[29M] Considering becoming a licensed doctor, with a long-term goal of equity/ownership. What is your advice?

[FogHorn]

I’m a diversely passionate person, with few known specific talents. I’ve spent most of my 20s around the healthcare field at the insistence of family. I stuck with it, because I like science, I like working with my hands, and I want to have skills that make me indispensable. I exited recently, and have been spending that time with family who are old and experiencing critical health issues.

It’s time to get back on the career track, and think about whether or not I want to finish it and become a doctor.

I obsess over details autistically, think like an engineer, communicate like a lawyer scientist, and move like a climber. I am extroverted with self-taught emotional intelligence, but my capacity to interact is cognitively intensive.

I want nothing to do with public hospitals—everyone there is miserable, the economic model is unsustainable, and the residents are waiting for their contract to end so they can leave. The ones who stay, do so because it’s their home, but otherwise resent it. I also want nothing to do with large private equity-driven establishments, as I’ve heard nothing but horror stories, from horrific treatment of patients/workers, to such mismanagement the clinics start losing money and defaulting on their contractual obligations.

I’ve thought about being a surgeon, as I take pride my ability to use my hands—but I’ve worked hard to develop a generally healthy and structured lifestyle.

I’ve been teaching myself chemistry (solid, liquid, material, organic), physics, biology, economics, business management, clinic administration, law, liability, accounting and bookeeping, supply chain, debt and equity financing, payroll practices, tax structuring, sales, entrepreneurship, and competition strategy.

As I approach 30 and learn more about life, I don’t think I want my career to revolve around incremental salary bumps as I work up a hospital’s hierarchy. I want to make choices that give me the shortest route to equity or full ownership, and I want a specialty that has hands-on creativity. I want to provide the best service to patients at the lowest costs without compromising their treatment, and without the overhead interference of management organizations or insurance requirements.

I’ve been teaching myself chemistry (solid, liquid, material, organic), physics, biology, economics, business management, scaling, clinic administration, law, liability, accounting and bookeeping, debt and equity financing, payroll practices, tax structuring, sales, entrepreneurship, and competition strategy.

I know that is an unorthodox approach to the field of medicine—but it is doable? Or am I better off looking elsewhere?

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[A Deep Breath]

A life in medicine might not be a good fit for someone who highly values creativity, reinventing the status quo, and a breadth of intellectual pursuits.

Consider whether you'd be happy in the work environment of a typical doctor. It's harder to do things differently than you might imagine.

 

[FogHorn]

A life in medicine might not be a good fit for someone who highly values creativity, reinventing the status quo, and a breadth of intellectual pursuits.

Consider whether you'd be happy in the work environment of a typical doctor. It's harder to do things differently than you might imagine.

I’m referring to life after residency—opportunities to start a lean private practice, that I own, and scale it over time.

 

[A Deep Breath]

I know. I chose medical school with the same dream. Some of what you write reminds me of myself back then. If I could talk to myself 15 years ago, I'd say:
1. A medical practice isn't really a business. It's self-employment. You can start a real business with unlimited upside that can potentially run itself someday, or you can be stuck trading time for money with your own medical practice. A practicing doctor has less time freedom than just about anyone.
2. Scaling a practice doesn't accomplish what you think it will. It mostly lowers overhead so that you'll receive more money per time. Forget about selling a practice for a big payday. Those days are over. If you can even find someone interested in buying your practice at the right time, the deals suck.
3. The current economics of medicine mean that independent practices get screwed. The price for the autonomy of a private practice is that you work harder for less money per unit of work. The situation has consistently gotten worse for decades. Be completely prepared for it to make more sense to work for a healthcare system. There are reasons everyone else isn't living your dream.
4. Once you're in medical school, there's a low risk you won't have a stable upper middle class income. But there's a significant risk you're not going to get to be the kind of doctor you want. For example, I know a lot of people who had their heart set on surgery and ended up not especially happy in internal medicine. Only a subset of medical specialities are suited to a baller private practice like you're envisioning.
5. The exceptions to point 4 usually occur when doctors are either practicing outside of the scope of what they were trained in, are offering treatments that most doctors would consider scams, or are utilizing an army of midlevels. You wouldn't want a loved one seeing a doctor who does this kind of stuff. You're probably not going to feel good about yourself being the one who does it.
6. If everything goes well, we're talking about 15-20 years of very hard work to get to the kind of life you're imagining. That's a really long time and, despite some amazing experiences and personal growth, those years deeply suck in many ways. Envision your perfect life. It probably involves the freedom to do what you want and more money than a doctor makes. If you were to spend the next 15 years working very hard in the right direction, you can be much closer to that perfect life than you ever would get with medical school.
7. When you're starting older, a lower percentage of your working years will be high income. This hurts more than you realize.
8. The happiest doctors don't spend much time questioning the system you already don't buy into. The most burnt out doctors talk like you already do.
9. To the extent it's worth it, it's because all of those years of hard work mean I can help people in a way few can. It sounds like cheesy premed stuff, but it's true. I don't think less of people who chose a path that doesn't involve this type of satisfaction.

