A poll from an old timer -Why are young people still going into medicine?

I am new to this board and somewhat intrgued by the number of people still anxiously wondering if they will get into medical school. I have been a practicing Internist for nearly 20years. Had any of you spent some real time working with physicians currenlty in the field of Medicine, Pediatrics, ObGyn, and most of the other specialties, you would be aware of the overwhelming sense of disatisfaction prevalent among practitionres these days. Without cataloging all the issues that are making medical practice so difficult, I would like to hear from some of you to gauge your awareness of the issues and hear how this has affected your thinking.

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I look forward to your responses.

Are you aware of what's going on? What have you heard?

Click to expand...

Well, I've heard many grumblings from people in every section of the totem pole. But it is hard to guage the actual situation of what it's like in medicine by listening to people on a forum. I mean, most people that post here talking about their situation, are probably doing so because they are unsatisfied with it. I don't believe it is an accurate cross-section.

What are your expectations in regards to earnings?

Click to expand...

Well, my expectations are based on the published numbers. 150k-750k, lowest being primary care, then surgery, then anesthesiology and plastics. Perhaps not perfectly accurate, but close enough.

What are your expectations for quality of life?

Click to expand...

Pretty much the majority of my time being taken by medicine. After I finish residency, then perhaps it will be possible to balance life and work. I except a few rewarding experiences in a vast sea of BS and misery

What kind of medicine to you hope to practice?

Click to expand...

Emergency med, Anesth, Rad, something along those lines.

I'm still considering med school among other options, so my question to you is, what would you rather have done?

Thanks for your perspective, and we welcome your input.

macgyver22 said:

Are you aware of what's going on? What have you heard?

Click to expand...

That tuition and overall regulation is going up while reimbursements are going down.

macgyver22 said:

What are your expectations in regards to earnings?

What are your expectations for quality of life?

Click to expand...

Within ten years, physician compensation will not increase at the same rate as inflation. Quality of life is highly dependent on specialty.

macgyver22 said:

What kind of medicine to you hope to practice?

Click to expand...

The prevailing theme at my school is that if you work your butt off and make top marks, you will get to do what you want to do, and regardless of your choice, doctors do well in life.

I think it's clear, though, that people are gravitating toward the higher paying specialties nowadays given the issues you brought up.

macgyver22;6073906=macgyver22;6073906 said:

Are you aware of what's going on? What have you heard?

Click to expand...

The idea came after talking and several job shadows with a radiologist and a ED ER physician. As in people abusing the ER and using it as a drug dispensary, or using it as a regular checkup, I'm aware of it.

macgyver22 said:

What are your expectations in regards to earnings?

Click to expand...

Im happy if I can raise a family without having to worry about money, so 120K.

macgyver22 said:

What are your expectations for quality of life?

Click to expand...

A four lettered word that starts with the letter S, with a few happy, touching moments here and there.

macgyver22 said:

What kind of medicine to you hope to practice?

Click to expand...

Idealistically, ER or Surgery, but I rather focus on getting into med school for now.

Are you aware of what's going on? What have you heard?
Yes, I have talked with many physicians and having been a chronic condition patient for 4 years know first hand some of the problems and talk with my personal doctors about others. Also I just finished my MPH which gave me a whole new idea about other problems that exist in healthcare.
What are your expectations in regards to earnings?
Honestly doesn't matter to me. I wanted to me a meteorologist or teacher before deciding on medical school. I also know that is alittle naive to say because of the debt from going to medical school.
What are your expectations for quality of life?
I want to be a hospitalist (neonatologist) so I know that there will be weeks were I work the wards and when not on service I am expected to work nights and weekends. I know there will be days I am at the hospital longer than I plan. I know that residency can consume your life and it's tough, long hard hours. I haven't decided what I want my family situation to be, but I know that it is possible in neonatology because 2 docs I work with just had their 2nd child.

What kind of medicine to you hope to practice?
I want to do something in Pediatrics especially relating to critical care like neonatology, pediatric intensivist, or pedi trauma surgery, or maybe pedi EM

macgyver22 said:

I am new to this board and somewhat intrgued by the number of people still anxiously wondering if they will get into medical school. I have been a practicing Internist for nearly 20years. Had any of you spent some real time working with physicians currenlty in the field of Medicine, Pediatrics, ObGyn, and most of the other specialties, you would be aware of the overwhelming sense of disatisfaction prevalent among practitionres these days. Without cataloging all the issues that are making medical practice so difficult, I would like to hear from some of you to gauge your awareness of the issues and hear how this has affected your thinking.

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I look forward to your responses.

Click to expand...

1. Completely aware. My mother is in med school, I've personally known an IM doctor who dropped the field and switched out to business.

2. Expectations? Anything above 80K before taxes is fine w/ me. Mantaining my hobbies is more important than mantaining a rich lifestyle.

3. Crap, all the way till residency 3rd year.

4. Pediatrics/ pediatric oncology.


I haven't been able to get much patient experience in the states (mind you I have been cursed out already by an angry nurse assistant), so I'm going oversees this summer to make up my mind whether I can tolerate medicine and the environment in general. I expect decent grades in gross anatomy, decent in histology, and below average in biochemistry or whatever the chem class is... Clinical will be fun except for the studying right after long shifts, residency? I have weird ass sleep patterns. If I am actually doing something I like it wont be a problem.

I'm just a lowly person waiting to start in the fall, but here's my take on the career as a whole.

Dissatisfaction comes about when people have unrealistic expectations of what they're getting themselves into. This applies to everything though, not just medicine. I anticipate lots of bureaucracy, hazing/bs during residency and beyond, and compensation that will leave me comfortable at best. I'm also the kind of person though, that if everything is easy then it's not fun or worth doing. Intellectual challenge and obstacles are what keep me going.

I did Peace Corps. I also married an African man and we are currently living with my parents and have been for over a year now. If these two experiences haven't been trying, I don't know what is!

