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Mama don't let your babies grow up to be doctors, therapists, counselors...and cowboys.
First, my apologies to the late, great Country Western singer and songwriter Waylon Jennings for totally messing with the title of his beloved song.
Most of you must be scratching your heads wondering what I mean by dissuading young people (and their mamas) from wanting people to grow up to pursue one of the aforementioned health or helping professions. “Why not?” After all, careers in health and mental health services are among the noblest of professions. We all know it takes dedicated professionals to save lives on a day-to-day basis and to help others reach their full potential and attain better physical, psychological, and emotional health.
Yes, all this is true but now let’s look at the reality of what recent graduates of medical, nursing, or graduate school are facing after years of classes, hours upon hours of studying, and massive student debt. It’s estimated that most health and mental health professionals will graduate with student loan debt ranging from $40,000 to $150,000. If this were 20 years ago, most medical professionals and mental health professionals would be able to chip away at student debt in a reasonable amount of time and still enjoy a decent lifestyle. However, this is not the case in today’s world, and unfortunately one of the main culprits is the health insurance industry.
You may recall hearing about this back in the 2016 Presidential election when, in the days and weeks leading up to the election, Republican candidates would not miss an opportunity to criticize Obamacare and how both premiums and deductibles were increasing exponentially. Then-candidate Donald Trump promised on “Day 1” he would repeal Obamacare and replace it with something better—better coverage and less costly policies that the American public could afford.
The spirit of the Affordable Healthcare Act was to allow most of the 50 million Americans who had no health insurance coverage to obtain coverage affordably; however, as most now know, that never happened.
But here are some hard truths about healthcare in America. First, most health insurance plans have significantly reduced the amounts they reimburse for procedures and services while increasing the amounts that patients have to pay either in co-payments or deductibles, especially if the provider is considered out-of-network. If providers are in-network, they have agreed to take lowered reimbursement rates in exchange for increased referrals from those particular insurance companies. If providers are out-of-network, often insurance companies won’t reimburse at all or they saddle consumers with outrageous deductibles that they must pay out-of-pocket. This is horrible if you’re a patient and horrible for providers (doctors, nurse practitioners, psychologists, social workers, etc.) but it’s a windfall for executives of major health insurance companies and their shareholders.
So, not only are providers stuck with overhead expenses, huge annual malpractice insurance premiums, and student debt, but they also face dwindling reimbursement rates. While insurance reimbursement rates have steadily declined in the past ten years, day-to-day operating expenses continue to rise (malpractice insurance, rent, etc.).
Hopefully you’re saying to yourself, “Wait a minute, my deductibles, co-pays, and other out-of-pocket expenses continue to go up, my doctor or therapist's rates of reimbursement are going down, so who’s profiting?" To answer this question, simply look up the salaries of the CEOs and other administrative executives of the top insurance companies. Their salaries have not gone down. Their annual bonus packages have not been reduced. If anything, their annual bonuses alone are more than what most of us will ever make in our lifetimes.
And here’s their other little secret. I can be the best or worst doctor or therapist in the state or I could have 30 years of experience or be right out of med school or grad school, or I could win the Nobel Prize, and guess what? I’m still going to make the same old reimbursement rate. In other words, this is a system that has no incentives for providing the best possible care and no incentives for keeping better trained, more experienced providers in their network. The only incentives are for the CEOs and top management within the health insurance industry.
How most providers have managed to stay afloat is by taking on two or sometimes three jobs and by sharing expenses with other practitioners. Most providers I know work 60+ hours a week to make what most providers were making 20 years ago during a 35-hour week. Most skilled tradesmen make a higher hourly rate than most health and mental health providers. Plus tradesmen get to set their own fees and rates. (Maybe Senator Marco Rubio was right when he said we need more welders and fewer philosophers.)
There are specialties within the medical and mental health field that are still making out quite well (surgeons, especially cosmetic surgeons, anesthesiologists, neuropsychologists). However, general practitioners are no longer making the type of salaries they were 20 years ago, prior to the advent of HMOs.
There are many advantages of being a medical or mental health professional. Without a doubt, it is intrinsically rewarding to help others, and most professionals can work into their 60s or 70s. But no matter who’s in the White House or which party controls Congress, at the end of the day, who’s really in control of healthcare in America? It's the huge, powerful health insurance lobby. Also, the United States is the only industrialized country where crushing medical debt can bankrupt families with one major illness, accident, or surgery. So pray you don’t get sick!!!
Here's the takeaway: if you want to be in a profession where you're guaranteed that your income will remain stagnant or go down every year, sign up for a medical or mental health job. If you really want to be someone who makes life-or-death decisions on a day-to-day basis and decisions that will impact people’s health and overall well-being? The answer is simple, go work for one of the healthcare insurance companies.
If you really want to be further enlightened, read Elisabeth Rosenthal’s recent book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.
References
Rosenthal, E. (2017). An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. New York: Penguin Books.
