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...
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?
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...
- 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:
- Productivity based bonuses (similar to the US),
- Kickbacks from big pharma for prescribing medicines, and
- Bribes from patients known as "red envelopes" - most commonly given before a surgical procedure
- 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.
- 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...
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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