What is working as a hospital MD really like?

[jmills]

Hi

I am interested in vet. med, but am also considering human medicine. I am a sophmore in high school, and my mom is a nurse. She is a nursing home nurse, so you can imagine that her point of view isn't very optimistic. She is extremely opposed to me going into human medicine, to the point that when she suggested that I ask a pharmacist friend of mine, she was disappointed when he answered "Yes", that medicine would be a good choice because of my intelligence. She says that most (not all) of MDs are mostly in it for the money, despite that I can think if numerous examples of very dedicated and kind doctors that we know.

1.) Is this true based on your observations?

2.) I don't know if I would want to run a private practice, what benefits/downsides are there to hospital work.
Does working in a hospital "get me out" of having to deal with insurance paperwork and things like that.

3.) How will the recent changes in healthcare law affect the practice human medicine (Please don't make this subject a heated debate...). There are lots of rumours running around the internet, which ones are true, which ones are not?

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[mcloaf]

1. No, not in my experience. The money is a big plus, however, considering the debt most of us have to take on and the decade spent in training.
2. I don't have much insight in this area, but working for a big group/institution will probably lighten up the time you'd have to spend on stuff like this, dealing with malpractice insurance, etc., but you'll never be able to totally avoid it.
3. Nobody knows. Reimbursements in some areas are already falling, but no one can really say what's going to happen in the future.

I think it's sad that your mom doesn't support you doing whatever interests you, it sounds like she has had her own problems with physicians and is taking it out indirectly on you. I'd suggest doing more investigation on your own and trying not to involve your mom too much for the time being. If you're in high school you still have a lot of time to figure out which direction you want to go, so don't stress about it too much now. Try some shadowing if you want to get a better idea of what someone might be doing in each field (this would also be a good chance to talk to each about the pros/cons of their professions).

 

[group_theory]

Hi

I am interested in vet. med, but am also considering human medicine. I am a sophmore in high school, and my mom is a nurse. She is a nursing home nurse, so you can imagine that her point of view isn't very optimistic. She is extremely opposed to me going into human medicine, to the point that when she suggested that I ask a pharmacist friend of mine, she was disappointed when he answered "Yes", that medicine would be a good choice because of my intelligence. She says that most (not all) of MDs are mostly in it for the money, despite that I can think if numerous examples of very dedicated and kind doctors that we know.

1.) Is this true based on your observations?

2.) I don't know if I would want to run a private practice, what benefits/downsides are there to hospital work.
Does working in a hospital "get me out" of having to deal with insurance paperwork and things like that.

3.) How will the recent changes in healthcare law affect the practice human medicine (Please don't make this subject a heated debate...). There are lots of rumours running around the internet, which ones are true, which ones are not?

Welcome to SDN. The good news is that you have at least 4+ years to decide what you want to pursue. While in high school, try to take as much rigorous courses available to you (competitive and highly competitive colleges look at these things), and do well in these courses. And even if you start college undecided on whether you want to pursue veterinary medicine or human medicine, most of the required courses overlap so you have a few more years to decide. Some vet schools will require biochemistry and/or calculus, but some med schools will require those as well.

As to your questions

1. MDs are only in it for the money. Yes and No. If you're only in it for the money, the hours of studying in college and med school, the student loan debt burden, the long hours and lost weekends while in residency, and seeing your friends in their 20s starting to make more money (and getting married, buying a house, having kids) while you're still "in training" requires a certain amount of desire and dedication to the field. Money is a nice reward (because no one would put up with this process if it didn't have a nice reward at the end).

While money may not be a sole consideration, it is something to consider.
The median Vet salary is $84,460 (2012 data, BLS). Starting salary for a Vet is $45,575 (source: AVMA, NYTimes article). The average student loan debt for a 2013 vet graduate was $162,113 (source: AVMA)
http://www.nytimes.com/2013/02/24/b...lling-demand-trap-new-veterinarians.html?_r=0

2. This question has a very complicated answer - and it depends on who the doctor actually works for. Some are part of a group that works at/contracts with the hospital. The doctor actually works for the group (or is a partner/part-owner of the group). Some doctors are self-employed and have privileges to see patients (and write orders/do procedures) at the hospital. And some are directly employed by the hospital. The advantage of being self-employed - you decide on your schedule, which patients you want and don't want, which insurance companies you want to work with, and also which hospitals you want to work with. Disadvantage of being self-employed - loss of economic of scale, being responsible for the business (being human resources, making sure all permits/insurances/paperworks are in order, making sure account statements are accurate or hiring someone to make sure those are accurates), your income is not predictable but is based on what is left after what you bill, what you actually receive in payment, and expenses. The upside is that you can make a lot. The downside is that you can make little. Advantages of working in a hospital - fixed salary (plus bonuses). Economy of scale (negotiation with insurance companies, hospital lawyers/risk management, not having to worry about human resources, etc). Disadvantage - you're an employee, not your own boss. You can't fire people you don't like (have to go through process). Hospital have leverage over you (require you to do committee work, QA/QI, demand more call schedule, etc). Really depends on what you want, and what you don't want, and what you are willing to sacrifice to get what you want.

3. With the changing landscape, it's hard to answer this question. Right now a lot of smaller hospitals are trying to find a bigger partner to partner-up with due to the ACA and potential for reimbursement loss if they stay independent. If you read your local newspapers, you will see local health systems partnering up or creating new affiliation. Smaller group practices are finding it harder to stay independent because of increasing regulatory burden (and the potential for decrease reimbursement in the future) - so more group practices are being bought-out by hospital systems (thus becoming hospital employees). With laws and policies still written, and the new insurance requirement just implemented, it's too early to determine long term impact on physicians, health systems, and patients.

 

[da8s0859q]

Hi

I am interested in vet. med, but am also considering human medicine. I am a sophmore in high school, and my mom is a nurse. She is a nursing home nurse, so you can imagine that her point of view isn't very optimistic. She is extremely opposed to me going into human medicine, to the point that when she suggested that I ask a pharmacist friend of mine, she was disappointed when he answered "Yes", that medicine would be a good choice because of my intelligence. She says that most (not all) of MDs are mostly in it for the money, despite that I can think if numerous examples of very dedicated and kind doctors that we know.

1.) Is this true based on your observations?

2.) I don't know if I would want to run a private practice, what benefits/downsides are there to hospital work.
Does working in a hospital "get me out" of having to deal with insurance paperwork and things like that.

3.) How will the recent changes in healthcare law affect the practice human medicine (Please don't make this subject a heated debate...). There are lots of rumours running around the internet, which ones are true, which ones are not?

For perspective, I am an MD, an emergency medicine resident doc, in my first year after medical school. I was also never the stereotypically optimistic premed student, much less med student.

1. Yes and no. Money matters. May not be the primary reason, but would you submit yourself to a minimum of ~11 years or so of undergraduate education, medical school education and training, and residency training without any mention of a respected, financially secure future?

2. Not entirely. You still have to know something about coding and billing. That said, the farther away you are from administration or being in private practice, the less you have to deal with administrative headaches unless you're on a bunch of committees which task themselves with said administrative headaches.

3. No telling. Some people say that reimbursement is going to go up, especially for primary care, since so many of the newly insured weren't paying medical bills previously. Others talk about increased demand of services, something's got to give, we're doomed, etc. In the end, the more difficult -- or less secure -- the powers that be make medicine, the more they're going to drive people from the field.

(edit: beaten to it, but there you go!)

 

[sonofva]

The amount of paperwork and bureaucracy involved shouldn't necessarily dictate whether you work in the hospital or clinic. You should experience both and then decide from there. They are very different environments.