Thewrongstuff said:

...Anything above 80K before taxes is fine w/ me. Mantaining my hobbies is more important than mantaining a rich lifestyle...

Click to expand...

There is no way that I would be able to pay off my student loans and maintain a mortgage/family with only 80K. I think that the 80K ballpark would be great for the training required to become a midlevel, though. Lots more time for hobbies too.

Jolie South said:

Dissatisfaction comes about when people have unrealistic expectations of what they're getting themselves into. This applies to everything though, not just medicine.

Click to expand...

Definitely agree with this. The problem I see is that with many careers, students are heavily indebted/invested before they are able to recognize the actual terrain of the work.

Thewrongstuff said:

2. Expectations? Anything above 80K before taxes is fine w/ me. Mantaining my hobbies is more important than mantaining a rich lifestyle.

Click to expand...

I'd say **** medicine if thats the best salary I can make with an MD. I can work within my major and make that kind of money.

Background: I shadowed two family practice docs last year.

macgyver22 said:

Are you aware of what's going on? What have you heard?

Click to expand...

Well, I know it's getting rough out there. Don't know too much about specifics, but I do know that it's getting harder to treat people because of insurance problems, religious belief, and WebMD.

macgyver22 said:

What are your expectations in regards to earnings?

Click to expand...

Well I think my earnings will be modest, probably a little over $1 million a year

macgyver22 said:

What are your expectations for quality of life?

Click to expand...

I don't expect it to have a negative impact (overall), as I don't plan on being an indentured servant...i mean working in a hospital.

macgyver22 said:

What kind of medicine to you hope to practice?

Click to expand...

Probably something tech-savvy....opthalmology sounds nice.

Are you aware of what's going on? What have you heard?
Not so much. Volunteered at a hospital during high school but don't know anyone in the medical profession.

What are your expectations in regards to earnings?
Enough to but a house/condo and live comfortably. I do not need a mansion, just a place to call home.

What are your expectations for quality of life?
I expect to be working constantly but I like to be busy. As for a family, I will make it very clear to my future husband that I will not give up my career. I am undecided on children, kind of just depends on life.

What kind of medicine to you hope to practice?
Thinking emergency medicine, but am open to other areas.

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I hope that as a future physician I will be satasified by knowing that I had a direct impact in someone's life. I think of diagnosis as a jig saw puzzle and I am really into a variety of puzzles.

Expectations: long hours, demanding workload, and every now and then, a patient that reminds you why you chose the field ya did.

Problems: the healthcare system in this country is a mess, malpractice inscurance, knowing that I will probably at some point injure/harm a person

Arc said:

I'd say **** medicine if thats the best salary I can make with an MD. I can work within my major and make that kind of money.

Click to expand...

The funny thing is that a lot of P.A's are getting pissed off at a 60K while doing as much work as the doc does.

I'm getting flak for this but if the salary and associated daily schedule interfere with my sanity you can bet your bottom dollar i'll take a hit on the salary side to enjoy my life.

Crixivan said:

Definitely agree with this. The problem I see is that with many careers, students are heavily indebted/invested before they are able to recognize the actual terrain of the work.

Click to expand...

I would agree. I don't think college prepares anyone for careers. It's all about learning theoretical knowledge, but never about how that could be parlayed into a career. Most people don't even realize till way down the line what jobs they could get with their education (myself included before I decided on medicine) or how exactly they would function within those jobs.

For medicine, at least, adcoms want to see that you've explored the career even in the most minimal sense before jumping into it.

I think another problem that might arise is when people have their hearts set on these high paying lifestyle specialties only to find out down the road that they don't have what it takes to match and thus become frustrated if they end up with primary care. I'm not knocking primary care, but most people don't want to admit that they could be average (in terms of the match at least).

Thewrongstuff said:

The funny thing is that a lot of P.A's are getting pissed off at a 60K while doing as much work as the doc does.

I'm getting flak for this but if the salary and associated daily schedule interfere with my sanity you can bet your bottom dollar i'll take a hit on the salary side to enjoy my life.

Click to expand...

I posted something similar in another thread. I feel the same way in that aspect.

http://forums.studentdoctor.net/showthread.php?t=485893 (its the 25th post BTW.)

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

macgyver22 said:

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

Click to expand...

1) I know healthcare is a huge issue right now in the US, doctors are getting the shaft and will get it even worse if a democrat is elected president and springs their commie healthcare plans on US.

2) I don't care about being rich, I don't need a huge house, or a boat, or a Beverly Hills address. I want my family to be able to depend on me to provide when needed, for my kids to be able to go to the college they want to. If I can make 120-150k a year, pay off my debts, I'm happy.

3) I know life will be hell for years, but any well paying job requires that sort of dedication. On one hand, being a doctor may likely drive me to insanity, but on the other hand, being a doctor may also provide fulfillment that no other profession could. Unless you've endured hardships along the way, you've really accomplished nothing.

4) Hopefully surgery, but I'll cross that bridge when I get there.

Thewrongstuff said:

The funny thing is that a lot of P.A's are getting pissed off at a 60K while doing as much work as the doc does.

Click to expand...

That would be pretty low for a PA in my region, but the high salary for their bosses is recompense for the responsibility rather than the workload.

Thewrongstuff said:

I'm getting flak for this but if the salary and associated daily schedule interfere with my sanity you can bet your bottom dollar i'll take a hit on the salary side to enjoy my life.

Click to expand...

I apologize if it seems like I'm giving flak, and I agree that 80K is plenty if the education didn't cost anything. I just don't want to be stuck with the equivalent of a second mortgage after twelve years of higher education if I can't break even on the debt.

A lot of people go into medicine with altruistic goals only to be beaten down by the system during the training. That's why many specialties deliberately keep their number of residency slots low. They don't want a lot of people competing with them for insured patients.

macgyver22 said:

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

Click to expand...

