class.
During my residency I met a guy who was a Baltimore Homicide Detective. We became close friends. He resigned a year short of retirement because the demand for overtime was killing him. He went on to work only for the Federal Government, first in Medicare Fraud, then in Homeland Security. When he retires, he will receive
3 checks!
I don't have the time to explain all the complexities regarding the economics of medicine. What I can say, is that since 1989 I struggled with a 90 K educational debt and declining insurance reimbursement, insurance and paperwork being the bane of my existence. I really busted my butt.
My first position out of residency was as a part-time medical director for a substance abuse program. However, it was not my only position. I was working two jobs. During the day from 9 to 5 working for someone in a combination medical practice/urgent care center. i got off at 5 pm, grabbed a quick bite, and then saw patients where I where I held the position, AND at two others. i got home at around 11 pm. For a year I was also studying acupuncture so for that year at 11 pm I studied.
After a couple of years there was a shake up in substance abuse. The program in my hospital closed. I left with an A/R of $70 K because the hospital got paid by insurance companies first and I got paid second which for reasons beyond this discussion, resulted in my getting nothing. (I received only a very small stipend so I really had worked for nothing.) This would be of no consequence if i did not have all that educational debt.
So, for me it is highly ironic that for my entire career I have worked with patients who get fed from the government trough but I never had an opportunity to eat from it myself. And, on top of that, all of them have retirements at the expense of the taxpayer
That said, I have no regrets. I have done what I wanted to do and enjoyed it which is why I say that it is simply ironic for me. I never really cared about money. However, the educational debt over my head was a problem. I could write a book about that!