(With a hat-tip to Hybrid Vigor for the idea-PB)
Dear Medical School Hopeful,
I wouldn’t presume to imply that you haven’t given your decision to apply to medical school a lot of thought. Of course you have. The application process alone will weed out anybody who is not completely serious. Still, you may have some lingering doubts and if you do, it is better to hash them out now than when it is too late and you are so deeply into it that to withdraw will mean an unacceptable loss of your considerable investment in time and money.
The first thing you need to do is to cool your jets. Medicine is a good career but it’s just a job. I’m sure you will meet some zealots who seemingly breathe, eat, and live medicine but for the most part, by the time you get into residency you will find that most of your colleagues want pretty much what other working people want, namely a useful job with good pay and decent hours. In this regard, maybe the years of working long hours for little of no pay like you’re going to do in medical school and residency beats the idealism out of people but I prefer to think it teaches them the difference between professionalism and fanaticism. Naturally you have to pretend to be driven to get into medical school as showing passion is a de facto requirement. Your real reasons for wanting to be a physician, while perfectly legitmate, would sound trite and self-serving if you even dared breathe them aloud. Just between me and you I didn’t want to save the world either and just applied to medical school because I thought being a doctor would be kind of cool.
And it is kind of cool, at least when you’re not at the hospital making a career out of not knowing things (which is going to be your modus operandi for most of your training). Still, people who don’t know what goes on during medical training are likely to be impressed. Your mother is going to be proud, your friends will be amazed, and your annoying brother-in-law will have a hard time one-upping you on this one.
It’s a decent career but the fanaticism is not warranted. It isn’t that good. Nothing is. That’s why fanatics are so creepy. They see and hear things that normal people do not.
So, as you are about to commit to a huge undertaking in terms of both time and money and one which will set the course for your entire life, you have to ask yourself if it’s worth it.
From an economic perspective, it may or may not be worth it in the end. Doctors do make a pretty decent salary but what seems like a lot of money to a young, single college student might not seem like so much after four years of medical school and a minimum of three years of low-payed residency training. You can, for example, bust your hump for seven years to become a pediatrician (the lowest-paying specialty, on average) and make under the talismanic “six figures” which is the mantra of salary expectations. $90,000 a year seems like a lot now but it’s the medical equivalent of minimum wage.
I understand that the majority of people in the country live on half of this and are not considered poor but most other careers don’t quite involve the same level of sacrifice. It’s a cliche, but never-the-less true, that while your friends in college who decided on engineering, business, or law are building their careers and starting to enjoy the fruits of their labors you will be working brutal hours for very low wages, losing sleep on a regular basis (in fact, sleep deprivation is both expected and built into the training), and suffering the kinds of indignities that you probably can’t imagine at this point in your adventure.
Just keep in mind that all doctors, after residency, start at salaries much higher than is typical for any other profession. Maybe some lawyers can leave law school and go straight into well-paying jobs but most just sort of scrape along. The same with business and engineering. Still, if you put as much effort into your engineering career, let’s say, as you are about to put into a medical career you will probably do better than most. I don’t buy into the theory that people who are smart enough for medical school will automatically do well at other careers but if you have any other other legitimate talents you might want to mull this over.
The bottom line here is that you are going to sacrifice a decade of your life and arrive at the start of your career with almost nothing to show for it but gray hair and a mountain of debt. The debt is inevitable because medical school is an expensive undertaking, the exact cost of which depends on many factors. Some state medical schools, as they are subsidized by the taxpayers, are a relative bargain while others, like super-premium ice cream, are much more expensive. A year’s tution and fees at Harvard Medical School which is a typical pricey confection will set you back close to $40,000 per year. Compare this to my air-injected, vanilla-flavored alma mater, LSU Shreveport, which charges only $13,000 for in-state residents.
These fees do not take into account living expenses which, while minimal for a single, young medical student are not trivial. Fortunately as most pre-meds are used to eating ramen noodles and living in crappy apartments the standard of living in medical school will not be too much of a shock. You’re going to be pretty busy for four years anyways and a futon on the floor of some ratty place with thirty-year-old shag carpets and furniture that makes it look like the set of a pornographic movie will probably be enough and all you’ll really need.
But you do have to live and, as it is almost impossible for most medical students to work while in medical school, things are going to be tight. What do you need to live? Again, it depends where you live. I imagine that housing is a little more expensive in New York City that it is in Bossier City, one of the suburbs of Shreveport. Crossing the Red River to get to Shreveport as it involves a barely noticable interstate bridge is also a good deal easier than crossing the Hudson River to get to New York.
You need to think about these things when you select a medical school. I wouldn’t insult the aspirations and dreams of thousands of pre-meds and their prestige-hungry parents by stating that price is the most important factor but it is top three. However, at the risk of drawing their ire, if you know perfectly well that you despise research and academic medicine and are almost completely sure that your goal is private practice, it probably makes no difference where you go to medical school as you can match into any specialty from any medical school provided you have the grades and the board scores. Not to mention that a Radiologist who went to medical school in Sistercouple, Arkansas and trained in Trailer City, Oklahoma probably makes the same as one who trained at Dartmouth.