1. My mom is a nurse, and father was a doctor, and so I have heard a lot of both the positive (feeling an immense sense of pride about profession and helping people, job stability, etc.) and the negative (dwindling medicare reimbursement, long hours, high expectations, occupational stress). That said, I still want to be a doctor more than anything.

2. I would like to make enough to support myself, own my own house, a reliable car, help family when they need it, and take a short vacation every year or so. Enough to not have to worry as long as I'm responsible and not frivolous.

3. I expect long hours, disgruntled patients, the stress of (eventually) running my own practice and hiring trustworthy staff BUT also intellectual/emotional fulfillment, a nice salary, the joy of being able to see people's lives improve and being a part of their growth as a human being.

4. I plan on going into Psychiatry. Although, I'm also still in pre-med, so that could possibly change. But I'm fairly certain.

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

1) I'm fairly aware of the fact that there are many physicians who are unhappy with their chosen career path. However, this applies to every career, so I take this information as par for the course. I don't have an in-depth knowledge of the major (and more subtle) issues currently affecting our healthcare system, only a cursory idea.

2) I expect to make anything over 100k probably.

3) I expect my quality of life to be strained for the school/residency years, but after that hopefully it pans out a bit more, especially since I won't be doing major patient contact work.

4) My goal is to go into Pathology.

There are some interesting replies here. I didn't expect to get so many so quickly. I appreciate the feedback.

Let me give you a little background about myself so you can see where I am coming from. I practice in a major metropolitan area. I am an Internist in solo practice and my wife is an ObGyn. I've been doing this for about 20 years and spend a fair amount of time in the real world discussing practice and medicine with many of my collegues.

I got into medicine at a time when things were very different than they are today, but my expectations at the time were that I would open my own practice, be able to make enough money to live comfortably. This means different things to different people, but when I started out an internist in this area could expect to have one of the nicer homes in the neighborhood, take a nice vacation every year, start easing back on his schedule in his 50's and easily retire by 65 without any worries. I also had an expectation of respect from my patients and collegues, and the general impression that if you practiced good medicine then lawsuits were not something you would have to worry about.

The reality turned out somewhat different. I have been running my own practice for the past two decades, but during that time despite working longer and harder I now make only what I did 15 years ago. To give you the hard facts, I make about $140k/yr ( about $100K after taxes). While that may seem like a lot to those of you whose highest paying job has been at McDonalds let me put it in perspective for you. The average police officer who has been on the job for 10 years in our town makes about $130K/yr, my neighbor is a plumber and makes more than I do. A home in this area costs on average about $500K for a nothing special 1800 sq foot, 3 bedroom house. Mortgage and taxes on such a house will cost you about $60K/yr. For anyone who's supporting a family you know that there are many more expenses that will quickly eat up the remaining income. Were it not for my wife working we'd be in a bit of a bind.

I do feel that I get alot of respect from my patients and collegues, but even that has changed. With the advent of managed care there has been a definite decline in the level of respect from some patients. There is a segment of society that seems to have greater respect for things that cost more. When they only have to pay $20 for an office visit they start to treat you with less respect than the hairdresser they paid $80 to for a haircut. There also seems to be a sense of entitlement that has developed among some patients. They feel that they pay a lot for their insurance and they are entitled to what ever they want when they come to the office. Luckily this is a small percentage of the patients. The majority of my patients are a pleasure to take care of which is the main reason I still get up and go to work each day

Lawsuits are another issue. Don't let anyone tell you that good doctors don't have to worry about lawsuits. maybe its becuase I live in one of the countires lawsuit capitals. Maybe its because I'm married to an ObGyn, but lawsuits have become a major issue. I have reviewed charts for lawsuits and seen cases drag through the courts for years that have no merit. I have seen cases settled for exhorbitant sums that have no merit. The system is severly broken and no one seems to want to fix it except the doctors. Nothing could be more disheartening than to give 100%, put in long hours, do nothing wrong, and still end up in court. Every single ObGyn in our area has been sued and most of them have been sued multiple times. Something is desperately wrong with a system that allows that to happen.

Insurance companies are frustrating in ways that go far beyond low reimbursements. With each day they intrude more and more on the doctor patient relationship. I have spent hours over the past month writing letters to insurance company executives and legislators trying to correct problems with new rating systems that the insurance companies are rolling out. These systems are meant to give patients ehlpful info when picking a doctor by rating them based on 'agreed upon standards'. The problem is the standards are not agreed upon. Some of the standards they are using are wrong, and the data is extremely error prone ( 95% inaccurate in some cases). It has now become my responsibility to correct the mistakes the insurance company made - time I could use much more productively on patient care if I weren't doing this.

Medicine is still a rewarding field in some ways. As I said, its the patients that keep me going. There are still fields where you can make a very good living, but I think its difficult to advise a young college student who wants a family, to go into a primary care field today. Crixivan asked what I would do if not medicine and I can't honestly say what it would be. I might have chosen a field of scientific research or computer science but everyone has to chose whats best for them.

My only advice would be to spend some real time working in asa many medically related jobs as possible. Try to get a real feel for what the job is like and don't be shy about asking professionals in the field how they feel about their job. You will get very different answers depending on the specialty, whether they are part time or full time. hospital based or private. Just make sure you research this before you invest $250,000 and 8 years of your life into your dream.

macgyver22 said:

My only advice would be to spend some real time working in asa many medically related jobs as possible. Try to get a real feel for what the job is like and don't be shy about asking professionals in the field how they feel about their job. You will get very different answers depending on the specialty, whether they are part time or full time. hospital based or private. Just make sure you research this before you invest $250,000 and 8 years of your life into your dream.

Click to expand...

I really like this advice. When I first started reading your post, I was a little concerned we were "in for it" by another angry, burnt out attending. Thanks for being realistic while not being condescending or dramatic.

