Even though I’ve started my new practice, I keep getting solicitations from recruiters for emergency medicine Jobs. I tell each of them my rate is $675 an hour. The responses are pretty funny. Before you think that’s too high, what do you think about an attorney who has been out for 20 years and has all that experience? How much did they charge? Sometimes $1000 an hour. The market is set by what physicians are willing to take. As a whole we are absolute morons when it comes to negotiating or business. I’m just trying to help the next generation by creating a data point and an expectation. You don’t slave away and get out in your 30s with $500,000 of debt to make $200 an hour. Everything has become pretty much unaffordable in tier 1 cities. Doctors have willingly become middle-class. Before you say so what, do you really want the person who is operating on you or who is trying to make decisions about the most unfortunate day in your life be motivated by money? No. When I got out of residency 20 years ago, we made enough money to be extremely happy and not money stressed ever. There was too much money it just went into savings. That freed us up as doctors to focus on our art and are calling. Now everybody has a side gig. Now money actually motivates physicians to do unethical things at times. Most do not, but money is high up on everybody’s list of stressors. Money in society is broken. It’s a failing system. It’s always worth less and less overtime which keeps people on the hamster wheel. But the incentives have caused the hamster wheel to run faster and faster and people are being flung off. I’m not saying asking for more money is going to fix anything. I don’t think it will. But the best in the brightest are leaving medicine and the incredible calling which it is has lost so much of its luster because of corporate greed and bloated intermediation. We need to make some massive changes. If we don’t, they will happen anyway but they will be far more volatile. Personally I think it happens through innovation, disruption and physician entrepreneurialism. stop fighting the system, it’s collapsing under its own weight. That’s like trying to repair the Titanic after it struck the iceberg.