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

I'm so glad this thread got bumped back from the dead. It reminds me that SDN is still human (read: not full of wildly idealistic people who are hoping for rainbows, ponies, Patch Adams clones, and lovey-dovey goodness in med school and beyond).

With a hat-tip to the OP, Onco, and company.
 

macgyver22

Full Member
10+ Year Member
Jan 11, 2008
155
1
  1. Attending Physician
    Even though you did not really address my questions, I think your post makes it clear why you are unhappy....

    I think you've misinterpreted a lot of what I said. Income was only part of the reason I turned away from basic research. Income was not the only thing that attracted me to medicine. I liked the strong emp emphasis on science, and the opportunity to do something important. I liked and still like working with patients.

    As far as picking specialty, badasshairday is right. When went into IM 20 years ago the average internist in my area made 200-250K/year. Most of the IM residencies were filled with very bright students. We didn't have a single FMG in my program of 100 IM residents. Money wasn't my main reason for choosing IM. I felt that whatever I did I would make a comfortable income based on the economics of medicine back then. I went into IM because it is what I really enjoyed. The diagnostic challenges in IM are much greater than they are in any other field. Unfortunately these days its not enough to compensate for the dramatically reduced income and rapidly increasing hassle factor.

    I have to correct something else you said. Its true that no matter what you do in life, your net worth is going to have as much to do with your investing prowess as it does with your income, but that's really beside the point and has nothing to do with the topic here. The implication however, that a business savy physician can make more money in his main occupation than one who isn't needs to be clarified. In short, there is no way to make significantly more unless you are willing to do things that are either immoral or illegal. I'll explain.

    There are internists in my area that make at least $100,000/yr more than I do. these are some of the methods they use.

    1) Perform stress tests in their office and then advise everyone over the age of 50 that this is a recommended part of an annual exam at that age ( its not)

    2) There are many companies that will pay thousands of dollars per month to "rent" space in your office. Once a month they bring in sono, echo and other equipment and perform tests on your patients. There is a blatant conflict of interest here. these companies are paying far above market value for the space with the implied agreement that you will generate business. What always happens is these doctors order many of these tests on patients who don't need them just to keep the money coming in.

    3) Sell designer vitamins to your patients at ridiculous prices and get them to pay for this by abusing their trust in you. At least one doctor in my area quotes bogus studies to back up scare tactics that he uses to get patients to buy these vitamins at $100/bottle.

    4) Do botox injections in your office even though you are not properly trained for this.

    Unfortunately due to the current climate an attitude is developing in the medical community that two wrongs do make a right. Many physicians now seem to feel that since the insurance companies are using underhanded tactics and cheating the doctors, that its OK for us to now do the same. The insurance companies know that some of this goes on and they lower their fees to compensate. The end result is that the doctors who don't cheat are being punished twice. They're not earning all the money that the cheaters are and the insurance companies are reducing their rates so they can pay for the cheating. For those doctors who are playing fair there is little incentive to report any of this. First you rarely have any proof, and most of this stuff isn't technically illegal, just immoral.

    So the next time you you hear of some internist who is doing very well financially ( and I don't mean from his investments) keep in mind that being "savvy" in medicine usual means you've simply decided to sell your moral compass to the highest bidder.
     
    Last edited:

    Jmoh

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    Apr 7, 2008
    11
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    1. Pre-Medical
      Macgyver, I just spent a good hour or so reading this entire thread, and I want to thank you so much for the time you put in and the great answers you have given. I learned so much, and though it hasn't changed any of my current ambitions, it has given me a better understanding of the system.
       
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      macgyver22

      Full Member
      10+ Year Member
      Jan 11, 2008
      155
      1
      1. Attending Physician
        Macgyver, I just spent a good hour or so reading this entire thread, and I want to thank you so much for the time you put in and the great answers you have given. I learned so much, and though it hasn't changed any of my current ambitions, it has given me a better understanding of the system.

        I give you a lot of credit. I don't think I would have had the patience. I'm glad you got something out of it. Good luck.
         

        macgyver22

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        10+ Year Member
        Jan 11, 2008
        155
        1
        1. Attending Physician
          Finally, income is not only specialty-dependent, but individual-dependent as well. These days it takes certain business acumen to make money. Almost no one relies on salary alone to build wealth, no matter how high that salary is (yes, even hedge fund manager salaries). In some states you can pay up to 45.3% tax (happens to be CA). If at the bare minimum you can't figure out ways to avoid at least part of the taxation, then right there half of your income is gone. I know PCPs who are very happy with their job. I also knew a surgeon who made good money but he hated his life and had no family. The nurses hated him too and always talked behind his back. What makes you think that if you had gone into specialty you would fare better? Maybe the income would be higher, but with no love whatsoever for what you do, can you imagine being on the job almost every hour of every day? I don't think you'd like that. The issue is not just income here.

          I meant to address this. It is a common misconception that you can easily lower your tax rate. If you make millions of dollars/yr there are still cost effective tax shelters, but for the average upper middle class person there is not much left. The AMT has pretty much canceled out a lot of the tax havens that were once available to us. I have a pretty sharp accountant who was referred to me by several very bright wall street friends and he has a tough time finding much of anything. Unfortunately there is not a whole lot you can do to keep money from Uncle Sam anymore.
           

          dragonfly99

          Full Member
          10+ Year Member
          May 15, 2008
          5,090
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          1. Attending Physician
            Hi.
            Internal medicine subspecialty fellow here.
            Good post.
            Excelcius, I believe you are wrong in your assessment of mcgyver. Wait another 5-10 years and then see what you think. He doesn't come across as super money-driven to me.

            Part of the problem or issue here is that drmcgyver is living in one of the areas where practicing medicine is not very profitable. If you plan to do any primary care type field or OB/Gyn in urban areas of major cities in Pennsylvania, Massachusetts, California, Chicago or NYC, you may end up with financial difficulties, so plan accordingly (if you are premed). Up to 150k loans I think you'll be fine, but if borrowing 200k, 300k or more, watch out.

            mcgyver, in my case I wanted to do either family practice, general IM or cardiology when I started out in medical school. In med school I liked IM, liked its subspecialties from what I saw, didn't like fp after I saw what it was like, liked surgery but didn't care for the atmosphere, and didn't think I had the grades to be competitive, particularly for ortho, which was the field of surgery I liked. I borrowed only my tuition and had 132 in debt when I graduated in 2004, which luckily I was able to consolidate at 2.9% interest. I did have some money saved prior to going, and my parents also helped me out. Getting such a low interest rate on your loans won't be possible for you current premeds, as the government has now fixed the Stafford at 6.9% I believe (or 6.5%?). That means the rates can't go higher (like 9 or 10%) but also they won't be going down to the 3% range again either. It is necessary to make realistic financial plans. This includes not getting in to credit card debt, driving a cheap car, not living in a luxury apartment unless your parents are paying for it, and if you are married, expecting that your spouse will likely need to work, particularly while you are in school and residency. If you plan to have kids during training, you have to financially plan for that. I honestly don't know how people will manage that with the increasing student loan burdens (say 240k vs. the 130k that I had).

            You don't know what specialty you'll choose, or even which ones you'll be competitive for. You won't all be able to do dermatology, radiology or even ER or anesthesiology even if you want to. I see applications for primary care residencies going down even more in the next 5-10 years.

            Loan repayment options such as the military and primary care shortage areas are an option, but they will get their pound of flesh. Usually for the primary care ones, you have to sign a 3-5 year contract and get probably 20k/year loan repayment for that, which you may have to pay taxes on (as income).
             

            dragonfly99

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            May 15, 2008
            5,090
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            1. Attending Physician
              Both the financial issues and some of the insurance company issues are somewhat better in areas of the country that have a lower cost of living and lower HMO penetrance. For example, a doctor in medium or small sized town in Arkansas, Tennessee or Missouri usually does pretty well financially. The respect issue is separate. I didn't go into medicine thinking I would get a lot of respect, but I did hope for a little more than I do get. I think that more premeds today have lower expectations for both salary and respect than physicians who entered medicine in the 1980's or 1970's and then saw their income go flat and began to get less respect from the general public.

              I would advise all students to make the cost a factor to be considered in where you attend medical school. For the most part the private schools offer the same education, even a worse education in some cases. It is not like undergrad where paying the higher tuition buys you perhaps some better teaching and more opportunities. The schools try to tell you differently but unless you want to do academic research there is probably little or no benefit to attending most private medical schools. Of course you must consider other factors besides cost, but it should be on the list particularly if your family cannot pay your tuition for you. Particularly if you are even considering peds/family practice/general IM it likely does not make sense to pay 20k/year more to a private med school to get the same education (in fact probably a worse education for those interested in primary care).

              I would advise all premed students to realize that interference from the government, insurance companies, hospital bureaucrats and encroachments from other health professions will continue to be issues probably throughout my and your career. You probably will not have nearly the autonomy in decision making that you think you will. For primary care, there is the chance that nurse practitioners or PA's may take over much of it (which from the general public's standpoint might be OK, bad or good...the jury is still out) which may make spending the time to do residency in things like pediatrics and family medicine questionable. For internal medicine, we still have the option of becoming hospitalists specializing in inpatient medicine. Family practice and peds may have that option also, but it's to a lesser extent.