I think your advice is spot on. I think a lot of premeds have no idea what they are getting into because their clinical experience consisted of pushing gurneys around and taking blood samples to the lab. I don't see enough of these volunteers talking to doctors, interacting and asking meaningful questions. It all seems so automatic. I was blessed to have a great MD take me under her wing, expose me to medicine in the real world and give me a realistic take on what's going on. I consider her my mentor for that.

macgyver22 said:

Crixivan asked what I would do if not medicine and I can't honestly say what it would be.

Click to expand...

I think that was FinchHead, but I do appreciate your detailed response nonetheless. Thanks for telling us your story. I haven't seen a lot of posts by practicing doctors on this forum. 👍

5 Star thread. 🙂

As a healthcare provider I have seen and heard almost everything you are talking about. I know that taking care of people is a dirty dirty job. I wonder to myself all the time why are all these people dying to get into medical school? Do they have any idea of what they are getting themselves into? I think that in addition to taking the basic sciences to get into med school, everyone should work in a hospital taking care of patients as a paid position. It is the only way to really see and feel the environment.

I can only speak for myself, but maybe some people on this forum feel similarly.

After cleaning up poop, having people die in my arms despite doing everything i could to save them, being told by others what to do and how to do it constantly, I still enjoy moments, while sparse, when i get some appretiation from a patient for what i did for them.

I am also fascinated by science, research, and the overall goal in making our species thrive and survive.

I also want job stability. I want to be able to fall back on 150,000 if things dont work out in a high paying specialty.

I want the challenge. We are growing up at a time where the pressure is greatest to be successful. Where we are told day in and day out that you have to work hard in order to be successful. What could be harder than the physical and emotional stress of a residency? maybe a few jobs. But it is right up there.

I feel like you want to say more to us so I hope you do. Please tell us how you feel on your worst days and your best days.

Thanks for starting this post.

Crixivan said:

There is no way that I would be able to pay off my student loans and maintain a mortgage/family with only 80K. I think that the 80K ballpark would be great for the training required to become a midlevel, though. Lots more time for hobbies too.

Definitely agree with this. The problem I see is that with many careers, students are heavily indebted/invested before they are able to recognize the actual terrain of the work.

Click to expand...

Well - I know of several pediatric specialists that are making about $90k a year. I also know several nurses who've been pulling in a LOT more than that for some years now. Without the debt!

macgyver22 said:

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I look forward to your responses.

Click to expand...

It's great that you're asking people to give real consideration to these things because it's clear on these forums and in my own class (M1) that people don't really thoroughly get the situation. It's more swept under the carpet of their mind. "Oh yah, that's a problem for some people, but it won't be for me." Not to be too picky but my question is - if young people don't go into medicine, who will? Old people? They aren't going to be willing to put up with this &$^^@!%%% for the most part!! (Trust me - I'm one!)

I think this is a very interesting thread you've started here and the points being brought up are definitely important to consider

My experience in the medical field has been shadowing doctors in a hospital, so I guess I didn't speak with many primary care docs. But from what I found, the most common thing the doctors I met said was that they were afraid of being sued. No one really expressed concerns about compensation..but again, not primary care. Some of them warned me that medicine would be going downhill and you'd have to more or less be out of your mind to go into the field right now, however, others said that this kind of thing happens in waves and I've heard from others that when they entered medical school 2 decades ago, they were also being told that they would not be rewarded at all in medicine.

Basically, I am of the belief that you should choose a career in medicine if you cannot see yourself doing anything else. The hours are long, the work is hard, the patients are not always appreciative, and the pay may be less than ideal. However, for this, you get a profession that is intellectually stimulating, which gives you a chance to interact with people and better their quality of life, and possibly opens doors to other opportunities.

I know medicine won't give me the playboy lifestyle that some people associate with doctors. I don't think I will mind as long as I can pay off my loans, live comfortably, and support a family.

Speaking of loans...every doctor I've met (even new ones just out of residency, including a pediatrician) said basically not to worry about them and that paying them off is not a real big problem. What is your opinion about this? If tuition stays the same or increases, and primary docs salaries continue to decline, how can society realistically expect people to go into that field where they may be in debt forever? Will the ER become the new clinic?

Maybe after a few years of doctors being extra careful for fear of getting sued people will actually sue less! Probably not realistic but...

Anyways, like I said good thread and I look forward to hearing what you have to say.

Also, if I may ask, what city do you practice in?

Orthodoc40 said:

Well - I know of several pediatric specialists that are making about $90k a year. I also know several nurses who've been pulling in a LOT more than that for some years now. Without the debt!



It's great that you're asking people to give real consideration to these things because it's clear on these forums and in my own class (M1) that people don't really thoroughly get the situation. It's more swept under the carpet of their mind. "Oh yah, that's a problem for some people, but it won't be for me." Not to be too picky but my question is - if young people don't go into medicine, who will? Old people? They aren't going to be willing to put up with this &$^^@!%%% for the most part!! (Trust me - I'm one!)

Click to expand...

90k by choice or lackthereof?

macgyver22 said:

I am new to this board and somewhat intrgued by the number of people still anxiously wondering if they will get into medical school. I have been a practicing Internist for nearly 20years. Had any of you spent some real time working with physicians currenlty in the field of Medicine, Pediatrics, ObGyn, and most of the other specialties, you would be aware of the overwhelming sense of disatisfaction prevalent among practitionres these days. Without cataloging all the issues that are making medical practice so difficult, I would like to hear from some of you to gauge your awareness of the issues and hear how this has affected your thinking.

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I look forward to your responses.

Click to expand...

Retire

Edit: I should qualify that i posted without reading your followup. You're obviously not coming in here bitter, trying to disenchant people. So, I apologize for being glib.

Orthodoc40 said:

Well - I know of several pediatric specialists that are making about $90k a year. I also know several nurses who've been pulling in a LOT more than that for some years now. Without the debt!

