Would you do it over again

[RedLightPass]

Knowing what you know now, if given the option to go back all the way to undergrad, would you choose again to pursue medical school? And, if so, would you re-select neurology as your specialty?

If no, what would you have done instead?

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[typhoonegator]

I'm happy now, but I probably would have been just as happy as an engineer, and I would have spent much less time and money to get there.

 

[neurologist]

I'd say med school would still be about a 60/40 chance. There are probably 3 or 4 other careers I could/would/should have more seriously considered.

Neurology, absolutely not. Would have done path, maybe rads or possibly even ortho or other surgical subspecialty (I was an "older" med student - the surgical option would have been in play more had I gone to med skool right out of college).

 

[RedLightPass]

I'm happy now, but I probably would have been just as happy as an engineer, and I would have spent much less time and money to get there.

While I agree that you would have saved many years by becoming an engineer, it seems odd to argue that you would have spent less money doing so. I suppose technically you would have "spent less," but doesn't a doctor have greater lifetime earnings than an engineer? Even accounting for student loans and present value of money, you still have 30-40+ years of a much higher salary.

 

[RedLightPass]

Neurology, absolutely not.

Why such distaste for neurology? What makes neurology that much worse compared to the other specialties you listed?

 

[typhoonegator]

The yearly salary for an academic neurologist is not "much higher" than a well-trained engineer. I'll spend my whole life climbing out of a financial hole, and after spending thousands of dollars a month on loan repayment, my take-home is not much different. And then you have to add nights, and weekends, and constant grant submissions, and constant travel.

 

[neglect]

1. I have some engineer friends. Some are very successful, but even they have huge stresses: travel, bosses, utilization, incompetent underlings, and <<< job security. One has directly mentioned that he wished he had gone to med school. Grass is always greener.

2. If you, Typhoonegator, don't like academic neurology - and I agree that there's not much to like - then you have options. I moved out into practice after meeting very bright people getting caught up in the bull**** (research that wasn't going to change anything, institutional mindsets, their 2 Nature-Neuroscience papers a year, second moonlighting job, and all the things you mention) and suffering for it. I'm heavily involved in trials, I can teach, and I've applied for grants (and after getting denied, thankful my day job isn't contingent on public assistance), and I have regular hours when not on call with one day off per week, which I usually waste by doing trial work - but I try to be better over the summer and really take it off. You are not a slave. You would be welcome at many hospitals looking to advance their neuro-care (essentially every hospital). Less bad, more good.

3. I'm happy with neurology because it was a perfect fit for my brain. Perhaps I could have found a happy home in a medical subspecialty, but first of all, I love pure neurology. My brain can't be bothered with all the flea-like details that make someone good at radiology, medicine, surgery. And I'm not money driven enough to do something that I don't really like. I'm conceptual, and neurology (when it really is neuro) is essentially a set of principles and a limited map - and from this, you place the patient's problems on the map. It is the practical extension of neuroscience. And it is only love that will make you good at anything - you can't get your brain to devote itself to the study of something it doesn't enjoy. As time goes on, I find myself maturing into liking other aspects of neurology: just taking a good history, getting to know patients, listening to their stories and troubles - which is universal for all doctors, even derm.

So I'm happy with my choice. But it isn't for everyone. And that's also why I believe that neurology will always attract excellent people. Neurology will select good fits.

 

[typhoonegator]

I already said I'm happy now, and I enjoy academia. But I could be doing a very similar job, also in academia, without having gone through the rigmarole of medical training to get to where I am. My research is funded, and I'm comfortable. But 85% of what I do is not medicine, it's science. And I could be doing that across the river at MIT without having gone through the MD part of my education, and without having incurred the debt associated with medical training.

 

[bustbones26]

1. I have some engineer friends. Some are very successful, but even they have huge stresses: travel, bosses, utilization, incompetent underlings, and <<< job security. One has directly mentioned that he wished he had gone to med school. Grass is always greener.

2. If you, Typhoonegator, don't like academic neurology - and I agree that there's not much to like - then you have options. I moved out into practice after meeting very bright people getting caught up in the bullcrap (research that wasn't going to change anything, institutional mindsets, their 2 Nature-Neuroscience papers a year, second moonlighting job, and all the things you mention) and suffering for it. I'm heavily involved in trials, I can teach, and I've applied for grants (and after getting denied, thankful my day job isn't contingent on public assistance), and I have regular hours when not on call with one day off per week, which I usually waste by doing trial work - but I try to be better over the summer and really take it off. You are not a slave. You would be welcome at many hospitals looking to advance their neuro-care (essentially every hospital). Less bad, more good.

