A FORK IN MY ROAD - - shall I go left or right???

[notdeadyet]

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I said this before, but I guess I will say it again. Why do some of the sour med school students, residents or attendings (not all just the sour ones) think medicine is the only career that takes sacrifice? There are a lot of 80+ hour per week jobs:
--attorney
--small business owner (restaurant / bar / lawn care , etc)
--teacher (during the school year)
--most managers

There are differences between medicine and other white collar careers. The biggest is sleep deprivation and unpredictable schedules through training. There are exceptions in other fields, the occasional all-nighter, but this is the norm as a physician-in-training (and beyond for many specialties). I don't think its inappropriate to acknowledge the challenges of our field.

I agree with both of you.

punkiedad- Most folks in medicine feel it's the only career that involves sacrifice because for a (shockingly, to me) large percentage of folks in medicine, it's the only career they've had any exposure to.

gastrapathy- I don't think the hours/schedule of business or law school hold a candle to that of med school/residency, though I haven't gone to either of the former.

That said (and I think this is important), you're talking about the training years. Whenever folks reference the "hours" of medicine, they harp on residency, which is a small portion of your career. Hours in your actual post-training are long in medicine, but for most specialties, they're no longer than most white collar careers. Having worked in tech, my average hours were longer than the average listed hours of all but the most hardcore specialty.

If you want to go to med school, plan on some of the longest/least hospitable training schedules of any career path. After that, if you want the 50 hour/week life, you can do so if you choose your specialty appropriately. If this is conducive to your specific family and family situation and its your dream, go for it.

 

[atomi]

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[Gastrapathy]

I agree with both of you.

punkiedad- Most folks in medicine feel it's the only career that involves sacrifice because for a (shockingly, to me) large percentage of folks in medicine, it's the only career they've had any exposure to.

gastrapathy- I don't think the hours/schedule of business or law school hold a candle to that of med school/residency, though I haven't gone to either of the former.

That said (and I think this is important), you're talking about the training years. Whenever folks reference the "hours" of medicine, they harp on residency, which is a small portion of your career. Hours in your actual post-training are long in medicine, but for most specialties, they're no longer than most white collar careers. Having worked in tech, my average hours were longer than the average listed hours of all but the most hardcore specialty.

If you want to go to med school, plan on some of the longest/least hospitable training schedules of any career path. After that, if you want the 50 hour/week life, you can do so if you choose your specialty appropriately. If this is conducive to your specific family and family situation and its your dream, go for it.

This is a nice idea and I hear it all the time. Med school was the easiest part of my training, by far. And now, I work as many hours as I did in fellowship. You CAN choose to work fewer hours in certain situations (milmed not being one of them) but, if you are going to do that, this brings us full circle: why choose medicine at all?

You have to be 100% sure that you want a decade-long apprenticeship. I'm glad I did it but to start that in your late thirties just isn't the same as starting it 15 years earlier. I'm not sure why people are so reluctant to acknowledge this. I'm not saying no one 40+ should go to med school, just that it will be harder. I know it was easier for me to work a 36hr shift a decade ago than it is now.

It sounds like the OP has her heart set on medicine. So, she should go for it. But not military medicine. Please.

 

[atomi]

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[atomi]

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[notdeadyet]

Med school was the easiest part of my training, by far. And now, I work as many hours as I did in fellowship.

Oh, I believe that.

You CAN choose to work fewer hours in certain situations (milmed not being one of them) but, if you are going to do that, this brings us full circle: why choose medicine at all?

This gets dangerously close to the "profession or calling" argument, which I have zero interest in getting into and has been done to death. I disagree with the notion that you should not enter the medical field unless you want to work 90 hours/week the rest of your life. There is a lot of variability in medicine and marytrdom isn't a requirement. If you don't want to work 90 hours/week, there are many specialties and jobs that accommodate this. I don't think less of anyone who wants to have a life outside of medicine and don't think this makes them a worse doctor.

