The Hidden Costs of Speaking

Doctor comes from the Latin “docero”, meaning: teacher. Etymologically speaking, my primary role as a doctor is to teach. Though, to be clear, I feel that my primary role is to care. Firstly, with my actions (warm welcome, listening ear, caring focus, compassionate stance), prior to even teaching and treating with words, medications, or the scalpel.

But teaching, lecturing, tutoring, public speaking and all manners of podium and online presentations are part of the work I do as a specialist surgeon. With my scalpel I can only help one patient at a time. With my words, I can potentially raise a generation of health care workers who can care for patients well long after I’m gone. I am committed to carefully using words and the scalpel as masterfully as possible.

That’s why I can’t seem to ever say “no” to a speaking invitation. I am passionate about passing on knowledge so that others can learn and do better at caring for patients.

But can I make a confession? Teaching costs dearly. It’s unpaid work that eats into my family time. It’s work that even costs me a lot of money in some situations. And it’s work that does not benefit me in academic progress in Australia. It’s not measured, because it’s not treasured. Let me explain.

In October alone, I have 9 speaking engagements. That’s anything from a 15-minute plenary lecture at a conference to a 90-minute tutorial for my specialist trainees. My audience ranges from medical students, surgical residents, ENT specialist trainees, specialist paediatricians, trauma clinicians, cleft clinicians, and medical radiation practitioners. Each of the talks will require somewhere between 2-5 hours of prep and research. The talks are given early in the morning, late in the evening and also during the weekends. You can see how much time this takes from me, on top of my usual busy schedule? By the time you start counting prep time, travel time, delivery time and associated physical preparation on site, it’s probably about 4 hours for an online talk and 6-7 hours for an in person talk. Times 9 in October.

Do I get paid for any of this? NO. Not at all. In fact for one of the talks, I had to pay for doing the work and the talk.

You see in Australia, as a surgeon, I am renumerated hourly for my public hospital CLINICAL OUTPUT: the patients I see and the operations I do. I do not get renumerated for any papers I publish, lectures I give or tutorials I conduct. Unless I am employed as a University Staff member I do not get any time allocated to do research or teaching. Yes there is a small percentage of time allocated per month to do admin, but that’s quickly taken up by triaging referrals, audit and improvement projects, supervising trainees paperwork, requesting equipments, writing protocols, and doing 375 e-modules that needs to be done.

All of the tutorials and lectures I give are done outside of clinics and operating hours, while having dinner, being oncall, and replying to phonecalls. This happens all the time to a lot of speakers and teachers. It eats into personal rest time and family time.

It’s frankly not the renumeration I seek, only the recognition that the work of teaching is important. These multiple teaching engagements are an Academic exercise that parallels the work of writing a manuscript. A good teacher will spend hours in researching the subject matter and understanding the audience. A good teacher will spend hours in crafting and preparing the message so as to be relevant and practical. A good teacher will spend hours ensuring that the talk is a synthesis of good information with practical application. We need to treasure it and start measuring it. Interestingly, I can spend the same amount of time writing a case report or writing a review article which will be published in a journal that is only going to be read by about 20 people, yet that activity is measured, while the multiple hours spent teaching is not.

Not only is the work of teaching costly in terms of personal time sacrifice and not measured as an academic achievement, it can also be really financially costly. Case in point: an invitation was sent out for a speaker for an international conference on a particular topic. Because the person who invited was a dear friend, and the topic is significant, I said “yes”. When the invitation came, it also came with a registration fee of $725 dollars. So now I am obliged to attend a conference that is not even my specialty area, spend hours preparing a talk and then delivering that talk and pay out $725 from my own pocket. Yes, I have checked and asked. This was the “discounted” fee. I have given my word to the dear friend who invited, so I felt I could not back out of it.

If you are an organiser to a conference, pay your invited speakers. Respect their time and renumerate them properly. There are a few things you can do: pay for their time, pay for their airfare, pay for their accommodation, pay for their car parking, waive their registration fee, etc. You can do some or all of the above as a respectful gesture of the time that the speakers have given you to prepare a talk for your audience. This applies to invited speakers, especially. Every conference I know has industry support. Where does all that industry support go to? Profit for the organisers? Why not use them to cover the registration of a speaker, and perhaps even the registration of those from low and middle income countries? Use the money to open the doors to low and middle income country experts. Platform them and give them a voice.

I know that there are other circumstances. For example if I submitted an abstract and my paper was accepted for presentation, it’s only fair that I pay for my registration. If I was going to a conference that is my own local subspeciality, I feel like I am sharing knowledge with my family so it’s probably fair that there was no renumeration. But if I had to travel internationally, I hope some renumeration would be offered as there is significant loss of income and costs associated with travelling. If you were already attending and for some reason the organiser invited you to be part of a panel or present something, that too perhaps is a fair situation. I would not expect any renumeration if I was speaking to medical students, surgical residents, trainee surgeons, patient groups, etc because I feel that teaching is a gift and and investment I want to give for these groups. But if you were specifically inviting someone to speak at a conference, I hope waiving the registration fee would be the least one could do. Though I sincerely think that renumeration for hours of prep and delivery is very reasonable.

So why do I still do it? Because teaching matters for the next generation of clinicians and their patients. Even though it’s costly and not recorded anywhere, I see it as service I do for the next generation. I am where I am because of the teachers before me.

But I will begin counting the cost. Each time I say “yes” to a talk, is a “no” to myself and my family. This is a lesson I should have learned a long time ago. I hope you don’t repeat my October mistake. It will be a “No”-vember from this point onwards.