3. I'm happy with neurology because it was a perfect fit for my brain. Perhaps I could have found a happy home in a medical subspecialty, but first of all, I love pure neurology. My brain can't be bothered with all the flea-like details that make someone good at radiology, medicine, surgery. And I'm not money driven enough to do something that I don't really like. I'm conceptual, and neurology (when it really is neuro) is essentially a set of principles and a limited map - and from this, you place the patient's problems on the map. It is the practical extension of neuroscience. And it is only love that will make you good at anything - you can't get your brain to devote itself to the study of something it doesn't enjoy. As time goes on, I find myself maturing into liking other aspects of neurology: just taking a good history, getting to know patients, listening to their stories and troubles - which is universal for all doctors, even derm.

So I'm happy with my choice. But it isn't for everyone. And that's also why I believe that neurology will always attract excellent people. Neurology will select good fits.

Former practicing engineer here, so I'll chime in.

1. The economy was much better back whenever I was an engineer. There is no doubt that in the time required for me to complete medical school and residency, I would have had a virtually all of my personal debts paid off and had a good jump start on my retirement savings.

2. Huge stresses? Bosses? Incompetent underlings? If you think that I never had to deal with those dilemmas in medicine, then you are wrong. Geeze, I was in the military, the only place in the world (other than perhaps rural/underserved medicine) where a PA-C is given all of the same rights and privileges as a board certified doctor, the surgeon general is an RN, and a hospital commander can be a helicopter pilot.

Yes, the economy runs engineering jobs. I had colleagues back in the day that took big positions with Exxon and BP, yeah, I bet a few got axed or laid off over the years. A couple of years ago, Pfizer laid off a number of R&D scientists. My former company was a vinyl plastics manufacturer that sold their products to window, doors, decking companies. I.e. our success depended on how construction was doing, I'm sure the housing bust hurt.

Politics, economy, etc drive physician jobs too. I see doctors moving around frequently.

At the end of the day, there are nuances of this job. I often think, if Michael J. Fox went back to the year 2000 in his delorian and tried to talk me out of it, would I have listened? Have to admit, probably not. Unfortunately, medicine is one of those professions that you just cannot appreciate what it is like until you are already knee deep in it.

 

[neglect]

Medical science is much more painful than the other sciences. For a drug or device ot get to market, you have to have an idea, then mucho dinero to develop it. Compare that with google and facebook. Click publish to web, grab coffee.

Engineering is a great profession. I wish I'd given it more of a chance, but I knew nothing in high school. My engineering friends marvel at medicine's craft mentality - a very individual approach in which the doctor is the final word.

 

[fleshwound]

.

 

[Silent Cool]

The yearly salary for an academic neurologist is not "much higher" than a well-trained engineer. I'll spend my whole life climbing out of a financial hole, and after spending thousands of dollars a month on loan repayment, my take-home is not much different. And then you have to add nights, and weekends, and constant grant submissions, and constant travel.

Don't be an academic. Problem solved.

 

[typhoonegator]

Yeah, that makes sense. "Don't be who you are, be someone different. Problem solved."

 

[AlbinoHawk DO]

Yeah, that makes sense. "Don't be who you are, be someone different. Problem solved."

You understand that you come off as hating your job, right?

 

[fleshwound]

I likely see myself heading the same direction for better or worse. I recognized that Neuro is a good fit for me and my idealism will probably lead me into neuro research/academia where I'll seek intellectual solace whilst in a deep hole of debt. Alternatively I could say screw the idealism, sell out, and open a boutique headache clinic or better yet do a mindless procedure heavy specialty but I think a part of me would die inside from that decision to give up the intellectual pursuit. Can't change who we are.

 

[typhoonegator]

You understand that you come off as hating your job, right?

It's a thread about hypothetically doing it over again. The whole point of this thread is to discuss those issues. There are things I don't like about my job. Go and talk to some people whose careers depend on highly volatile NIH funding that requires a huge amount of their attention, and tell me how many of them love that aspect of their job. That's not to say that there aren't positives as well, but that's not what we're talking about here.

 

[Silent Cool]

Yeah, that makes sense. "Don't be who you are, be someone different. Problem solved."