There are no bad LCME accredited American medical schools. They are all good and you will get a quality education at any of them which, no matter where you go, also depends on how much effort you put into it. So you have to ask yourself whether the potential for a quarter-million in debt (on top of your undergraduate debt) for nothing but prestige and name recognition among a very small subset of people is is better than $80,000 dollars of debt at your state medical school.
Having a familiy will magnify the difficulties of selecting a medical school (assuming you have the luxury of more than one acceptance) especially if you are giving up a well-paying career. The bills will not go away and the cost of living needs to be considered carefully.
Practically, unless you go to an inexpensive medical school, can live without a salary for four years, and can pay for tuition and fees out-of-pocket, you are going to have to borrow money and lots of it. Fortunately (or unfortunately because the availibility of financial aid is one of the most important factors driving up the cost of education) the financial aid office at your medical school can arrange a combination of federal loans and the occasional scholarship or grant to almost exactly cover your cost of attendance.
Funny how that works out.
In a nutshell, your medical school’s finanacial aid office will calculate you cost of attendence which includes tuition, fees, and estimated living expenses and tailor an aid package, primarily of loans, to cover as much of it as they can. Almost nobody actually writes a check to their medical school and it’s easy to think of these loans as funny money. This would be a mistake because you will have to pay them back. They can, however, be deferred while you are a resident and you can consolidate them at a lower interest rate. There are some drawbacks to consolidation as you may lose your rights to deferment and forebearance but if you run the numbers, it will be a lot less expensive to service and pay your debt if you can consolidate at a low rate.
So that’s the choice you have to make, namely, whether a decade of your life, huge debt, and the opportunity cost of medical training are going to be offset by what you can make as a doctor. People are pretty good at gauging their willingness to incur debt but are unfamilar with the simple concept of opportunity cost. Opportunity cost is the price you pay for not doing something. Suppose you have a $60,000 per year job (or the potential to have one) which you give up to attend medical school. The real cost of your education is four years of lost income plus the money you pay for tuition and fees plus the difference between the salary you gave up and your pay as a resident.
Suppose you need to borrow $40,000 per year. Thats $160,000 in debt added to the $240,000 opportunity cost of medical school plus the $60,000 dollar opportunity cost of a three-year residency where you will make about forty thousand a year. That’s almost half a million bucks, not even considering the time value of money which is not working in your favor. if you match into pediatrics and make $90,000 per year, your net benefit from all of those long years will be $30,000 a year which, again ignoring the time value of money, puts your break-even point sometime in 2031. This explains perfectly why American medical school graduates eschew the lower-paying primary care specialties. They are fairly intelligent and can do the math.
Many pre-meds have degrees that, while rigourous, are not worth much except as a requirement for medical school and some people don’t incur nearly as much debt as others so your mileage is going to vary considerably. But as opportunity cost is a measure of what you could have done, not what you did, I think you can see how you still have to consider it.
Another thing to consider is that you can match into specialties that currently pay very well and, even if they require a few more years training, will obviously pull your break-even point closer. Working against you, however, is the disturbing trend of the electorate to insist on paying nothing for health care. While there is no such thing as a free lunch, the vast amounts of money needed to pay for free health care is not necessarily going to be paid to you. You need to know that in some Western democracies with socialized medicine, physicians make less than a typical American electrician. In Germany, for example, surgeons are pulling in the equivalent of sixty to seventy thousand dollars a year, on top of which they live in a high tax society which pays for cradle to grave socialism by punishing the productive sector of which they are a part. Now, it’s true that they didn’t incur the debt that you will and their opportunity cost was less but suppose you muddle through only to have the rules change on you five or ten years from now when the electorate, driven by the trailer-park and ghetto vote as it sometimes is, finally takes leave of its senses and leaves you holding the bag?
That’s going to smart a little, no doubt.
And then their is the question of malpractice. I’m not one to be an alarmist but in this case, medical malpractice is a very real crisis and is sucking the life out of medicine. Under the onslaught of completely unethical plaintiff’s attorny’s it is possible to be successfully sued even if you did nothing wrong. Remember, the case is not decided by a jury of your peers unless your peers are people who can take two weeks off from their job and look at living at the the local Motel Six and eating off of meal vouchers for that time as a little slice of hog heaven. The days are also coming to a close when your malpractice carrier, win or lose, would protect you. Even they are forced to stipulate caps to their liability and the lawyer is now going to come looking for your assets. Because medicine is a high risk profession that deals primarily with an unhealthy and irresponsible public, the simple act of plying your trade will routinely place your home, your livelihood, and your savings in jeapordy. Think about how you’ll feel having your wages garnished to pay the widow of a crack dealer on whose discharge instructions you forgot to write, “Follow up in the Emergency Department if your chest pain returns.”