              I would advise you that the government has created a graduated, income-based repayment plan for residents so that you will be required to pay some payments on your student loans while you are a resident. With the current rules it would be 15% of your income, somewhere in the 300/month range or thereabouts. This probably would not cover the interest on your loans so they will get larger while you are a resident unless you choose to pay a greater amount/month. I was able to pay $540/month while a resident most of the time, but I was single with an old car and pretty cheap apartment.
               

              dragonfly99

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              May 15, 2008
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                For those of you wondering what we (med students and physicians) can do to improve patient care and our profession, I recommend joining medical organizations such as your state and local medical societies, and the AMA. I have and although at times people have not agreed with me, nor taken/adopted all of my ideas, that is the price of working with others. I know many of you think that we (docs) "haven't tried" or lack motivation or the smarts to effect change, but I think that is very naive and simplistic, or perhaps just overconfidence on your part. I have only just immersed my toe in the practice of medicine (having just finished residency a year or so ago) and know that I have much more to learn. Please do not assume that you can be the lone ranger reinventing the wheel with no help or input needed from practicing physicians. If the problems in health care were easy to solve, they would be fixed by now. It will be long hard haul, probably to be continued throughout your time practicing.

                Some of the asinine comments toward mcgyver implying that he can't possible be paying 40k in taxes on 140k of income in New York show how ignorant some people on here are about real world issues such as debt and taxes. You also don't know how insurance company and government pressures are going to affect how you practice medicine. It IS annoying after training for 7-13 years to have someone with (in many cases ) less than a college education and who does not have your patient's particular interests in mind deciding whether you can or cannot give a patient a treatment or a certain medicine. And that doesn't have anything to do with being a "greedy" physician. I have no problem with my fellow salary but it would be nice not to be saddled with huge loans and it would be nice if people respected my education a little more. I can live with the fact that they don't and I can live with my 120k debt and am still glad I pursued medicine.
                 

                scarletgirl777

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                Mar 25, 2008
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                  IM and general surgery were among the most competitive specialties 20-30 years ago. They also got compensated best. Also, money can make you like your job more. Sure I like seeing patients and helping them with their health, but I will like it more if you pay me well for it. Also I'll like it even more if I don't have to worry about lawyers and insurance/government taking my hard earned money. Things have changed, so I can see why macgyver feels the way he does. What if you go into a subspecialty of surgery because you can pay off your debt and you enjoy it... but lets say 20 years from now your compensation drops by 50% while your malpractice insurance goes up, wouldn't you be a little annoyed? Sure you may still like what you do, but you might like it less.

                  I remember this thread! So depressing....

                  Anyway, I just wanted to comment on that bold statement. It's amazing how things change! Doctors are the only professionals who can't really count on making more and more money as the years go by.
                   
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                  Excelsius

                  Carpe Noctem
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                  Apr 6, 2008
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                    I think you've misinterpreted a lot of what I said. Income was only part of the reason I turned away from basic research. Income was not the only thing that attracted me to medicine. I liked the strong emp emphasis on science, and the opportunity to do something important. I liked and still like working with patients.

                    As far as picking specialty, badasshairday is right. When went into IM 20 years ago the average internist in my area made 200-250K/year. Most of the IM residencies were filled with very bright students. We didn't have a single FMG in my program of 100 IM residents. Money wasn't my main reason for choosing IM. I felt that whatever I did I would make a comfortable income based on the economics of medicine back then. I went into IM because it is what I really enjoyed. The diagnostic challenges in IM are much greater than they are in any other field. Unfortunately these days its not enough to compensate for the dramatically reduced income and rapidly increasing hassle factor.

                    I have to correct something else you said. Its true that no matter what you do in life, your net worth is going to have as much to do with your investing prowess as it does with your income, but that's really beside the point and has nothing to do with the topic here. The implication however, that a business savy physician can make more money in his main occupation than one who isn't needs to be clarified. In short, there is no way to make significantly more unless you are willing to do things that are either immoral or illegal. I'll explain.

                    There are internists in my area that make at least $100,000/yr more than I do. these are some of the methods they use.

                    1) Perform stress tests in their office and then advise everyone over the age of 50 that this is a recommended part of an annual exam at that age ( its not)

                    2) There are many companies that will pay thousands of dollars per month to "rent" space in your office. Once a month they bring in sono, echo and other equipment and perform tests on your patients. There is a blatant conflict of interest here. these companies are paying far above market value for the space with the implied agreement that you will generate business. What always happens is these doctors order many of these tests on patients who don't need them just to keep the money coming in.

                    3) Sell designer vitamins to your patients at ridiculous prices and get them to pay for this by abusing their trust in you. At least one doctor in my area quotes bogus studies to back up scare tactics that he uses to get patients to buy these vitamins at $100/bottle.

                    4) Do botox injections in your office even though you are not properly trained for this.

                    Unfortunately due to the current climate an attitude is developing in the medical community that two wrongs do make a right. Many physicians now seem to feel that since the insurance companies are using underhanded tactics and cheating the doctors, that its OK for us to now do the same. The insurance companies know that some of this goes on and they lower their fees to compensate. The end result is that the doctors who don't cheat are being punished twice. They're not earning all the money that the cheaters are and the insurance companies are reducing their rates so they can pay for the cheating. For those doctors who are playing fair there is little incentive to report any of this. First you rarely have any proof, and most of this stuff isn't technically illegal, just immoral.

                    So the next time you you hear of some internist who is doing very well financially ( and I don't mean from his investments) keep in mind that being "savvy" in medicine usual means you've simply decided to sell your moral compass to the highest bidder.

                    I meant to address this. It is a common misconception that you can easily lower your tax rate. If you make millions of dollars/yr there are still cost effective tax shelters, but for the average upper middle class person there is not much left. The AMT has pretty much canceled out a lot of the tax havens that were once available to us. I have a pretty sharp accountant who was referred to me by several very bright wall street friends and he has a tough time finding much of anything. Unfortunately there is not a whole lot you can do to keep money from Uncle Sam anymore.


                    I think you are somewhat missing my main point. Doing well financially does not necessarily mean receiving the highest salary. Business acumen means that you have the skills and the drive to not rely only on your income. That's why someone who is making far less money than you are can be more financially successful - and I know several people like that. Anyone who relies on salary alone is not going to become wealthy. Since doctors are still in the top 10% or so of income earners in USA, they are in the best position to make their money work for them.

                    Also, it is NOT up to your accountant to save you money. Your accountant is not your personal consultant. All he does is ask you to give him your financial statements, Quicken, Quickbooks, etc, and based on that he tries to save you as much money as possible. He only works with whatever you give him. "Garbage in, garbage out" is completely apropos here. It is really up to you to be financially involved in other areas as to allow not only for additional tax breaks, but additional income. I disagree with you that "all savvy doctors have sold their moral compass to the highest bidder." Besides being a blanket statement, it reveals a certain level of inflexibility. What makes you think that the only way you can make extra money must be related to medicine?

                    Since you may disregard arguments from someone who is not aged enough, I refer you to a very bright attending right here on SDN: Andrew Doan. Read these posts by him (and threads too): Post 22, For those seeking financial independence

                    It's interesting to see how many people don't get what he's trying to say. They blame the books for not being "specific" enough, etc. But, you either get it or you don't. And many don't.

                    One more observation: I assume that you have been practicing for many years. Since the compensation for primary doctors didn't change overnight, it means that you have had a chance to work under the previous system which according to you was much more generous to primary doctors. Judging by your posts, I assume that you really have not accumulated enough wealth, even during those years when you were compensated enough. This again illustrates my point that if you don't manage your money properly, it doesn't really matter if you make a lot of money or not. You should probably be happy that your income is in the top 10% of US because you if you made as much money as those with masters degrees or Ph.D.s (average of about 60K), I doubt you could make ends meet.

                    Just to be clear, I agree with you that given the expense and duration of medical education, primary doctors are not compensated enough. But my point is that even with that income you have many options to explore secondary sources of income without having to impugn morality.
                     

                    OncoCaP

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                    Aug 28, 2006
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                    1. Medical Student
                      I think you are somewhat missing my main point. Doing well financially does not necessarily mean receiving the highest salary. Business acumen means that you have the skills and the drive to not rely only on your income. That's why someone who is making far less money than you are can be more financially successful - and I know several people like that. Anyone who relies on salary alone is not going to become wealthy. Since doctors are still in the top 10% or so of income earners in USA, they are in the best position to make their money work for them.

                      Also, it is NOT up to your accountant to save you money. Your accountant is not your personal consultant. All he does is ask you to give him your financial statements, Quicken, Quickbooks, etc, and based on that he tries to save you as much money as possible. He only works with whatever you give him. "Garbage in, garbage out" is completely apropos here. It is really up to you to be financially involved in other areas as to allow not only for additional tax breaks, but additional income. I disagree with you that "all savvy doctors have sold their moral compass to the highest bidder." Besides being a blanket statement, it reveals a certain level of inflexibility. What makes you think that the only way you can make extra money must be related to medicine?

                      Since you may disregard arguments from someone who is not aged enough, I refer you to a very bright attending right here on SDN: Andrew Doan. Read these posts by him (and threads too): Post 22, For those seeking financial independence

                      It's interesting to see how many people don't get what he's trying to say. They blame the books for not being "specific" enough, etc. But, you either get it or you don't. And many don't.

