“I’ve done made a deal with the devil. The devil is going to give me an air condition place when I go down there, so I won’t put all the fires out.” – Red Adair, 1991

Figure. Comparison of salaries between a physician and a UPS driver.

Red Adair, the famed oil fire fighter, was called to control a massive oil well fire in the Middle East. The fire was causing the loss of several million barrels of oil each day. Red Adair was called to put out the fire, which he successfully did in just a few days. He submitted a bill for $800,012.95. The king was curious about the bill and said that the bill was certainly justified, but he asked why this strange bill including the $12.95? Red Adair said, “The $12.95 was for the cost of the chemicals used, but the $800,000 was for knowing which chemicals to select and the $800,000 was the fee submitted for knowing how to use them! ”

What lesson can we learn from this perhaps apocryphal story? We spend 12-plus years after graduating high school to become a urologist. We frequently have 70-plus-hour work weeks. We frequently don’t have dinner with our families. We often are called at night to go to the emergency room. We frequently take phone calls in the evening and on weekends to answer questions from patients and provide service for which we aren’t compensated and yet we are legally responsible for the care. We are at a higher risk for drug and alcohol abuse. We have a higher rate of divorce than the rest of the population, and we have a higher rate of suicide than other professions.

Let’s put this into perspective that our patients will understand. The figure from Authentic Medicine compares the incomes of a UPS truck driver and a physician. A UPS truck driver can go to work after completing high school with an annual salary of $60,000. A pre-med/medical student/resident/fellow will often incur $300,000 of debt prior to starting a practice. The physician will often defer earning a living until age 28 to 30. As a result, it will take a doctor 17 years to earn as much as a UPS truck driver. Now, please continue reading and hang in there with me, because the next statistic might just shock you. If the UPS truck driver were to work the 70-plus hours a week that a physician commonly does and the truck driver receives time-and-a-half for overtime after 40 hours a week, it would take a whopping 24 years for a physician to equal the salary for a UPS truck driver! Also, throw in that the UPS truck driver is usually home for dinner, doesn’t get awakened during the middle of the night to go out and deliver a package, and is highly unlikely to be named in a lawsuit by someone sending a parcel to another person!

I’m not trying to be maudlin and compare the practice of medicine to a truck driver. As urologists, we are part of the greatest profession on earth. We receive daily gratification from serving others and we hear every day from our patients how terrific we are. I doubt that the UPS truck driver receives those kinds of compliments and accolades after delivering a package.

My bottom line: We don’t have to justify our fees. Let’s be more like Red Adair. A small amount of our fee is for the cost of the medication, but the largest part of our fee is for the decision making for which medication to prescribe and the directions for using the medication. So if anyone ever questions your fees, tell them the story about Red Adair or show him the graph comparing your salary to the UPS truck driver.