Sex, Syphilis, and The Taboo of Money in Medicine

Mark Soth is a mid-career academic intensivist in Ontario, Canada. He as the Loonie Doctor about physicians' personal finance

 

We really have come a long way as a society in that "the talk" is not so much of a big thing anymore. We speak more openly about sex - the benefits, the pitfalls, and the repercussions both within our families and in our public institutions. It is no longer a major taboo. That was not always the case.

Historically, the taboo of sex has contributed to much misery. For example, when syphilis ran rampant around the world in the 16th century, many were denied care because it was considered “the wages of sin”. Of course, they treated syphilis with mercury back then, so that may have been worse. The advent of penicillin as an effective cure for syphilis in the 1940s was revolutionary, but it still did not eradicate the disease. With penicillin, education, and condoms - syphilis is much less common now, except on internal medicine exams.

Did all that talk about sex make you uncomfortable? Probably not. In fact, some medical nerds are probably chomping at the bit to correct me on some fact about syphilis.

"Let's talk about money." There, I bet that worked. "You do or will get paid lots of money... and you like it." Now, I bet you are squirming even if you're in the privacy of your own home. Talking about money is still a taboo in medicine. One of the core values of the medical profession is altruism. We are also taught, and most genuinely feel, that practicing medicine is a privilege. Admitting that we get financially compensated for our altruistic-profession-that-we-should-feel-lucky-to-practice causes dissonance for many of us.

I think of a strong medical career like a person. To be a great doctor, you need to be a "whole person". You need a heart for empathy, a sharp mind to problem solve, and a sense of purpose to feed your spirit. A medical practice also has physical needs, just like a physical body, to be healthy and effective. Finances are the physical need for "the body" of that practice. If your financial house is not in order, then you are like a person trying to function without enough food or sleep. Just think back to your last night of in-house call to remember how well that works out for you. You can put physical needs off, but not indefinitely and ignoring the body too much can lead to disease.

We have so strongly policed this money taboo within medicine that it is even externalized outside of our medical tribe and much of the public feels the same way about physician finances. Unfortunately, like the taboo of sex, the taboo of money in medicine has hurt us. Just look at the successful moves by Provincial Governments to unilaterally slash fees and the Federal Government raising taxes almost surgically targeted at physicians for recent examples. We have a limited immune system to fight off those types of attacks.

We have also seen how that pans out for us on many other levels. Despite our earning power, there are many docs stressed about money. Over our careers we juggle student debts, practice costs, taxes, family, retirement planning etc. We need to know how to look after our financial health. There are no shortage of people looking to help doctors with that. We are the perfect clients - we have money, little time, variable levels of knowledge, and egos that like to be stroked (I do anyway). Fortunately, there are financial advisors out there who do understand the finances of docs. However, there is also lot of variability in the quality and motivations of those advisors and doctors are famous for their financial "stupid doctor tricks" for a reason.

We need financial and tax experts. They are like the doctors of our finances. However, as financial patients, we also need to be informed. Similar to a medical problem, where there are often many different viable approaches to treatment - there are often many ways to approach a financial plan. Just like in dealing with your health, where it is important to be an informed patient to get the best possible care for your individual needs - it is important to be an informed client when dealing with financial experts to get the best possible plan for your situation. Medicine is a very unique profession and no one really understands it as well as those who practice it. For these reasons, I also think that we need physicians talking with physicians about money.

I hope that us having "the talk" here helps motivate you to look after your financial health. If not, well financial syphilis is a good motivator.