                      One more observation: I assume that you have been practicing for many years. Since the compensation for primary doctors didn't change overnight, it means that you have had a chance to work under the previous system which according to you was much more generous to primary doctors. Judging by your posts, I assume that you really have not accumulated enough wealth, even during those years when you were compensated enough. This again illustrates my point that if you don't manage your money properly, it doesn't really matter if you make a lot of money or not. You should probably be happy that your income is in the top 10% of US because you if you made as much money as those with masters degrees or Ph.D.s (average of about 60K), I doubt you could make ends meet.

                      Just to be clear, I agree with you that given the expense and duration of medical education, primary doctors are not compensated enough. But my point is that even with that income you have many options to explore secondary sources of income without having to impugn morality.

                      The main difference is that he's speaking of his experience, which is a very common one, and you are speaking idealistically and quoting idealists. This isn't to say that there is anything wrong with idealism or that experience is somehow better; they are just different, that's all. There are plenty of practicing physicians who like their jobs also (including the one you cited) but there is no guaranteed formula for liking your job as a physician. You take your chances going into this field. He's not missing your point. He's giving his experience and pointing out that a lot of us are not going to be very happy campers once we become physicians. You can be saving up a ton of money and still be extremely unhappy about your job as a physician. As long as you are getting your joy in life from something other than financial rewards, respect, etc., you might be OK.

                      This isn't to say that there aren't many reasons for being extremely grateful as a physician in his situation. He's just mystified when he and many of his compatriots are feeling demoralized and defeated to a certain extent ... like rats looking to abandon a sinking ship ... why there are all these fresh recruits signing up to go to war completely unaware of how miserable many physicians feel about their careers? I can think of many amazing physicians who are just completely miserable; it's a kind of curse. It mystifies me also to a certain extent, but I don't deny it's reality. Of course there are plenty of happy physicians also. Personally, I get the sense that there is an atmosphere of false expectations in going into medicine. That if you do everything right, you'll be happy and financially successful. For me, I'm always amused how people focus on doing what you like in picking your specialty, etc. when so few people actually get to do what they like (that doing what you like for a living is the exception, rather than the rule). Would you advise a kid who likes to play football to go for a career in professional football because that's what he likes (more than studying other school stuff, say)? Unless the kid shows unreal football talent, you would probably not be helping the kid by advising him to do the minimum to pass and focus on football as a career; you'd probably suggest a balance between doing fun stuff and studying, even if studying is not a lot of fun for this kid (even though he might wind up coaching football and enjoy many aspects of the game). The idea that most people love their jobs is simply not the case. It's more like 50/50 in the general U.S. population and less so among physicians. While ~50% of the general population is "completely satisfied" with their job, many physicians would advise students to consider other careers. Don't get me wrong, there are plenty of miserable engineers and teachers out there also. Becoming a physician is no longer considered to be one of the top career choices for many people. There are plenty of physicians who do love their jobs, but you can't assume that you'll wind up in that category. For a variety of reasons, physicians think that after all the trouble they have been through to get there and the value that they provide, they deserve a rewarding job; that's often not the case. I guess as long as you are prepared for your job as a physician to be very stressful and not unusually rewarding financially (considering the investment and time lost) and in other respects (making a positive difference is very difficult in some situations) then you might not have unrealistic expectations and be prepared for the slog through your career without too much bitterness, should things be somewhat difficult (might not want to defer gratification so much if you are going to become a physician; seek a balance between life and work as much as possible.).

                      http://www.gallup.com/poll/109738/US-Workers-Job-Satisfaction-Relatively-High.aspx

                      http://www.rwjf.org/reports/grr/027069.htm

                      http://www.gpscholar.uthscsa.edu/gpscholar/FacultyScholars/cr/genmed/library/aimvol162pg1577.pdf

                      http://www.usnews.com/articles/business/best-careers/2008/12/11/overrated-career-physician-2009.html

                      http://www.usnews.com/sections/business/best-careers/


                      I've talked to successful cardiologists and have them tell me things like "we're seeing a lot more patients for the same or less money" (having to work much harder but barely or not keeping up). Or talked to a 2nd generation ophthalmologist with a huge practice and have him tell me that if he had to do it all over again, he wouldn't do medicine ... too much work compared to other options for the money. I've talked to a general surgeon who leads a large group who hates the politics of his job, but in his case isn't bothered by the declining compensation. It's not always about compensation. The number of physicians who have tried to talk me out of medicine vastly outnumbered those who think its a great career. I just tell them I'm not going into it because I think it's going to be a fun job. I tell them I'm doing it because it's something I want to do, whether it's enjoyable or not. I see and appreciate the value of the work that physicians do, whether I personally benefit from the value I provide or not.
                       
                      Last edited:

                      Bigpwn

                      Resident
                      10+ Year Member
                      Apr 9, 2008
                      37
                      0
                      1. Resident [Any Field]
                        Medicine is always going to be attractive.
                        1. One of the few careers that your value increases as you age.
                        2. You will never face unemployment.
                        3. High social prestige.
                        4. Extremely gratifying.
                        5. If you are a surgeon, OR days are exciting.
                        6. Good income.

                        The above is not in any order.

                        I am currently an ENT resident. I love almost every moment of it. All my faculties are as enthusiastic as the first day they started. Gotta love it.
                         

                        OncoCaP

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                        Aug 28, 2006
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                        1. Medical Student
                          Medicine is always going to be attractive.
                          1. One of the few careers that your value increases as you age.
                          2. You will never face unemployment.
                          3. High social prestige.
                          4. Extremely gratifying.
                          5. If you are a surgeon, OR days are exciting.
                          6. Good income.

                          The above is not in any order.

                          I am currently an ENT resident. I love almost every moment of it. All my faculties are as enthusiastic as the first day they started. Gotta love it.

                          Very cool. It's always wonderful when you enjoy what you are doing. Just out of curiosity, do you have a lot of debt from your med school years (and if so, are your pretty confident you'll be able to pay that back reasonably quickly)?

                          Also, do you think you would enjoy pretty much any residency (IM, General Surgery etc.) or is there something about being an ENT resident that appeals to you (makes it worth it when it otherwise wouldn't be)? After all, most people won't be able to match into ENT even if they wanted to. I've talked to the Urology residents and they said that the first general surgery year is rough due to the workload and working conditions, but it can be more enjoyable after that (when they do Urology work which maybe is more interesting to them).
                           
                          Last edited:

                          Excelsius

                          Carpe Noctem
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                          Apr 6, 2008
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                            The main difference is that he's speaking of his experience, which is a very common one, and you are speaking idealistically and quoting idealists. This isn't to say that there is anything wrong with idealism or that experience is somehow better; they are just different, that's all. He's not missing your point. He's giving his experience and pointing out that a lot of us are not going to be very happy campers once we become physicians. You can be saving up a ton of money and still be extremely unhappy about your job as a physician. As long as you are getting your joy in life from something other than financial rewards, respect, etc., you might be OK.

                            This isn't to say that there aren't many reasons for being extremely grateful as a physician in his situation. He's just mystified when he and many of his compatriots are feeling demoralized and defeated to a certain extent ... why there are all these fresh recruits signing up to go to war completely unaware of how miserable many physicians feel about their careers? I can think of many amazing physicians who are just completely miserable; it's a kind of curse. It mystifies me also to a certain extent, but I don't deny it's reality. Of course there are plenty of happy physicians also. Personally, I get the sense that there is an atmosphere of false expectations in going into medicine. That if you do everything right, you'll be happy and financially successful. For me, I'm always amused how people focus on doing what you like in picking your specialty, etc. when so few people actually get to do what they like (that doing what you like for a living is the exception, rather than the rule). Would you advise a kid who likes to play football to go for a career in professional football because that's what he likes (more than studying other school stuff, say)? Unless the kid shows unreal football talent, you would probably not be helping the kid to do the minimum to pass and focus on football as a career; you'd probably suggest a balance between doing fun stuff and studying, even if studying is not a lot of fun for this kid (even though he might wind up coaching football and enjoy many aspects of the game). The idea that most people love their jobs is simply not the case. It's more like 50/50 in the general U.S. population and less so among physicians. While ~50% of the general population is "completely satisfied" with their job, many physicians would advise students to consider other careers. Don't get me wrong, there are plenty of miserable engineers and teachers out there also. Becoming a physician is no longer considered to be one of the top career choices for many people. There are plenty of physicians who do love their jobs, but you can't assume that you'll wind up in that category. For a variety of reasons, physicians think that after all the trouble they have been through to get there and the value that they provide, they deserve a rewarding job; that's often not the case. I guess as long as you are prepared for your job as a physician to be very stressful and not unusually rewarding financially (considering the investment and time lost) and in other respects (making a positive difference is very difficult in some situations) then you might not have unrealistic expectations and be prepared for the slog through your career without too much bitterness, should things be somewhat difficult (might not want to defer gratification so much if you are going to become a physician; seek a balance between life and work as much as possible.).