Click to expand...

Indeed, 90K isn't that atypical for ped's in my region either, and I know of many nurses and who make more if they're willing to put in the hours. A pediatric specialist needs 3 years in peds and often a few more for a fellowship, so looking back on what my school was charging for medical tuition ten years ago, 90K after malpractice might work out for me in today's market given a working spouse.

Orthodoc40 said:

"Oh yah, that's a problem for some people, but it won't be for me."

Click to expand...

I hear a lot of that too.

Thewrongstuff said:

90k by choice or lackthereof?

Click to expand...

Pediatricians aren't given a great reimbursement rate due to low acuity. It's definitely a specialty that docs choose because they love the field.

DocWalken said:

No one really expressed concerns about compensation..but again, not primary care.

Click to expand...

Also, it may have mattered what kinds of doctors you were following. The way compensation works for a general surgeon is different than the way compensation works for a general internist, which is different from the way compensation ends up working out for a cardiologist.

DocWalken said:

Speaking of loans...every doctor I've met (even new ones just out of residency, including a pediatrician) said basically not to worry about them and that paying them off is not a real big problem. What is your opinion about this? If tuition stays the same or increases, and primary docs salaries continue to decline, how can society realistically expect people to go into that field where they may be in debt forever? Will the ER become the new clinic?

Maybe after a few years of doctors being extra careful for fear of getting sued people will actually sue less! Probably not realistic but...

Click to expand...

Loans are definitely an issue (speaking as a current med student). The amount of money spent to finance medical school is enough to buy multiple luxury cars. The amount that I spend in ONE year (tuition, fees, and living expenses) is enough to buy a brand new Lexus.

My sister, who is a young attending, says that she's not sure how her colleagues manage to have families and still pay off their debt. The simple answer is that they pay off their debt very slowly, and are still in debt in their 50s.

A lot of doctors tell you that "Oh, loans are not a problem!", but I wonder how much of that is them trying to convince themselves. Sometimes you push problems off to the back burner, because you simply have w-a-a-y too many things to worry about. (This is ignoring the fact that a lot of doctors cannot intelligently manage their money, and lack basic financial aid knowledge.)

If you don't mind being in debt (and are willing to defer your loans until you're finished residency, despite the oppressive burden of interest that will build up), then, no - loans are not a problem. But being able to actually use all of your post-tax salary on you and your family would be nice....

macgyver22 said:

I am new to this board and somewhat intrgued by the number of people still anxiously wondering if they will get into medical school. I have been a practicing Internist for nearly 20years. Had any of you spent some real time working with physicians currenlty in the field of Medicine, Pediatrics, ObGyn, and most of the other specialties, you would be aware of the overwhelming sense of disatisfaction prevalent among practitionres these days. Without cataloging all the issues that are making medical practice so difficult, I would like to hear from some of you to gauge your awareness of the issues and hear how this has affected your thinking.

Are you aware of what's going on? What have you heard?

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

I would really like to get a feel for what the expectations and impressions are of young people who are considering a future in medicine these days. I will be happy to discuss the rewards and problems of medicine as I see it from the front lines today, but I would really like to here your views first.

I look forward to your responses.

Click to expand...

My daughter is a MS 4 and will go through the match process shortly to determine the location of her residency. I own a small business. I am a manufacturing representative.

I do not understand why doctors do not form a union. When the employers operate as a monopoly with standard nonnegotiable low paying resident contracts and 80 hour weeks with no means to negotiate, I think I would go on strike. Meat packers have it better. Please understand after 8 years of study, your first paid position as an intern will be $40k-$42k per year. This will be for three years. Then when you apply for a fellowship you will be paid $60k-$72k for another 2-5 years. You will be in your early 30's at best and maybe older if you were a non traditional student, before you can practice in your specialty.

I compare that to a technical sales person. At the public college in our state the average graduate earns $55,000 per year starting out. There is something wrong with this system. When someone with a UG degree gets paid more than a graduating medical student. The UG works less and certainly has less responsibility.

The business world pays better and has less headaches and quite honestly you are paid at least what you are worth because you can negotiate or go to a competitor who wants your services more when the opportunity presents itself.

Anyone of you could go to work in many fields and be successful. I have explain this to my daughter but she continued on into medicine turning down a 6 figure sales job with a medical device company.

She did this for several good reasons-
1. She likes the recognition
2. She feels like the money will be there
3. The biggest reason is that she has a chronic disease and wants to treat others with this disease.

Hopefully, all of you want to be in medicine for good reasons but I am like the good doctor, I do not see why.

I am glad that as many highly qualified applicants are still available as I approach the time of life when I will need them most. Thank you for being there but make sure your reasons are well thought out.

macgyver22 said:

Medicine is still a rewarding field in some ways. As I said, its the patients that keep me going. There are still fields where you can make a very good living, but I think its difficult to advise a young college student who wants a family, to go into a primary care field today. Crixivan asked what I would do if not medicine and I can't honestly say what it would be. I might have chosen a field of scientific research or computer science but everyone has to chose whats best for them.

Click to expand...

What fields in medicine do you feel offer a good experience?

1. Are you aware of what's going on? What have you heard?

I think we've all heard about the dissatisfaction in the medical field, as well as in other high-profile fields. However, just because things are changing, doesn't mean that people who are now entering the field won't be able to adapt. One of the biggest things that I have heard, both from the news and physicians that I personally know, is that dissatisfaction is higher because of how the job is perceived by the public. That is something I've been hearing for over a decade now from various physicians. Many older physicians seem to be troubled by this because they partly got into the field because of the prestige. Perhaps those currently entering the field will be dissatisfied because they won't find the prestige that they expect. Some of us, though, will hopefully be able to adapt and thrive in this new environment.

