S3E16: Money's Impact on Health Care

Bushra: No, we stay ready. We don't got to get ready. We stay. And that's fine, Chloe. I have a lot of good things to say. Good things to share with the people.

Harjit: What are you doing?

Leen: I just recorded myself eating really loudly in the mic.

Harjit: Yeah, it's like ASMR.

Bushra: ASMR.

Harjit: Okay, so welcome to the studio, you all. It's your girl, Harjit.

Bushra: Hey girl, Harjit.

Leen: Hi.

Harjit: I don't know why I said it like that, but we also have Leen and Bushra in the studio.

Bushra: What up? What up?

Leen: Got Leen on the track.

Harjit: I know we finally got Leen on the track. You've been busy in life doing cool stuff.

Leen: Busy.

Harjit: Even right now you're out in Provo doing some rotation.

Leen: ICU.

Harjit: I see you.

Leen: Not like I see you but like I literally C U.

Harjit: Like Intensive Care Unit.

Leen: Yes.

Harjit: And Bushra's chilling.

Bushra: I am technically chilling, meaning I don't have any clinical duties at the minute. However, it's like, you know, idle time can be your worst enemy especially since submitting our rank list is right around the corner.

Leen: One's done and gone.

Bushra: Well, for me, I wish I was like that, Leen.

Leen: It's not stressful, just do it.

Bushra: I like keep back and forth on a couple of things and I am unsure of a lot of things.

Harjit: I am very unsure too.

Leen: Just follow your heart.

Harjit: I wish it was not easy. It's really like sometimes . . .

Bushra: I think in some aspects I'm like, okay, I know what I want and then the rest of it is just like, oh, I need backup plans.

Harjit: Yeah, you need all the backup plans. Speaking of interviews, I am currently on a cash cleanse. Have you guys heard me using that word a lot?

Bushra: Yes.

Harjit: I'm just like trying to be good with my money because interview season was so expensive.

Leen: Bad.

Harjit: Bad, right? Like real bad. And kind of moving on to our next step of our life, I really want to be good with my finances because I don't want to be in like a downward spiral ditch situation.

Bushra: Same.

Harjit: So because I've been having these thoughts a lot, I've been thinking a lot about financial security and what it means to be financially secure. We're all going into this profession which from the outside world people say often that, you know, they make pretty good money living a good life. In some ways comparatively, we can't complain because there are a lot of people who have nothing, but my understanding of money has evolved a lot through medical school and even kind of the way I grew up. So I wanted to ask you what your relationship with money has been growing up.

Bushra: I think for me growing up I have seven siblings and then my mom who is a single parent and so obviously she bore a lot of the responsibility to provide for the household but also my older siblings. Pretty much all of them had a job to help with the household. I never really, me myself, I never worried about like paying the bills or anything like that and never fell on my head. It was usually my older siblings that kind of took care of that, and in a lot of ways, I was kind of coddled throughout my life because everything, all the necessities were provided for me.

I know that things got a little bit better once we started getting financial aid money when we started college, me and my sister and my older brother, and so that contributed to the household. I never used that money first. It's just like it wasn't my money, it was our money. And I think that's the way that our family thinks about money, it's like it's ours and not like mine kind of thing.

Harjit: Yeah. Bushra, I actually really liked that you bring up that whole concept of ours, not mine because I think in my culture as well, money is always seen kind of like as this reserve that people can utilize when needed. Another concept that I also grew up with is that you need a savings. My parents would always be like, we can't buy this right now because we need to save this money. We need to save this money for this. We need to save this money for that. Which is another concept that I think my parents really, really would sacrifice some of the stuff we would get when we were younger just so that we can like build our future. So I really connect with that aspect.

Bushra: I will say though, for a lot of people in my community, I think people get into trouble when it comes to using credit cards. And I know a lot of people get into debt because they open up credit cards and they buy a lot of things that they can't afford and then they are stuck with a bill with like an astronomical like interest rate. And I don't know that there's a lot of financial literacy that's taught within my community. Those are some of the issues that I see people facing is opening up lines of credit that they can't afford and then not spending within their means because they think it's free money when it's actually not. And then as a result of that, ruining credit scores, which makes things a lot difficult later in the future.

