I read two articles in the newspapers today, one about Governor Romney’s 2011 tax returns and the other about a welfare mother. (Remaining cognizant of the fact that this is the NYT, a newspaper with a liberal bent.)
It made me think about my role in this society. I am a legal alien. I came to this country as a student and went through specialized psychiatric training. I invested a huge amount of my own money to start the process and was then paid a salary by my training programs, in return for the patient care I provided as a trainee. By general consensus, medical trainees provide a lot more skilled labor than they are paid for. While training as a specialist, I worked 80 hours a week, took overnight calls taking care of extremely sick patients, and made anywhere between 30,000-50,000 dollars a year throughout my 5 year training.
At the end of this training period, my agreement with both US and Indian governments was to return to my country. But like most skilled immigrants, I wanted to stay. The US government allows me to do that if I promise to serve in an under-served area with a health professional shortage, for a minimum of three years. Before hiring me, a health organization has to prove that they advertized for an American citizen to take the job for at least 6 months, and no one did. I took one such job.
I now work for a Federally Qualified Health Center in an inner city area. All my patients are poor, most of them have Medicaid, with a small proportion being on Medicare and private insurances. I also see patients who do not qualify for Medicaid yet can’t afford private insurance- the center puts them on a sliding fee scale, and they are able to see me and their other doctors at about $20/visit. This adds up when you add the cost of paying for medication out of pocket, but thankfully, the 4 dollar drug programs from companies like WalMart allows me to make sure they have the bare bones medications they need.
What does this mean for me? Most days, my practice feels like trying to plug a hole in a dam with my finger. A vast majority of my patients have been too sick to work for years. This includes those with schizophrenia, those with severe bipolar, crippling depression, dementia, traumatic brain injuries, moderate-severe mental retardation.
Some people who come to see me have milder symptoms. Often, they bring in disability papers for me to sign. Sometimes, I have to tell them that, in my opinion, their mental health diagnosis is not enough to keep them from working. A lot of these people drop out of treatment when I tell them that. Some don’t.
Most of my patients live in a continual state of crisis. They don’t have transportation, or housing, or food, or money for their children’s school supplies, money to take their family to doctors who don’t accept Medicaid. I try to see them often, because every month brings a new crisis. “I lost my visiting nurse because the insurance said I no longer qualify.” “I can’t afford physical therapy.”"I went to interviews, but no one will hire me because I’m old/have a prison record/have visible tremors/am overqualified.”
I work as hard as I can. The clinicians I work with often double as social workers for these patients, helping them finding crisis housing when they lose their apartment, filling out paperwork for them to be brought to the doctor’s office when their clunker dies, finding vocational opportunities that allow them to find work, even if a few hours a week.
For this work that I do, the government pays me a salary that puts me squarely in the top 10 percentile of the income distribution. This salary is considerably lower than what other specialists make, and considerably lower than what I would make if I were in private practice, or employed by a for profit hospital or university. It is more than enough for what I consider a very comfortable life.
And I’m grateful for this. I’m grateful for the opportunity to remain in this diverse, open country, grateful for the opportunity to do what I do best, grateful that my 30-35% taxes pay for this health center, the roads, the traffic lights, the police, the EMS, urgent care centers, housing shelters, and yes, various forms of government assistance.
Because I come from a country where there is no government assistance. Every day, I’m aware of the fact that most of my patients, had they been in India, would either die, or resort to begging on the street in order to survive. This nation allows them not to do that. And for that, I’m grateful.
*Disclosure- I am neither a Democrat or a Republican. Being on a visa, I cannot vote. Like most Americans, I try to see beyond the smoke screens both parties put out. I don’t completely support either side, but have a clear bias towards one.