2. What are your expectations in regards to earnings?

I certainly don't expect to get rich by being a physician alone. If I wanted to be rich, there are plenty of other fields that offer a much higher earning potential. I expect to live comfortably, and not have to worry about money like I do currently (where I support 2 people on less that 40k a year). Of course, part of that is because my fiancee will be a veterinarian, and although her earning potential isn't the greatest either, together we should be able to enjoy our lives.

3. What are your expectations for quality of life?

I expect to enjoy my job, and have an excellent home and family life. If that doesn't happen within a decade or so, I will definitely consider another field in medicine where I can find a higher quality of life.

4. What kind of medicine to you hope to practice?

Although that's really up in the air, I enjoy working with children, so I'm hoping to do some form of pediatrics. Yes I realize that their earning potential is lower, but again, if my enjoyment is higher, I'm not too worried about earning potential.

MattD said:

Retire

Edit: I should qualify that i posted without reading your followup. You're obviously not coming in here bitter, trying to disenchant people. So, I apologize for being glib.

Click to expand...

Well played sir. It's a good thing first impressions arent the only ones. 🙄

decafplease said:

I really like this advice. When I first started reading your post, I was a little concerned we were "in for it" by another angry, burnt out attending. Thanks for being realistic while not being condescending or dramatic.

I think your advice is spot on. I think a lot of premeds have no idea what they are getting into because their clinical experience consisted of pushing gurneys around and taking blood samples to the lab. I don't see enough of these volunteers talking to doctors, interacting and asking meaningful questions. It all seems so automatic. I was blessed to have a great MD take me under her wing, expose me to medicine in the real world and give me a realistic take on what's going on. I consider her my mentor for that.

Click to expand...

And yet you, like most of your other pre-med peers, still only understand half the battle

smq123 said:

If you don't mind being in debt (and are willing to defer your loans until you're finished residency, despite the oppressive burden of interest that will build up), then, no - loans are not a problem. But being able to actually use all of your post-tax salary on you and your family would be nice....

Click to expand...

I don't exactly plan on going to med school right after undergrad...I got bills to pay. And is it even possible to hold a job in med school?

Arc said:

I don't exactly plan on going to med school right after undergrad...I got bills to pay. And is it even possible to hold a job in med school?

Click to expand...

I don't think you can

Thanks for a great thread!

I agree that people going into medicine intending to enter IM, FM, Peds, or OB/Gyn and to practice in the United States are insane.

Fortunately there are still pockets of our profession that are worthwhile.

DadofDr2B said:

I do not understand why doctors do not form a union.

Click to expand...

It is illegal for physicians to organize. Because it will never become legal (insurance companies and such have too much political power, and patients would object also), things will continue to get worse every year in this country.

Some ortho guys in Texas recently made a joint decision to stop taking Blue Cross insurance. Blue Cross sent some anti-trust suit their way, won, and the doctors have to pay them millions and millions. Plus they have to accept Blue Cross.

I would not enter any field without the backup option of being able to practice abroad or to operate a pure cash-only practice in the US.

Where else can you get the job qualities of a physician? For me, I value the most:

1) Not behind a desk all day (surgery). Active, walking around, meeting new people, etc.

2) Academic environment (if you choose it). Your peers are well educated, a career in research can be combined with a clinical practice, etc.

3) Make a positive change in the individual lives of others. I realize this exists in other fields, but it's tough to find with #'s 1 & 2.

4) The pay will always be something decent. Again, this is usually not the field of choice if you want to make big bucks - but hard to find with #'s 1, 2, & 3.

I think we all know how unhappy physicians are right now - shadowing is a pretty crucial requirement. Almost every surgeon I've spoken with says something along the lines of "Don't become a doctor! You'll be competing to do appy's (sp?) for $20 on street corners." But it's a life of service and it comes along with a lot of crap - it's an individual choice whether or not it's worth all the crap.

I'm sorry for not being available for feedback. My wife finally got home from the delivery room at 2am and I decided it was time to go to bed. I would like to respond to soem of your comments though.

DocWalken said:

Speaking of loans...every doctor I've met (even new ones just out of residency, including a pediatrician) said basically not to worry about them and that paying them off is not a real big problem. What is your opinion about this?

Also, if I may ask, what city do you practice in?

Click to expand...

I find it hard to believe that any doctor could honestly say "don't worry about the loans" unless someone else had paid for their education and they really didn't know what it was like to finance it all with loans. When I finished med school I had $100K in loans and my wife had a similar amount. We were making more back then so we were able to pay it all off in about 10 years, but things have changed today. Students are graduating with more than $200K in loans and some have more than $250K. I don't see how anyone making $150K before taxes and trying to buy a home and raise a family can expect to pay that off without making tremendous sacrifices. Primary care fields are going to suffer.

to tnaswer your last question I live and practice in a suburb of NYC.

DadofDr2B said:

My daughter is a MS 4 and will go through the match process shortly to determine the location of her residency. I own a small business. I am a manufacturing representative.

I do not understand why doctors do not form a union. When the employers operate as a monopoly with standard nonnegotiable low paying resident contracts and 80 hour weeks with no means to negotiate, I think I would go on strike.

Click to expand...

Doctors aren't allowed to form a union in most cases. Under our system each physician is treated like a company. Getting together to go on strike or negotiate with an insurance company or even to discuss our rates is considered collusion and could result in jail time. I agree we should be allowed to unionize but it is currently illegal and there is zero public support to change that.

Chuckwalla said:

What fields in medicine do you feel offer a good experience?

Click to expand...

That's really a personal question. If you want maximum rewards and instant gratification then do plastic surgery. If you don't mind working in the trenches and are willing to accept an income that is less than many of your peers who went into finance or law in exchange for the rewards of being the family doctor and getting the respect that comes with that then primary care may be for you. Radiology is a good career for those who don't need direct patient contact. My brother is a doc in Mich and radioogist near him do very well, but here in NY a collegue of mine in his late 50's recently had to abandon his busy practice because he couldn't meet payroll.