 

[FogHorn]

I know. I chose medical school with the same dream. Some of what you write reminds me of myself back then. If I could talk to myself 15 years ago, I'd say:
1. A medical practice isn't really a business. It's self-employment. You can start a real business with unlimited upside that can potentially run itself someday, or you can be stuck trading time for money with your own medical practice. A practicing doctor has less time freedom than just about anyone.
2. Scaling a practice doesn't accomplish what you think it will. It mostly lowers overhead so that you'll receive more money per time. Forget about selling a practice for a big payday. Those days are over. If you can even find someone interested in buying your practice at the right time, the deals suck.
3. The current economics of medicine mean that independent practices get screwed. The price for the autonomy of a private practice is that you work harder for less money per unit of work. The situation has consistently gotten worse for decades. Be completely prepared for it to make more sense to work for a healthcare system. There are reasons everyone else isn't living your dream.
4. Once you're in medical school, there's a low risk you won't have a stable upper middle class income. But there's a significant risk you're not going to get to be the kind of doctor you want. For example, I know a lot of people who had their heart set on surgery and ended up not especially happy in internal medicine. Only a subset of medical specialities are suited to a baller private practice like you're envisioning.
5. The exceptions to point 4 usually occur when doctors are either practicing outside of the scope of what they were trained in, are offering treatments that most doctors would consider scams, or are utilizing an army of midlevels. You wouldn't want a loved one seeing a doctor who does this kind of stuff. You're probably not going to feel good about yourself being the one who does it.
6. If everything goes well, we're talking about 15-20 years of very hard work to get to the kind of life you're imagining. That's a really long time and, despite some amazing experiences and personal growth, those years deeply suck in many ways. Envision your perfect life. It probably involves the freedom to do what you want and more money than a doctor makes. If you were to spend the next 15 years working very hard in the right direction, you can be much closer to that perfect life than you ever would get with medical school.
7. When you're starting older, a lower percentage of your working years will be high income. This hurts more than you realize.
8. The happiest doctors don't spend much time questioning the system you already don't buy into. The most burnt out doctors talk like you already do.
9. To the extent it's worth it, it's because all of those years of hard work mean I can help people in a way few can. It sounds like cheesy premed stuff, but it's true. I don't think less of people who chose a path that doesn't involve this type of satisfaction.

I saw a clip from Person of Interest, that made me think.

“If what interests you is technical mastery, are you really motivated to heal?”

I would primarily be interested in procedural subspecialties. It therefore makes no sense to spend years of my life, training in family, internal, or psych.

What would you recommend in my position?

 

[A Deep Breath]

These decisions are very personal. Take advice from as many people as you can, but take it with a grain of salt. Trust yourself more than anyone else because you care the most.

You have to balance your desire to be a proceduralist vs. how much risk you’re willing to take that you may not match into a procedural speciality and that the work environment may not be what you hope.

I also think more people should envision the life they want and work backwards. Doctors make good enough money for most people, but the way we spend our time is exceptionally rigid. Think about what matters to you.

 

[FogHorn]

These decisions are very personal. Take advice from as many people as you can, but take it with a grain of salt. Trust yourself more than anyone else because you care the most.

You have to balance your desire to be a proceduralist vs. how much risk you’re willing to take that you may not match into a procedural speciality and that the work environment may not be what you hope.

I also think more people should envision the life they want and work backwards. Doctors make good enough money for most people, but the way we spend our time is exceptionally rigid. Think about what matters to you.

I grew up wanting to be an inventor and CEO, Tony Stark, working with his hands. For a variety of reasons, I went down the medical path, and neglected vocational experimentation. I didn’t know any better.

Now that I’m older, I realize there isn’t anything glamorous about either of those things. Edison beat everyone to the lightbulb not by brilliance, but by shear hours. His competition just wasn’t running the same volume of experiments per day. Little has changed, except that international law makes things more litigious.

