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

[Rabbit36]

Are you aware of what's going on? What have you heard?
I'm trying to make a real effort to learn as much as I can from the mouths of practicing physicians, so thank you for this thread. So you know macgyver, I am not at all dissuaded from practicing medicine by these problems, and I know you don't want to discourage people from becoming physicians. Like you said you need smart people to replace you, and I really appreciate you wanting to tell us things you wish you had known when you were in our shoes. I hope that knowledge of the current climate can make me more tempered in my approach and expectations, so that I am not completely crushed by the time I am an attending who realizes medicine is not what I had expected when I started down this road.

I think it's especially important to realize how recent and sudden these changes to the profession have been, and that is perhaps what a lot of people don't understand. It's not a matter of "that's how it's always been" or "just suck it up". If these same trends continue, the medical profession will be vastly diminished from how it was not long ago (and already is). Things need to change and people do need to be outraged, not just because of decreased income, but because of the disastrous consequences all these factors (and many many more) are having on health care in our country. I agree with other posters that the apathy bred by people saying "you should be happy to have 60K" is dangerous and will only allow the current problems in medicine to get worse. Just taking what you get is asking to get more taken from you. I think a lot of people tend to take their anger with the system out on doctors, so they don't care if doctors get paid less because they don't understand we're all getting screwed together, and that good doctors really are taking the brunt of it. I'm not going to pass judgment on how other people feel they'll be able to live comfortably. I think too much suffering has been caused in this world by people telling others how they're supposed to think and live.

What are your expectations in regards to earnings?
~$250,000 with $200,000 in loans to pay off

What are your expectations for quality of life?
Financially, fine. I eventually want a nice home and some little pleasures, but I was really never one for luxury. My greater concern (and I think the bigger issue here) is time spent dealing with non-medical issues like paperwork/malpractice/insurance and being able to see my family. I know it's going to be very tough with all the BS, so I hope my patient time (which of course can be its own headache) will be able to make it worth it. I hope past fellowship to have relatively livable hours and time to be around while my kids grow up.

What kind of medicine to you hope to practice?
Heme/onc. I am definitely concerned by the decrease in medicare reimbursement for chemotherapy, but it if it stays the same it probably won't be as bad for me since I wouldn't know it any other way.

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[229141]

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

Whenver I talk to some of the Docs at my gym they say this too...its definitely the reality from the people I've talked to. The ONLY doctors I've met that feel other wise are ones that are retired or are retiring soon.

I know I can make good money and probably have more of a life if I am a pharmacist...but despite all of this I love medicine and still want to be a physician

 

[229141]

Are you aware of what's going on? What have you heard?
I'm trying to make a real effort to learn as much as I can from the mouths of practicing physicians, so thank you for this thread. So you know macgyver, I am not at all dissuaded from practicing medicine by these problems, and I know you don't want to discourage people from becoming physicians. Like you said you need smart people to replace you, and I really appreciate you wanting to tell us things you wish you had known when you were in our shoes. I hope that knowledge of the current climate can make me more tempered in my approach and expectations, so that I am not completely crushed by the time I am an attending who realizes medicine is not what I had expected when I started down this road.

I think it's especially important to realize how recent and sudden these changes to the profession have been, and that is perhaps what a lot of people don't understand. It's not a matter of "that's how it's always been" or "just suck it up". If these same trends continue, the medical profession will be vastly diminished from how it was not long ago (and already is). Things need to change and people do need to be outraged, not just because of decreased income, but because of the disastrous consequences all these factors (and many many more) are having on health care in our country. I agree with other posters that the apathy bred by people saying "you should be happy to have 60K" is dangerous and will only allow the current problems in medicine to get worse. Just taking what you get is asking to get more taken from you. I think a lot of people tend to take their anger with the system out on doctors, so they don't care if doctors get paid less because they don't understand we're all getting screwed together, and that good doctors really are taking the brunt of it. I'm not going to pass judgment on how other people feel they'll be able to live comfortably. I think too much suffering has been caused in this world by people telling others how they're supposed to think and live.

What are your expectations in regards to earnings?
~$250,000 with $200,000 in loans to pay off

What are your expectations for quality of life?
Financially, fine. I eventually want a nice home and some little pleasures, but I was really never one for luxury. My greater concern (and I think the bigger issue here) is time spent dealing with non-medical issues like paperwork/malpractice/insurance and being able to see my family. I know it's going to be very tough with all the BS, so I hope my patient time (which of course can be its own headache) will be able to make it worth it. I hope past fellowship to have relatively livable hours and time to be around while my kids grow up.

What kind of medicine to you hope to practice?
Heme/onc. I am definitely concerned by the decrease in medicare reimbursement for chemotherapy, but it if it stays the same it probably won't be as bad for me since I wouldn't know it any other way.

Oh my God your MCAT score is EPIC!!

 

[da8s0859q]

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

How I so very wish???

"How I so very wish I could meet the 40 year old version of myself and ask how things turned out" has absolutely dick to do with being an idealistic premed. That's just me wondering out loud how things -- medicine in general, my own profession, etc. -- will actually progress from here through the next couple decades or so. I suspect that many people here do the same; our kingdoms for crystal balls and all.

And besides, even the most cynical/jaded people wish, or hope, or would rather things be some other way, whatever word they choose.