                            http://www.gallup.com/poll/109738/US-Workers-Job-Satisfaction-Relatively-High.aspx

                            http://www.rwjf.org/reports/grr/027069.htm

                            http://www.gpscholar.uthscsa.edu/gpscholar/FacultyScholars/cr/genmed/library/aimvol162pg1577.pdf

                            http://www.usnews.com/articles/business/best-careers/2008/12/11/overrated-career-physician-2009.html

                            http://www.usnews.com/sections/business/best-careers/

                            I've talked to successful cardiologists and have them tell me things like "we're seeing a lot more patients for the same or less money" (having to work much harder but barely or not keeping up). Or talked to a 2nd generation ophthalmologist with a huge practice and have him tell me that if he had to do it all over again, he wouldn't do medicine ... too much work compared to other options for the money. I've talked to a general surgeon who leads a large group who hates the politics of his job, but in his case isn't bothered by the declining compensation. It's not always about compensation. The number of physicians who have tried to talk me out of medicine vastly outnumbered those who think its a great career. I just tell them I'm not going into it because I think it's going to be a fun job. I tell them I'm doing it because it's something I want to do, whether it's enjoyable or not. I see and appreciate the value of the work that physicians do, whether I personally benefit from the value I provide or not.

                            Idealism is good only if it is not completely far fetched and unreachable. I know that since I haven't experienced the life of a physician (you have not either), I brought an example of an attending who demonstrates a similar ideology to mine. If you are calling him an idealist as well, I am not sure if there is anything I can say that can be convincing enough.

                            You are talking about getting your joy in life even without the high salary. Macgyver is clearly not happy because of the finances and that's why I questioned whether financial motivation was the only thing guiding him to medicine. The research company where I work has many scientists working around the clock. We are working on a huge project and people come early in the morning and leave very late in the evening. Then they also come back to work during the weekends. Many people clock double time and the pay is miserable compared to what a doctor would make. Still, just talk to some of these people. They are in love with their job despite all the hurdles and low income. It is contagious to speak to these people. Do you think they don't face challenges as doctors do? They have to work against bureaucracy all the time (the quality assurance department) and if they screw something up, the project will be terminated and they will be laid off. Even if they complete the project successfully, they will still be laid off unless they're really good. Doctors definitely face their own challenges, but what macgyver doesn't realize is that challenges are not enough to turn someone away from the war. If you like something, you fight for it. The reason physicians' lives suck right now is because the past generation of physicians didn't fight enough for their rights. That's why they have left nothing but grief and complaints for the new generation of pre-meds.

                            You do make some valid points and I don't disagree with you. I am just saying that the approach can be different. I looked at your sources and they indicate that physician satisfaction is on par with the national average of job satisfaction. However, a more reliable source (a little older) says that physician satisfaction is much higher than the national average: 70%. Another source listed Immigration Specialist as a top job, while physicians as overrated. I found that interesting because I know an immigration specialist who works close to 80 hours a week and barely makes ends meet. Again, this is only a perspective as to what a job is supposed to be "overrated."

                            You make a great point about landing the residency you need. I don't think I'll agree with you that matching into competitive residency is as hard as becoming a professional football player (some ROADS residencies have over 80% match rate), but your main idea is correct. This is why I disagree when a med student tells pre-meds that they should just relax and not worry about residency at this point. I believe that you need to prepate for residency even before you start med school. Sure, you may change your mind along the way, but you have nothing to lose if you prepare for a competitive residency ahead of time. I have seen so many pre-meds choose medical schools just based on price, without trying to find out whether that med school is known for the specialty they want to go in. I have seen med students post threads like "P=MD," having no clue that just passing a course even at a P/F school can be disastrous. There are also some who do very poorly on Step 1 simply because they weren't sure of it's importance. Others lack research. The list goes on and on. If you know what you want and you do everything possible to get it well in advance, I think the chances are very high that you will match into any residency you want.
                             

                            Excelsius

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                              Also, do you think you would enjoy pretty much any residency (IM, General Surgery etc.) or is there something about being an ENT resident that appeals to you (makes it worth it when it otherwise wouldn't be)? After all, most people won't be able to match into ENT even if they wanted to. I've talked to the Urology residents and they said that the first general surgery year is rough due to the workload and working conditions, but it can be more enjoyable after that (when they do Urology work which maybe is more interesting to them).

                              I am sure that many people like only specific residencies. There are even some who simply cannot do certain specialties just based on their Keirsey personality. If you end up in a specialty you don't want to be in, this is probably the worst thing that can happen to you. I wonder - is there a statistic showing what percentage of US graduates end up in specialties they don't want to be in? This will remove the argument that the reason a specialty like NS has over 80% match rate is because of students' self-selectiveness (not applying if they don't think they'll make it).
                               

                              OncoCaP

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                                Idealism is good only if it is not completely far fetched and unreachable. I know that since I haven't experienced the life of a physician (you have not either), I brought an example of an attending who demonstrates a similar ideology to mine. If you are calling him an idealist as well, I am not sure if there is anything I can say that can be convincing enough.

                                You are talking about getting your joy in life even without the high salary. Macgyver is clearly not happy because of the finances and that's why I questioned whether financial motivation was the only thing guiding him to medicine. The research company where I work has many scientists working around the clock. We are working on a huge project and people come early in the morning and leave very late in the evening. Then they also come back to work during the weekends. Many people clock double time and the pay is miserable compared to what a doctor would make. Still, just talk to some of these people. They are in love with their job despite all the hurdles and low income. It is contagious to speak to these people. Do you think they don't face challenges as doctors do? They have to work against bureaucracy all the time (the quality assurance department) and if they screw something up, the project will be terminated and they will be laid off. Even if they complete the project successfully, they will still be laid off unless they're really good. Doctors definitely face their own challenges, but what macgyver doesn't realize is that challenges are not enough to turn someone away from the war. If you like something, you fight for it. The reason physicians' lives suck right now is because the past generation of physicians didn't fight enough for their rights. That's why they have left nothing but grief and complaints for the new generation of pre-meds.

                                You do make some valid points and I don't disagree with you. I am just saying that the approach can be different. I looked at your sources and they indicate that physician satisfaction is on par with the national average of job satisfaction. However, a more reliable source (a little older) says that physician satisfaction is much higher than the national average: 70%. Another source listed Immigration Specialist as a top job, while physicians as overrated. I found that interesting because I know an immigration specialist who works close to 80 hours a week and barely makes ends meet. Again, this is only a perspective as to what a job is supposed to be "overrated."

                                You make a great point about landing the residency you need. I don't think I'll agree with you that matching into competitive residency is as hard as becoming a professional football player (some ROADS residencies have over 80% match rate), but your main idea is correct. This is why I disagree when a med student tells pre-meds that they should just relax and not worry about residency at this point. I believe that you need to prepate for residency even before you start med school. Sure, you may change your mind along the way, but you have nothing to lose if you prepare for a competitive residency ahead of time. I have seen so many pre-meds choose medical schools just based on price, without trying to find out whether that med school is known for the specialty they want to go in. I have seen med students post threads like "P=MD," having no clue that just passing a course even at a P/F school can be disastrous. There are also some who do very poorly on Step 1 simply because they weren't sure of it's importance. Others lack research. The list goes on and on. If you know what you want and you do everything possible to get it well in advance, I think the chances are very high that you will match into any residency you want.

                                I don't know. I'm an idealist, and there have certainly been times when I enjoyed my little fantasies quite apart from real life. I would say I'm a happy person in large part because I'm an idealist ... I don't let the daily grind of life get me down, so to speak.

                                I know you make a big deal about Dr. Doan. In fact, let me quote him. Here's what he said here:
                                http://forums.studentdoctor.net/showpost.php?p=2704477&postcount=27

                                ***********
                                "I am in the rat race if I must work for a paycheck. The key is to keep the day job and mind a business/idea/intellectual property at night to produce passive income.

                                "The rat race in medicine is when insurance companies and Medicare dictate how much we are paid. Surgeons must see more and more patients and complete more surgery to make ends meet.

                                "I don't advocate quitting your day job. I encourage you to be the best doctor you can be for your patients!
                                ***********

                                On that thread I also asked him how much of his income comes from his passive investments. I'll wait to find that out.

                                Anyway, I personally have owned and run a business and generated plenty of money with it. It can be done, but I did it as an active owner rather than passive investor. We don't need to read too far down the front pages to see that a lot of investments aren't doing so well these days and how a lot of businesses are no longer around. Investments are not risk free. Generally, the more you stand to gain, the more you stand to lose as well (as in your entire investment). I personally prefer active investments because it's a lot more difficult for your operators to pull the wool over your eyes in terms of what is going on financially.

                                If someone like Dr. Doan is saying in so many words that physicians depending on their paycheck is a "rat race" ... that's not exactly a "thumbs up" for the profession if you know what I mean. Perhaps Dr. Doan would look more favorably on practices that were cash-only (and thus not dependent on insurance companies and medicare), and some physicians are going that route ... some with good results. I asked him about that in my post as well.

                                I agree, there are a lot of people working hard who really like their jobs. I'm not sure I entirely understand why so many physicians hate (and I do mean HATE) their jobs. To see someone incredibly gifted doing amazing work for so many patients tell me that they really can't stand their job and recommend that I do something else, is well, is a bit shocking.

                                I'm in my second year of medical school and I really like it. However, I can see why many people don't like it. The people I'm around are used to being the smartest people at whatever they did before. In medical school, everyone is redistributed and that really hurts for the people who aren't on top; the people on top work their tails off also and feel a fair amount of stress.

