Chester County Medicine Spring 2021 - 30

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MD = Much Debt
BY STEVEN B. SIEPSER, MD, FACS

oday our hard fought and difficult path of
becoming a physician is lined with some
worrisome side effects. Recently I was
reading the book " Willpower, " a New York Times
Bestseller, by Roy Baumeister and John Tierney,
and their discussion of alcohol, substance abuse and
smoking addiction ran so very true. I always tell my
colleagues that if it weren't for alcohol, tobacco and
obesity I wouldn't have a job. But what really struck
me was the comment, almost a sidebar, that people
can be addicted to debt. With that in mind it seemed
that the debt to equity value of a medical education
is reaching the zero sum limit for those of us that
funded their education with scholarships, work and
debt instruments that were available 40 years ago. We may have
been lured into the high debt mentally by a career that promised a
very comfortable life that would certainly easily cover our past debts.
This problem may actually be accelerating due to the increased debt
load of our current doctors and the now limited economic opportunities they face. This might be one of the reasons we are seeing so
many burns outs, suicides and departures from our calling.
Then again it is of great interest to me that there were 400
suicides among our colleagues last year alone, almost two graduating medical school classes from my era. How could this be and
what could this be coming from? It is time to carefully look at this
problem and try to parse out some of the causes. Now that I lost a
colleague to suicide, an extremely talented, academically oriented,
internationally known, fellow ophthalmologist who I have collaborated with over the years; I am bothered wondering how could this
have happened? Now wizened by a few years of practice under my
belt, and also a few pounds, I can sit still long enough to evaluate
this situation. In my specialty you either work for an entity that
supplies the capital equipment or you take on enormous debt to
self fund these monstrously expensive clinical devices, needed for
modern sophisticated ocular surgery results demanded by our active
baby boomers.

30 CHESTER COUNT Y Medicine | SPRING 2021

If you come from a time when taking on debt
to complete your education seemed OK, or buying
a dream house, maybe taking on debt to get access
to the finest equipment seemed very reasonable and
rational. However, as any MBA can tell you, this is a
zero sum game and volume cannot always cover low
margin activities with high debt, high fixed and variable
costs with an environment that attempts to discount
professional services. I believe that many physicians
were almost pre-selected to accept high levels of debt, in
fact they may have an addiction to this that made them
" normalize " these high risk behaviors or tolerate them
better than most students. Was this an ability to defer
rewards? Or is this a serious addiction that has gone
unrecognized until this epidemic of suicides that seem too often to
have an economic and social cause.
The joke with realtors now is just one of those truisms that is
disarming. Realtors no longer worry whether a young doctor will
buy the house they are pitching but whether the doctor can actually
afford the house they are trying to sell!
As a society we should be ashamed that we pay athletes millions
and professionals fractions of those incomes. It is no wonder parents put such stress on athletic prowess and sports activities for their
children as they only want the best for them, and obviously athletics
is where the money is! So why stress academics when families can
spend more resources and time on athletics that seem so much more
economically rewarding? Ask any teacher and they will tell you
that if students just used a small fraction of the time they spend in
athletic activities in after school programs, travel teams and the like,
student's academic performance would be spectacular. Just like anything worth developing an academic skill takes training and lots of
it; if we spend our children's time on athletics instead of academics
we might be mortgaging all of our futures.

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Chester County Medicine Spring 2021

Table of Contents for the Digital Edition of Chester County Medicine Spring 2021