 

[135892]

When is it ever a good thing?

...When you have the mindset of "I always thought doctors made too much..."

 

[229141]

Here's something interesting to ponder. We say that doctors make too much...but at the same time pro athletes can make over $15,000,000 a year!? (Don't get me wrong...I love football!! LOL) Yeah sounds fair...I wouldn't mind working out for a living and making 60 times a doctors salary

 

[Excelsius]

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

Most students on SDN know about the challenges facing the doctors today. The medical students, residents, and attendings keep all the premeds here on check. Most of them are very pessimistic to begin with, so they give a very clear picture as to what is going on in medicine. If you look at OncoCap's graph, you'll see that it is not true that all specialties have decreased their compensation. Some on that list have almost doubled their salary just within seven years. I would like to see a graph from 1960s to 2008 for doctors compensation, if anyone can find it. Then we can compare the compensation for lawyers and other professionals within the same period to see how different doctors actually are.

See, this is where I completely disagree with you. You are saying that this is my problem? How so? When these changes happened, they happened under your watch. What did you do to solve this problem when it happened? What did you generation of doctors do? You see, this actually is your problem: thinking that it is someone else's problem. When these changes were happening, some of us may not have even been born. And yes, it will now become our problem but not because we contributed to it, but rather because your generation is handing it over to us. It is a bequest by default, not a problem. Now you're saying that the point of this thread is to notify the students about the inheritance the current generation is bestowing upon them.

Anyway, I think that instead of just saying: "medicine sucks, how come you still want to become a doctor," you could have offered some constructive advice. But that doesn't matter because you can still do it. Why not spend the next 500 posts in this thread actually discussing solutions? Why don't you start by making several proposals as to what you think that the next generation of med students should do? Maybe you can teach us what you have learned from your colleagues' mistakes when HMO took over and what you would have done differently. What are some good resources/authors to refer to for intelligent solutions and what have you been thinking about as to what is the best thing to do for the coming generation of doctors? Your advice will be especially helpful to med students and residents, since they are the closest to starting their practice. Practicing physicians are the ones who should start working on it right now, instead of waiting for the next bus to arrive.

 

[Excelsius]

Here's some data from 1997-2004:

http://forums.studentdoctor.net/showpost.php?p=4832396&postcount=74

There are some fields (like diagnostic Radiology) that appear to have seen increases. Most appear to be more or less stagnant if you consider inflation.

Stagnant is not the same as decreasing. The salaries would decrease only if they stayed the same without including the inflation, but that's not the case, at least in the last decade or so. When you count the inflation, the salaries seem to have neither decreased nor increased for the lowest compensated specialties, but increased a lot for some specialties (according to your graph).

 

[Excelsius]

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.

For someone coming from the land of logic, that is a pretty illogical statement to make. So let me get this clear: patients have not seen any decrease in their premiums (only increases), doctors have lost salaries, and only insurance companies have benefited, is somehow supposed to be a good thing sometimes? I might have bought what you said if physician salary decrease directly decreased patient premiums, but absent that, your statement is way off. If you don't mind giving part of your salary to insurance companies, you do that. If you want to be somewhat smarter about it, I'd say why don't you fight for your salary and use the extra money that you don't need to help those patients who need surgery but can't afford it? Or maybe contributing food and clothing to the homeless? Let's not be ridiculous. I also highly doubt that if you had 200K in salary you would donate 100K to charity. By not fighting for doctors salary, you are not fighting for your patients.

 

[Excelsius]

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!

That's fine. I was talking about your implication that all leftists are for decreased compensation. What you have noticed among premeds doesn't have anything to do with being liberal. It has to do with being clueless and idealistic premeds. Just look at some of the comments on this thread. Add to that the fact that many premeds wouldn't know the difference between the right and the left.

 

[Livingapparatus]

"How I so very wish I could meet the 40 year old version of myself and ask how things turned out" has absolutely dick to do with being an idealistic premed. That's just me wondering out loud how things -- medicine in general, my own profession, etc. -- will actually progress from here through the next couple decades or so. I suspect that many people here do the same; our kingdoms for crystal balls and all.

And besides, even the most cynical/jaded people wish, or hope, or would rather things be some other way, whatever word they choose.

man I am just having some fun, its not the wish that made me laugh but the way it was written and how it sounded like a corny disney line

 

[da8s0859q]

it sounded like a corny disney line

Will you be my princess, dahhhhh-ling?

(With apologies to macgyver for the screwing about in his fine thread.)

 

[229141]

That's fine. I was talking about your implication that all leftists are for decreased compensation. What you have noticed among premeds doesn't have anything to do with being liberal. It has to do with being clueless and idealistic premeds. Just look at some of the comments on this thread. Add to that the fact that many premeds wouldn't know the difference between the right and the left.

I've actually never thought of it as them being idealistic premeds...thats so true. And you're right- my friend tells everyone he is very liberal but constantly talks about how we need a flat tax...haha. Come to think of it there are so many idealistic pre meds running around here.

 

[Forbes]

...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...

...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...

**Waits patiently to be flamed**

What the hell is with people talking about Obama? Alaska said nothing about Obama.... or Socialism for that matter. Try not to draw false conclusions. Stereotyping is weak sauce.

