Thread by @usnehal

On reading this my thoughts:
-not a primary care field
-two-specialist couple
-focus in procedures and lucrative call, not humans being treated
-these “options” possible if one has chronic illness, elder care, etc
-derisive towards colleagues
-no interest in equity

Realistic?

https://twitter.com/fin_successmd/status/1372337200801648649

It’s great that doctor made it work to retire at 43 and have gotten the math right all along. If one is going to judge colleagues, though, be ready for the reverse. We have a rising maternal mortality rate and increasing disparity. IUDs are an important part of reducing that, yes

Even if we stick just to ob/gyn field: some may wish to not only be the “IUD queen” (birth control is SUPER important - not at all discounting it), what about the ob/gyn who chooses to live in NYC and focus in whole person care for WOC who do give birth?

health.ny.gov/community/adul…

As a former administrator, if I read this piece with that hat on, I would look at the ob/gyn salary, the focus in inserting IUDs (low risk, high volume), and wonder why it needs to be a residency trained physician at all. There are many clinician types who can do procedures.

When physicians share their fiscal job motives & how they do the math on their finances, don’t be surprised when administrators do the same. That is not big bad administration, that is fiscal pragmatism and improved operating budget. Personnel/staff is often biggest budget item.

This might make some people upset, of course, but it is a reality.

I am not vilifying money. We need to talk about it more openly.

You need money to live. Fiscal literacy is sorely lacking among many physicians on their own finances or healthcare finances.

I would just say that when you colleagues make different choices, say work in an inner city, dealt with complex SDoH, take on the risk of complicated pregnancies, that is not them being dumb. Some people choose mission and service. Often is at the expense of lifestyle or 💰.

No one is obligated to use the full scope of training either. But if clearly staying limited to low risk procedures, that is ripe for replacement.

It makes sense to front load call and do less in middle age or later. Though it does affect the group, yes, to drop call entirely.

I see a lot of MDs upset about various clinician types in healthcare, invoking the profession at risk.

This particular article is one that would make it very hard to justify that narrative.

Personal finance savviness has been lacking in my own career, I admit.

I had a peer point out while I was volunteering I could be moonlighting.

Although as a pediatrician in Boston my compensation was 1/2 to 1/4 of other specialties. Plus, I like addressing inequity.

What is the profession we seek to honor or defend about?

I don’t think we should force values on anyone else. But these are things asked in med school applications and residency applications that are gatekeeping steps to who are our peers.

Some recently did not match.

As a former FQHC CMO where a recruiting draw was loan repayment for primary care docs needing to pay NYC rents & cost of living and taxes, I think about how we make it financially feasible to acquire the same med school debt and then do work in primary care or inner city.

We also need to stop with the idea that service means wearing a horsehair shirt and being derisive of making money. We need to judge less cuz that only sets us up for this. Healthcare is a business. It is 1/5th of our GDP. “Shoulds” do not pay bills.

nytimes.com/2019/06/08/opi…

It may sound harsh & uncaring

but divorcing service from the budget needed to deliver quality & safety is is how we give up control

then 🤔 how the quality went down

Just look at PPE as one tiny part that needs a budget: “dysfunctional costing model”

ncbi.nlm.nih.gov/pmc/articles/P…

Clinicians have died from PPE shortage.

If you give up the control of healthcare finances to non-clinicians, you make yourself another data point in an operating model analysis.

*Everyone* loses when a clinician exits a profession in a body bag.

medicaldevice-network.com/comment/health…

America or UK there are disparities among clinicians. This is not doctor vs nurse but often by race. BIPOC or BAME die at higher rates. No, not their fault or their health. PPE. (As did health - stress can reduce health, btw)

bma.org.uk/news-and-opini…

So my first response to the article in the first tweet was to dismiss. Except there *is* a real issue of finance on a personal & systems level. We have to face it head on, transparently, as an industry and as professions. And let’s stop using finances as a way to judge each other

@threadreaderapp please unroll