Why I talk about money: A call to do good

Money and medicine have historically had a bit of a ‘don’t ask, don’t tell’ relationship. Most physician contracts have confidentiality clauses prohibiting physicians from discussing details of their compensation with others. Employers often market the ability to care for patients without having to worry about payments from patients as a benefit of being an employed physician – “you can just see patients and do what you love, no money headaches,” they say.

Some citizens (and physicians) even suggest physicians have an ethical duty to provide care regardless of payment. Many physicians shy away from the physician compensation conversation, not because of ignorance or disinterest, but due to a fear of being branded a physician who’s “in it for the money.” Heck, I know physicians who intentionally avoid purchasing things or sharing certain experiences publicly to avoid displaying an impression of wealth. All of this labels money as a faux pas in medicine.

The changing landscape of physician compensation

Physicians make a fine living; however, the profession is not a golden ticket to the lifestyle of the rich and famous as it may have been a few generations ago. As I outlined in an article published in 2019, a number of pressures have led physicians away from private practice to the employed physician setting – with the changing financial landscape of physician compensation being the primary driver.

Unfortunately, giving up ownership of physician practices also means giving up autonomy over charity care, office hours, patient mix, care patterns and a number of other factors that are important for physician fulfillment.

Like it or not, money makes the world go around. Those in need of money are often forced to sacrifice fulfillment to meet financial needs, while those with abundance of money are well-positioned to leverage their finances for profound contributions to society.

Somewhere along the way, through the Stark Law, anti-kickback laws, RVUs and big-pharma regulations, physicians were branded as greedy businesspeople preying on illness for personal gain, rather than incredibly compassionate servant leaders who commit their lives to healing and helping those in need. The vast majority of physicians I’ve known are in the latter category.   

At its core, this is exactly why I talk about money in medicine: Eroding the financial capacity of physicians erodes our voice and our helping hand.

If we stand silent, we are complicit in eroding our value, eroding our voice, eroding our impact.

I keep no secrets about my desire to increase my earning capacity and grow asset-driven income streams. I talk openly about how I seek to do this in the current compensation environment, how this is an important part of my career decisions, how I’ve failed and the lessons I’ve learned.

When money meets compassion

I also talk about how important it is to advocate for system-level changes that put physicians back in the financial driver’s seat. No, not because money defines success (it doesn’t, but it sure helps to facilitate it!) – because making more money allows me to give more to the causes that are important to me, and I believe all physicians should have that freedom.

Making more money allows me to help immediate and extended family in need. It allows me to support charitable organizations that are important to me, such as the American Osteopathic Foundation. It allows me to be a supportive alumnus for my alma maters. It allows me to donate hundreds of hours per year of my time in professional service. It allows contributions to political action committees like OPAC that support the interests of physicians.

It allows me to go, personally and professionally, where I feel I am needed most. This, to me, is the ultimate form of fulfillment, and I strive to earn more; to be in more places, for more people. Sure, I unabashedly like nice possessions and experiences as well, but, as is the case for most physicians, there’s a far deeper motivator.

When money meets compassion, the impact can be extraordinary. We saw this for decades in the offices of private practice physicians across the country that have now become an anachronism. Sure, there’s no record of these countless acts of charitable kindness, but they were profound; and they’re largely lost now to the corporatized “charity policies” of corporate health care employers. I long for the ability to restore those experiences. In the interim, we must find new ways to have the same impact.

Learning more about money

I encourage all physicians and medical students to use your desire to serve as a driving force to learn more about money.

Learn about how to maximize your professional value. Learn where we have physician compensation wrong and advocate for change. Learn about regulations that have removed physicians from the financial transactions in health care and advocate to change them. Learn how to earn more and to protect what you have. And learn more about all the ways you can pay it forward.

After all, to borrow from Benjamin Franklin, we should feel no shame in doing well by doing good.

Related reading:

Start strong: Financial do’s and don’ts for med students and early-career physicians

Work for assets, not money