To me it seems as if your liberal friends are not in touch with the real world. However, Is it possible that you are assuming the Liberals who say "I'm going into medicine to help people" and do not mention the prestige and financial possibilities are arrogant? I am liberal, I understand and hope I will be well compensated, I hope I will be able to live comfortably, I will not donate 100% of my salary thats for dam sure! Yet I am going into medicine primarily because I want to help people, does that make me arrogant or wrong? Sorry for the run on sentence hehe.

Most service professions are 'helping people'. The cashier at McDonalds helped me today, without him I would be hungry .

Being the devils advocate, is seems to me as if you are purusing medicine largely, but not singularly, for the compensation. I could care less about ones motives to become a physician, as long as they did their job at an average or above average level.

But if you are not looking into medicine simply for the compensation, than what is your reasoning? I am not meaning to flame so try not to kill me ahah.

Other than that I agree with you completely. I have noticed people here get REALLY bent about politics.

 

[NotForTheMoney]

Well I'm too lazy to copy and paste, but my name says it all. Honestly, I'm not doing it for the money(I know some of you are gonna think I'm full of it, but w.e.)Since I've been a kid I've always dreamed of being a doctor, not for the money, but for the self-accomplishment that came with it.

I am planning to go travel the world once I get out of medical school as well.(google doctors for Africa and you'll see what I mean) I find enjoyment in helping others and feel as if that is a reward itself. Like others said, "This is a career, not a job", so as for balancing my personal time and my work you ask? There's no line, they're intertwine with one and the other. I knew what would be on the line and what I was risking even before I decided that I wanted to be a doctor.

I can go on and on, but my laptop is about to die and I left the charger in the car. lol night ya'll (yea I'm Asian with a southern accent)

oh yea I'm either going for I.M. or surgeon(C.T.)if possible

 

[Excelsius]

Well I'm too lazy to copy and paste, but my name says it all. Honestly, I'm not doing it for the money(I know some of you are gonna think I'm full of it, but w.e.)Since I've been a kid I've always dreamed of being a doctor, not for the money, but for the self-accomplishment that came with it.

I am planning to go travel the world once I get out of medical school as well.(google doctors for Africa and you'll see what I mean) I find enjoyment in helping others and feel as if that is a reward itself. Like others said, "This is a career, not a job", so as for balancing my personal time and my work you ask? There's no line, they're intertwine with one and the other. I knew what would be on the line and what I was risking even before I decided that I wanted to be a doctor.

I can go on and on, but my laptop is about to die and I left the charger in the car. lol night ya'll (yea I'm Asian with a southern accent)

oh yea I'm either going for I.M. or surgeon(C.T.)if possible

I don't think most people become doctors for the money. Advocating a higher salary for whatever you do doesn't mean you're in it for the money. Many people have a hard time understanding this and your screen name implies as if you are trying to isolate yourself from the rest of SDN who are all for the money...

Finally, if you have more money, you can reach more patients. Make more, donate more.

 

[macgyver22]

Most students on SDN know about the challenges facing the doctors today. The medical students, residents, and attendings keep all the premeds here on check. Most of them are very pessimistic to begin with, so they give a very clear picture as to what is going on in medicine. If you look at OncoCap's graph, you'll see that it is not true that all specialties have decreased their compensation. Some on that list have almost doubled their salary just within seven years. I would like to see a graph from 1960s to 2008 for doctors compensation, if anyone can find it. Then we can compare the compensation for lawyers and other professionals within the same period to see how different doctors actually are.

See, this is where I completely disagree with you. You are saying that this is my problem? How so? When these changes happened, they happened under your watch. What did you do to solve this problem when it happened? What did you generation of doctors do? You see, this actually is your problem: thinking that it is someone else's problem. When these changes were happening, some of us may not have even been born. And yes, it will now become our problem but not because we contributed to it, but rather because your generation is handing it over to us. It is a bequest by default, not a problem. Now you're saying that the point of this thread is to notify the students about the inheritance the current generation is bestowing upon them.

Anyway, I think that instead of just saying: "medicine sucks, how come you still want to become a doctor," you could have offered some constructive advice. But that doesn't matter because you can still do it. Why not spend the next 500 posts in this thread actually discussing solutions? Why don't you start by making several proposals as to what you think that the next generation of med students should do? Maybe you can teach us what you have learned from your colleagues' mistakes when HMO took over and what you would have done differently. What are some good resources/authors to refer to for intelligent solutions and what have you been thinking about as to what is the best thing to do for the coming generation of doctors? Your advice will be especially helpful to med students and residents, since they are the closest to starting their practice. Practicing physicians are the ones who should start working on it right now, instead of waiting for the next bus to arrive.

Actually I don't think most students do know the realities of medical practice in the real world. When you see the discontentment among practicing physicians ( not all but clearly a significant minority and perhaps even a majority in some of the most important fields) and the degree of enthusiasm among prospective medical students there is obviously a huge disconnect.

