I am not a money-minded sort of person. I have a very one-to-one attitude toward finances and once I start getting into numbers higher than the thousands it all starts to become a bit beyond the scope of my understanding. Although I’m fortunate enough to have a family to fall back on should anything truly awful ever happen, I’ve never done much more than support myself from paycheck to paycheck.

Which is why the prospect of hundreds of thousands of dollars of student debt terrifies the crap out of me and is also why I think anyone who tells me about how someday I’m going to be a “rich” doctor is utterly insane. It’s not that you can’t become extremely well off as a physician, it’s just that, to do so, you have to go into practice with a sense that making money is a goal and to make choices along the way that get you closer to that goal.

Less vaguely what I mean is that medicine pays well for people who perform procedures. It’s easy to put a price tag on a CT scan or an appendectomy because it is a tangible action that has taken place. It’s a lot harder to put a price tag on a thought process. A doctor contemplating a diagnosis cannot bill for the effort required to make that assessment. So specialties, like, oh say, neurology, don’t pay as well as radiology. Beyond that, the amount a doctor is compensated is a delicate negotiation between insurance companies and individuals who have varying abilities to afford their treatment.

My musings on this subject are nothing new, but this blog post was prompted by an article that CNN ran online regarding physicians who were running into debt. The article itself wasn’t terribly interesting, but it prompted a heated response. One prevailing attitude was that it was so easy to get rich as an American physician that anyone who was not luxuriating upon stacks of hundred dollar bills was clearly mismanaging their funds.

There certainly are some money-grubbing doctors out there. One commenter defended his extravagant lifestyle by patting himself on the back for years of hard work, as though anyone without a million-dollar home and a BMW had spent the majority of their lives sitting on their butts watching the Bachelor. (He earned my particular enmity by suggesting that English majors don’t work as hard because their major isn’t financially practical.) But as in any profession, most people don’t end up wealthy by accident. They make specific choices about their specialty, about the type of practice they are going to run, about the location and types of patients they are going to see. You don’t make it big being reimbursed by Medicaid or seeing patients without health insurance. And yet many doctors do precisely these things, either because they must or because they feel a moral responsibility to the greater good.

It isn’t wrong that some physicians choose positions that don’t force them to deal with populations who can’t pay them, any more than it is wrong for a grocery store to decline  customers who can’t pay for their food. But there is a choice involved, and you could call it a selfish one. By the same token, it would be selfish, but not wrong, of me to choose a specialty like neurology because it interests me more than a needed specialty like family practice. It’s my life and my future; I deserve to be a little selfish.

We, doctors and non-doctors alike, need to keep in mind that medicine is not a singular profession and that physicians are not all of the same mind. They can include both selfish and selfless individuals. And regardless of what anyone would like to believe, it is entirely possible, even easy, for a physician to run into financial difficulty. The truth is that these are probably the doctors who are doing the most for people who have the least.