Harjit: Yeah. And I think that a lot of that has to do kind of the promotion of credit cards. There's that whole cycle of to get money you got to promote getting, taking and giving money. So it's that whole cycle. So I think a lot of that comes with that as well. Leen, what about you? What kind of relationship did you have with money growing up?

Leen: Money for us kind of came in three phases in the sense. My dad came from a household of 13 in a village in Palestine and they were farmers and villagers and so money wasn't necessarily something, like it was something . . . it was something they valued of course but I think for us land was a big thing so our currency was a very different aspect. But when he came to the U.S., he very much instilled in our family, like we have to support each other in our immediate family, but also our extended family.

So we'd support family abroad but at the same time we also believed in like money is used to sustain like a future for yourself and that meant house, car, finances and like the basic necessities. And then the big thing that we constantly emphasize was education. Money should always bring you something later.

It shouldn't be like you shouldn't spend it on something that's like quick. It should be something that you can put forward to something else. So if you know, you put a towards education, education hypothetically will bring you money.

I think the idea of recognizing being grateful for what you have is a big part of it as well. And sometimes that went really far, I think in our family, when we would go to buy video games, you know, we'd always be reminded, oh, the kids in Gaza don't have video games. And so we kind of feel like the sense of guilt in a sense, but it was there to remind us that we're also like, we come from a place that's still struggling.

And then the key is always to give back as well. I think that's a big part of money in our family. My dad never shied away from . . . my dad and mom, they never shied away from charity and so we'd always, you know, wherever you can give money, we'd give money to students for scholarships, we'd give money at like shelters we'd give them, you know. So I think they really instilled this huge idea of giving back because, in our religion, I guess it's if you give something, God will might provide you with it and so we're like, it's okay. That was kind of growing up. Finances were meant to like either further you to like help you sustain yourself, but you should always give it back as well.

Harjit: I can relate to a lot of what you said. My mom and dad both grew up in a village. They were, you know, in a farming family. They both had huge families. My mom had eight siblings and my dad had eight siblings and I think a big drive for us to come to America was so they could be more financially independent.

Once we were here, I always knew that being a woman, and I've discussed this a lot in prior podcasts, that for me to have my own independence, that would also mean me having my financial independence. And growing up, I have a very interesting journey I think with money because I feel like I've jumped socioeconomic statuses even within my own lifetime.

Leen, actually you might remember this me and you had gelato in 9th and 9th. There's a really good gelato shop there, public service announcement. But I was sitting there and eating gelato and I remember telling you, Leen, like I'd never imagined my life like this. I can go to a gelato shop and buy a $5 ice cream even though it's from loan money, but like I could buy a $5 ice cream and sit in this fancy neighborhood and eat ice cream.

I think my journey with money has been interesting, but it's also been scary because when we had nothing, we were happy with the small amount that we did have, but as you get more money, you have to be responsible but it's a really fine boundary line.

Being around all these different types of people that come from varying socioeconomic statuses, especially in our med school, has the way you think about money changed?

Bushra: Okay. So the way that I think about money has changed over the years. I have a little bit more responsibility of taking care of myself and obviously with the help of my family too, we do have this like mentality like I mentioned before, like collective finances. But I think for myself, I want to be more financially independent and think about my own stuff more especially since, you know, we're moving for residency in a few months or possibly I should say, we don't know where the hell we're going yet.

For me, I've always been the more fiscally responsible one in my family compared to my other siblings and I think part of it is just the nature of like where I am in line with my siblings. I think they went through a lot more tougher times than I did because obviously, they had a lot more responsibility. And then for me, like when I started working, I remember that my money I could use to take care of some of my stuff like gas and like just the stuff that I needed because I wasn't really making that much money but it was sufficient enough for me to take care of my own needs instead of asking my family for that.