As for the graph, I would like to see where that information comes from and what they use as their source. I can tell you for a fact that were you to show that to any physician around here they would laugh at it. It might as well be a graph of the price of peas in China. It has no correlation what so ever with reality in my part of the country or most other areas that I know of. My wife is a Gynecologist at the busiest Ob/ Gyn practice in the area and I am telling you for a fact that their income is down 50% compared to what it was 10 years ago. They now get paid $3,000 for a delivery. 10 years ago it was $5,000 per delivery. They are currently paying $175,000/yr/doctor for malpractice insurance. 10 years ago it was less than half of that. Rent, payroll, supplies and everything you need to run a medical practice have gone up accordingly. The graph just doesn't jive with the facts.

As far as what I have done personally about the problem I guess you're right, I have not spent much time on that through out this thread, but then no one really asked. There have been a number of things that I and my colleagues have done. Some have had success and others have not. Personally I have spent a lot of time writing to federal and state representatives. Occasionally I have had success and gotten good feedback. I have been part of several organized physician rallies to protest malpractice rates and lobby for malpractice reform. I have written to periodicals and local newspapers trying to make the public more aware of some of the issues. These things often have no quantifiable immediate effects, but increasing awareness among the public and our representatives is a long term project and minds aren't going to change over night.

Other more immediate efforts have included the formation of a physician owned and run managed care organization that was started and funded by myself and several thousand local physicians. Unfortunately it failed, most likely because we came to the game too late to grab enough market share and because the idea was fundamentally flawed. we had hoped to set up a kinder better HMO, but employers cared more about cost than quality so the company eventually failed. The fact is we tried though.

In another effort to take some control back nearly 100 physicians from local Ob/Gyn groups banded together to form a single megagroup. By doing this they circumvented the antitrust laws that prohibit doctors from going on strike or negotiating as a single group. The jury is still out on whether this is working or not but again physicians are trying something.

One of the biggest disadvantages physicians face is the fact that their job is to take care of patients. Taking care of business is necessarily a side job that requires more time than most of us have. despite some misconceptions, most physicians really do care more about their patients than the money and the insurance companies know that and use it to their advantage.

My recommendation to you and all premeds is to be aware of whats going on. Watch what we are doing. Learn what works and what doesn't and build on that. To a certain extent some of the coming changes are inevitable. It will be more important than ever for young doctors to anticipate those changes so you can make decisions and adapt. That part at least will be easier for you than for me. You have few commitments and more flexibility.

I've posted this before but I'll say it again. There is a free add driven magazine called Medical Economics. This isn't The NEJM, but it will give you a real "ear to the ground" insight on where things are going in medicine. The graphs and data they often publish in there aren't filtered through government statisticians and bureaucrats, they come from doctors working in the field. Give it a look when you have a chance. I'm pretty sure a subscription is free, but if not your local library may carry it.

 

[OncoCaP]

The data in the graph that is linked above is published in the New England Journal of Medicine. That gives it a certain amount of credibility. The source in that NEJM article is "Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005," which is well known, although not the most reliable source.

I spot-checked the data with reports from Medical Economics and the results are consistent in terms of salaries for various specialties when you look at the 2006 numbers in Medical Economics and 2004 figures in the graph. The Medical Economics data also tells the story that macgyver22 has been emphasizing that primary care physicians who see adults (like GP's and OB/GYNs) have seen their income drop recently. If it weren't for Peds, primary care pay would have shown a downward trend in comparing 2006 to 2007. However, another survey I quote below (I'm not sure which is more accurate) does not show such a high salary for Peds. In any case, there clearly is an issue with decreasing compensation in medicine (what other professions are seeing decreases in pay when their demand is up?).

http://medicaleconomics.modernmedic.../Article/detail/532638?contextCategoryId=8426

Below is another survey. For now, it appears that physicians are OK financially ... and if their earning expectations are very low, physicians will be able to make rent in a trailer park this year, be able to buy bags of potatoes to cut and fry up in vats of vegetable oil for the kids, pay the basic cable TV bill, get the oil changed on the 1985 Ford F-150 pickup and have some money left over for Christmas presents .

http://bp0.blogger.com/_jyVH1tFBOXI...BWRCaIf_RTA/s1600-h/2008+MD+Salary+Survey.jpg

This second survey, which is not from the source macgyver22 recommended, does not show a jump in earning for pediatricians that the prior source did.

Not wanting to earn a lot of money is fine, but sometimes family members aren't as supportive of this idea. I joke that if you don't want your spouse to leave you for the meat packer at Kroger's because butchers are "filthy rich" by comparison to what a physician earns and doesn't require his or her kids to sit in the back of an open pickup bed in the snow, sleet, and rain, some thought needs to be given to physician compensation and the fact that insurance companies and even legislators are putting pressure on physicians and it's a competitive market. The executives at the health insurance companies are exactly clipping coupons to make ends meet. Why should physicians be the ones taking the hit when they provide so much value and everyone else seems to be earning more money?

In my mind the answer lies in two effective, proven strategies. One strategy that we find among the higher-paying specialties is to limit the number of seats by holding down the number of residency and fellowship slots. In other words, let a limited supply of certain types of physicians match and get board certified and then let the excess demand force do what toy manufacturers do to get parents to stampede like livestock at Christmas shopping time ... limit supply so that parents must scramble and pay full price to get the coveted toy or be forced to come home empty handed and try again another day or give up and try to talk your kid into getting a bike, ball, or doll. Unfortunately, under this strategy everyone must pay more because if you don't want to pay the orthopod's, radiologist's, or dermatologist's fee, there really is no option B that a patient can live with (I guess I'll just let this broken arm heal naturally isn't something I hear in places where people drive on paved roads). The problem with this strategy is that it drives up cost when Americans are already suffering significantly under the magnum-sized medical bills.