                                I don't want to come across as overly negative, and I don't think that saying that most physicians aren't going to like their job is overly negative ... it's what I'm observing at the moment, whether it should be that way or not. Reading and following "Rich Dad Poor Dad" as Dr. Doan suggests is not going to change the job satisfaction of most physicians.
                                 
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                                OncoCaP

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                                  I am sure that many people like only specific residencies. There are even some who simply cannot do certain specialties just based on their Keirsey personality. If you end up in a specialty you don't want to be in, this is probably the worst thing that can happen to you. I wonder - is there a statistic showing what percentage of US graduates end up in specialties they don't want to be in? This will remove the argument that the reason a specialty like NS has over 80% match rate is because of students' self-selectiveness (not applying if they don't think they'll make it).

                                  Yes, I agree. Bigpwn says that "Medicine" will always be attractive. I'm sure Bigpwn is a smart cookie if s/he matched into ENT, even if it was at his/her own school ... that's a competitive specialty. The very best medical students I know are going into fields like ENT, ophtho, plastics. I'm guessing s/he was probably in the upper 50% of her/his class, maybe a lot higher than that. ENT really isn't an option for most medical students. It really isn't even on the radar unless you are a top medical student as far as I can tell.

                                  For him/her to say that s/he's loving PGY-1 (which at some schools is the same as general surgery) is interesting to me. Maybe PGY-1 is a cake walk for Bigpwn, but I'm guessing that maybe there is something about it that makes it "extremely gratifying" and "exciting" (perhaps the challenge, instant positive outcomes...). Residents don't have a very high income (yet).

                                  What I hear from the general surgery residents too often is "don't go into this field under any circumstances ... if you like it, I guess you have no choice." Some Urology residents have told me their PGY-1 was their roughest year in terms of the workload and really made them appreciate the fact that they were not going to go into General Surgery. Maybe Bigpwn has some insight as to why it worked out so well for her/him and not for many others; those things are always good to know.

                                  I really don't know what to make of NS & its match rate. I get the impression that most medical students probably go for specialties that they have a reasonable chance of getting into. Maybe someone who wasn't qualified for NS would get the message when they weren't getting any interviews and change direction before they find themselves "scrambling." The way I look at a 80% match rate in neurosurgery is that out of 100 people, maybe 95 of whom were very well qualified and competitive, only 80 got the thumbs up and the other 15 had to figure out if they were going to try to strengthen their resume with a research year or similar avenue or go into something less competitive.

                                  I know that the two neurosurgeons I spoke to most recently (residents in their final year) were very cynical about their career. They didn't exactly suggest that their field was a good one to go into, even though they are probably going to make a very high income when they get out.
                                   
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                                  Nilf

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                                    I don't mean to sound like an ass, but what if a few patients die if doctors go on strike? At least maybe our society will start helping us get rid of the hassles and limitations that are making doctors' lives a living hell, and will help us to ultimately save lives on the long run. Maybe if we put our altruistic crap aside for a second, and simply fought for our rights, we'd get further (or at least somewhere). Obviously this is just hypothetical. But it does make me think.

                                    I can't think of a plumber who will give two craps if a home is getting flooded - he will not come and fix anything if he won't get paid fairly.

                                    At the end of the day, medicine is just another job, and we deserve to get compensated fairly, just like everyone else.

                                    When I was a third year I witnessed Ob-Gyns doctors go on strike over malpractice premiums and tort reform. I've heard one of them utter the sentence: "Patients must suffer in order for things to get better".

                                    Several years have passed, and things got worse. And they won't be getting any better, not with this administration.
                                     

                                    Nilf

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                                      Medicine is always going to be attractive.
                                      1. One of the few careers that your value increases as you age.
                                      2. You will never face unemployment.
                                      3. High social prestige.
                                      4. Extremely gratifying.
                                      5. If you are a surgeon, OR days are exciting.
                                      6. Good income.

                                      The above is not in any order.

                                      I am currently an ENT resident. I love almost every moment of it. All my faculties are as enthusiastic as the first day they started. Gotta love it.

                                      Point by point:
                                      1. Your value increases as you age and get experience in almost ANY career.
                                      2. Depends on your specialty and where you are willing to live. I personally know unemployed doctors.
                                      3. Agreed, but IMO it won't last, as it's tied to income.
                                      4. Agree.
                                      5. Disagree.
                                      6. Depends on your specialty, place you practice. Rest assured, the incomes will decrease, hence #3.
                                       
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                                      han14tra

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                                        Are you aware of what's going on? What have you heard?
                                        Lots of uninsured people. However, that's only the tip of the iceberg. Insurance companies in general are a problem. They treat the patients poorly, and they treat the doctors poorly. Access to care can be a problem because of insurance companies, but also because of geographic barriers (rural).

                                        What are your expectations in regards to earnings?
                                        I don't care. I just want to work for the people who need help. Money is only nice so that I can use it to do something for the community. I grew up on $30,000 a year for a family of 4 and I don't plan on living differently once I'm a doctor.

                                        What are your expectations for quality of life?
                                        Good. I will be very satisfied because I get to do what I love.

                                        What kind of medicine to you hope to practice? Rural FM.
                                         
                                        Are you aware of what's going on? What have you heard?
                                        Lots of uninsured people. However, that's only the tip of the iceberg. Insurance companies in general are a problem. They treat the patients poorly, and they treat the doctors poorly. Access to care can be a problem because of insurance companies, but also because of geographic barriers (rural).

                                        What are your expectations in regards to earnings?
                                        I don't care. I just want to work for the people who need help. Money is only nice so that I can use it to do something for the community. I grew up on $30,000 a year for a family of 4 and I don't plan on living differently once I'm a doctor.

                                        What are your expectations for quality of life?
                                        Good. I will be very satisfied because I get to do what I love.

                                        What kind of medicine to you hope to practice? Rural FM.

                                        I appreciate the idealism, but you are going to get picked apart, either in this thread or in the minds of its readers. I think it's hard to say you won't care about earnings, quality of life, etc., until after you've already gone through medical training and have all of the usual post-training worries.

                                        But hey, good for you. May you still be like that once you have your degree. :thumbup:
                                         

                                        OncoCaP

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                                          I couldn't agree more...:)

                                          Many patients are suffering now and things are not getting better. I just read an article the other day on CNN how a pregnant mom had a physician induce her ASAP because she was about to be laid off and would lose her insurance. The insurance denied the claim and she was stuck with and $18K bill anyway. Not exactly optimal. We know we need truly portable insurance (not $2000/month insurance you can continue after your job ends and you have no money for rent, let alone a huge insurance bill) for every American and hopefully that will come with the next administration. Even under the best-case scenario, this would likely take a while to be implemented and it might not address care for immigrants who still have health issues while living and working here and show up at the ER because they can't pay or show up to deliver a child, the health of which is a complete unknown. Part of the problem here is that physicians who do want to make improvements in patient care and physician quality of life are quite limited in how much they can innovate. If you propose something that is quite different from how things have been done in the past, you run a risk of everything from the ire of your fellow physicians, aggravating members of your community, lawsuits or all of the above.

                                          For example, let's say you were concerned about the fact that there was an 8-12 hour wait at an emergency room because there were many people there who needed essentially primary care for a cold, stomach flu, etc., and that although perhaps these were painful and unpleasant conditions warranting care, they were often not true emergencies. Let's further assume that it cost the ER ~$200 to process any of these "not so sick" patients mainly because they were coming to an ER with it's high cost of operation, and this was money obtained through cost-shifting to paying patients and to the county, state, or other sources. The hospital was burdened financially, the care was spotty (nothing preventative because patients only came when they or their child was miserable), and ER physicians were not enjoying this crush of non-emergency patients either.

                                          Initially you carefully considered getting a grant for physician deliverd primary care for these patients, many of whom have little cash and no insurance, but could not find enough primary care physicians to provide it and the cost would have been even higher because after some pilot studies it turned out that this alternative was actually more convenient (sans the 12 hour wait) and more patients under this pilot went to their primary physician more often than they used to go to the ER. No only that, but state bureaucrats wanted to pay physicians much less than the going rate which would make it even less likely that you would find the physicians you needed.

                                          Rather than just give up and continue the slog, you wanted to do something, and so you decided that it would be better for patients with minor ailments to see a PA clinic at a nearby Wal-Mart or CVS, where the cost was ~$60/patient and there was maybe a 30 minute wait and decided to apply for a grant to the state to fund this option for patients who can't pay the $60 either, but reducing the overall cost and perhaps improving care because patients might be more likely to see the PA for minor issues if the wait is 30 minutes, available where they shop, thereby eliminating some of the barriers that play a role in patients waiting too long and not getting preventative care. Furthermore, you also propose similar PA-run OB/GYN clinics in shopping centers to reduce the number of poor mothers who get no prenatal care.

                                          In pursuing this kind of grant, you might find that the people who would shoot this grant proposal down might be physicians who don't like the idea of promoting PA-delivered care as it represents a threat to their revenues and potentially inferior care because PA's don't have as much training and community members who don't like the idea of funding health care for poor immigrants (even though this care would be available to them also, would reduce the wait for true emergencies, and the care for immigrants is going to be funded anyway at a much higher rate otherwise). You would think that promoting this kind of alternative would either lead to its approval or the proposal of an even better idea. But, that's not what happens. Your colleagues and community leaders might ensure the idea is shot down and never bother to propose a viable alternative.