But then also I like started to thinking more about my credit score, making sure all of my bills are paid on time, and like just being a little bit more responsible so that in the future when I do need to like take out a loan, like a mortgage or something that I would have every opportunity to get whatever house that I dreamed of having or something like that. For me, like I do think a lot more about the future than the present and just kind of making sure I am prepared for the next steps in my future.

Leen: I think for me, from a young age, I knew I wanted to go to med school and everybody would tell me, oh, it's so expensive, like are you really ready for this? And I just thought, okay, well, I don't want money to hinder me in that aspect. I was crazy and I like saved out $20,000 under the mattress before I came to med school.

Bushra: Wow. That's old school. Under the mattress?

Leen: My dad found it and he was like, "What in the world is this? You need a bank account?" I was like, "No, I don't."

Bushra: That's like old people who don't trust banks.

Leen: That's pretty much what it was. I was like, I don't trust anybody. I worked hard for this money from, you know, from third grade. So I really wanted it.

Bushra: So you were thinking about money at a young age.

Leen: Yeah. Ever since I've been saying I wanted to go to med school, which was when I barely walked, people would always tell me it's expensive and I was just like, I don't want to suffer. But you know, ultimately 20,000 is not going to pay for med school so I was able to just, you know, only pay for tuition and live off the 20,000 for the last four years including interviews is insane but yeah, now this money is getting low.

So from that aspect though, like in terms of what's changed in my idea of what finances is, you know, obviously I'm starting to worry more about the actual like financial aspect of it and I realize I am the most, I think this is like my biggest weakness in terms of education as it comes to finances. And I think part of it stems is my family thinks it's a form of endearment for them to support me through these financial issues.

I appreciate that they're really looking out for me but in the end, it kind of does me a disservice as well because now I'm about to like get an income and it's like, what is a credit score? I don't even know if I need a credit score. Can I just go back to stuffing money under my mattress and like saving up until I have enough to buy a house and I don't need to pay interest and get . . . you know what I mean? Part of me kind of thinks like, can I go back to this idea and then part of me is like, no. Leen like that is totally not feasible.

I've been trying to learn more and more about it recently to be honest, especially when with interview season, you know there would always be posts on our Facebook class page about you should sign up for this credit card because it gives you these sky miles or something and where you can gather them up for like some credit score. I don't know anything. This is what I read and now this is what I understand. I don't know. It's kind of scary actually to finally think like, oh my goodness, we have to actually be thrown into this financial world and I don't have financial literacy.

Harjit: Yeah. I also have struggled with the same thing and I'm like now even in medical school, I'm, "With more educated individuals to have to have a more educated language," and now I'm starting to think about these words. But I always imagine if I was younger, it'd be so difficult for me to even understand the world of money. Just like every other institution, it also is deeply embedded with ideologies that don't really favor one group over the other and t's the group that has the money.

I've been thinking about that a lot and also a lot about our peers and our colleagues. Like I said, we're all from different socioeconomic backgrounds and I'm always like, oh, this person is saying this, but I don't know if I sometimes can relate to them when it comes to money. Wanting to live a life that is, you know, fancy or like full of fun things like going and eating out, like going and doing events, all of this costs money and it's something that I'm not used to. I'm not used to like, you know, having money for fun because we only had money for our needs before. So I think that's been a really, really huge struggle for me, and I think one that I will continue to have to tackle.

Leen: What I think also kind of worries me if I have kids, I kind of want them to understand that struggle as well. And when you're finally a physician, you're going to be well off. You're going to be more than probably well off and I think it's like how do you continue to pass it? Because I think it's important to understand the struggles of when you had the basic necessities.

I remember living in a one-room apartment when we first moved to New Mexico and we only had a watermelon. This is like a constant joke in our family where they're always like, remember when we only had a watermelon, we were sitting in the corner eating watermelon. We were happy. And I feel like these are very important values to instill. My thought is, I wouldn't want them to take the idea of money of being for granted. I want them to still find the value in it and how each dollar has hard work behind it.