Just a few things to consider.
66 thoughts on “Is it Worth It?”
I think about this everyday and it frequently crosses my mind that I should cut loose now.
I am glad that I am an ER doctor. I take pride in what I do and enjoy the challenge of practicing in an impossible environment. It is healthy for me to maintain that attitude in order to survive and provide for my family. But knowing what I know now if I could go back 25 years in time when I was niave there is probably NOT A SNOWBALLS CHANCE IN HELL……….
Working against you, however, is the disturbing trend of the electorate to insist on paying nothing for health care. While there is no such thing as a free lunch, the vast amounts of money needed to pay for free health care is not necessarily going to be paid to you. You need to know that in some Western democracies with socialized medicine, physicians make less than a typical American electrician. In Germany, for example, surgeons are pulling in the equivalent of sixty to seventy thousand dollars a year, on top of which they live in a high tax society which pays for cradle to grave socialism by punishing the productive sector of which they are a part. Now, itâ€™s true that they didnâ€™t incur the debt that you will and their opportunity cost was less but suppose you muddle through only to have the rules change on you five or ten years from now when the electorate, driven by the trailer-park and ghetto vote as it sometimes is, finally takes leave of its senses and leaves you holding the bag?
PB — Can you come to my health care systems class and educate the idiots in my class who deride me for saying that we can’t just give drugs and services away for free? Given the track this country is headed on, I fully expect to be making 60K per year (or the inflation adjusted equivalent) by the time my career is over. Thank god my husband’s job pays well.
PB, you beat me to it. I was planning a similar style entry today in honor of the just passed May 15 deadline for narrowing the options down to one school for applicants. Great post as usual. I just hope I can get through residency and get a few essential items paid for before salaries completely tank.
D@mn, Bear. Like a punch in the stomach – no fun. You know, I had a chat with a Crital Care doc a few weeks ago, and he truly believes that there is going to be a serious shortage of med school applicants. Or how he put it, the “last one in the room will turn off the lights.” The more truth comes out about the negatives about this field – through sources like your blog – it is going to be interesting to see what kind of effect this has on the applicant pool.
I just hope after it all goes to shit I can still afford the property taxes in Trailer City.
JPH: I think the physician you spoke with is incorrect in his thinking. The number of applicants to medical school has been rising over the past few years. Every time the economy starts to slow, anxious college students begin looking for other ways to make money. See the trends here: http://halfmd.files.wordpress.com/2007/03/apps-vs-matrics.gif
As an MS0, I’ve been thinking about whether it’s worth it since… well, forever.
And fuck if I know if it is.
Oh, well, I guess my wife had better keep her job. :-/
“Iâ€™m sure you will meet some zealots who seemingly breathe, eat, and live medicine”
I swear I thought you were going to say “willing to eat a poop hot dog to get into medical school.” Haha.
btw, this thread has your name all over it:
I assure you folks, however, that I like Emergency Medicine and while maybe I’m not exactly champing at the bit to go in for my shifts, once I get going it is very interesting and rewarding work, sometimes both.
I can’t wait to fuck up my life by becoming a doctor!
“Think about how youâ€™ll feel having your wages garnished to pay the widow of a crack dealer on whose discharge instructions you forgot to write, ‘Follow up in the Emergency Department if your chest pain returns.'”
Maybe the most sobering thing I’ve read on entering medicine. Woah.
And yet I know of a malpractice suit that was lost for the sake of a clerical error even more trivial than that.
As an MS1, this is probably the scariest thing I have read to date. Panda, did I make a huge mistake?
The thing that sucks is that medicine is like crack, once you get your first taste it’s really really hard to get out (for a wide variety of reasons).
I’ve been out of residency 12 years and love love love medicine, especially since the advent of Google. So take heart- I guarantee you will be so much happier when you never have to deal with the interior of a hospital…if you like people, you will love medicine once you survive the trauma that is residency.
Of course I say this because I work half-time in urgent medicine and have for years…whenever I work full-time I start to feel creaky and crusted over. So keep all your other talents and wits sharp, make money in other ways if you can, to get rid of the loan.
Learn to cook quickly, cheaply, and well. Shop at goodwill. Drive cars with salvage titles. Buy a fixer house and sand windowsills on the weekends. Take in short-term exchange students from cool countries like Japan. Maintain a massage table and chair if possible. You think I am kidding, but I am NOT.
Noone told anyone the best-kept secret in medicine- 30 hours a week is what most people thrive on. Beyond that, it’s diminshing returns on your personhood.
old Md girl: Although I’m less a fan of a completely private medical system than some, I will say that it astounds me how so many people seem to not understand that NOTHING is free. Aspirin isn’t free, xrays aren’t free, ct scans aren’t free, and NOBODY’s time is free. There is a financial and opportunity cost for everything in life. So, people don’t seem to understand that having a national healthcare system of any kind won’t actually be cheaper for most people (given government administrative costs, which are usually (?Always) higher than private admin costs, especially), it will actually be more expensive for the vast majority of people.