You have to be 100% sure that you want a decade-long apprenticeship.I'm glad I did it but to start that in your late thirties just isn't the same as starting it 15 years earlier. I'm not sure why people are so reluctant to acknowledge this.

Who is? I think everyone probably agrees that it's not the same for a 22 year old as a 37 year old. The big advantage of the 22 year old is (probably) less outside responsibilities and more (probably) energy. The big advantage of a 37 year old is that you're pretty much a fully-fledged adult and not a work in progress. Every physician or resident I've met that says, "god, this was a mistake" came to medicine via the traditional path, probably starting medical school before they settled into who they were.

What I disagree with is how much harder folks seem to think it is for those of us with a few miles on the tires. Either it's a lot rougher for the younger crowd or folks underestimate us older types. I've talked to non-traditional med students, residents, and attendings and don't hear a significantly different set of gripes from anyone. Too little sleep, too little time for those they care about, too little time for an outside life.

I'm not saying no one 40+ should go to med school, just that it will be harder. I know it was easier for me to work a 36hr shift a decade ago than it is now.

Yeah, the sleep schedule is no joke. I'd be curious to see how much of this has to do with age and how much has to do with physical condition. I'd bet it's probably more to do with the the former than I'd hope.

It sounds like the OP has her heart set on medicine. So, she should go for it. But not military medicine. Please.

I'll leave that for the military folks to debate. If the 100 hours/week martyrdom thing is a requirement for milmed, it's probably best suited for the younger crowd. By the time you hit your thirties, you are painfully aware that there is a great world out there outside of your workplace and that trying 100 hours/week is better for quantity than quality.

 

[notdeadyet]

You contradict yourself. At first say that MORE MDs are going into primary care because they are forced into going there (don't know where this is coming from btw), then you say there are more vacancies than MD interest in primary care jobs, suggesting that there are fewer MDs in primary care.

You might reread my post. I said more MDs (if anything) are going into primary care. It's math. The number of allopathic grads is growing faster than the number of residency slots. This means a higher percentage of allopathic grads in the residencies (unless IMGs/FMGs/DOs are gaining cache, which I haven't heard).

And the job opportunities in primary care is a reflection of the demand in the marketplace. It's not tied directly to the number of residency slots.

Post your thoughts in the Family Practice forum and see what kind of response you get. The Sky Is Falling feelings about the dire future of things like Family Practice (due to NPs/PAs) and Anesthesia (due to nurse anesthesists) is much more prevalent in the med school crowd than anywhere else.

The number of allopathic residency slots isn't dropping,?
http://www.medfriends.org/match_statistics/2007 NRMP Match Advanced Data Tables.pdf

Look at Family Med.

You're right. The number of family med spots dropped by 471 spots nationall (or 15%) since 2001. But more spots were opened in 2008 as compared to 2007 (33 slot increase or rise of 1.3%).

I think that Family Med got bloated in the 90's with the big push towards the HMO model that did not fully take off. The idea that was pushed back in the day was that everything would be funneled through a PCP. This didn't really happen, with more and more people pushing for PPOs. I think the residency programs are just correcting themselves.

But again, for the inside dirt of if Family Med is really going the way of the dodo, I'd post in the Family Practice forum and see what kind of replies you get. You might be surprised.

 

[notdeadyet]

People are reluctant to acknowledge this because they are reluctant to acknowledge the realities of getting old. I'm mid 20s,

Please don't take this personally, but hearing about the realities of getting old from someone in their mid-20's reminds me a little bit of the sex talks I used to get from the priests in Catholic school.

I'm mid 20s, and I know that if it were ten years later, I probably would not go down this path, and it would make me very depressed. I don't think it's fair to say that because I wouldn't start 10 years from now, that I shouldn't start now. Life isn't that one-dimensional.

Understood. You would not be cut out for medicine if you started 10 years later. Some of us would not have been cut out for medicine if we'd started 10 years earlier.

