The Medical Practice and Why Money Motivated Us

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The insult came over lunch. "Private medicine and hospitals are motivated by money," said someone in the military. They gave me a look, like I could never understand what it was like to have sick patients.

It dawned on me. To them, I was just a snotty surgeon's wife who was sitting there having spent her entire life playing Marcus Welby MD. They probably thought we played golf on Wednesdays and that I had my hair and nails done on Monday, followed by tennis at the country club. Of course, it would never dawn on them how I got here.

But I couldn't say much. Because anyone who comes in from business knows, no one cares about your issues. The small practice or business owner wants to know: "Can you handle the job? Can you bring it in on time? Can you do it in a way that is efficient, well mannered, and profitable?  Do you treat people well? Are you going to fit in?"

But still, I can't let this stereotype just sit there. No. Because the group of civilian medical practitioners that I know, the very ones who are seeing a mindblowing 500 patients a day in the ER at trauma centers in major metropolitan cities deserve better than to be thought of greedy, self serving money whores. Because they are not. They're in a trench that lasts them a lifetime, with absolutely no guarantee of a pension and the only question that both the heathen insurance companies and Medicare/Medicaid have is: Will you do it and how little can we pay you?  And then they both run over the physicians, hospitals and staffs.

Physicians today --whether in individual, or small groups, wonder whether or not insurance companies are going to pay out. Their administrators will often have the numbers of two CFO's of different healthcare organizations on speed dial in order to badger them to pay what has been billed. The physician has to work their tail off in order to come up with quarterly payments to malpractice insurers --a healthy chunk. There is also payroll to be made, and one must be diligent and pay the payroll taxes at the same time by sending them into the state. The practice owner looks at their staff and realizes that every purchase made by them (a car, their children's clothing, or medicine) was because of the hard work that everyone in the business performs as a team.  Without money, we couldn't run the practice to help patients. Without money, my employees couldn't feed their kids.

 I cannot and will not speak for other physicians, but we were always motivated first to provide the highest quality medical and surgical care in a compassionate and disciplined setting. However, money is important. We just see money in a different way.

The small business owner sees money as a necessary resource to grow and fulfill professional and personal dreams; to be able to pay their employees well and to provide sustenance for their family. Money bought us equipment, helped us make our quarterly taxes on time, and all the other payments that come with a business.

When we had our practice, we didn't take a vacation for four years. We worked on an average of 60-80 hours a week. Our appointments were double booked, and often the wait to see us was several weeks. We were on call 24/7. Everyone had our phone numbers. As the administrator of the practice, what worried me was coming up with the $18,000 minimum each month to keep the doors open. That's just what it cost to run the practice each month. Anything over that was ours.  Admittedly, there were months when we'd sweat --wondering if Blue Cross, Aetna, United Healthplan, or any other combination of IPA's would pay out enough after having taken their cut, so we could make both mortgage and office rent. But don't forget: it was all pre-tax. Our profit was less than a fireman, higher- paid teachers, and realtors. But don't get me wrong: while it was hard, we also loved it. When we closed it we were at the top of our game and we found all our employees jobs. Ironically, we netted much less than what we are making now. My husband drove a used Toyota truck, then. Today he has a souped up Mustang.

Something most people in the service don't realize: the small business or practice owner always pays their employees first, the payroll taxes second, rent, expenses and themselves last.  It's a common formula, and if one is lucky it goes smoothly and the owner gets the lion's share. But it takes every waking moment to get there.  That's our story, and it would behoove those in the military who might think they will never be motivated by money to perhaps look at it in a slightly different light. Money allows business owners to support themselves while serving others.  I would argue: military medicine must also be motivated by money in that they must work very efficiently with the dollars entrusted to them by the tax payers.

I'm cognizant that our Army paychecks are only possible because of the hard toil of small business and practice owners everywhere. Am I thankful for their toil? Yes. Are small businesses motivated by providing a good service? Yes. Are they motivated by money? Yes, and I'm grateful for it. 
(And by the way, I am still a small business owner).