                                          You might find that your colleagues feel like you are promoting inferior care never really thinking too much about the fact that many patients wait a long time to get care under the current system and there are mothers showing up to deliver a very ill babies that will need amazingly expensive emergency neonatal care that either could have been planned for or perhaps prevented with antibiotics, antivirals, or other well established measures. I'm not suggesting there are easy answers to these problems, but because physicians themselves are often uncomfortable with any innovative changes, the problem never gets resolved until legislators are forced to address the problem, often with band-aids and solutions that are even less satisfactory than what physicians could have come up with if they had chosen to address the problem and come up with actual actions instead of just complaining about it.

                                          If physicians themselves were more open to considering various potential improvements in medical care our profession might have more input into what changes are actually made and the quality of the outcomes. Of course, it's hard to control the outcome of changes and there is a risk that the situation could get worse for physicians and patients with some type of change despite the best of intentions. Physicians are often uncomfortable with such risks that major changes bring, and thus are often more the recipients of even more unpleasant and ineffective changes that legislators make and the problems just fester rather than getting better for anyone.
                                           
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                                          han14tra

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                                            I appreciate the idealism, but you are going to get picked apart, either in this thread or in the minds of its readers. I think it's hard to say you won't care about earnings, quality of life, etc., until after you've already gone through medical training and have all of the usual post-training worries.

                                            But hey, good for you. May you still be like that once you have your degree. :thumbup:

                                            I don't think I'm going to have any "post-training worries." Med school is already paid for.
                                             

                                            OncoCaP

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                                              I don't think I'm going to have any "post-training worries." Med school is already paid for.

                                              If you're accustomed to living on $30K/yr in 2008 dollars for a family of 4 and plan to live like that when you get out, you should be able to provide quite a bit of reduced cost care to people who cannot afford it. You could be a godsend to a lot of rural Americans.
                                               

                                              Excelsius

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                                                What are your expectations in regards to earnings?
                                                I don't care. I just want to work for the people who need help. Money is only nice so that I can use it to do something for the community. I grew up on $30,000 a year for a family of 4 and I don't plan on living differently once I'm a doctor.
                                                I don't think I'm going to have any "post-training worries." Med school is already paid for.
                                                You simply cannot know whether 30K/year is all you will need in the future. Maybe you can get by, but once you have a wife and children to feed and send to college, you may change some of your opinions. A running theme among most parents these days is that they provide better care and opportunity for their children than they had when they grew up. Providing better service to your patients is not incompatible with this idea. Given that money buys power these days, maybe one day you'll see that with more income and clout you can benefit those same patients much more than with a 30K salary. Being just one doctor servicing just one rural community will NOT help the undeserved patients in USA in general. Neither will it help patients when you don't object to decreased doctor compensation because even though you may be fine, there are other doctors like macgyver for whom income and the ability to provide for their family is important for their happiness. Happy doctors are much more likely to be serving their patients better than the ones who hate their job. That's why I'd suggest that before you or anyone else makes a claim like 30K is enough, think whether your proposal would benefit the system as a whole. You may be headed for primary care and have your med school paid for (I hope you don't change your interests while in med school), but others do have debts beyond 300K to pay back. The solution must benefit everyone. Saying that you will be ok with minimal compensation doesn't help your patients (maybe insurance companies) and harms your colleagues. Not well thought out.
                                                 
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                                                macgyver22

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                                                  I think you are somewhat missing my main point. Doing well financially does not necessarily mean receiving the highest salary. Business acumen means that you have the skills and the drive to not rely only on your income. That's why someone who is making far less money than you are can be more financially successful - and I know several people like that. Anyone who relies on salary alone is not going to become wealthy. Since doctors are still in the top 10% or so of income earners in USA, they are in the best position to make their money work for them.....

                                                  .

                                                  I don't know where you got the idea that I was in difficulty financially. I've been in practice for 20years and we've made good investments. I'm doing fine. That doesn't mean I appreciate seeing my salary cut 30% from what it was 10 years ago or my wife's cut by over 50% during the same time period. Your emphasis on investments really has nothing to do with this thread. Knowing how to manage money properly is important no matter what you do. The point of this thread was to shed some light on the changes that have occurred in medicine and not just reduced pay, but increased rates of lawsuits, insurance company paperwork and restrictions etc etc.

                                                  My comments about doctors who are doing well financially was referring to money earned through their practice and my comments stand. They are accurate. If a particular physician has done better than his peers through investing that's good, but you shouldn't expect to do better than the average. By definition that is not realistic for the majority of people.

                                                  As far as your accountant goes you are incorrect. While everyone should make sure they have a reasonable understanding of taxes that is not your primary job. Your job is to take care of patients and if you're spending all your free time studying tax law and investment strategies when you should be reading medical journals then you're not doing your job. You wouldn't ask an accountant to advise you on medical issues. You shouldn't try to be you're own tax expert. You do a disservice to yourself and your patients. That being said you will pay a significant portion of your income to the government no matter what you do. If you think you are going to outsmart the guys who do this for a living I think your simply suffering from a little youthful arrogance.
                                                   
                                                  Last edited:

                                                  macgyver22

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                                                    MacGyver: How would you say your current position as an IM Attending compares with your work at the Phoenix Foundation?
                                                    :laugh::laugh::laugh::laugh: Well there are certainly some similarities. It can be exciting at times, you get to help people, and it helps to be able to think outside the box a bit. On the other hand a good head of hair isn't a requirement for this job ( Thankfully), I actually look forward to commercial breaks ( heck I'll take any kind of break these days), and I don't have to worry about being canceled now ( For the moment anyway).:laugh::laugh::laugh:
                                                     
                                                    About the Ads
                                                    In regards to people saying they do not care about income and are only going into medicine to help people:

                                                    It is true you must go into medicine for a reason other than money or you will never make it. Either you're passionate for science or really want to help people etc...besides you can go get a 4 year engineering degree and make great money by 21.

                                                    Now- are you people seriously telling me that you don't deserve to make a good salary after putting in 8 yrs of college (likely costing over 250k..), then putting years into residency where you do not make that much? It's simple supply and demand...there is a demand for doctors therefore they will get paid more than school teachers, mechanics, blah blah blah everyone knows this. Considering how much docs pay for school and malpractice insurance they really don't make THAT much money...not to mention the large portion of their life they give up to help people. I would say paying them a high salary is the least they deserve.

                                                    I know a bunch of you who lean to the left wing believe we should give everyone everything for free and doctors shouldn't make much money...but the fact is we live in a capitalist society. If you invest a lot into your career you will make more than a high school drop out...how you would want it any other way boggles my mind. And nearly every liberal friend says they would do anything to be a doc so they can help people...are they being so arrogant as to say that the only way to help people is to be a doctor? Seems awfully insulting to teachers, peace corp workers, volunteers, social workers, and 100000 other professions that help people every day. If it bugs you so much, you can always donate 100% of your salary to charity... For those who do so, I suggest you think twice before inferring doctors to not deserve their current salary.

                                                    **Waits patiently to be flamed** ;)
                                                     

                                                    Lippert7

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                                                      Are you aware of what's going on? What have you heard?
                                                      Yes I am, I've shadowed a lot of different MDs and ODs. I've heard mixed reviews some are very happy with their jobs and some are not so happy.

                                                      What are your expectations in regards to earnings?
                                                      150-225k

                                                      What are your expectations for quality of life?
                                                      With the money I know I will have a pretty solid quality of life. I'm more concerned with being able to be there for my family when needed which will be difficult.

                                                      What kind of medicine to you hope to practice?
                                                      Psychiatry, neurology or something with immunology.
                                                       
                                                      I know a bunch of you who lean to the left wing believe we should give everyone everything for free and doctors shouldn't make much money...but the fact is we live in a capitalist society.

                                                      ...

                                                      **Waits patiently to be flamed** ;)

                                                      No flames here, mate. I'm on your side. I also don't lean to the left by any stretch of the imagination, but I'm on your side. The only thing I have in common with the more idealistic premedders is, well, I do admit to liking Patch Adams. I still get all warm and fuzzy at the board hearing.

                                                      How I so very wish I could meet the 40 year old version of myself and ask how things turned out.
                                                       

                                                      landoflogic

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                                                        Some people don't need a salary of $200,000 a year to be happy or think they deserve that type of salary because they went to school for 8 years, spent four years in residency, and then a fellowship. Some people feel that they are required to earn a really high salary just because of the above mentioned.

                                                        I grew up on a farm my whole life. I wouldn't know what to do with $200,000 a year even if I had $350,000 in debt because I don't want to live in New York, Boston, Chicago, or San Fransisco. What is wrong with living in Madison, Wisconsin, Des Moine, IA and the like? I could easily buy a house in cash (full 100% of sale price) with a salary of $200,000 in two years of work...just live off my wifes salary of $35,000 a year and just pay my monthly student loan bills with my own salary.....I will continue to drive my used car until it no longer runs. I don't need a $65,000 SUV to feel good.
                                                         
                                                        No flames here, mate. I'm on your side. I also don't lean to the left by any stretch of the imagination, but I'm on your side. The only thing I have in common with the more idealistic premedders is, well, I do admit to liking Patch Adams. I still get all warm and fuzzy at the board hearing.

                                                        How I so very wish I could meet the 40 year old version of myself and ask how things turned out.

