Doctors in general earn a significant portion of their incomes in a hospital setting. It looks easy. There is no overhead, the patients are conveniently gathered and the job of the doctor is to preside over their convalescence or death in such a manner that pain and discomfort are minimized, and the healing process is optimized.
Doctors
charge the patients a per diem fee for this. Surgeons make the greater part of
their incomes in hospitals, rarely buy their own instruments and have free use
of the operating suite and complex facilities involved in successful surgery.
All physicians are handsomely supplied with support services in the intensive
care units.
Patients
often complain that the doctor has spent no time with them but are sent a per
diem bill nonetheless. Actually the doctor’s job with respect to hospitalized
patients is to govern the therapy, study laboratory reports, view the x-rays,
chase down wandering information, and alter diets and so forth, a mélange of
chores that cannot be performed at the bedside. Patients are critical of the
“invisible” doctor who just pops his head in the door and sends a bill.
The
patients are not mindful of the fact that the physician has a 24 hour
responsibility for the patients an must be available at all times; nor is it
appreciated that being awakened at 2 a.m. can wreck a night’s sleep completely,
and two bad nights can wreck a week. The job is onerous and the doctor who just
“pops in” is really quite busy with patient care and is preoccupied with the
patient during the entire day, as well as during rounds, even when not with the
patient.
“Hands
on care” is comforting but in today’s high tech environment I alone cannot
suffice.
Hospital
trustees and administrators also feel that the doctor has some debt to pay the
hospital for the privilege of working there. Let’s analyze that. The trustees
contribute their time and receive in return status that can do naught but help
them in their business. They distribute millions of dollars annually which
makes them popular figures in any community. Administrators on the other hand
are the hirelings of the trustees. Then enjoy large salaries and work a 40 hour
week. Salaries of administrators and their employs are paid through patient
revenues; doctor fees are paid through patient revenues.
However,
the doctor makes an additional contribution, greater than tat of the trustees,
and certainly greater than the administrator whose workday is reimbursed by salary.
In order to create and govern their medical staff the doctors must fulfill
preordained chores. They must govern themselves at various level of staff
function.
First
the monthly departmental meeting which last two hours at the very least; then
the committee meetings, utilization, quality control infection committees,
tissue committees, executive committee meetings (five hours each deadening
monthly meeting, the joint conference and so forth.
Last
year I toted up the annual contribution of doctors to just one hospital by
calculating the time donated at $50 an hour. It came to $345,000. No other
faction makes an equivalent contribution. Why then demand that the doctors “pay
back? They already have.
Another
factor lost sight of is the service coverage of the emergency room. Each
specialty covers this community at each of its hospitals 24 hours a day 365
days a year. For all of the hospitals in the area this contribution of time
adds up to more than a million dollars annually.
This
isn’t an accolade for doctors, merely an explanation of the hidden,
unpublicized contribution to community health made by doctors annually.