Should You Drop Your Doctor Job and Become a Plumber? Is it Time for Physicians to Become Plumbers? Is it Time for Physicians to Become Plumbers?

I am losing my hair.  Maybe because of the stress of being a physician?  Maybe because I am just getting older?  Maybe because my hormones are out of balance?  But, regardless of the cause of this premature balding, my drains often get clogged in my sinks and showers with this shedding hair.

According to a national average, it costs an average of $90 for a plumber to clear a blocked tub drain (  According to CostHelper, a poll of readers report paying $95-$210 to have a toilet unclogged, at an average price of $164.   Even if drain cleaning only takes 5 minutes, most people will never pay less than $50 in the United States according to

Let’s do the math.  How long is the training for a plumber to learn how to cable a drain?  Training time is pretty quick for most drain cabling jobs.  Most people can get the hang of basic drain cabling within a month on the job and some can learn the technique in a day.  Plumbers’ apprenticeships are positions (mostly paid) for plumbers to learn all the intricacies of plumbing.  The formal training period usually lasts four years after high school with one licensing exam.  Education required for physicians to care for patients?  A minimum of 11 years beyond high school, passing MCATS and a minimum of four sets of Medical Board Exams (Steps 1-3 and your Specialty Board Exam), getting near perfect GPAs, interviewing to get into medical school and then again to get into residency, and a commitment to work 80 hour work weeks with hundreds of sleepless nights.  Cost of education to become a medical doctor?  Don’t ask.   I think I need to stop this analysis before I lose more hair.

I had the plumber over the other day to unclog my shower drain full of my shedding hair.  It took him 7 minutes and the total cost was $125 dollars.   After the plumber left, I sat down to grab a cup of coffee and skim the newspaper to get my mind off the exorbitant bill I just paid.  Rather than making me feel better, I was about to pull out my remaining 10 scalp hairs as I read the following article on the front page of the Los Angeles Times: “Ruling Could Cut Medi-Cal Spending.”  According to this article, a three-judge panel of the U.S. 9th Circuit Court of Appeals decided unanimously that California may cut reimbursements to doctors, pharmacies and others who take Medi-Cal insurance (Medicaid for California) by 10%.  Under President Obama’s new healthcare law, there will be as many as 2 million new patients who would qualify for Medi-Cal.

Do you know what the going rates are for physician reimbursement by the California government for office visits under Medi-Cal (California Medicaid Rates as published November 11, 2012)?  I decided to look into this:

  1. Problem Focused Established Patient Office Visit by a Physician (code 99211): $12 ($10.80 after 10% reduction)
  2. Intermediate Established Patient Office Visit by a Physician (code 99213): $24 ($21.60 after 10%  reduction)
  3. Detailed Established Patient Office Visit by a Physician (code 99214): $37.50   ($33.75 after 10% reduction)

Alas!  A revelation!!   I could see 10 patients in the office and still make less than my plumber who unclogged my drain in 7 minutes without even subtracting out my office overhead costs!  Respect for all the training, education, expense, and sacrifice that it takes to practice medicine has officially gone down the drain.

Henry Mann MD

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