The other route is for physicians to innovate so that they provide more value for roughly the same amount of effort. For example, maybe physicians could focus on certain high profit procedures (cosmetic procedures and the like) and refer out all money losing procedures to government-paid physicians working at the medical schools, county hospital and others. A variation would be for a physician to go for volume with a low per-patient cost structure instead of high per patient profit and to hire a fleet of PAs and NPs. This would leave the physician to manage employees instead of seeing patients all the time. This doesn't generally appeal to a crowd that has spent years or even decades fine-tuning their neurological exam (not to mention that many physicians are very new and relatively inexperienced when it comes to managing money, let alone managing wily employees who can take a path of least resistance when the physician least expects). Technological innovation also fits under this route ... a physician with a well managed practice can automate the generation of mountains of paperwork and billing somewhat, saving a couple of hours every day and actually make it to his kid's ball game once in a blue moon.

One problem with the technological approach is that insurance companies don't exactly make it "point and click" to download your money, and thus there are certain things that take physician time no matter what. There are already physicians that provide you with a service to allow you to talk to a physician over the phone after you have established a relationship and it has been determined that you have a minor ailment, such as perhaps an occasional adenovirus sinusitis or urinary tract infection. Rural telemetry makes it possible for some patients to get care that would otherwise involve very inconvenient and expensive travel. All of this boils down to the physician providing more value by treating more or otherwise difficult patients in less time with less time wasted somehow. The problem with this approach is that technology providers aren't always "cheap" and the more efficient solution sometimes winds up costing much more than what it replaced, particularly if it involves integrating communications with a hospital or other large organization in any way shape or form. Furthermore, insurance companies and government bureaucrats will see the saved costs as money that they need to recoup and leave the physician back where he or she started income-wise. However, given the current situation of rising demand and costs, this second general approach will get a lot of airtime.

No matter what happens, physicians need to look beyond what they have always done if they would like to maintain their high income without making life even more miserable financially for many U.S. patients who can ill afford care today.

 

[229141]

What the hell is with people talking about Obama? Alaska said nothing about Obama.... or Socialism for that matter. Try not to draw false conclusions. Stereotyping is weak sauce.

To me it seems as if your liberal friends are not in touch with the real world. However, Is it possible that you are assuming the Liberals who say "I'm going into medicine to help people" and do not mention the prestige and financial possibilities are arrogant? I am liberal, I understand and hope I will be well compensated, I hope I will be able to live comfortably, I will not donate 100% of my salary thats for dam sure! Yet I am going into medicine primarily because I want to help people, does that make me arrogant or wrong? Sorry for the run on sentence hehe.

Most service professions are 'helping people'. The cashier at McDonalds helped me today, without him I would be hungry .

Being the devils advocate, is seems to me as if you are purusing medicine largely, but not singularly, for the compensation. I could care less about ones motives to become a physician, as long as they did their job at an average or above average level.

But if you are not looking into medicine simply for the compensation, than what is your reasoning? I am not meaning to flame so try not to kill me ahah.

Other than that I agree with you completely. I have noticed people here get REALLY bent about politics.

Its really a balance. I am in love with science and simply find that medicine is the most interesting thing to study out there. In addition to that I've encountered several physicians who have treated me like crap; I'd love to become a physician who treated people like peers instead of test subjects or lower beings. And yes- I have family members who have suffered through serious diseases only to be treated horribly by doctors...it hit home for me and made me determined to be a doctor who treated people right.

So when choosing a career it was finding a balance between something I loved to do and something that would put me well off financially. And who knows..maybe I'll find out next year I am better suited for medical research or something. While the money is a plus of being a doctor, it is by no means why I want to go into that field. Like I said..If I just wanted money I'd get my degree in chem engineering and start making good cash at 21!

 

[8744]

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.

Just one patient. Just one. Can suck up all of the money you save the system by working for a fifth of what you are worth. I admit at least three patient's a shift who I know will suck up fifty grand of unnecessary and completely wasted medical care before they are discharged to perpetually teeter on the brink of another equally costly admission.

Folks, doctor's salaries are not the big driver of health care costs. A regular hospital admission, for example, to a regular bed, is reimbursed by Medicare to the tune of $5000 a day. The physician who attends probably adds a hundred bucks to this bill if that. An ICU admission, and I have seen plenty of patients who spend weeks in the ICU before they inevitably die, our best efforts serving only to animate their carcasses until nature gives us the finger, costs Medicare...are you ready for it....$15,000 a day of which the doctor's fees are, again, only a small fraction.

Besides, the purpose of the health care system is to match patients to physicians who then diagnose, treat, and manage their medical problems. Everything else is just support, necessary and valuable support of course but the doctor is not just another interchangeable part.

 

[OncoCaP]

Just one patient. Just one. Can suck up all of the money you save the system by working for a fifth of what you are worth. I admit at least three patient's a shift who I know will suck up fifty grand of unnecessary and completely wasted medical care before they are discharged to perpetually teeter on the brink of another equally costly admission.

