”People ask what you do for a living so they can calculate the level of respect they will give you.”

Physician. That title carries with it a privilege. The privilege that it offers is second to no other profession. That privilege is one of the qualities that attract many people, including myself, to medicine. Therefore, we must use that privilege accordingly.

In my wife’s practice, they are looking to hire a physician. After one of the candidate’s interview, he said he could not work at the practice because “the patient population was too poor, and there are too many uninsured.” 

That is the reality that we face. Being a physician is a career, and you need to be realistic with what you want to accomplish. The path to becoming a physician is difficult and paved with a lot of sacrifices. It makes sense that you want to reap the rewards at the end of your journey. It’s a career. It’s a job that you must go to every day. Therefore you need to find what makes you happy.

Social Determinants of Health

Working with the poor is not for everyone, and you have the right to tailor your business the way you want to, but we can’t be blind to the social determinants of health that affect the communities around us. We must not let our biases affect the quality of care that we provide. People are not choosing to be born into poverty.

“Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.”In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins”. Healthypeople.gov 

I did not become a physician to work with the rich or the poor. I became a physician to work with people, whether rich, poor, old, newborn, LGBTQ+, and no matter their skin color or religious beliefs.

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick” – Hippocratic Oath.

When you hear a colleague tell you, “I can’t work here because the patients are too poor.” That discrimination hits differently, and it gives me pause about the quality of your character. If I have to work with you, I will do my best as a professional. Outside of that, I’m washing my hands of you. 

As a physician, it’s NOT in my best interest for you to receive preventive care. It’s NOT in my best interest for you to get your influenza vaccine (flu shot), it’s NOT in my best interest for you to get bi-annual mammograms, it’s NOT in my best interest to give smoking cessation counseling, it’s NOT in my best interest to provide exercise counseling. 

Financially, it’s in my best interest for you to keep smoking, for you to get the flu, for you to keep gaining weight, etc.,  You know what? Because all those things make me money. You get the flu, end up getting pneumonia..oooh, can you say $$$. You end up getting lung cancer from smoking $$$$. You are morbidly obese and end up having a heart attack $$$$$$$$. You end up with stage 4 breast cancer because you never got proper screening; YES, that’s money in my pocket.  

The more complicated your medical condition, the higher my reimbursement. I go from billing established patient annual preventive exams to Level 4 Established Office Visit (99214) or Level 5 Established Office Visit (99215), which significantly increases my bottom line. 

Unfortunately, in a truly free market, that’s what we would have. Unfortunately, there are likely some physicians that are practicing in this manner. 

Yes, I would be making more money. How much are those extra zero’s worth?

Morally, where would I be? 

Knowing this, would you want me to be taking care of you, your spouse, father, mother, daughter, brother,  grandparents, or any of your friends or family?

I would hope not. 

Can you imagine in the U.S a patient being seen in the emergency room for a stroke and a physician says, nope, I can’t treat you because you are too poor? No CT scan, No MRI, No tPA (all very expensive)…think about that….

Thankfully, in medicine, we have standards of care. 

“Medical malpractice is a legal fault by a physician or surgeon. It arises from the failure of a physician to provide the quality of care required by law. When a physician undertakes to treat a patient, he takes on an obligation enforceable at law to use minimally sound medical judgment and render minimally competent care in the course of services he provides. A physician does not guarantee recovery… A competent physician is not liable per se for a mere error of judgment, mistaken diagnosis or the occurrence of an undesirable result.” Hall v. Hilburn, 466 So. 2d 856 (Miss. 1985).

Physicians not upholding this standard of care need to get their license revoked. 

In our profession and in life, we must realize that character matters. Leadership matters, and it’s not all about money. You can be financially wealthy but morally broke, and people will dance on your grave.