All I can say is do your homework. Try to get as much 1st hand experience in the field your interested in even if you have to work for free.

russiandoc said:

I feel like you want to say more to us so I hope you do. Please tell us how you feel on your worst days and your best days.

Thanks for starting this post.

Click to expand...

Its hard to say what my worst day was, but the worst part of most of my days involves the nonsense caused by the isurance industry. There is nothing mroe frustratin than wasting valuable time fixing problems caused by people who don't know what they're doing or worse, people who are paid to cause problems for us. Every insurance company has their own bag of tricks they use to deny payment, or prevent patients from getting the care they need. It costs them nothing to stamp a denial on a claim, but it costs me alot to spend hours or pay someone else to spend hours trying to overturn these denials. I win nearly every appeal, but in the end I lose because of the cost both financially and emotionally. Why should a highly educated physician have to spend hours on the phone with someone who has no medical knowledge at all and is just reading off a computer screen. If insurance companies had to incur the same costs as physcians by being forced to put a physician on the phone every time a physician calls they would think twice before denying things.

My best days are ususally the ones that aren't overwhelminigly busy, where I get to actually spend time talking to people and get an occasional reminder how much some people still appreciate what we do.

This is neither a best or worst day story, just a funny no good goes unpunished story. This sort of thing can drive you nuts, but if you can laugh at it than maybe you can do this job

I was covering for another doctor one weekend when he had a teminally ill elderly patient in the hospital. I was making rounds and went in to visit her. She probably had less than a week to live and was there for end of life care. She had no family. When I walked in she was looking at her breakfast tray with a forlorned look on her face, When I asked her what was wrong she let out a weepy sigh and said that the food was awful and she just couldn't eat it. All she wanted was a decent muffin. Hospital food certainly isn't great and I'm not sure I would want it as my last meals either. After examining her and saying goodby I decided to walk down to the cafeteria. The food down there is actualy pretty good. I found a some muffins and not sure what she would like I baught her 3 different ones, picked up some butter and jam, paid the $10 and treked back up to the 8th floor. I wasn't looking for a big thank you or any kind of personal reward other than some recognition in her face that this small deed had made her day a little better. I walked into the room and said hello. I helped her up in bed, spread the items out on he tray for her and wished her good day. As I turned to leave the room she looked up and with the most irritated accusatory look on her face she said to me "what, they had no whole wheat?".

Half of me wanted to lean over and pull out the miriad of plugs that powered her life supporting devices. Luckily the half that couldn't help laughing won out. It was just so absurd you couldn't help seeing the comedy in it. I apologized for my thoughtlessness and left the room holding off my laughter until I got to the nursing station. Like they say "No good deed goes unpunished" 🙂

Dr.M, if you could do it over again, would you still become a physician knowing what you know now?

Maxprime said:

I think we all know how unhappy physicians are right now - shadowing is a pretty crucial requirement. Almost every surgeon I've spoken with says something along the lines of "Don't become a doctor! You'll be competing to do appy's (sp?) for $20 on street corners." But it's a life of service and it comes along with a lot of crap - it's an individual choice whether or not it's worth all the crap.

Click to expand...

I think this is one of the most frutrating things about the situation right now. While individuals may value what we do, society as a whole does not seem to. When a repairman with a fraction of my overhead and no education beyond highschool comes to my house and spends an hour fixing something, the labour charge alone can be $150. If I spend an hour with a new patient their insurance company pays me $98.

Its not uncommon for women in this area to pay $80-100 for a haircut, but if my wife travels all the way to the hospital just to circumsize a baby she gets paid $37.50! Sounds crazy but that is the current reimbursement rate for a circ from Oxford United Healthcare in this area.

That's the sort of disrespect that doctors find infuriating.

Auron said:

I guess I'll be gunning for Rads after all...

Excellent thread, it would be great if more attendings could post on these forums, their input is invaluable.



Dr.M, if you could do it over again, would you still become a physician knowing what you know now?

Click to expand...

Nice avatar. I'm a bit of an astronomy buff myself.

Would I do this again is a hard question to answer. Its hard to see my wife working so hard and knowing she has to continue because my income isn't enough. I think if I knew then what I know now I might have pursued a little different path. I had a real interest in optho ( My astronomy background gave me a real appreciation of optics), and that would have paid a bit better. I like the part of my job that involves taking complex issues and making them understandable for people. I would love to have a job as a network science and medicine correspondent but those are not easy jobs to come. Most of the people doing that job now are pretty bad.

I know alot of people who went into the finance industry here in NY and from a strcitly financial standpoint they are much better off but you have to like that sort of thing so for me its not an option.

If you really want to play the grass is always greener" game, a teaching/research job in an engineering field at MIT would be interesting I suppose, but you never know what another path would have brought.

My purpose here wasn't to tell people not to pursue a career in medicine, but to make sure kids have more of an idea what they are getting into. TV, parents, and friends often have an idealized and completely unrealistic impression and I find most premed students do also. They tend to over glamourize the positives and downplay the negatives. Comments like "yeah I understand that I will have to give up my personal life but the rewards wil be worth it" are a bit naive. You really need to put yourself in that position for a while before you can honestly make that statement.

If I were going to change the medical education system, I think I would do several things. I would require all premed students to spend a couple years working in a demanding, rewarding, low/no pay job like the peace corps. Inexchange the government should pay for their medical education. This would give students a better idea of real sacrifice and at the same time remove the loan burden that is going to scare many students away from the primary care positions that we need filled the most. Society doesn't need more specialists, it needs more generalists, but if you look at the posts above the ratio is more towards higher paying fields and for good reason

Thewrongstuff said:

1. Completely aware. My mother is in med school, I've personally known an IM doctor who dropped the field and switched out to business.

