Future Proof Shares - Happy Fourth of July!

Happy Fourth of July!  A few month back, I shared with you the first special edition of Future Proof Shares.  I thought today would be a fitting opportunity for another special edition of the Shares.  Today I want to tell you why I'm so thankful I'm becoming a physician in the United States of America...

A bit of background...

Photo of the Harbin Ice & Snow Festival (2011) from my personal collection.

Two generations of Dr. Lius.  My grandfather is 86 years old and he still stops by the clinic occasionally.

This post, as well as all others on FPMD, are colored by my personal bias and preferences.  So I thought I would share a bit about where I come from so you can get a better understanding of why my views are what they are.  I was born and grew up in the largest city in northeastern China - Harbin, Heilongjiang.  My hometown is famous for a few things: cold weather, Russian food/architecture and Harbin beer (an Anheuser-Busche Inbev subsidiary).  My grandfather was a traditional Chinese doctor in a rural community (village?) called YongYuan, which translates into "forever source".  As a child, I spent quite some time in his home and clinic where I got to see the kind of relationship he developed with the patients he served.  Remember Sue Lowden's ill-fated 2010 senate run where she suggested that patients should pay for their medical bill with chickens?  Yep I got to see that.  Although a chicken was a rare form of payment.  Most of the time, he would receive a basket of radishes or some other type of produce.  The rest of my medical education journey, you already know from How I Became a Radiologist and Why Interventional Radiology?

American Privilege

Fact - it is a privilege to become a physician in the US.  I'm not only referring to "privilege" in the sense that you should be honored to be in a position to serve your patients, but also the fact that you had to be a fierce competitor, to excel above so many others to get into medical school, residency, fellowship...  If you've never seen healthcare from a different perspective, it's easy to dismiss what you have.  Let's face it, it's human nature to take what's good for granted and focus on what's negative - the so-called "picking bones out of eggs."  Let me share with you a few facts about the Chinese healthcare system...

  1. Chinese doctors are rich, but not because they earn a high salary - Chinese physicians typically earn a salary comparable to the average worker, which is to say not a lot.  However, they make up the difference via 3 main additional sources of income:
    1. Productivity based bonuses (similar to the US),
    2. Kickbacks from big pharma for prescribing medicines, and
    3. Bribes from patients known as "red envelopes" - most commonly given before a surgical procedure 
  2. Gray income breeds mistrust - #2 and #3 together constitutes what's called "gray income."  Since they are essentially bribes, it is no surprise that the physician-patient relationship has degraded dramatically over time.  The default assumption is that your doctor is in medicine to make money, rather than to help you get better.  I had a first-hand experience with this phenomenon recently when one of my family members became ill and asked me to review her medical records.
  3. Mistrust leads to anger and violence - I've always known that attacks on Chinese physicians by patients and their family members happen not uncommonly.  But I didn't know how frequently they occurred.  "According to a 2012 survey of nearly 6,000 Chinese physicians in 3,300 hospitals, 59 percent of doctors had been verbally assaulted and 6 percent had been physically assaulted. News accounts for 2002-2011 yielded 124 incidents of “serious violence” against hospitals, including 29 murders and 52 serious injuries." (Source: Chinese Doctors In Crisis: Discontented And In Danger).

As an additional comical anecdote, my mother threatened to disown me when I told her I want to become a radiologist.  She had wanted her son to become a surgeon.  I didn't understand why she took that stance until I realized that in China, a consultant like a radiologist does not benefit from "gray income" since we have minimal direct patient contact.  I suppose she must have thought I was going to starve after all these years of education...

Closing Thoughts

While I have shared a few disturbing facts about the Chinese healthcare system, I believe many other physicians from different backgrounds can probably share with you similar stories.  On this day of BBQ and fireworks, I hope you will first of all, be safe.  But I also encourage you to reflect on the privilege of living in the United States of America and becoming a physician in such a great country.  Have a wonderful Fourth of July!  I'm proud to be an American.

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Future Proof, MD

Dr. Bo Liu is an aspiring radiologist-in-training and the founder and editor of the White Coat Money Blog.  He has an interest in interventional radiology and helping his medical colleagues get ahead in this mad world of medicine and money.  When he's not crushing the list at the PACS station or typing up your next favorite blog post, you can usually find him at the local badminton club, movie theater or the most recently opened restaurant.