Being a physician is a strange thing. One of my patients compared it to a religious order. The strangeness revolves around being paid for our work. While this is the subject of debate on the national level, I would like to look at it from a different perspective--the resident. The Internal medicine resident is paid a salary, low compared to our years of schooling, for our time and training. An interesting phenomenon arises, which is payment does not change based on work. What does this mean? Some weeks I push the limits of legal and work 80 hours, with many of those hours consecutive (up to 30) and overnight. And I receive my weekly check. Other weeks, I am in clinics from 9-5 for 4 and half days a week, never on the weekend. And I receive my weekly check. Effectively, residency has separated the natural relationship between work and income. I am paid the same no matter how much, or little I work. My friends ask questions that seem silly to me, such as "Do you get paid more for overnights, or weekends, or overtime?" No I tell them, I barely get paid at all.
Take in contrast moonlighting--working short medical shifts for pay. Last week I worked overnight for 13 hours with 3 admissions. Those well compensated 13 hours were more than my weekly salary. And for every extra admission and every extra hour, I was paid. Very different feeling. My desire to be productive and do things was much higher, as I am paid for them.
This mental separation of work and money pervades health care, and puts us at risk to be taken advantage of by our money-comfortable colleagues in other industries. Politics, health care, manufacturers are all very comfortable with work and money, profit and loss. And we are not, and yet we complain.
Residency is funded by the government, paid to our institutions who then pay us in turn. The money comes no matter how productive we are, as long as we have worked on a given day. Well, that changes too....