Lately in this blog, I have been discussing cultural values of Latino patients and the importance of cultural self-awareness on the part of the doctor. However, cultural beliefs and biases do not affect only the doctors and patients, but also can be found among instructors of Spanish for healthcare professionals courses. That is to say, how an instructor views medical professionals as people, how the instructor views their character or even views the amount of time they have, can affect the levels of respect, courtesy and even sympathy that they have for their students. Though most language professors are trained to recognize and overcome cultural biases, I think it is still an important issue to address given that, in my own experience, I have met people with the biases I am going to discuss. In order to introduce and discuss these biases, I am going to refer to and cite a letter posted on another blog by the physician Dr. Matthew Moeller, a gastroenterologist in Michigan, and also published in The Guardian. I have chosen his letter because it is well-written and, to me, seems fairly representative of some of the complaints I have heard from physician friends and co-workers. While I do recognize that the intention of Moeller’s letter is not to address prejudices but is instead more political in nature, my intention is not political; I simply hope to use his writing to reveal some of the biases physicians face in the United States, so that instructors can reflect on which biases they may hold and how they may affect their form of teaching or their interaction with their students. In this post, I will highlight a few of the aspects in which Moeller describes feeling misunderstood, and I ask you to reflect on whether or not these are biases that you also harbor. I will specifically look at three biases:
- Doctors make a ton of money
- Doctors get into the profession in order to make a ton of money
- Doctors work more or less normal hours and still have plenty of time after work for other things
Doctors make a ton of money
If you were to ask around, doctors make a ton of money, is a seemingly common belief throughout the United States. Though in theory this is true (that is, when you look at the raw numbers on a pay stub), the reality is quite different. That is, one must first consider the amount of school debt that has been accrued and must be paid off. First there is undergrad:
For me, it began in college, taking rigorous pre-medical courses against a large yearly burden of tuition: $27,000 of debt yearly for four years. I was one of the fortunate ones. Because I […] obtained an academic scholarship, covering 70% of this tuition. I was fortunate to have graduated from college with “only” $25,000 in student debt.
Then four years of medical school:
Two weeks after finishing my undergraduate education, I began medical school. After including books, various exams that would typically cost $1,000-$3,000 per test, and medical school tuition, my yearly education costs amounted to $45,000 per year. Unlike most other fields of study, the demands of medical school education, with daytime classes and nighttime studying, make it nearly impossible to hold down an extra source of income. I spent an additional $5,000 in my final year for application fees and interview travel as I sought a residency position in internal medicine. After being “matched” into a residency position in Michigan, I took out yet another $10,000 loan to relocate and pay for my final expenses in medical school, as moving expenses are not paid for by training programs.
At that point, with medical school completed, I was only halfway through my journey to becoming a doctor. […]. I didn’t know whether to cry at the number [amount owed in loans] or be happy that mine was lower than most of my friends. My number was $196,000.
But it doesn´t stop there:
As a resident in internal medicine, I earned a salary of $39,000. All the while, interest continued to accrue on my motherlode of debt at the rate of $6,000 per year due to the high-debt burden. Paying down this debt was not possible while raising two children. My wife began working, but her meager salary as a teacher was barely enough to cover daycare costs. During residency, my costs for taking licensing examinations, interviewing for specialty training positions, and interest on the large loan ballooned my debt further, now exceeding $230,000, all before I began my career as a “real doctor.”
So the cost of education for physicians is high and the years of education very long, meaning it will take a long time to pay off these loans. This does not even include the lost time for saving for the future nor does it take into consideration the number of hours that physicians work per day which brings their per hour salary down to close of that any other professional worker (see this article which explains how this is so).
Relatives and friends often ask me, “Now that you are a ‘real’ doctor, aren’t you making the big bucks?” […] First, I was 32 years old as I began training and I now had over $230,000 in debt. Had I invested my talents in other pursuits such as law school, I would not have built up this level of debt. Also, as I did not start saving when I was younger, financially speaking, I have lost the past 10 years without the ability to save and invest to earn compounding interest.
So we see that, in reality, while doctors may be paid more, it will take them many years before they can make up for the debt and the lost time saving money.
Doctors get into the profession in order to make a ton of money
As we have just seen, when taking into consideration the education costs and the hours worked per day (as I will touch on in the last section), it is not the best profession to choose if your goal is to make a lot of money. You would be far better off becoming an accountant or a lawyer. So why do people choose this profession? Because they truly care for the patient. I know some readers may have not felt “cared for” at times by their doctor, but keep in mind that we all have tough days, that we are not always as kind as we would hope. Also keep in mind that there are always exceptions to the norm. Though I have met the occasional exception, I very much agree with Dr. Moeller when he states:
You may ask why do we do all of this? It’s because we have pride in what we do. We truly care for the well-being of the human race. We have been conditioned to think, act, talk, and work as a very efficient machine, able to handle emotions, different cultures, different ranges of intellect, all to promote the health of America. We are doctors.
Doctors do what they do for the love of it, to offer help to those who need it. It is not fair when we approach them with a bias based off a few exceptions which deprecates their true intentions.
Doctors work more or less normal hours and still have plenty of time after work for other things
Finally, as instructors, it is very important to understand that this last bias just isn´t true. Though many clinics are only open from 8am to 5pm (closing for an hour at lunch), physicians do not simply leave at 5pm. Instead, they have to wrap up charting notes, call to check on patients or give them test results, or study to keep up with the required continuing education requirements (among other things).
In addition, as physicians, though we make more money than many others, we are not reimbursed for many of the services that we provide. We, as physicians, are always available for our patients no matter the time of day. We do not record time spent with patients as a means to our reimbursement as other professions do. No, we listen to patients and answer their questions, however long it may take. Even if it is the 30-second straight hour of work, which happens very often, we listen, respond, and formulate a logical plan. If it involves calling a patient at home after I just worked 30 hours in a row and just walked in the door to see my family, I do it. I never come “home” from work.
The wrap-up and take home
While other biases regarding doctors do come up in the United States context, the biases I’ve mentioned are ones that each instructor should keep in mind when teaching Spanish for healthcare professionals courses in order to best motivate our students and promote a good learning environment. We as instructors need to recognize that:
- Doctors are attending the course because they truly want to offer better care to their Latino patients (most will never get a pay increase for being bilingual).
- Despite their desire to learn the material for the good of their patient, their time is limited. We cannot expect them to attend class and then go home and do an hour of homework. This is not because they are unmotivated, but simply because it is an unrealistic demand given their work “schedule”.
Moeller, Matthew (2013): “I went $230,000 into debt to become a doctor in America.” http://qz.com/67304/i-just-finished-my-87-hour-work-week-and-have-230000-in-medical-school-debt/
Brown, Benjamin (2010): “The Deceptive Income of Physicians”. http://benbrownmd.wordpress.com/