Folks, doctor's salaries are not the big driver of health care costs. A regular hospital admission, for example, to a regular bed, is reimbursed by Medicare to the tune of $5000 a day. The physician who attends probably adds a hundred bucks to this bill if that. An ICU admission, and I have seen plenty of patients who spend weeks in the ICU before they inevitably die, our best efforts serving only to animate their carcasses until nature gives us the finger, costs Medicare...are you ready for it....$15,000 a day of which the doctor's fees are, again, only a small fraction.

Besides, the purpose of the health care system is to match patients to physicians who then diagnose, treat, and manage their medical problems. Everything else is just support, necessary and valuable support of course but the doctor is not just another interchangeable part.

That's insane. I wish someone could make it stop. If there is no hope, let's admit them to hospice care and have a CNA care for them under an RN's supervision.

This particular person wants to go into rural primary care. Really the only way to get down to $30K/yr is to treat a lot of immigrants without any money and no insurance in a state/county that doesn't reimburse for that. Even then, there are probably grants this person could get to keep his or her pay above $100K if that was desired. Rural primary care is not going to cost $5000K/day (unless this physician is providing chemotherapy, there is a hospital admission, helicopter flight, etc.).

 

[in pectore]

Panda Bear and macgyver22,

Have you read A Second Opinion: Rescuing America's Health Care? If so what did you think of the plan outlined in that book?

Do you think it would improved the practice of medicine?

Just one patient. Just one. Can suck up all of the money you save the system by working for a fifth of what you are worth. I admit at least three patient's a shift who I know will suck up fifty grand of unnecessary and completely wasted medical care before they are discharged to perpetually teeter on the brink of another equally costly admission.

Folks, doctor's salaries are not the big driver of health care costs. A regular hospital admission, for example, to a regular bed, is reimbursed by Medicare to the tune of $5000 a day. The physician who attends probably adds a hundred bucks to this bill if that. An ICU admission, and I have seen plenty of patients who spend weeks in the ICU before they inevitably die, our best efforts serving only to animate their carcasses until nature gives us the finger, costs Medicare...are you ready for it....$15,000 a day of which the doctor's fees are, again, only a small fraction.

Besides, the purpose of the health care system is to match patients to physicians who then diagnose, treat, and manage their medical problems. Everything else is just support, necessary and valuable support of course but the doctor is not just another interchangeable part.

 

[Forbes]

...If I just wanted money I'd get my degree in chem engineering and start making good cash at 21!

Yeah but chemical engineering is boring right?


Another question to Panda Bear and macgyver22 or any other experienced physician with opinions on the health care "crisis",

Is simple safety work like that of Dr. Pronovost a foreseeable part of the solution? It boggles my mind that he saved the state of Michigan hundreds of millions and an estimated 1500 lives simply by making people adhere to checklists. Do you embrace this idea and other safety research as part of the solution?

My source,

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande

 

[macgyver22]

Panda Bear and macgyver22,

Have you read A Second Opinion: Rescuing America's Health Care? If so what did you think of the plan outlined in that book?

Do you think it would improved the practice of medicine?

I haven't read it but I'll put it on my list. I want to read Tom Daschle's book first (Critical: What We Can Do About the Health-Care Crisis ). It may not be as insightfull, but he is going to be in charge of the nations health and human services for the next four years at least and there are already some concerns about his competence for this job since he has come out in defense of the supplement industry.

 

[OncoCaP]

Panda Bear and macgyver22,

Have you read A Second Opinion: Rescuing America's Health Care? If so what did you think of the plan outlined in that book?

Do you think it would improved the practice of medicine?

I took a look at it on Google Books. It proposes band-aids for major problems and fails to address the heart of the problem that Panda introduced above. Until we are willing to say, "no" to certain types of expensive end of life care, making people either accept the fact that they are going to suffer or die if they do certain unhealthy things (and taxpayers will not fund expensive non-palliative treatment for disease that they caused themselves), and put more emphasis on prevention, we will not get anywhere. I'd go so far as to put a healthcare tax on any unhealthy food or activities ... (that Big Mac will be $3 plus $15 in healthcare tax. All cigarette taxes should go to pay for lung cancer medical care and other related treatment before any politician uses it to pay for education, for example.). I like the fact that we have a free country, but if you break your body by doing things we know are unhealthy, then you get to pay to fix it if you want to live.

For example, we could require a license for smokers which they obtain by agreeing that they are personally responsible to pay in cash for any non-palliative medical costs related to their smoking (unless a charity chooses to pick up the bill) ... go ahead and smoke, but you don't get the CABG or the lung cancer chemo at the expense of taxpayers ... you caused this and you personally pay for it in cash if you want to fix your own mess.

Once we have a certain amount of reason and responsibility back in the way healthcare is paid for and how the money is used, there will be more than enough money for every expectant mother to get a prenatal checkup and in some cases even be able to fund things like lung transplants for CF kids, etc.

The above will never happen, and thus there will be rationing based on ability to pay. Whoever can pay for care that they get (whether through a gov't program or otherwise) gets care and those who can't afford to pay, will just have to suffer and/or die.

 

[in pectore]

I took a look at it on Google Books. It proposes band-aids for major problems.

Wow, I never thought anyone would call the sweeping health care reform proposed in that book just a band-aid. Maybe you should read it first.