It has nothing to do with not being who you are; it has everything to do with being practical. Everyone has to make concessions in life. You would still be practicing Neurology, but you and your family would have a better life if you were in PP instead of academia because you would have more money. It's not practical to be such a "purist" about everything. Life involves compromise, and that seems like a reasonable one.

 

[typhoonegator]

It has nothing to do with not being who you are; it has everything to do with being practical. Everyone has to make concessions in life. You would still be practicing Neurology, but you and your family would have a better life if you were in PP instead of academia because you would have more money. It's not practical to be such a "purist" about everything. Life involves compromise, and that seems like a reasonable one.

Yeah, but as I noted above, the whole point of this thread is to talk about the negative things that would have made us pursue a different career. That's what I've done here. If you look earlier in the thread, I clearly stated that I'm happy. That doesn't mean I'm 100% happy, for the reasons stated. But I'm doing what I'm best at, and even for less money and more aggravation, there is satisfaction that goes with that. Put it this way, I have friends who left our institution to take leadership positions in the NINDS and DoD. There are aspects of their new jobs that literally drive them crazy on a regular basis, and on top of that they took a pay cut for the "privilege". But in their value system it was a net positive move. If they came on here to this thread, they would talk about the stuff that they don't like, but it doesn't mean they don't derive self-worth from what they do, or that it would make sense for them to do something easier for more money.

I'm not here looking for sympathy. I'm a funded physician-scientist with a faculty position at a pretty darn good research institution in Boston. But if I could go back in time and design a path that maximizes what I love about my job and minimizes what I hate, it would not look the same as the the one I took. I think many of us would say the same thing.

 

[danielmd06]

Why such distaste for neurology? What makes neurology that much worse compared to the other specialties you listed?

Meh. I realize you weren't asking me but I'll chime in. I love neurology, but it certainly has some downsides. Neurology is hard to learn, and is hard to practice properly. At least in my opinion. Patients are often much more complicated and unstable in our specialty than what your colleagues in certain other specialties might see. Patients can have bad outcomes more commonly than in some other specialties even when you are doing everything correctly. Lawsuits for neuro-type cases rank amongst the top alongside OBGYN and oncology. The specialty requires a four year residency, and this training period is often quite difficult compared to what your colleagues in EM or IM experience. The specialty reimburses less than virtually every medical and surgical subspecialty with the exceptions of psychiatry, pediatrics, and internal medicine. To be blunt you can make more money (or nearly as much) as a neurologist as a nurse anesthetist with a fraction of the debt, training time, malpractice risk, and continuing education financial burden. Or you could just be a dentist and make more. The specialty has taken reimbursement hits, has seemingly weaker lobbyists than other specialties so our interests are often not heeded, and faces an unsympathetic array of politicians who aren't really concerned about doctors in general.

I am not trying to sound too cynical here, but these are reasonable points to bring up. There is no question that I could have made more money alot faster and easier doing something else.

But you know what? I love my job. I would do it again.

 

[Leo Aquarius]

Psychiatry is lower in the compensation reports only because we work on average 30 hours a week. If adjusted for a 45 to 50 hour income, psych would be higher than a handful of specilaties. Just fyi.

 

[Yoyomama88]

Its pretty clear from the number of hours worked that psych will easily have an avg salary similar to neuro with an increased workload.....However if you look at the top earners a few neuro are >500-600k. There isnt a single psych making > 500k. But then again, 26% of neurologists work greater than 50 hours a week....compared to 7 % psych from the survey. So I wonder if there were a greater number of psychs working heavy hours if we would see top earners similar to neuro? Maybe not, bc there are no procedures in psychiatry?

 

[anbuitachi]

Its pretty clear from the number of hours worked that psych will easily have an avg salary similar to neuro with an increased workload.....However if you look at the top earners a few neuro are >500-600k. There isnt a single psych making > 500k. But then again, 26% of neurologists work greater than 50 hours a week....compared to 7 % psych from the survey. So I wonder if there were a greater number of psychs working heavy hours if we would see top earners similar to neuro? Maybe not, bc there are no procedures in psychiatry?

One of the psychiatrists cleared 600k a couple yrs ago at one of the hospitals I rotated at... here it is...
http://www.foxnews.com/us/2011/10/02/ny-psychiatrist-reported-working-average-110-hours-per-week/

 

[Yoyomama88]

I dont know if that's enough money for 110 hrs a week. I bet neurosurgeons/ortho/urologists etc. make more than that by working 60-70 hrs a week.