Anyway, I digressed. I wanted to say that medicine is worth it ONLY if you really love it. If you can talk yourself into doing something else, then do that. I love love love obstetrics. And I’m a subspecialist, so my compensation will be better than some (although I’m certainly paying my price for that now). But if you don’t like obstetrics or family medicine, or whatever specialty, it’s likely that you will not be compensated enough to make you glad to be doing something you don’t like. And life’s too short to spend so much time working in something you don’t enjoy.
Mike, you did not make a mistake. I just want you to have your eyes open is all.
Interesting read Panda.
I think it’s funny because this, and many other nuisances that accompany medicine, are the reason I decided not to hit submit on my completed AMCAS application for this year. Instead, I’m choosing to continue working, and in a few years apply to business school. For some reason, my parents, who happen to be rose-colored glasses wearing immigrants, believe I’ve failed them, even to the point that my father has all but disowned me. He believes from the start it was a mistake I majored in Economics and Finance in college, but I now know it’s what has saved my life.
It’s always nice to read your blog, miami med and other who understand that medicine is more than just prestige and title. I love medicine, but I see in it apparent flaws that one cares to correct or even address. In a perfect world, we would all be doctors, but the world is not perfect and I’ve accepted that.
Like I tell anyone who ask me why I no longer chose to apply to medical school; “I ventured to learn more about the economy, and instead became a cynic.”
I’m planning to start a blog, and I can honestly say, you and Miami Med are my truly my inspiration.
Thank You…and look out for questions from me as I try to iron out the nuances of blogging.
I started the pre-med journey as an 18 year old, convinced that I wanted to go into medicine. Did I have any conception of what I was getting my self into…definitely not. My mom told me for years that I shouldn’t go into medicine, but when was that last time that a 20 year old college student listened to his mother’s wisdom? It’s tough when you’re a pre-med to look beyond the pages of your orgo text book and to imagine what you’re life is going to be 3 or 10 years from that point. You want it to be the land of sunshine and puppy dogs because all you have to go off of is TV, anecdotal evidence from friends/acquaintences and a few meager hours of following a resident around.
As an MS1, I’ve become increasingly jaded with my classmates, my education and medicine in general. And now that I’m in it for the long haul, it’s sobering to realize how naive I was just a few short years ago. I wish I had read your blog before I was so heavily invested in the process.
I’m enrolling in the fall, and I’m not going to parade premed idealism in the face of your experience, which is certainly sobering.
The fundamental dilemma you present, staggering debt in the face of declining income, affects all students in higher education, not just those going into the medical profession.
30 years ago, and I know because this is exactly what my father and many others of his generation did, could finish high school and step into a well-paying factory or civil service job and make enough money to own a house and support a family. Nowadays, even if you’re a recent college graduate, good luck finding a job and a cheap apartment, let alone owning a house or having enough money to support a family.
Lets say, however, I heed Panda’s warning, and go into a more practical field like business, and I had chosen a more practical major, like finance. Even if I land a job, there is no guarantee that after 7 years (the equivalent of med school and residency) I will rise up the corporate ladder and be in a position to own a home and start a family.
One might object, however, and say that anyone with the potential to get into med school has the merit to rise up the ladder in the business world and achieve similar success. The problem is, however, the the business world operates on a different set of rules that do not necessarily reward intellect in the management chain. Ask any IT guy who takes orders from a moron who makes more money than him and you’ll get the point.
A career in medicine, however, EVEN with the tremendous opportunity cost involved is a more secure route to “living comfortably” for someone with a strong intellect who might not have the necessary attributes to succeed in the business world, that being, a near complete lack of ethics, good looks, and a penchant for backstabbing.
I know a lot of doctors complain about declining income, more work, and less autonomy, but I think this has less to do with the fact that doctors have been taking it in the rear more than most other segments of society, and more to do with the hard fact that American society is simply in a state of decline.
There are more people competing for fewer resources than ever before, so they’re willing to put more on the line for fewer rewards. Some things they put on the line, they delay mating (one of our most basic and strongest biological instincts), give up their financial freedoms by incurring more and more debt, and work longer, harder hours for less pay.
A MS1 heavily invested?
It’s not too late. You have three more years of medical school and god knows how much residency. Then the rest of your working life in the profession. You are only one year in – you can leave if you want – remember that.
Whoa, you all have got to simmer down. I didn’t say it was a bad career, just that you need to pick your specialty or your business plan wisely.
For the record I like Emergency Medicine. Maybe you will like pediatrics, internal medicine, cardiology, or even Family Practice. Just go into it with your eyes open and don’t expect things to ever get easy because they will never be as easy and as laid-back as your first two years of medical school, or, as I like to call them, the “cool years.”