For those who do not know, the book proposes a single-payer insurance program supported by a health care tax. Also the plan includes making every hospital not-for-profit and would make physicians salaried employees of not-for-profit group practices. It is hard to compress the ideas of an entire book into a few sentences, so I urge people to pick up a copy and read it. It is a short, quick read (maybe 180 pages).

Also, OncoCaP I hope you are joking about an unhealthy tax. I can hardly imagine the amount of administration needed to collect taxes on unhealthy habits and then directing the revenue to pay for the treatments those habits led to. Also, back to the beginning of the thread - how would that improve the job satisfaction of a physician…specialists would get to turn away people because they made stupid choices. What about primary care docs, and all the problems with insurance and managed care.

 

[OncoCaP]

Wow, I never thought anyone would call the sweeping health care reform proposed in that book just a band-aid. Maybe you should read it first.

For those who do not know, the book proposes a single-payer insurance program supported by a health care tax. Also the plan includes making every hospital not-for-profit and would make physicians salaried employees of not-for-profit group practices. It is hard to compress the ideas of an entire book into a few sentences, so I urge people to pick up a copy and read it. It is a short, quick read (maybe 180 pages).

Also, OncoCaP I hope you are joking about an unhealthy tax. I can hardly imagine the amount of administration needed to collect taxes on unhealthy habits and then directing the revenue to pay for the treatments those habits led to. Also, back to the beginning of the thread - how would that improve the job satisfaction of a physician…specialists would get to turn away people because they made stupid choices. What about primary care docs, and all the problems with insurance and managed care.

Unlike what Panda is suggesting above, physicians and related providers do make up a significant chunk of the cost of healthcare: http://www.chcf.org/documents/insurance/HealthCareCosts07.pdf . Both hospitals and physicians are getting squeezed as the government, insurance companies, and employers look for ways to deal with healthcare costs that rise at many times the rate of inflation.

Even a single payer system is unaffordable if we throw everything possible at every sick person. Yes, it would distribute dollars more evenly in some ways, but it would generate tons of waste in other respects. By making it a single payer system, it becomes more open to corruption and inefficiency. Folks like Gov Rod would be running it working hard to figure out how they can enrich themselves. The end result would be roughly the same amount of care delivered in roughly the same way to roughly the same people. We can provide an amazing array of treatments and if every sick person got a large amount of medical care, it doesn't matter how you shuffle the dollars, we still can't pay for it. Look at Mass that recently started providing universal care ... the amount of care and the cost went up and it's unlikely that there will be any savings whatsoever. One important reason that Europeans have traditionally been able to keep medical costs down is because when you're 80 years old and very ill, they don't do much for you (at least in the gov't system). They sort of expect your body to give out at a certain point and that you will die at that point rather than artificially prolonging life in an unaffordable way. This is changing to some extent, and their healthcare system costs are also going up dramatically.

The amount of administration that an unhealthy tax would require would be trivial compared to the revenue collected and the impact it would have in funding care. I have yet to hear anyone complain about the difficulty of administering the cigarette taxes. It's a non-issue. However, you are correct. It is unlikely that politicians would send those dollars to actually care for people or that such a tax would ever have a chance of passing in the first place.

I guess what I'm getting at, is that many of our healthcare funding issues are due to self-inflicted health problems (such as obesity and smoking) and in other cases our unwillingness to say that we are not going to provide extremely expensive medical care with dollars that could be better spent preventing serious health problems through better primary care and other programs that improve health, such as P.E. for kids in schools.

In terms of improving physician satisfaction, we could set expectations that pay will be decreasing as time goes by. As long as people know their pay will go down, it's not going to hurt quite as much. Improved working conditions would also be a plus in certain cases. If physicians worked the kind of hours that dentists did (40 hours per week, a couple of afternoons per week off and double pay for call or weekend work), you would have fewer unhappy physicians. There are many common sense things that can be done, and some of them will happen as more women enter the workforce and some tell their employers that they will work half time and no, they aren't taking call. They are going to be in a strong negotiating position. Look at pharmacy. It used to be a male dominated field. Now it's mostly women and they have pretty reasonable hours that they work. There are pharmacists that live a very comfortable life working half time. Many physicians could do the same. A stressful job isn't nearly as bad if you're only putting in, say, 30 hours per week and taking home $150K/yr.

 

[starseeker]

I don't think most people become doctors for the money. Advocating a higher salary for whatever you do doesn't mean you're in it for the money. Many people have a hard time understanding this and your screen name implies as if you are trying to isolate yourself from the rest of SDN who are all for the money...

Finally, if you have more money, you can reach more patients. Make more, donate more.

I agree with you 100%. There are lots of people who don't go into medicine for the money. But if after taking care of your family, paying back your loans, and paying a morgage and other bills, you find there is not much money left over there has to be a little bit of content. Saying that you would like to live with a higher salary isn't chasing after the money, it's asking for what you feel you deserve. Besides the basis of the argument isn't people asking for $500,000 salaries, it's just asking to make enough. I believe people just want to feel that after all their expenses are paid there is enough for them to enjoy. After all 8 years of school plus 3+ of residency is not easy and does require a lot of sacrifice.

