Efforts and Rewards

I recently retired from my practice of internal medicine. One of my primary services was the comphrehensive assesment of the health of complex elderly Medicare patients. These evaluations typically entailed spending an hour with the patient and another fifteen minutes after office hours to write a detailed note. By my final year in practice my compensation for this effort was down to seventy-five dollars: sixty bucks an hour. This figure is actually somewhat inflated because my multi-specialty group saw fit to subsidize its internists.

I recently saw two young friends. One is a college dropout who writes code for a tech startup which anticipates an IPO next year. At that point his stock options will likely amount to severalfold my earnings as a physician over forty years. He is contemplating retirement in his early thirties. Currently he and his colleagues work hard, although they put in nothing close to the hours which I did during my training. Their company provides a convenient service but it is hardly life and death.

My second young friend completed her postgraduate training in clinical psychology about two years ago. She now works with underprivileged, troubled and very tough high school students in the worst part of town. She also works hard, and frequently comes home emotionally exhausted herself. She has been physically assaulted and injured by her clients. She recieves credit toward her required intership hours and earns about forty thousand dollars a year.

I did not become a doctor to get rich, and my practice afforded me important non-financial rewards. However I truly worry about the future of medicine. Will smart young men and women, however dedicated, continue to undertake eight arduous years of postgraduate training to become an internist, as I did? And who will sign up for clinical psychology? Journalism, academics, architecture, and law have all experienced significant deterioration in recent years. I am concerned that the extraordinary amounts of money to be made in tech (and in finance), so disproportionate to effort and value, are grossly distorting the distribution of talent in our society. If the most capable of our young people are attracted largely to these two professions, surely we will suffer for it down the road. It certainly looks ominous to me.

Richard Williams