                                                        I really agree with you on this one- You have to balance capitalism with being a good person for sure...I was reminded of this last week. I had to see a surgeon and he accused me of being a paranoid kid and examined me for less than 30 seconds...even though I my family doc examined me extensively and said I needed surgery (hernia). The surgeon simply told me I should just wait til it strangulates then operate...to put it plainly he was mean! If I end up like that one day I will hate myself forever...so I agree with you that it is a balance for sure.
                                                         
                                                        Some people don't need a salary of $200,000 a year to be happy or think they deserve that type of salary because they went to school for 8 years, spent four years in residency, and then a fellowship. Some people feel that they are required to earn a really high salary just because of the above mentioned.

                                                        I grew up on a farm my whole life. I wouldn't know what to do with $200,000 a year even if I had $350,000 in debt because I don't want to live in New York, Boston, Chicago, or San Fransisco. What is wrong with living in Madison, Wisconsin, Des Moine, IA and the like? I could easily buy a house in cash (full 100% of sale price) with a salary of $200,000 in two years of work...just live off my wifes salary of $35,000 a year and just pay my monthly student loan bills with my own salary.....I will continue to drive my used car until it no longer runs. I don't need a $65,000 SUV to feel good.

                                                        I actually do agree with this in a way- First off, I would MUCH rather live in wisconsin, iowa, oklahoma, nebraska, etc than live in a huge city. No need convincing me of that! And even if I had millions of dollars I would not buy Rolex's and ridiculous cars, 200 dollar jeans, simply because there is no use for such things in my opinon.

                                                        On the other hand, 200,000 dollars a year is not as much as one may think for someone with a wife who staying home with your 3 kids, who you want to ensure get a good education some day. The part I disagree about is where you say "Some people don't need a salary of $200,000 a year to be happy or think they deserve that type of salary because they went to school for 8 years, spent four years in residency, and then a fellowship. Some people feel that they are required to earn a really high salary just because of the above mentioned."

                                                        That last part kind of confuses me..the harder you work the more you deserve to make (honestly in todays world not everyone believes this anymore :| ) . Some will call me a prick, but I feel if I spend 8 years of my youth studying really hard while my friends get drunk everyday and get straight C's that I just might deserve more cash than them ;)

                                                        But honestly- I agree with a lot of what you said and respect the fact that we all have different opinions
                                                         

                                                        landoflogic

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                                                          I actually do agree with this in a way- First off, I would MUCH rather live in wisconsin, iowa, oklahoma, nebraska, etc than live in a huge city. No need convincing me of that! And even if I had millions of dollars I would not buy Rolex's and ridiculous cars, 200 dollar jeans, simply because there is no use for such things in my opinon.

                                                          On the other hand, 200,000 dollars a year is not as much as one may think for someone with a wife who staying home with your 3 kids, who you want to ensure get a good education some day. The part I disagree about is where you say "Some people don't need a salary of $200,000 a year to be happy or think they deserve that type of salary because they went to school for 8 years, spent four years in residency, and then a fellowship. Some people feel that they are required to earn a really high salary just because of the above mentioned."

                                                          That last part kind of confuses me..the harder you work the more you deserve to make (honestly in todays world not everyone believes this anymore :| ) . Some will call me a prick, but I feel if I spend 8 years of my youth studying really hard while my friends get drunk everyday and get straight C's that I just might deserve more cash than them ;)

                                                          But honestly- I agree with a lot of what you said and respect the fact that we all have different opinions

                                                          Sorry for not elaborating on what I was referring to about the quoted parted. Some people will think they are entitled to a certain amount of salary according to their beliefs for how much they should be paid and some just enjoy the work and take the money that goes with it (as long as they can afford to pay the bills).

                                                          For myself, I have a freelance medical writer job that pays $100 an article ($4,000 a month contract) to go along with my other job. So I make just under $100,000 a year right now ($91,000 to be exact). If all I cared about was money I would just keep doing what I'm doing. I'm not satisfied personally because I'm not yet doing what I'm passionate about. So the money I make right now is basically just a number in the bank account that has little meaning. I am 27 years old have worked in the real world for several years...so I'm not some 19 year old pre-med. I've had my bank account go to the zero dollar level several times in my life and I felt the same as a person with zero dollars than I do now. The only difference between now and than is not having to worry about being able to buy a mountain dew when I want one. I still drive the same care I had when I was no money in my checking acount, I still wear the same clothes, live in the same apartment, and nothing else has changed...my main hobby outside of work and spending time with my wife is playing football on a video game (has been this way for years and years). If I were to make $250,000 a year as a doctor, I could easily live the same way I do now until I have a kid....but I'm not going to go out and buy a bunch of expensive clothes or a lot of toys for the child(ren)----the less toys they have, the more thinking they have to do.
                                                           
                                                          Sorry for not elaborating on what I was referring to about the quoted parted. Some people will think they are entitled to a certain amount of salary according to their beliefs for how much they should be paid and some just enjoy the work and take the money that goes with it (as long as they can afford to pay the bills).

                                                          For myself, I have a freelance medical writer job that pays $100 an article ($4,000 a month contract) to go along with my other job. So I make just under $100,000 a year right now ($91,000 to be exact). If all I cared about was money I would just keep doing what I'm doing. I'm not satisfied personally because I'm not yet doing what I'm passionate about. So the money I make right now is basically just a number in the bank account that has little meaning. I am 27 years old have worked in the real world for several years...so I'm not some 19 year old pre-med. I've had my bank account go to the zero dollar level several times in my life and I felt the same as a person with zero dollars than I do now. The only difference between now and than is not having to worry about being able to buy a mountain dew when I want one. I still drive the same care I had when I was no money in my checking acount, I still wear the same clothes, live in the same apartment, and nothing else has changed...my main hobby outside of work and spending time with my wife is playing football on a video game (has been this way for years and years). If I were to make $250,000 a year as a doctor, I could easily live the same way I do now until I have a kid....but I'm not going to go out and buy a bunch of expensive clothes or a lot of toys for the child(ren)----the less toys they have, the more thinking they have to do.

                                                          Very understandable.
                                                          It's really good to see someone who doesn't go out and buy a bunch of expensive things just because they can afford it- I am the same way. I'll never buy a beamer or a ridiculously big house since I won't ever need those things...I'll always be the boring guy who puts his money in the bank :)

                                                          You also make a good point about people who work solely for the money vs people who enjoy their work and take the money with it. I would agree its a balance between having enough money to live without having too many financial concerns.
                                                           

                                                          Excelsius

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                                                            I don't know where you got the idea that I was in difficulty financially. I've been in practice for 20years and we've made good investments. I'm doing fine. That doesn't mean I appreciate seeing my salary cut 30% from what it was 10 years ago or my wife's cut by over 50% during the same time period. Your emphasis on investments really has nothing to do with this thread. Knowing how to manage money properly is important no matter what you do. The point of this thread was to shed some light on the changes that have occurred in medicine and not just reduced pay, but increased rates of lawsuits, insurance company paperwork and restrictions etc etc.

                                                            My comments about doctors who are doing well financially was referring to money earned through their practice and my comments stand. They are accurate. If a particular physician has done better than his peers through investing that's good, but you shouldn't expect to do better than the average. By definition that is not realistic for the majority of people.

                                                            As far as your accountant goes you are incorrect. While everyone should make sure they have a reasonable understanding of taxes that is not your primary job. Your job is to take care of patients and if you're spending all your free time studying tax law and investment strategies when you should be reading medical journals then you're not doing your job. You wouldn't ask an accountant to advise you on medical issues. You shouldn't try to be you're own tax expert. You do a disservice to yourself and your patients. That being said you will pay a significant portion of your income to the government no matter what you do. If you think you are going to outsmart the guys who do this for a living I think your simply suffering from a little youthful arrogance.


                                                            I am glad that at least now you clarified that you are financially well off. This somewhat defeats the purpose of this thread, which had the main implication as to why students want to go to med school since they will not be well off financially. That's not the case with you. You're just unhappy that your salary has decreased. Maybe you can better help me understand the decrease in your salary, but as far as I am aware, the reason doctors' salaries have decreased is not because the compensation has decreased, but rather because it has remained stagnant compared to inflation. Now your particular field may have been hit harder than other fields, but a lot of that has also to do with supply and demand. This happens in every field. I heard that dermatologists weren't popular decades ago, now their field is the most competitive to get into. Therefore, even though your field has been affected very negatively, other specialties have not been affected to the same degree. And despite the decrease in your compensation, you are still doing well financially. As such, it is not very logical to question all medical students as to why they want to go into medicine. If your main concern was just the extra paperwork or any other non-financial concerns, I could understand your frustration. But even then, you would be saying that students should not become doctors so eagerly just because there are many problems with the system. That still isn't enough reason to question the determination to do what you like. If you were financially struggling, that would be a better reason to question students' decisions, since essentially they would be sacrificing the quality of their life by choosing medicine.