Harjit: Yeah. I think that's really an important point, Leen, and I have never thought about money more than I did when I got med school because I was very grateful I had scholarships when I was an undergraduate student, so this was the first time I even took out a loan and, you know, it's a very complicated process. I just want to move forward hoping that I could be responsible with that.

But now that I look kind of in the field of medicine, how I see medicine and money related, they're very tightly related. They almost parallel. There's a lot of talk about money, you know, in healthcare, like healthcare costs. It's like a big talking point even for political candidates. I always wonder how I will contribute to that relationship of money and healthcare.

Leen: Yeah. That brings up a really good point. Going into medicine, I never once thought about money. It was always, I want to be able to help people and be able to reach people and you know, provide the best healthcare that I can. And I remember it was during first year, I believe so I can't remember the exact scenario, but I remember this attending saying, don't ever forget that what healthcare is and don't let the system make you believe it's the business model. Don't go into medicine doing transactions and things like that.

And at first, when I was a third year and a second year and we're not in clinic, I was like, yeah, of course. Duh, that's obvious. Now when I'm in fourth year, you know, going on these interview trails and they like present to you the income for each year you're in residency, when I'm sitting down doing notes, I finally realized the reason we do notes isn't truly because like it provides a purpose to help the team or the next person coming on to like follow the path of what's going on but the real purpose is actually like billing. We do like, yeah, it's like you need a physical exam, you need this, you need this.

Bushra: You need a 10-point review system.

Leen: Yeah, and it kind of threw me off and I actually just learned about this like a few days ago and I was like, wait, so we're not actually doing this to like make it succinct in our head and make it a system so we can provide the best care. We're doing this to bill people? And then going into emergency medicine, how many times do we hear like patients are like, "I'm not taking the ambulance. It cost way too much. I'm going to take my own private car."

Bushra: Take an Uber.

Leen: Take an Uber. And it's sad because I truly see physicians working their best to make it as affordable as possible. It's like, let's not order these labs for this patient today. We can work off of the labs previously. Let's kind of do this procedure rather than this procedure. But at the same time, does that hinder the actual quality of care we give to our patients? It's super frustrating.

Bushra: Yeah. I feel like . . . the only time I feel like or the one time I remember distinctly thinking about money when it comes to medicine was when I was on my psych rotation and it was inpatient psych and a lot of like dispo, discharge meanings, and talks that we had about patients centered around a lot of the times what insurance was going to cover. And if a patient had crappy insurance or no insurance at all, they were, you know, as soon as the insurance deemed that they were getting better, we discharge them. But the people that had better insurance that covered for a longer treatment stay got that much more treatment. It did make me feel like a little weird, especially when we like discharged a patient and then they come back.

Harjit: How I view the whole money and healthcare situation is it causes a lot of physicians to get jaded because they went into medicine to help people with therapies and diagnoses, but they can't even do that half the time because of what's covered and what's not covered.

They have to get creative, they have to like try different methods to kind of give their patients the same care, and even that is such a struggle. I always imagine that it's already difficult when people are of a lower socioeconomic bracket and then you also put on top of that that either they don't have insurance or they have insurance that doesn't cover much. It causes a lot of barriers to access of care. And I think that's the biggest thing that I'm realizing now, this world runs on money. Because of that, I sometimes wonder if we are unable to do or follow the path we'd really want with a patient because we're hindered by that and that makes me sad.

Leen: In my opinion, the whole system needs to be revamped. This just doesn't make sense to me. I mean this is what the politicians are trying to answer. You know what I mean? I don't have an answer.

Bushra: Exactly. That's literally exactly like it comes with policy change. Like we don't set prices on things. We don't have that power as physicians. I feel like the only thing that we can do is get involved with lobbying for these kinds of things. Being aware of like how the political system affects the kind of healthcare that we give and the kind of healthcare that we receive as patients as well. And I think one good example is the lowering of insulin prices here in Utah to I want to say it was like . . .

