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The Dispensable Doctor Dilemma


One way the government, insurance companies, and corporate entities are going to reduce health care costs is to put a target on physicians' backs. What's your financial plan to address being replaceable?

Many physicians I meet make way too many excuses about why they can’t get their finances and investments straightened out.

They cite some or all of the following as reasons:

“I don’t have time.”

“I’m too busy.”

“I’m too tired.”

“I work long hours and don’t have many days off.”

“I can’t stand thinking about investments, retirement, insurance, or wills.”

“It’s not fun.”

“I’d rather plan my next vacation.”

The other day I got a call from a physician who used to make all of those excuses for years, but, one day, he suddenly decided to take action and get his personal finances in order.

What motivated him after all these years?

Here’s what he said: “I’m replaceable.”

He realized that one way the government, insurance companies, and corporate entities are going to reduce health care costs is to put a target on physicians’ backs.

If you don’t meet whatever standards they’ve set—for example treatment protocols, time to see the patient, number of days the patient has been in the hospital, readmission rates of your patients, complications from procedures you perform, whether you’ve met the dubious “standards of care,” and so on—then you will be replaced by cheaper alternatives.

These alternatives include physician assistants, nurse practitioners, and nurse anesthetists as I’ve written about in previous articles. But there are also other doctors who are willing to work for low wages.

You see, these outside entities know that you can easily be replaced with someone else who will bend over and accept their rules. And work for lower pay.

Take newly graduating physicians as an example. Many new residency graduates are mired in over $200,000 in debt. I’ve met a number of them who have over $350,000 in loans to pay off. They have no choice but to accept whatever work they can get at whatever salary they can obtain.

These young physicians haven’t built up enough assets—and likely won’t for a long time if they make the same money mistakes so many other doctors make—to have any control over their pay.

Which means they must work and won’t complain about the hours, the demands, or anything else. (Though silently inside their minds they’re wondering what they got themselves into.)

I know contract management groups who market mostly to new graduates because corporations know that young doctors can’t stand up and push back.

Realizing that you are replaceable should scare the daylights out of you. No longer does medicine equate to “job security.”

Yes, you’ll have a job. But that’s about it.

And that’s all it will be, as you become a salaried worker on a corporation’s balance sheet or, even worse, on the government’s payroll. Or just a warm body to fill holes in the schedule.

The sooner you realize this, the sooner you’ll stop spending so much time planning your next vacation or remodeling your kitchen, and the sooner you’ll start taking the painful, but necessary, steps to get your finances and investments in order.

So if you are plucked like a chicken in the factory of medicine, you won’t have to suffer the fate that so many physicians who don’t have their financial lives together may face—which is to work because they have to and not because they want to.

Tell me: what’s your plan to address this dispensable doctor dilemma?

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Victor J. Dzau, MD, gives expert advice
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