I’ve been asked if I’d do research, because of how hyper focused and obsessive I can be. Engineers spend their time staring at schematics on the screen, Medical researchers spend their time looking through microscopes and filling pipets. I don’t know that either is appealing to me.

Then there’s the issue of costs. Someone has to pay for that R&D, and that’s either a university or investors. Assuming you manage to convince those stakeholders, that you’re the right horse to back, how do you ensure control of your IP? The chances of you becoming an owner in that world seem very slim.

I actually once read a post by former engineers, who said they switched to medicine because they were tired of staring at computer screens in cubicles. However, their background gave them clear and demoralizing insight into all the operational incompetence at the hospital, which they couldn’t do anything about.

I always figured that surgery would give me a happy middle ground between these issues.

I know people who work in high-level finance and other things, and I had the opportunity to peak behind the curtain, see what “the high life” looks like. While the “high” was nice, what really fascinated me was how these people look at tax laws, minimalism, assets, the methods they use to acquire, trade, and protect them. I knew just enough to keep up with the technical conversations. I felt such a rush realizing that I could develop the capacity to see the world the way they do, and play the game, be a part of the club.

I don’t want to spend what’s left of my youth trying to impress anyone, but I do want to be competent at something, live a generally healthy life, travel, have a spirited independent wife I can build an empire and adventure with, be a stakeholder in my community, and have the possibility of a family.

 

[FogHorn]

I know. I chose medical school with the same dream. Some of what you write reminds me of myself back then. If I could talk to myself 15 years ago, I'd say:
1. A medical practice isn't really a business. It's self-employment. You can start a real business with unlimited upside that can potentially run itself someday, or you can be stuck trading time for money with your own medical practice. A practicing doctor has less time freedom than just about anyone.
2. Scaling a practice doesn't accomplish what you think it will. It mostly lowers overhead so that you'll receive more money per time. Forget about selling a practice for a big payday. Those days are over. If you can even find someone interested in buying your practice at the right time, the deals suck.
3. The current economics of medicine mean that independent practices get screwed. The price for the autonomy of a private practice is that you work harder for less money per unit of work. The situation has consistently gotten worse for decades. Be completely prepared for it to make more sense to work for a healthcare system. There are reasons everyone else isn't living your dream.
4. Once you're in medical school, there's a low risk you won't have a stable upper middle class income. But there's a significant risk you're not going to get to be the kind of doctor you want. For example, I know a lot of people who had their heart set on surgery and ended up not especially happy in internal medicine. Only a subset of medical specialities are suited to a baller private practice like you're envisioning.
5. The exceptions to point 4 usually occur when doctors are either practicing outside of the scope of what they were trained in, are offering treatments that most doctors would consider scams, or are utilizing an army of midlevels. You wouldn't want a loved one seeing a doctor who does this kind of stuff. You're probably not going to feel good about yourself being the one who does it.
6. If everything goes well, we're talking about 15-20 years of very hard work to get to the kind of life you're imagining. That's a really long time and, despite some amazing experiences and personal growth, those years deeply suck in many ways. Envision your perfect life. It probably involves the freedom to do what you want and more money than a doctor makes. If you were to spend the next 15 years working very hard in the right direction, you can be much closer to that perfect life than you ever would get with medical school.
7. When you're starting older, a lower percentage of your working years will be high income. This hurts more than you realize.
8. The happiest doctors don't spend much time questioning the system you already don't buy into. The most burnt out doctors talk like you already do.
9. To the extent it's worth it, it's because all of those years of hard work mean I can help people in a way few can. It sounds like cheesy premed stuff, but it's true. I don't think less of people who chose a path that doesn't involve this type of satisfaction.

To clarify point 2– are you saying that independent doctors currently have a very difficult time retiring, because nobody wants to buy their practice anywhere near the asking price?

 

[Entadus]

I’m a diversely passionate person, with few known specific talents. I’ve spent most of my 20s around the healthcare field at the insistence of family. I stuck with it, because I like science, I like working with my hands, and I want to have skills that make me indispensable. I exited recently, and have been spending that time with family who are old and experiencing critical health issues.

It’s time to get back on the career track, and think about whether or not I want to finish it and become a doctor.

I obsess over details autistically, think like an engineer, communicate like a lawyer scientist, and move like a climber. I am extroverted with self-taught emotional intelligence, but my capacity to interact is cognitively intensive.