Harjit: Thirty dollars.

Bushra: . . . $30 and before it was like $500 a month or something astronomical like that. Making things more affordable, especially when people need it to survive. The kind of changes that we need can only happen with policy change.

Leen: See now I'm going to even challenge you on that. How long have we been talking about policy change? How long has everybody been talking and going back and forth and fighting between parties, but honestly like is there a different system we can utilize to overcome this and maybe it can't be through politics?

Bushra: No.

Leen: You don't think so?

Bushra: No.

Leen: I just feel like they're not doing anything. I think it's a lot of stalemate, to be honest.

Bushra: I think that it can feel like that, and the worst thing that can happen to a person, especially in a political climate, is develop apathy when it comes to these kinds of things. You can't say a lot of things to be quite fair because then you stop working for the things that you care about. And I'm not going to lie like I felt it before. I'm like, I don't give a shit. Like nothing's going to change anyways, so why the hell should I put like this much effort into it? But the thing is change will come slowly. It will, but we also have to keep fighting for the things that we want to see changed. Otherwise, they can get worse too.

Leen: You're right but at the same time, we're also not making any progress. But like I read an article where the Utah state . . .

Bushra: But it has changed a little bit. Of like the Affordable Care Act made it so that the idea of pre-existing conditions no longer applies to what insurance can and can't cover. There have been changes but not as fast or as grand of changes that we want to see. But there are steps forward.

Leen: I guess it's hard because you're in the immediate moment of patient care. The overarching kind of the government's kind of this really slow acting thing but what you see as the immediate moment where the patient can't afford anything. They can't afford to do this and we have to work with this. And that's the hard part I think. That's maybe why it's frustrating because we're on the ground.

Bushra: It's hard, and I feel like a lot of the times in outpatient settings . . . I feel like in inpatient setting you have to do like what you're legally obligated to do to treat a patient regardless of whether they can afford it or not. I think follow-up care's like huge because people don't have insurance and they don't have primary care providers to follow-up with and those people get lost in the fray and they're usually the ones that get impacted the most by this.

Harjit: Yeah. And I think that that common frustration is one that at some point like I said, might get jaded, might develop apathy. But for me, I think what we can do is, you know, get creative just as people have before and try to provide the best care for our patients and find new ways we can utilize our tools so they can get what is needed for them. That said, it's also true that there'll be people who don't get what they actually deserve, but you know, that's the ways of the world.

Leen: There shouldn't be though.

Harjit: But the world isn't fair, and our job as I hope future physicians is to keep on advocating for, you know, these policy changes, advocating for new tools, new therapies that are more affordable. Also understanding our relationship with money, people's relationship with money and how that impacts larger societies as well.

Leen: The idea that this world isn't fair is actually a statement of apathy in itself to acknowledge. And I think that's why we came into this field to say it's not fair. We need to do something. We shouldn't just say it's not fair.

Harjit: Right. And that's what we're trying to do slowly and surely.

Leen: Surely, but not as fourth-year med students.

Harjit: I mean we try.

Leen: We're just the little runt of the hierarchy.

Harjit: I think that us hopefully even having these conversations is us trying to expand the way that we think about things.

Leen: It just leads to more mistrust among patients and mistrust of the healthcare system, and that's when they start seeking out other practices that may or may not help them. And it's like we also have things that we can give to you that can help, but we are withholding it. Not we personally, but like financially.

Harjit: For sure.

Leen: Super frustrating, y'all.

Harjit: You know, I wish we could end every episode on a super positive note but the truth is that reality is complicated and there's a lot of positives and negatives apart of that. So I think it'd be great to hear you all's thoughts on this topic about financial security, both at an individual standpoint and then also as a community standpoint and what factors into that. With that, please follow us @bundleofhers Instagram page. Send us your comments and also listen to us wherever you get podcasts. Thank you for being a part of this journey with us. Bushra, do you want to say your bye-bye?

Bushra: Girl, bye.

Harjit: That's a new one.