It’s a great career if you can avoid doing a lot of pap smears. ER is fascinating but a little hot, you need to be a dispassionate sort who stays super cool in the face of everything while tolerating all sorts of crazy frustration. Burn-out is high.
I recommend Urgent Medicine. It used to be the purview of the people who couldn’t find jobs elsewhere; with the current climate, you have to be sharp to survive in it, because all sorts of deathly ill people are showing up there, most of them in denial, even more denial than the ones that go to ED.
If you work at a rural urgent care you get to see same fascinating craziness as ED, nailgun oops, went off in my eye; I’m getting ready to deliver these twins- whaddya mean my pregnancy test is negative, well I’ll show you when my babies are born..; i feel really bloated, whaddya mean I’m 6 months pregnant;
my guts keep moving around, whaddya mean I’m seven months pregnant; my leg is killing me, I’ve been too busy to come to the Dr because my wife is starting chemo…really?…i need to be admitted right now?…I have clotted off my leg?…what does that mean?; Guys at work keep getting headaches when they use that gas-powered thing to move stuff around, i’ve been vomitting all day; Dr, why do I itch and smell? Does it have to do with the fact that my last partner was, um, sorta big?;
listen guys, medicine is a riot, just keep a good distance from the flame and you will do fine. Bond with good attendings, it helps. I doubt I would have made it if the ortho attending hadn’t said to me- “this too will pass” after the gay borderline personality OB
attending screamed at me and asked me if I was on drugs because I didn’t know how to write post-op C/S orders…
Here’s to de-lurking. Cheers!
It’s always refreshing to see this kind of approach to planning any career. Personally, it was right after college that I started really deciding on medicine as a career. Being a chemistry major, I got to hang around with more than a few pre-med folks who flew right over the Fanatic line with a pair of rocket skates. So it was a little bit difficult to think “that’d be a pretty cool job” when the required standard attitude seemed to be miles beyond that.
Anyway, yet again another good blog Panda, and I’m always happy to read more.
P.S. – While I’m typing this though, might I bug you with a tiny question? Know any good spots to live in Shreveport, just off the top of your head?
Snarkie, Funny you should mention “the IT guy”. I AM that IT person and many of those reasons you talk about are exactly why I’m now pursuing a career in medicine.
Years ago while in college I just knew I wanted to be a doctor. I majored Biology and did quite well, but somewhere along my last year I met several med students who talked me out of it. Basically, same arguments Panda presented. “Computer stuff” was my hobby and I figured I’d make that my career instead. Finished up my biology degree, took a few years off school, and then returned to get my MBA.
Here I am, and IT is sucking the life out of me. I don’t mind being on-call, I don’t mind the high pressure situations, and I don’t even mind dealing with users. But what does bother me is the fact that there’s no promotion path. There’s no way to get ahead except to schmooze the big boss and somehow convince someone you know something. IT certs are meaningless and not a good measure of knowledge or ability anyway. There’s no college degree to “prove” you know what you’re doing. The best you can do is do computer science (but that’s in the engineering school) or MIS, which is in the business school. IT has no home, except in some community colleges who teach it as a trade. Essentially, any joe schmoe can walk in and do the job.
So now I realize that medical school is really where I belong. It took me years to figure out that I had it right all along, but hindsight is always 20/20. And now that I have a family, things are more complicated than ever.
In the end, I’m looking for a career that requires real training, a career that has a formal licensing process. I realize medicine is not the panacea that some make it out to be, but having spent time on the “other side” I realize I want to be there regardless. I’ve thought about other professions (pharmacist, PA, RN, dentistry, etc) and none excite me like human medicine. So with it’s ups and downs, I still want to be a part of it.
Thanks for the hat tip. You’re post, as always, is sobering. I often question whether I am making the right decision. Part of me is an idealist that thinks that the only way the system can be fixed is if good people are willing to go into it and try to change things or else medicine will become like politics – void of any real substance and capacity to be self-critical.
Yet, I read the SDN forums and see the posts by the uninformed/misguided pre-meds defending the dismal trend towards lower wages for physicians. Sadly, they don’t realize that having such low incentives for people to enter such a skilled profession will result in worse healthcare.
If you think that only folks in business are backstabbers, you are sorely mistaken. There are plenty of egocentrical bullies in medicine that will kill your career at the drop of a pin, without a second thought. This is partly what makes residency so difficult. When I worked in Corporate America, my bosses were paragons of virtue in comparison to many of the attendings I’ve worked with.
Why? Because, business hates losing talent to the competition. No such problem in residency.
OK, it’s time, Panda, please write a thoughtful post about the
When do you graduate?
And Snarkie, Mike is very right. Keep notes while doing your rotations with problem people. Don’t talk much. Write a lot and look like you’re looking up things a lot. They will tolerate you. Whatever you do, call for help and backup if you even have a whiff something is beyond your comfort zone. Anything goes wrong, you will be blamed…
I’ll never forget my first hospital rotation-ER.