I wouldn't presume to tell you that because you couldn't do it 10 years from now that it means you'll be less of a doctor. By extension, presuming to tell someone else how well they'll hack it doing it 10 years later than you probably doesn't carry a lot of water either, right?

 

[punkiedad]

This is a nice idea and I hear it all the time. Med school was the easiest part of my training, by far. And now, I work as many hours as I did in fellowship. You CAN choose to work fewer hours in certain situations (milmed not being one of them) but, if you are going to do that, this brings us full circle: why choose medicine at all?

You have to be 100% sure that you want a decade-long apprenticeship. I'm glad I did it but to start that in your late thirties just isn't the same as starting it 15 years earlier. I'm not sure why people are so reluctant to acknowledge this. I'm not saying no one 40+ should go to med school, just that it will be harder. I know it was easier for me to work a 36hr shift a decade ago than it is now.

It sounds like the OP has her heart set on medicine. So, she should go for it. But not military medicine. Please.

Guys, where in any of my post or even the OPs post does it say anything about wanting easier?? Or less work? I am doing this because I want to help others. I also want to serve my country. I was never so humbled as I was to see the enlisted people at MEPS volunteering to serve their country. It was really cool and only increased desire.

Besides, if I wanted to work less and still make six figures++ I would continue to be a drug rep. It is a really nice living though 😉

Sorry if I lead on I wanted to work less. I just want to be passionate about what I do. I have shadowed 230+ hours. I know what I am looking at. Actually, it is kinda motivating to me.

 

[atomi]

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[atomi]

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[rivera1md]

Just my $0.02: if you want doctor just apply for medical school, at least the first time around. Even if you do everything right (earliest possible app, high MCAT, applied broadly to both DO and MD schools, etc) you should be willing for med school admissions to take 2 admissions cycles. There's an unreasonable amount of luck involved here. If you send out a second round of applications then, MAYBE consider applying for PA school as well. If you want a safety in case you don't get into med school on your first try, maybe a 1 year MPH? They help with match, a little.

Again, this isn't to say that PA is a bad alternative career path, but it seems pretty clear your heart is set on medical school.

what is MPH?

 

[Perrotfish]

what is MPH?

A masters in public health. Probably the most common additional graduate degree for a physician to have, and also one of the only masters degrees you can get in just one year. By no means necessary (unless you're going into infectious diseases) but some residency programs seem to look favorably on it and it opens up some leadership possibilities. Again, this is NOT necessary for a medical career, and most physicians don't have one, but if you have a year to kill I think it would be a better option than PA school. Of course, that's the opinion of an M1, so take it for what it's worth.

 

[Gastrapathy]

Will you tell your terminal patients that it is better to give up than fight because it will cost too much or they will eventually die anyways?

Seems like you should be asking yourself why you went into medicine. I know why I am, and the only thing I am sorry about is that I didn't get it earlier.

I hadn't read your posts on this thread until you responded directly. I'm not sure how this got here from there.

My entire point was that for someone older, there are larger costs associated with deferring earning a staff salary from both a financial and social perspective. From a financial perspective, you have less time to retirement to recoup the cost of longer training. I think I've discussed the social/lifestyle downsides enough. The OP asked what people thought about two paths, I offered my opinion (which wasn't really either path).

None of this was directed at someone who had already decided he was premed.

As for the comment at the top, terminal patients are shunted away from aggressive treatment all the time. Its an important part of "Systems based practice" which is an ACGME core competency. As a system, we spend most health care dollars in the last year of life (and most of that in the last month). We will never be able to reign in costs if we don't do exactly what you seem to have casually dismissed.

 

[punkiedad]

Even if that were true, it's nothing you would need to apologize for or should feel guilty about. There is nothing wrong with wanting to maximize your per-hour compensation in order to reduce your total working hours. It's called efficiency! Being a doctor is not a career that is 100% about service. The sky-high compensation demonstrates that clearly.

wasn't apologizing. wasn't talking about compensation. Now that you have verified you are in your mid twenties, I get it. I was the same way back then. I was about the money more than the fulfillment. My whole point in my mini rants is that it is not, believe it or not, about the money for me. It is what it is.