 

[Leo Aquarius]

Not a single psych making over 500K you say? May I direct your attention to the business-savvy psychiatrists who run their own clinics in wealthy neighborhoods like Palo Alto, Menlo Park, Westwood, Pasadena, Manhattan, etc. who have been in the business a while and have full clinics, accepting credit cards, checks, and cash. Some psychiatrists work for the prison system and make over 500K - some of this information can be found on the Internet. And then there are those psychiatrists running clinical trials for big pharma who make over 500K, and this too can be found on the Internet.

You're right about a dearth of procedures in psychiatry though. However, the FDA recently approved TMS which may change that game a little.

 

[Silent Cool]

Not a single psych making over 500K you say? May I direct your attention to the business-savvy psychiatrists who run their own clinics in wealthy neighborhoods like Palo Alto, Menlo Park, Westwood, Pasadena, Manhattan, etc. who have been in the business a while and have full clinics, accepting credit cards, checks, and cash. Some psychiatrists work for the prison system and make over 500K - some of this information can be found on the Internet. And then there are those psychiatrists running clinical trials for big pharma who make over 500K, and this too can be found on the Internet.

You're right about a dearth of procedures in psychiatry though. However, the FDA recently approved TMS which may change that game a little.

Leo,
How typical is this? I'm guessing that setting up these boutique/concierge-style practices is difficult and atypical.

 

[typhoonegator]

A few of my favorite private cardiologists used to tirelessly perform inpatient pre-op consults on the surgical services at a well-known Boston hospital, and when their reimbursements for inpatient consults were slashed by Medicare, they just pulled out completely and opened a boutique fee-for-service practice. No insurance, no copays, no reimbursements. It was actually a great model for them, because they had built so much credibility and respect over the years in the community, and while plenty of their patients had to opt out, there were enough who were willing to bend over backwards to keep their physician that the transition went fairly smoothly for them. A gutsy move for a mid-career physician and certainly not without some significant start-up financial risk, but it's not like people in Boston aren't tripping over cardiologists on their way to the grocery store, so why shouldn't these guys have the option of seeking what the market will bear?

 

[danielmd06]

Not a single psych making over 500K you say? May I direct your attention to the business-savvy psychiatrists who run their own clinics in wealthy neighborhoods like Palo Alto, Menlo Park, Westwood, Pasadena, Manhattan, etc. who have been in the business a while and have full clinics, accepting credit cards, checks, and cash. Some psychiatrists work for the prison system and make over 500K - some of this information can be found on the Internet. And then there are those psychiatrists running clinical trials for big pharma who make over 500K, and this too can be found on the Internet.

You're right about a dearth of procedures in psychiatry though. However, the FDA recently approved TMS which may change that game a little.

There are exotic outliers making out like bandits in virtually every specialty, including family practice and, yes, neurology. So I stick to my original comments about income for psychiatrists. Sure, I admit I have no idea how much the average psychiatrist works. And I have no compunction about being corrected on this type of information. Whatever helps those who read these forums is great by my point of view. Also, the last time I closely scrutinized MGMA data and comparable sources was nearly three years ago.

 

[bustbones26]

Not a single psych making over 500K you say? May I direct your attention to the business-savvy psychiatrists who run their own clinics in wealthy neighborhoods like Palo Alto, Menlo Park, Westwood, Pasadena, Manhattan, etc. who have been in the business a while and have full clinics, accepting credit cards, checks, and cash. Some psychiatrists work for the prison system and make over 500K - some of this information can be found on the Internet. And then there are those psychiatrists running clinical trials for big pharma who make over 500K, and this too can be found on the Internet.

You're right about a dearth of procedures in psychiatry though. However, the FDA recently approved TMS which may change that game a little.

That is not an ideal patient population to work with. Whenever in residency we had one of these types give us a grand rounds lecture. He stated that one of his "famous" patients had two psychiatrists. Imaging the conflicts. I bet Dr. Murray was living up the high life too until he was accused of killing Michael Jackson. I cannot imagine the stress of one of those jobs. Not worth the 600K per year.

 

[neglect]

That is not an ideal patient population to work with. Whenever in residency we had one of these types give us a grand rounds lecture. He stated that one of his "famous" patients had two psychiatrists. Imaging the conflicts. I bet Dr. Murray was living up the high life too until he was accused of killing Michael Jackson. I cannot imagine the stress of one of those jobs. Not worth the 600K per year.

I concur. What is worse than an insane person? A rich insane person who pays you directly for care. This entails a very different relationship from a normal practice.

