In this monologue, a physician argues that medical training indoctrinates doctors to neglect their own basic needs in the name of patient care, creating a false "social contract" that promises future reward for relentless hard work. The speaker describes how, after years of residency, physicians find themselves still unable to attend to personal needs, despite higher pay, leading to widespread burnout, moral injury, and a sense of apathy. The discussion highlights that the contract is broken: doctors are expected to work for free, receive inadequate compensation, and bear the financial burden of massive student loans. The speaker blames insurance companies and low Medicare reimbursements for eroding physician income, noting that many doctors cannot sustain a livable salary even when relying solely on Medicare. Overall, the talk calls for recognition of physicians as humans who need rest, fair pay, and a realistic contract with society.
Chapters
In our training, we have been brainwashed and told that we just need to keep working, work harder, keep, uh, your head down, don't make a fuss. And we have been trained to put aside all of our needs and wants. We shouldn't have to go to the bathroom, we shouldn't have to eat lunch, um, and this is all done in the name of serving the patient. And we have been so brainwashed into serving the patient that we don't take care of ourselves. And, you know, there has been this contract with society where if we just go to school, do a good job, work really hard, learn everything there ever was to know about the human body and about medicine, that we would be rewarded down the line. And this is the contract with society that we've And then what happens is when we're out of residency and we've been working hard and we've been putting off all of our dreams, hopes for school, and, you know, we're now in our mid-30s and haven't started living yet because we've been in school. This is this arrival fallacy where you, you're like, if I just do this hard work, I'm going to be happy. And then you arrive and you're like, I'm not. Wait, it's the same crap. I still can't go to the bathroom. I still can't eat lunch. I still can't have autonomy in my life and make decisions for myself. And I'm getting paid better, but that doesn't seem to make me any happier. This is definitely, I think, where most doctors start to question, what the heck did I do? What? How is this okay? And when is this going to get better? And unfortunately, the answer is it's not. The system has made this so you will continue to work for the system, and there is no exit strategy until you die. I think that doctors really need to understand that This contract, not only with society but with the hospital, but more the society, is broken. We are expected to work for free. We are expected to put aside all of our needs to "quote" serve the patient. Understanding that we're humans, we we do need to take care of ourselves. We need to sleep. We need to eat well. We need to rest. We need to be paid for our time, and I. Our expertise, and to have a livable life. And if we don't have our bare minimum needs met, we're going to continue down this road where we are now, where 50%, 60%, 70% of doctors are not well. They're burnt out. They have this moral injury. They have this apathy because they can't even take care of themselves. They have not been allowed. We've been sold this bill of goods that is broken. This contract with society, you know, I get it all the time. They're like, oh, well, you're a doctor, you're rich, you can afford it. And I'm thinking, have you looked at my bank account? I mean, honestly, the only reason that we're still above water is because we work twice as hard as the next person just to stay above water. And I think that is a fallacy. And that's that social contract where, you know, if we do all the hard work, we will be compensated. And maybe historically that was true. But once insurance companies got into the middle of that and started taking from both sides, from the patient and from the doctor, and our reimbursements have gone Down, down, down, down, down. If I were only to take Medicare as a, as a payer, I would not be able to keep my doors open. I get paid so little from Medicare that I can't actually pay my rent, pay my employees, pay myself a reasonably low salary. When you look at salaries across the board, I can't even pay myself a normal salary if I were only to take Medicare. I cannot take— I can't keep my doors open. I can't pay my medical loans. You know, to go to medical school is a pricey endeavor. And that we have been locked out. You know, everyone's getting their loans forgiven and doctors are not. Society's contract is broken. They have expected that— they think we're getting well compensated when I think where that money is going is the insurance companies.