 

[rivera1md]

Amen - I just hope she doesn't come on and post in a couple hours "Hey guys, I joined the reserves!".......other point - if she joins not as a med student can't she be deployed and have to drill throughout med school, let alone the prereqs

He rescheduled and wants to plan the best time to come over to discuss what the reserves can offer. Based on what you all have told me - - my answer should be no - - okay, got it. Now, I'm just going to have to dodge his phonecalls, or waste my time in entertaining him.

 

[rivera1md]

True of anyone, regardless of age. Don't go to med school unless you're prepared to make sacrifices. If you're 22, that means you making sacrifices and your playing less x-box and hitting less clubs. If you're 27, that means you and your wife making sacrifices and your doing less triathlons. If you're 32, that means you and your family making sacrifices and your playing less golf.

I found this to be so funny, as its so true! You know, I would have loved to start this 10 years ago but honestly, at mid 20's I would not have been ready, mentally. Yes, I would get through it cuz I'm not a quitter, and Yes I would have alot less responsibilities, But my ducks would not be in a row, therefore academically my grades would not be as good. I don't think I would enter the world of medicine with the right attitude either. So for me, its now or never.

 

[rivera1md]

Guys, where in any of my post or even the OPs post does it say anything about wanting easier?? Or less work? I am doing this because I want to help others. I also want to serve my country. .

YES thank you!

 

[punkiedad]

I hadn't read your posts on this thread until you responded directly. I'm not sure how this got here from there.

My entire point was that for someone older, there are larger costs associated with deferring earning a staff salary from both a financial and social perspective. From a financial perspective, you have less time to retirement to recoup the cost of longer training. I think I've discussed the social/lifestyle downsides enough. The OP asked what people thought about two paths, I offered my opinion (which wasn't really either path).

None of this was directed at someone who had already decided he was premed.

As for the comment at the top, terminal patients are shunted away from aggressive treatment all the time. Its an important part of "Systems based practice" which is an ACGME core competency. As a system, we spend most health care dollars in the last year of life (and most of that in the last month). We will never be able to reign in costs if we don't do exactly what you seem to have casually dismissed.

I am not sure how I got on the topic of the terminal patient either. I went back through all th eposts and was tough to follow the pattern. I will watch out with the direct posts and quote thepost I am referring to in the future.............

Anyways, I have cut and pasted your old post:

disagree that this is simple. You are 35. You'll be 36 prior to starting med school, 40 at graduation and a 41 year old intern. Depending on your specialty, you won't finish training until you are 43-48. Thats a decade from now. Worse still, because of the long road and your family situation, you are likely to decide that you need to get done ASAP and therefore choose a primary care field where you will be working side by side with PAs.

Ask a bunch of med studs and doctors this question, guess which answer you'll get. PAs can specialize in all sorts of things. In GI, we have hepatology PAs that manage complex patients, do procedures and manage inpatient transplant services.

I think it depends on what you want to do. If you want to do primary care, starting med school at 36 is nuts. Are you sure you want to be a doctor? If you can't stand any other thought, then welcome to the club. And, why in the world are you joining the Army?

So you seem to be softening your verbiage a little on your latest post. You said earlier anyone that wanted to go into primry care at 36 is nuts. Now you soften it by saying there are just more costs.

I agree with your 'costs' post, in addition, the payback is less.

I guess I will soften my approach a bit as well. You are an attending, so I will respect your opinion. At the same time, please know that as an attending (I am also assuming you are military medicine since you are on this thread, but you also shot that down--though you would not be the first milmed to feel that way) people look to your experience and opinion.

To you going into primary care and starting med shcool at 36 may be nuts, but to me it is my dream. So though I will respect your opinion, please try and respect my motives may not be the same as yours.

I will put this one to rest now.........................