As I See It

Demographics vs. Economics

A dose of reality is never a bad thing, even if it is a bitter pill to swallow.

By Paul S. Koch, M.D., Editor Emeritus

Having interviewed quite a number of residents over the years who — how shall we say it? — haven't a clue, I am frustrated that our current recession has not yet given them the cold-water drenching. Many of the pie-eyed optimists think it's a seller's market, that they can declare their working location, conditions and pay. The undercurrent among many seems to be, "Pay me a lot, I'll do your surgery, and you keep taking all the calls." The poor souls then wonder why they're still interviewing and have not yet been snatched up.

When some of my employees told me that they had chosen their last presidential candidate on the promise that they would benefit because my taxes would go up while theirs went down, I had to give them the bad news: the boss doesn't take the hit. If my taxes were to go up $30,000, one of them would be fired. If my taxes went up $60,000, two of them would be fired. The ones who still had a job would just have to work harder.

From the pale looks on their faces, I could tell they didn't see that one coming.

It's a Wonderful Life — Well, It Used to Be

One of my friends up here in New England (let's call him Otto, not his real name) went into practice about 10 years before I did. He did a lot of cataract surgery before the Medicare pay cuts took the wind out of our collective sails, and he practiced back in the day when an index card sufficed for a few office visits. Good pay and low administrative overhead let him prosper, buy a nice house on the coast and have an excellent life. He worked into his late 60s and retired comfortably.

The winters up here got too cold for him, so he bought a nice house down south and lived there about half the year. That lasted for several years, and then the recession hit.

Otto's retirement fund took a drubbing, but he still had quite a bit set aside. Unfortunately, he also had quite a few fixed costs: two houses, property taxes, maintenance and so forth. Whereas he used to cover those expenses comfortably, now they took a bigger part of his dividends. He decided to sell one of the houses but there were no takers.

You Can't Go Home Again

When I saw Otto this past winter he told me he was talking with his old practice about going back to work. He said he was doing okay but not great, and a part-time job would make a big difference in his lifestyle. Months later his old group decided they didn't want him back, but he found another one in his town that did. He's working 3 days a week and appreciating every moment.

After Me, the Deluge

The next generation of ophthalmologists (mine) did okay for itself. Perhaps we should work a few years longer, just to be safe.

That, of course, blocks the career pathways of many young and optimistic new doctors. They need us to get out of the way to create job openings for them. If we hang in there for an extra 10 years, young doctors who already have jobs will make out just fine. We'll eventually get too old to operate safely and we'll morph into office consultants. They'll pick up the surgery load just as the baby boomers stampede into our offices.

In this scenario, we're covered for a quite a few years. I do apologize to doctors in training, but for now I'm not going anywhere. I have a good-paying job and I want to keep it. OM