“These eye doctors do alright for themselves,” he judged with a crooked smile. “Did you see the Corvettes and Porsches in their parking spaces?”
We were in the waiting room at Albuquerque’s Eye Associates Center. Two seniors in a long parade of Baby Boomers with eye problems, waiting to see a specialist — aware of the growing gap in the food chain between today’s patients and highly paid physicians.
The Vettes and Porsches in the ‘Doctors Only’ reserved parking spaces don’t lie. Today’s doctors, 70% of whom are specialists, are today’s highest paid professionals, beating out lawyers, software developers, and finance managers. According to Fortune Magazine’s April 2016 study by Medscape, which surveyed 19,000 physicians across 26 specialties in the USA, physician’s salaries range from nearly half a million per year for Orthopedists ($443,000) down to a quarter million per year for Primary-Care Doctors ($225,000).
As I listened to my senior friend’s wry humor about doctor’s pay I remembered it was not always so. 150 years ago, following the Civil War, medicine rarely offered a path to wealth. In fact, according to historians, doctors’ annual income put them at the lower end of the middle class. A quick check of recent Bureau of Labor Statistics, however, shows that by 2012 doctors’ average annual earnings soared over 400% above the average worker’s income.
By contrast, I remember my amazed delight over Dr. Axel Munthe’s book, The Story of San Michele. Munthe was a Danish doctor, the youngest graduate ever of the famous l’ Ecole de Medecine, in Paris, who became a “fashionable doctor” practicing medicine in France, Germany, and Italy, during the first quarter of the 20th Century. Munthe was a doctor of a different kind. He moved among European royalty, yet he was drawn to animals and people of low estate. In a chapter titled “Doctors”, Munthe wrote about his cash-flow problems, which his partner in practice, Norstrom, diagnosed as a defect in Munthe’s mental machinery remedied only by keeping proper accounts and sending regular bills to patients like everybody else:
“I said it was hopeless to try to keep accounts and as to writing bills I had never done it and was not going to do it. Our profession was not a trade but an art, this trafficking in suffering was a humiliation to me . . . Norstrom said it was nothing but sheer vanity and conceit on my part, that I should grab all the money I could lay my hands on, as all my colleagues did, even if handed me by the undertaker. I said our profession was a holy office on the same level as that of the priest, if not higher, where surplus money-making should be forbidden by law. The doctors should be paid by the State and well paid like the judges in England. Those who did not like this arrangement should leave the profession and go on the Stock Exchange or open a shop. The doctors should walk about like sages honored and protected by all men. They should be welcome to take what they liked from their rich patients for their poor patients and for themselves, but they should not count their visits or write any bills” (pp. 201-2).
A very different notion indeed of the medical professional! Munthe’s is a vision of the physician’s work NOT as a trade, but as art that is a holy office where trafficking in suffering is a humiliation and surplus money-making is a shame.
But therein is our modern rub: how much is enough? When does money-making become “surplus” money-making? Is it when the doctor earns four times as much as the patient? Three times as much in a single year? Twice as much?
To ask the question is to expose the real ‘elephant’ in the room: it’s NOT the ratio between salaries, but that money drives our values, defining even healers and healing; the elephant in front of us and WITHIN us — ALL of us — is greed, the ubiquitous cashing out of Life and professions into dollars. We all do it. Not just doctors. We ask upon meeting, “What do you do?” as index of worth without the slightest inkling of Munthe’s humiliation over surplus money-making.
Somewhere on the ramp to the Fast Lane we made serious error in our choice of heroes. Surplus money-making became a virtue. We heard that greed is good and we bought it.
But greed is NOT good — for any of us. Accountants make heartless healers and wealth built upon suffering is sick.
There is no easy answer because the ‘enemy’ is not in white coats; the enemy is US. None of us effectively limit ourselves, effectively say “enough is enough.” And I don’t really wish to see jalopies parked in ‘Doctor Only’ spaces at the hospital.
But I admit, I could wish our ‘greed is good’ philosophy were NOT alive and well in hospital parking lots and operating rooms; I could wish to know when it’s time for my eye surgery that it’s NOT accountants driving the profession, but a physician of the Axel Munthe-type who has something noble to profess beyond highest salary, whose hands and heart serve sacred art, not a money-grubbing trade.
I’m not ashamed to wish.
Joseph Harvill, Scottiephile