                                                            Right now, this is how this thread comes off: a doctor is questioning why are students choosing medical careers just because his own particular specialty is not being compensated as much as other specialties due to the unpredictable changes in specialty compensation that happen every few decades (despite being well-off). Finally, some polls (UC Davis mentioned above) show that up to 70% of doctors are satisfied with their jobs. Another point: doctors are still in the top 10% of US income earners: Physician Compensation. That chart also shows that your income is far below the average of income of all internal doctors for all regions of the US. The chart does show that East coast has the lowest compensation for Internists. If you're unhappy with your salary, you have the option of seeking other employments within or without your state. You can also move to a state with lower income tax - 9 states have NO income tax, including Texas, where your malpractice insurance should be much cheaper due to their cap of about 250K when suing doctors... You do have many options if you're not happy. Even if you claim that you like where you live, you can still give other states a shot. If you don't like it there, you can return to your current residence after some years of up to 30% more income (when you combine no taxes, higher salary, lower malpractice). It is up to you. If your decreased income is so important for you as to question the whole reason of becoming a doctor, it would definitely be worth it for you to move even if you have to inconvenience your wife, children, and yourself. This is something that you accountant is not going to tell you. Nor is he going to tell you that you should publish a book to document your concerns or take on other business endeavors. There is a difference between a business coach and an accountant. You're welcome to think otherwise, but I would recommend you talk to a business coach to see the difference. And no, you don't have to know tax law to be aware of the information above.

                                                            Over the past three years I have consistently deducted over 50% from my taxes (schedule C), which I do myself with some advice (and I don't make millions). I don't call that "outsmarting," just using the loopholes in the system to my advantage. You must also have a pretty high opinion of those working for the government, IRS or not. You may be surprised, but the brightest people are not working for the government. Since one of my jobs is in law, I have to deal with the government a lot. I am amazed at the types of people who work there (lower levels). Many of them don't even have simple reading comprehension skills and we have to word our documents very carefully and make an argument that could be written in a sentenece into several paragraphs... A few years ago Mr. President enacted some kind of crazy tax that had a huge loophole. Some smart businessmen and doctors bought vehicles (like Hummers) using tax credits, making the items pretty much free! While I don't know all the details, you probably have not even heard about this.

                                                            And if you noticed from my previous posts, I do agree with you that doctors should be properly compensated and their income should always at least keep up with inflation. However, that's not what we're discussing here.

                                                            Could anyone find a physician compensation graph from 1960s to 2008? I couldn't find anything.
                                                             

                                                            Excelsius

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                                                              ...

                                                              I know a bunch of you who lean to the left wing believe we should give everyone everything for free and doctors shouldn't make much money...but the fact is we live in a capitalist society. If you invest a lot into your career you will make more than a high school drop out...how you would want it any other way boggles my mind. And nearly every liberal friend says they would do anything to be a doc so they can help people...are they being so arrogant as to say that the only way to help people is to be a doctor? Seems awfully insulting to teachers, peace corp workers, volunteers, social workers, and 100000 other professions that help people every day. If it bugs you so much, you can always donate 100% of your salary to charity... For those who do so, I suggest you think twice before inferring doctors to not deserve their current salary.

                                                              **Waits patiently to be flamed** ;)

                                                              I don't understand where you got that idea. Being liberal doesn't = being socialist (and Obama is NOT a socialist, let's not go there). I am on the left, but I am for proper physician compensation. We should move away from the moral righteousness of the far right. That crumbled in the last four months. No one group has the moral high ground or is a "true" American.
                                                               

                                                              landoflogic

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                                                                I've seen first hand the damage that has been done to primary care. In the city I live in, the primary care facility has their own building. I recently spent some time working with these primary care doctors collecting some research data. The whole time they bitched about how low their salaries are and how they are so looking forward to Bush leaving office (they would literature call the Bush "the dumb&^%$ in office----I'm dead serious--they literally yelled this in the halls where the offices are located when the election was done). So many of these doctors looked like crap physically. So many of them were not cleaned shaved, didn't dress professionally, and the language they used was a shocker. Than I look at a good friend of mine and his private family medicine practice and he rakes in over $200,000 a year after all other expenses are paid. The difference? :confused:

                                                                One of my family members in the North East was looking online for a primary care doctor and couldn't find one in a two hour drive and then when I can find several primary care doctors where I live (Wisconsin).

                                                                So I guess in some regions people don't have access to a primary care doctor. This is bad for the health of our country and primary care can help lower costs of medical care.

                                                                The only doctors that really have it tough are the ones that only make around $125,000 or less a year and live in a very expensive area.
                                                                 

                                                                Livingapparatus

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                                                                  No flames here, mate. I'm on your side. I also don't lean to the left by any stretch of the imagination, but I'm on your side. The only thing I have in common with the more idealistic premedders is, well, I do admit to liking Patch Adams. I still get all warm and fuzzy at the board hearing.

                                                                  How I so very wish I could meet the 40 year old version of myself and ask how things turned out.

                                                                  I disagree, the way you began that last sentence is another thing you have in common with idealistic premeds

                                                                  How I so very wish???
                                                                   

                                                                  macgyver22

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                                                                    I am glad that at least now you clarified that you are financially well off. This somewhat defeats the purpose of this thread, which had the main implication as to why students want to go to med school since they will not be well off financially. That's not the case with you. You're just unhappy that your salary has decreased. Maybe you can better help me understand the decrease in your salary, but as far as I am aware, the reason doctors' salaries have decreased is not because the compensation has decreased, but rather because it has remained stagnant compared to inflation. ....

                                                                    The point of this thread is that medicine used to be a very good profession but has suffered a lot of setbacks over the past decade. Yes I am doing OK, but primarily because I started my career at least a few years before HMO's were first introduced. Students going into medicine today will not have that advantage. You are misinformed to some degree about the state of physician salaries. reimbursements have certainly gone down since managed care was introduced. The big decrease was during the initial introduction. Since then rates have been more or less stagnant. The effects of that have been magnified by the ever increasing costs overhead. When reimbursements stay flat and overhead increases physician income goes down.

                                                                    I see approximately 50% more patients than I did 10 years ago. We offer more services, and yet the net profit is less.

                                                                    You keep trying to turn this into my issue when in fact its yours. The problem isn't that I don't know how to run my practice. The problem is that you guys are going to face a world where you may not get paid as much in ten years as you do next year. You are going to have student loans that are twice what mine were. Insurance companies and government agencies are going to take a bigger and bigger role in how you practice medicine. Law suits aren't going away any time soon. Respect from your patients isn't going to be what its been in the past and you're going to have to work harder than I ever did. I'm not trying to depress everyone, but by the same token I think its important for young students to go into this with their eyes wide open and maybe the more aware you are the more we can all do to improve things
                                                                     

                                                                    OncoCaP

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                                                                      landoflogic

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                                                                        The point of this thread is that medicine used to be a very good profession but has suffered a lot of setbacks over the past decade. Yes I am doing OK, but primarily because I started my career at least a few years before HMO's were first introduced. Students going into medicine today will not have that advantage. You are misinformed to some degree about the state of physician salaries. reimbursements have certainly gone down since managed care was introduced. The big decrease was during the initial introduction. Since then rates have been more or less stagnant. The effects of that have been magnified by the ever increasing costs overhead. When reimbursements stay flat and overhead increases physician income goes down.

                                                                        I see approximately 50% more patients than I did 10 years ago. We offer more services, and yet the net profit is less.

                                                                        You keep trying to turn this into my issue when in fact its yours. The problem isn't that I don't know how to run my practice. The problem is that you guys are going to face a world where you may not get paid as much in ten years as you do next year. You are going to have student loans that are twice what mine were. Insurance companies and government agencies are going to take a bigger and bigger role in how you practice medicine. Law suits aren't going away any time soon. Respect from your patients isn't going to be what its been in the past and you're going to have to work harder than I ever did. I'm not trying to depress everyone, but by the same token I think its important for young students to go into this with their eyes wide open and maybe the more aware you are the more we can all do to improve things

                                                                        Yes the field of medicine has gone through a rough change. Salaries decreased while debt increased as a result of HMO's. That isn't always a bad thing. I always though doctors made too much (surgeons, derms, and the like...not peds, family docs and the like).

                                                                        Things will even out and everyone will adjust. We just can't keep having the decrease in salaries and increase in tuition costs. I'm afraid that this won't change though.
                                                                         

                                                                        Livingapparatus

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                                                                          Yes the field of medicine has gone through a rough change. Salaries decreased while debt increased as a result of HMO's. That isn't always a bad thing. I always though doctors made too much (surgeons, derms, and the like...not peds, family docs and the like).

                                                                          Things will even out and everyone will adjust. We just can't keep having the decrease in salaries and increase in tuition costs. I'm afraid that this won't change though.

                                                                          When is it ever a good thing?
                                                                           
                                                                          I don't understand where you got that idea. Being liberal doesn't = being socialist (and Obama is NOT a socialist, let's not go there). I am on the left, but I am for proper physician compensation. We should move away from the moral righteousness of the far right. That crumbled in the last four months. No one group has the moral high ground or is a "true" American.

                                                                          Did I mention the words socialist or the phrase true American at any point in my post? LOL I didn't even mention Mr. Obama.

                                                                          If you are on the left and are for proper compensation and capitalism thats great...it just happens to be that a lot of the kids I know seem to be so liberal they believe we should spread the wealth out to the point where everyone makes the same amount...so I wasn't trying to imply that you personally (or even most liberals) are socialists. Just was trying to point out that a lot of the pre med kids at my college essentially are.

                                                                          Oh well didn't mean to start a political rant or anything, sorry about that!
                                                                           
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                                                                          7. This thread is locked.