A surgeon’s recommendation to take a person to the operating room should be solely influenced by medical facts, sound judgment, and experience. There are, however, particularly today, other influences tipping surgical decisions. Nowadays, surgeons are more pressured by “business” factors than ever before—they feel compelled to keep hospital operating rooms busy, to keep their practices going, and to maintain a living. After 20 years as a surgeon, I can say this: The line between operating for love or for money isn’t as distinct as it once was. The reality is that some surgeons are more motivated by money than the Hippocratic Oath they promised to uphold.
As a young newly minted general surgeon starting out, I was ready to operate, ready to make a living by improving lives. I was eager to conquer disease, ambitious in my desire to help all comers, and ready to take full responsibility for every person who walked through my office door. For me (and my colleagues back then), being a surgeon was not about money. We knew we were in for a nice pay raise once we left our residencies and started operating on our own, but we didn’t talk about it. We knew we were going to upgrade our standard of living significantly. While the subject of making money was never openly discussed, we assumed we were going to do well. Frankly, many of us thought we deserved it, given the debt we had accumulated and the personal sacrifices we had made behind during training.
The saying that “doctors make poor businesspeople” has some truth to it. Even today, during medical school and training, there is little acknowledgment of the business side of a surgical practice. We don’t get an insight into the costs, the profits, or how to maximize your value. Appropriately enough, the focus for interns and residents remains on becoming competent sur‐ geons. My mentors believed that the surgical profession was one of altruism; to talk about business and reimbursement in the same breath as the best way to take out a colon cancer would have been heresy. I believe that this perspective has contributed to the shortage and dissatisfaction in my profession today. Just as sad, the failure to understand the business side of a surgical career early on negatively affects patient care.