There are exotic outliers making out like bandits in virtually every specialty, including family practice and, yes, neurology. So I stick to my original comments about income for psychiatrists. Sure, I admit I have no idea how much the average psychiatrist works. And I have no compunction about being corrected on this type of information. Whatever helps those who read these forums is great by my point of view. Also, the last time I closely scrutinized MGMA data and comparable sources was nearly three years ago.

I tend to believe that psychiatry is emotionally exhausting. Patients with psychological illnesses can be quite ill, and their weight gets transferred easily. I can see many seizure disorders, stroke FU's, migraines (emotionally normal), dementia, PD patients without much emotional burden. But a single personality disorder can ruin you for several hours, especially if you get emotionally invested or even fail to recognize the fact that this is a personality disorder. I'm not a psychiatrist, and I'm not very empathetic, but hearing the multitude of complaints from mentally ill people would just make me feel terrible. So while I feel that I don't have enough experience to speak to this fully, I get the sense that psychiatry is difficult, which is why very few can tolerate >40 hours per week doing it without serious burnout and compassion fatigue.

 

[neurologist]

. . . I'm not very empathetic . . ."

Shame on you. Didn't you take the mandatory Empathy Class in med school?

. . . I get the sense that psychiatry is difficult, which is why very few can tolerate >40 hours per week doing it without serious burnout and compassion fatigue . . .

This is why as a med student I was very attracted to acute inpatient psychiatry and came very close to going into that field. Get 'em stable and and non-suicidal, set up on appropriate antidepressants/antipsychotics, some outpatient followup services, and d/c. However, the spectre of outpatient psych, with its endless parade of the chronically and incurably depressed and borderline with zero insight, was enough to steer me away from a career in psych. So intead I went in to neuro, with its own endless parade of the chronically depressed and borderline with zero insight plus somatiform disorders . . .

 

[neglect]

Shame on you. Didn't you take the mandatory Empathy Class in med school?



This is why as a med student I was very attracted to acute inpatient psychiatry and came very close to going into that field. Get 'em stable and and non-suicidal, set up on appropriate antidepressants/antipsychotics, some outpatient followup services, and d/c. However, the spectre of outpatient psych, with its endless parade of the chronically and incurably depressed and borderline with zero insight, was enough to steer me away from a career in psych. So intead I went in to neuro, with its own endless parade of the chronically depressed and borderline with zero insight plus somatiform disorders . . .

Ha ha. I probably should have failed my empathy boards, but that was before empathy was taught as a requirement and any deviation thought to represent a future problem physician. I had to get by on hard work, knowledge, love of neurology and science, smarts and wit.

As I said above, I still love the puzzle of neurology and I do like my patients plenty, despite the failed thought control and my med school thoughtcrimes. But I double down on what I said before: neurology doesn't require the emotional burden found in psych. I recently did an NPI/NPIc with a caregiver. What a horrible burden! Exhausting and boring. No lesion. No neuronal circuitry. No clean and elegant explanation. Just a seemingly endless list of complaints that have no good treatment: delusions, agitation, sleep disorder, lability, impulsivity. It was terrible. One hour of psych is at least 3 in neurology. Family meetings with palliative care don't even come close.

 

[Leo Aquarius]

To do psychiatry well is very difficult... I hear ya, and I'm a psych resident.

 

[neurologist]

No neuronal circuitry. No clean and elegant explanation.

I dunno, I have to disagree with that. To quote Kandel: "The brain is the organ of behavior." Psychiatric problems are aberrant behavior, and clearly "of the brain" and therefore ultimately "neurologic." It's just that we haven't really figured out the circuitry yet.
"Absence of evidence is not evidence of absence."

 

[neglect]

I dunno, I have to disagree with that. To quote Kandel: "The brain is the organ of behavior." Psychiatric problems are aberrant behavior, and clearly "of the brain" and therefore ultimately "neurologic." It's just that we haven't really figured out the circuitry yet.
"Absence of evidence is not evidence of absence."

The problems are referable to the brain full stop. Where is the lesion in agitated dementia and how many hours has Kandel spent with these patients? There is no solution, just long hours of phenomenology, which happens to be horrible, sad, detailed, boring, muddy, confusing, untreatable and difficult. Otherwise I agree with you. The brain causes the mind. Great. That doesn't help me in the middle of an NPI or trying to figure out how to zombify the horribly agitated patient properly. This process is not an elegant one, it is an ugly and coarse one.