I want nothing to do with public hospitals—everyone there is miserable, the economic model is unsustainable, and the residents are waiting for their contract to end so they can leave. The ones who stay, do so because it’s their home, but otherwise resent it. I also want nothing to do with large private equity-driven establishments, as I’ve heard nothing but horror stories, from horrific treatment of patients/workers, to such mismanagement the clinics start losing money and defaulting on their contractual obligations.

I’ve thought about being a surgeon, as I take pride my ability to use my hands—but I’ve worked hard to develop a generally healthy and structured lifestyle.

I’ve been teaching myself chemistry (solid, liquid, material, organic), physics, biology, economics, business management, clinic administration, law, liability, accounting and bookeeping, supply chain, debt and equity financing, payroll practices, tax structuring, sales, entrepreneurship, and competition strategy.

As I approach 30 and learn more about life, I don’t think I want my career to revolve around incremental salary bumps as I work up a hospital’s hierarchy. I want to make choices that give me the shortest route to equity or full ownership, and I want a specialty that has hands-on creativity. I want to provide the best service to patients at the lowest costs without compromising their treatment, and without the overhead interference of management organizations or insurance requirements.

I’ve been teaching myself chemistry (solid, liquid, material, organic), physics, biology, economics, business management, scaling, clinic administration, law, liability, accounting and bookeeping, debt and equity financing, payroll practices, tax structuring, sales, entrepreneurship, and competition strategy.

I know that is an unorthodox approach to the field of medicine—but it is doable? Or am I better off looking elsewhere?

1) biggest red flag is the bolded, imo. If you don't enjoy SERVING the less fortunate (helping the miserable masses who cannot help you back), I would think long and hard before going into healthcare. Even if you don't end up practicing in a public hospital after residency, you will spend years of hard work in many of them (med school + residency +/- fellowship). Do you want to be around sick people??

2) You didn't explicitly state a desire for high income / building wealth. But if that's a high priority for you, I don't think entering medicine as a non-trad is a good approach. Again, you probably need to either be consumed by your craft (ie. overworked surgeon) or thrilled with helping the less fortunate.

3) medicine tends to narrow your options and kill your hobbies/side crafts/passions. Don't get me wrong, there's positives to medicine too, and for the right person, it does open doors. But the default is giving up years of your life for a very narrow focus. Are you ready to SACRIFICE for medicine? (Sacrifice your time, money, energy, health, relationships, geography, LIFE??) Again, if you view the sacrifice as selfless/altruistic service, you will do better

Good luck. Imo you sound too smart and too old to go into medicine. It's a romantic field to outsiders but damn if it's not a long hard road of sacrifice. If you could be happy NOT going to medical school, you probably shouldn't.

EDIT: punctuation

 

[FogHorn]

1) biggest red flag is the bolded, imo. If you don't enjoy SERVING the less fortunate (helping the miserable masses who cannot help you back), I would think long and hard before going into healthcare. Even if you don't end up practicing in a public hospital after residency, you will spend years of hard work in many of them (med school + residency +/- fellowship). Do you want to be around sick people??

2) You didn't explicitly state a desire for high income / building wealth. But if that's a high priority for you, I don't think entering medicine as a non-trad is a good approach. Again, you probably need to either be consumed by your craft (ie. overworked surgeon) or thrilled with helping the less fortunate.

3) medicine tends to narrow your options and kill your hobbies/side crafts/passions. Don't get me wrong, there's positives to medicine too, and for the right person, it does open doors. But the default is giving up years of your life for a very narrow focus. Are you ready to SACRIFICE for medicine? (Sacrifice your time, money, energy, health, relationships, geography, LIFE??) Again, if you view the sacrifice as selfless/altruistic service, you will do better

Good luck. Imo you sound too smart and too old to go into medicine. It's a romantic field to outsiders but damn if it's not a long hard road of sacrifice. If you could be happy NOT going to medical school, you probably shouldn't.

EDIT: punctuation

I don’t have a problem helping the less fortunate—but in the longterm, I would rather do it through an organization that’s adaptable, and doesn’t rely on fixed reimbursements to support a patient volume that is greatly expandable. I like volunteer work, but not seeking tenure under leadership that is operationally, logistically, financially incompetent, unaccountable, and indecisive. Unfortunately, you have an infinite amount of people who need help at any given time. There’s only so much you can do without dropping dead from exhaustion.

I wouldn’t go so far as to say that wealth is my highest priority, but being an owner, stakeholder, contributing to my community, and being in a position to preserve it’s interests is something that matters to me.