Second year student. , someone comes in post-MVA. ER Dr, 3rd year resident, and myself evaluate the patient. I am called in, weeks later. Did you know you missed a wrist fracture? Patient says she told you her wrist hurt. How come you didn’t order an x-ray?
It all seems rather surreal now.
This probably doesn’t go on other places, it was a new school, new training program, had recruited a lot of born-agains who didn’t like my hair, or my bicycle, or the fact that I wasn’t racist and didn’t appreciate stories about adam and eve from the peds attending in clinic hours…..luckily, the Jewish surgeon on staff had my back.
Residency training programs are ripe for a very, very, big lawsuit for tolerating the assholes in their midst. Thankfully most people get out unscathed.
Mike is exactly right. In residency, you can be severly damaged professionally if you don’t do exactly what you are told in exactly the manner you are told at exactly the time you are told. Some attendings are petty dictators, the difference between them and the rest of the working world, as it is extremely difficult to quit and find a new residency position, is that they have you completely by the gonads.
The other difference is that your boss can only fire you, an irate attending can, in some circumstances, destroy your career completely, for example if you want a fellowship.
My advice is simple: pick lifestyle. They can (and will) screw you out of money, they can (and will) decrease your autonomy, they can (and will) expose you to law suits. But you know, I can tolerate damn near anything for 40 hours a week with minimal call and that’s why I busted my ass to break 250 on Step I and will be coasting into a 8-4 residency. Screw you Medicare, you can drop my salary to 100k if you want but I’ll still own you on hourly wage. The exodus of the most talented physicians to lifestyle specialty will continue unabated and the American populace will get exactly what they want: the driven, brilliant people who destroyed medical school as the dermatologist writing their rx for benzoyl peroxide while some bum who couldn’t even get a colorectal fellowship does their cardiothoracic surgery.
Mike and PB,
The difference, however, between the business world and residency is that there is a light at the end of the tunnel.
Even if you have to put up with a nightmare attending who makes you do everything he says you only have to put up with it for so long. At the end you can leave and be reasonable assured of good pay wherever you choose to work.
In the business world you can encounter the same exact scenario, only you’ve got much less job security and there is no guaranteed 6 figure income after 3 years of bullshit from a misanthropic attending.
That’s my point, and given a choice between the two, I choose the former.
Not exactly. After five years working for somebody else I went into business for myself as an engineer, something you can do in almost any profession. As for job security, I had just as much job security as anybody else in engineering, that is, except for a month or two that working for a big firm buys you none at all. That’s the price of freedom.
But at least when I billed 60 bucks an hour for engineering work, I got it all, not the 25-or-so you get as an employee. As engineering consulting is a relatively low-overhead business, it’s not hard to make, in a good year, what a low-end doctor makes.
I think Panda (an other bloggers such as Hybrid Vigor) are doing a great service to the pre-med community. Reality, like oxygen at 8000m, is hard to come by in the pre-med world. This is not just because of the lack of honest insight, but also due to the oddly euphoric condition that sets in with many pre-med students (I also suffered from it). I was so enthusiastic I found I could counter ANY reality based advice I received with my endless repository of happy thoughts. Now I see the world of med school as it really is. Those destined for medicine will submit that AMCAS regardless. I see advice such as this a valuable test for what I call “mental momentum”. You need it entering med school to get through the onslaught of sucker punches you will receive. Those deterred by the “realistic and sometimes negative” advice they get during their pre-med journey are doing the right thing by not submitting the AMCAS. Applying to med school despite this advice means you must have the much needed idealistic intent and hypomanic belief that you can do anything. This is what will get you through the first few years of medical school when you realize you can’t, but keep going anyway.
I can appreciate this post for bringing the cold hard truth to the starry-eyed pre-meds. You know, the ones who want to go into medicine for the prestige and money but really don’t like blood and guts.
As a non-trad switching from an almost 6-figure salary (darn self-employment tax!), I can tell you that I’d be thrilled to give up my job now for medical school and debt knowing that I finally found something I LOVE that will be more than putting food on the table. My career now leaves me so unfulfilled and I am starting to *hate* getting up in the morning for work.
Medicine is not all glitz and glam and can be very ugly at times. However, it’s a dream job in many many ways for people like me who have that passion. And don’t mind blood and guts.
Very well put ScutMonkey. I really believe that if you go into medical school with your eyes open and with a good sense of what your priorities and boundaries are, you will be much better off. Some of the most disillusioned people I interact with are the classmates and residents who came in thinking medical school would be a happy time full of fluffy white clouds and baskets of kittens. They have really had it handed to them on a platter as they have gotten the reality check during third year.
The job security you mention is an illusion. Check out the Semmelweis Society to see how easy it is to destroy a physician’s career simply by using available machinery through licensing boards or hospital committees.