2. Expectations? Anything above 80K before taxes is fine w/ me. Mantaining my hobbies is more important than mantaining a rich lifestyle.

3. Crap, all the way till residency 3rd year.

4. Pediatrics/ pediatric oncology.


I haven't been able to get much patient experience in the states (mind you I have been cursed out already by an angry nurse assistant), so I'm going oversees this summer to make up my mind whether I can tolerate medicine and the environment in general. I expect decent grades in gross anatomy, decent in histology, and below average in biochemistry or whatever the chem class is... Clinical will be fun except for the studying right after long shifts, residency? I have weird ass sleep patterns. If I am actually doing something I like it wont be a problem.

Click to expand...

This will change.

MattD said:

Retire

Edit: I should qualify that i posted without reading your followup. You're obviously not coming in here bitter, trying to disenchant people. So, I apologize for being glib.

Click to expand...

Matt Lauer . . . ?

macgyver22 said:

Are you aware of what's going on? What have you heard?

Click to expand...

I know that there are problems with getting enough people into primary care and getting specialists to take ER call and work in a hospital. The problem is reimbursement in both cases. Thinking and preventative care need to be reimbursed properly compared to procedures. The second issue has come about because specialists are realizing that their outpatient scheduled work that is more controllable and more enjoyable is actually making them all their money while they are just suffering through hospital work and call out of the goodness of their heart and because they feel it is part of being a doctor. Too many are saying f*** this (understandably) and abandoning inpatient work and call. If the reimbursement was right they would return.

The bigger issue is that power and money are being taken away from doctors and patients and going to executives, HMOs, insurance companies and pharm companies. The pharm part doesn't bother me as much because big money in pharm means more and better innovations in medications. Money is a big motivator for everyone whether they admit it or not.

What are your expectations in regards to earnings?

Click to expand...

About 150k first year increasing to about 300K+ by third year with gradual increases for the rest of my career.

What are your expectations for quality of life?

Click to expand...

Great with no nights, no weekends, no call and about 40 hrs per week.

What kind of medicine do you hope to practice?

Click to expand...

Outpatient Physiatry and Occupational Medicine

Thewrongstuff said:

90k by choice or lackthereof?

Click to expand...

The low end of physician salaries in primary care is in this range. It is largely dependent on specialty and geographic location, so in that sense there is probably some moderate choice component, if you are willing to relocate, do something you enjoy less, work longer hours and the like, you perhaps can earn more. Most people won't do this (and IMHO for good reason). And to some extent it can reflect what doors got closed to you during a rough medical school or USMLE experience. These days if you choose (or back into) a specialty with low reimbursements, you won't be earning six digits unless you are willing to work absurdly long hours. The average physician earns about $200k, the average primary care physician earns $150k or less. So the minority of specialists at the higher end of the spectrum bolster the average and keep the "highly paid profession" myth going, even while declining reimbursements erode the salaries of many of the front office crowd.

TRAMD said:

I know that there are problems with getting enough people into primary care and getting specialists to take ER call and work in a hospital. The problem is reimbursement in both cases. Thinking and preventative care need to be reimbursed properly compared to procedures. The second issue has come about because specialists are realizing that their outpatient scheduled work that is more controllable and more enjoyable is actually making them all their money while they are just suffering through hospital work and call out of the goodness of their heart and because they feel it is part of being a doctor. Too many are saying f*** this (understandably) and abandoning inpatient work and call. If the reimbursement was right they would return.

The bigger issue is that power and money are being taken away from doctors and patients and going to executives, HMOs, insurance companies and pharm companies. The pharm part doesn't bother me as much because big money in pharm means more and better innovations in medications. Money is a big motivator for everyone whether they admit it or not.



About 150k first year increasing to about 300K+ by third year with gradual increases for the rest of my career.



Great with no nights, no weekends, no call and about 40 hrs per week.



Outpatient Physiatry and Occupational Medicine

Click to expand...

Okay...see this is what's confusing: $150 to 300k after 3 years?? That surely doesn't seem like a poor salary, no? Also, those hours seem pretty nice. And I know I'm naive, but I've never heard of outpatient physiatry and occupational medicine being referred to as a really competitive specialty. Is it? How many other specialties are out there where you can make this kind of money and work those hours?

Could it possibly be that medicine as a high paying job is just a little more of a gamble than people would like to think? Like doing really well in business? I feel like people think all physicians are going to have stable, well-paying jobs, which certainly isn't the case..but there is still a good chance of making good money and being somewhat satisfied with your job and actually being compensated on a level on par with your training.

macgyver22 said:

Are you aware of what's going on? What have you heard?

Click to expand...

I am somewhat aware. My exposure to medicine comes from about 24 hours of shadowing a cardiologist and 100 hours volunteering in the ER. An ER doc told me that you can expect a frivolous lawsuit about every five years. The cardiologist told me he has worked 80 hours a week his entire life clear up until retirement (he just recently retired). He admitted that he worked above and beyond of what he had to, but I know it's going to be longer than my current 40 hour work-week. However, I'm ok with this. I know that this is what I want to do.

macgyver22 said:

What are your expectations in regards to earnings?

Click to expand...

I come from a large family that grew up on about $20,000 a year. As you can imagine, we had no security in our lives. Believe me, I'll be happy with enough money to buy a house, live comfortably, and have security. Residents make about $40000 - $45000? I expect family docs make about $130000 - $150000? If I specialize, it will be a bit more I think.

macgyver22 said:

What are your expectations for quality of life?

Click to expand...

Quality of life is such an arbitrary word. What might be quality to one, would suck to another. For me, quality is having a challenging job that I love and time for my family/hobbies. You get what you work for: I have no doubts that I will eventually obtain this balance as a physician.

macgyver22 said:

What kind of medicine to you hope to practice?

Click to expand...

I'm very open to anything now. I'll decide on my rotations. However, I'm not going to be an ER doc.