What might otherwise be simple business disputes often get escalated way above by the same bastards that make your life hell as a resident.
Unlike business, where PB and I can walk across to the competition, once you have been smeared by one of the bastards in medicine, no one will touch you. That means no license, no hospital privileges, no income and most importantly, no job security.
Interesting post, however I felt compelled to respond
I didn’t say it wasn’t worth it, just that it might not be worth it based on economics.
#1 Dino: I’m not putting down the passion necessary for medicine. Satisfying my internal economy by treating patients is one thing. Being adequately rewarded financially is something completely different.
studying medicine was not worth it. however, what is beyond is so worth it. studying surgery i found brutal to the extreme and on a personal level not worth is. but if i was put at the beginning of the whole journey knowing everything i know now, there is nothing career wise i’d do differently. it is so very worth it.
Good God, what a discouraging and disheartening post. I tend to idealize doctors, and it hurts me to the core to hear such negativity and sarcasm about what I consider one of the most noble professions in the world. (And yes, yes, before you say it–I’ll say it—it is my own emotional problem if my stupid bubbles get busted by someone’s honesty.)
But geez, I must admit that this is what I got out of your posting:
1. You’re upset about the money issue. But didn’t you know all this before you went into medicine?
2. And I’m sorry, but I think you’re assuming a lot. Not everybody thinks like you tell them they think.
3. Many people are perfectly willing to “sacrifice” for a career or an expensive high-falutin’ medical school. Big deal. They know what they’re getting into. Is there some sort of “stigma” that I’m not aware of among doctors about which school they went to and how much they paid for it?
4. Yes, malpractice suits are a risk. But even nurses can be sued for following a doctor’s order. Everybody knows that malpractice is the lurking monster of the medical world. And everybody knows that you can get sued successfully even if you did nothing wrong.
You are such a mercurial person—sometimes extremely fascinatingly witty, astute, and funny—and sometimes extremely negative in an ugly sarcastic way. You’re very intelligent and interesting, but I bet working with you would make me nervous….
(Heh! I just realized I’m in one of my armchair analytical moods tonight. But don’t worry–my advice is as worthless as it is free….)
You are overthinking my article. I was merely commenting on the opportunity cost of a medical career versus the potential income. I am in a specialty that pays very well (for the time being). I thought I was clear about this.
As for getting sued, sorry BRN, a lawyer is not going to come after your assets because typically (typically dammit), nurses are fairly blue-collar and don’t have that much to go after. Also, juries being what they are, nurses are also almost untouchable and very few lawyers will bother working on an unwinnable case.
On another note, why do I have to be funny and positive in every article? The subject sometimes sets the tone.
BRN, most premeds are completely clueless about the present realities of practicing clinical medicine. All they hear from friends and family that this is a certain path to a secure financial future. They also do not know how hard the road is and how difficult it is to walk away once one has invested time and money for the first couple of years of training. It is no wonder that many are bitterly disappointed with their lot.
PB does a public service by providing this information to premed.s
I am a fanatic and 32 years from medical school graduation. I hope that you are missing the point.
As I reflect on my years in medicine, what I see is the pleasure of helping patients. I love medicine emotionally and intellectually. I have made (and continue to make) a decent living, but the real reward is looking at yourself in the mirror, knowing that your goal is helping people.
I hope that once you finish your residency, you will rekindle your love for mediicne (or perhaps kindle it the first time). Perhaps you chose the wrong specialty or the wrong residency. I see residents all the time who really love medicine.
Your feelings suggest that your attendings do not understand. I will plan to post on this subject this week sometime. In the meantime, I highly recommend the #1 Dinosaur’s post.
What is the actual RECORD for number of comments on a post! I wonder…. The previous comment by “db” highlights something important. What is our training doing to us and what does this mean as we lead medicine into the future?
My article on Osteopathic Medicine got 84 comments which is the record. The one on CAM got about sixty.
Love is such an over-used word. I love my wife. I love my kids. I love my dog Persephone but other than that, I just don’t know. Institutionally I love the Marine Corps like all good Marines although I love it a lot more now than I did when I was actually serving. But “love” medicine? It’s just a job. I like it (minus the BS of residency training of course) but I’m not exactly champing at the bit to go in every day and I am thrilled to leave when I’m done.
It’s not a bad job, there’s just so damned much of it.
Short answer: No.
Long answer: depends. You will be making less than doctors are now, you will be making far less per procedure/intervention than now. You will have to rely on physician extenders (PAs, RNs) to see enough patients to pay the bills. Government control of the health care budget, now about 45% of total spending, will increase, particularly as commercial payers peg their reimbursement to Medicare rates. Medicare rates for reimbursement (based on RBRVUs) will drop 5% per year, according to some estimates.
Malpractice lawsuits will continue to take a bigger chunk of your income.
Patients will expect perfection, instant relief, and no risk, since this is what they are told to expect from their doctors.
Medical students, in general, have absolutely no idea of the logistics of medicine, and this is why medicine is still desirable at the premed level. My advice: take a basic economics course, and/or read as much as you can. Understand that you will have two mortgages for life: your house, and your student debt. If you don’t mind that scenario, go to it. It’s still a good gig!
Talking about IT field, I think nowadays you need to attend a graduate school if you really want to pursue a career in IT. I know quite some guys who got their Ph.D. in computer science. If they decide to go to industry, a base salary of 120k-140k is almost guaranteed if they came from a decent graduate program. That’s like 5-6 years without any further training. But of course, you gotta love all the research in the graduate school to “survive” it.
Panda, I enjoy the creativity in your writing, and I appreciate the fact that you often are blogging on little sleep and can’t avoid making spelling and grammar errors. But you consistently misspell “paid” as “payed” in post after post. Can you please try to break this habit?
You forget to mention that no one – NO ONE – really knows what they heck they signed up for when they started medical school.
And, in addition to the decade of training, huge debt, etc, there is also the years of life shaved off from an incredibly large sleep debt, horrible eating habits that rival Kobayashi’s barely human inhalation of junk, and undue stress from nasty attendings. There’s the loss of balance and our previously interesting well-roundedness as we are expected to sacrifice all for the training. And there’s the shrinkage of social networks starting from 3rd year of medical school, and the inability for many normal people to stand the stress of a one-sided relationship.
Most days, it’s a good job. But it’s a da#@ long road paved with enough days that suck.
Know yourself. Know why you want it, and what you’re willing to sacrifice for it. And most of all, make sure you start out as a happy person, because the decade of training will try to beat it out of you.
see it’s very define,your one of a kin. Piet Nirvana.
that’s why it will never wor. Gautam Asaf.
The part about the trailer park and the ghetto vote was the best.
I am writing a paper on this exact topic and i was wondering if you can point me in the direction of any links to the more academic sources where you gathered this information, or just might more thoroughly cover, the economic costs and benefits of a medical education. it would be a huge help. thanks.
This was just the post I needed to read today. I have just recently made the decision to not apply to med school and this posing only confirmed my decision. I am currently an attorney, and while going back to school to get a Masters in Health Administration, I got the fever to go to medical school. I maintained that fervor while working on all the required premed courses (Bio, Orgo, Chem, and Physics) at the same time I was working on the Masters degree. However, for financial reasons I went back to work for a health law firm while preparing to take the MCAT. My firm represents health care providers and hospitals mostly. My work has been a lot of research into the regulatory side as well as drafting employment agreements, etc.
My work experience has made me increasingly pessimistic about the future of health care in the U.S. as well as the work environment I would encounter when I finally finished medical school and the residency in about 10 years. I constantly see every rule and regulation passed as chipping away at both physician autonomy and reimbursement. Given the current call for health care reform and the plans put forth, I can only see the work environment for physicians getting worse with the government as payor, and a flat out disaster if they become the only payor in a universal coverage system.
All things being equal, I know the sacrifice of time, lost income, etc. would be worth it if my only consideration was job satisfaction and enjoyment of my daily workâ€”I would love the work itself. However, when I factor in the diminishing returns in reimbursement and increased regulatory restrictions or straight-jacketing of doctors I foresee, the 8-10 year sacrifice does not seem worth it. I believe I would love the work when I was done with medical school and the residency process, but I do not think I could stand the work environment, as it will exist in another decade.
Wow… I’m about to make my final decision about starting medical school in the Fall and I wonder if I should do it.
What is a better alternative?
I am a high school senior I want to become a MD but i i am worried about the future of health care in the US because of the big goverment movement and the bailout of banks i feel our whole economy will fail including the schools and hospitals
Wow. Give me a break. The AMA has controlled output for decades.. keeping physician salaries high. On top of that, the slipshod treatment patients experience is shocking… shocking that more cases CANNOT be taken on.
Keep in mind when an attorney takes a case he/she fronts the money for discovery. This is anywhere between $200,000 – $500,000. If the case isn’t worth it, the plaintiff attorney loses the investment. Our civil justice system is the ultimate capitalist venture. You cannot cry about socialized medicine when you want to socialize the law just so you can avoid the quality control procedures every other field has. I know they pump you up in medical school but get in tuned with reality.
Yea I really wanted to go to medical school and I certainly have the grades for it until I worked for a few MDs and found out all the nonsense involved. Now I’ve jumped ship and applied to dental school where the predator that is the insurance companies have not taken over.
Better alternative? Dental school. 4 years and you are out making money, most work 4-day work weeks, no call, no emergencies.
RE: What is a better alternative?
How about a DrPH? That’s the degree I’m considering vs. MD. I estimate it’s 1/2 the tuition, time, and offers a better quality of life in the field of healthcare.
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