 

[circulus vitios]

Well I'm too lazy to copy and paste, but my name says it all. Honestly, I'm not doing it for the money(I know some of you are gonna think I'm full of it, but w.e.)Since I've been a kid I've always dreamed of being a doctor, not for the money, but for the self-accomplishment that came with it.

I am planning to go travel the world once I get out of medical school as well.(google doctors for Africa and you'll see what I mean) I find enjoyment in helping others and feel as if that is a reward itself. Like others said, "This is a career, not a job", so as for balancing my personal time and my work you ask? There's no line, they're intertwine with one and the other. I knew what would be on the line and what I was risking even before I decided that I wanted to be a doctor.

I can go on and on, but my laptop is about to die and I left the charger in the car. lol night ya'll (yea I'm Asian with a southern accent)

oh yea I'm either going for I.M. or surgeon(C.T.)if possible

The only way this could be a bigger cliche is if your parents gave you a toy stethoscope when you were 5 and you knew since then that you always wanted to be a doctor.

 

[da8s0859q]

The only way this could be a bigger cliche is if your parents gave you a toy stethoscope when you were 5 and you knew since then that you always wanted to be a doctor.

Have to agree with my CV friend here. That's pretty cliché.

But, as I've said previously, every profession really does have all kinds. More power to you.

Myself, it has to be a job, not a "calling." I feel like I'd enjoy the work as much as any practicing doc does on those more career-reaffirming days, but I also value my sanity.

 

[scurred09]

What are your expectations in regards to earnings?

I don't care much about earnings as long as I can live comfortably.

What are your expectations for quality of life?

I don't seriously expect anything. As long as I am a physician and I pay off my loans and can live comfortably (not lavishly) I'll be happy.

I don't quite understand you. How could you not care about a Physician's earning but yet according to your own words, "wants to live comfortably"? Some people could live comfortably at $40k/yr. Is that comfortable enough for you? or perhaps $150K is comfortable?

 

[saintelsewhere]

Ooh, what a neat post.

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

Yeah, my first day shadowing the doc told me all of the crap she has to go through, took me through the paperwork and the insurance company fighting, and then said, All this stuff sucks but you have to do it or people won't get the help that they need. She's really kick-arse and it only motivated me more

What are your expectations in regards to earnings?

The measure of success for me is a house with a fig tree in the back yard and a fireplace in my bedroom. So enough money to have one of those is all I need.

What are your expectations for quality of life?

I think it will be a lot of long hard days but actually I am looking forward to that. I need a job that is also a lifestyle. That is something I have learned about myself. 9-5 bores me terribly (been there, done that) and that is something I really DON'T want to do.

What kind of medicine to you hope to practice?

Chances are it will change 540296854290592 times (it already has since I decided to go into medicine to begin with), but right now I would really like to be a breast cancer surgeon. Podiatry is another specialty I have been considering, along with orthopedic surgery, because I love bones! I'm not applying till 2010 though, and I might apply to pod schools as well as MD/DO programs

 

[Nilf]

Ooh, what a neat post.

Yeah, my first day shadowing the doc told me all of the crap she has to go through, took me through the paperwork and the insurance company fighting, and then said, All this stuff sucks but you have to do it or people won't get the help that they need. She's really kick-arse and it only motivated me more

The measure of success for me is a house with a fig tree in the back yard and a fireplace in my bedroom. So enough money to have one of those is all I need.

I think it will be a lot of long hard days but actually I am looking forward to that. I need a job that is also a lifestyle. That is something I have learned about myself. 9-5 bores me terribly (been there, done that) and that is something I really DON'T want to do.

Chances are it will change 540296854290592 times (it already has since I decided to go into medicine to begin with), but right now I would really like to be a breast cancer surgeon. Podiatry is another specialty I have been considering, along with orthopedic surgery, because I love bones! I'm not applying till 2010 though, and I might apply to pod schools as well as MD/DO programs

hehehe... so you like breasts, long bones, and feet. Don't get me wrong, those are important, but why exactly do you want to go to medical school?

If house with a fig tree is your goal, then go become an accountant. You'll achieve your goals much faster.

Oh and by the way, by the time you get through your training, 9-5 job will seem like an unattainable dream.

 

[macgyver22]

The measure of success for me is a house with a fig tree in the back yard and a fireplace in my bedroom. So enough money to have one of those is all I need.

Your answers are thoughtful, but your answer to this question is a bit romantic. If you read some of the posts above it is by no means unique. The unfortunate reality of life is that you will need much more.

Along with that house and a fig tree I assume you will need a car to get to work, and gas to put in that car, and money to insure it and repair it. You will need fuel to keep your little house warm and food to keep you from starving. You will need water to keep your fig tree healthy. You may get bored watching your fig tree every day and decide you want to travel. You may want to get married and have children etc. etc.

It reminds me of an old Steve Martin movie called the Jerk. Maybe you've seen it, but there's a scene where he's lost everything and he starts talking about the fact that he doesn't need all the stuff

And that's it and that's the only thing I need, is this. I don't need this or this. Just this ashtray. And this paddle game, the ashtray and the paddle game and that's all I need. And this remote control. The ashtray, the paddle game, and the remote control, and that's all I need. And these matches. The ashtray, and these matches, and the remote control and the paddle ball. And this lamp. The ashtray, this paddle game and the remote control and the lamp and that's all I need. And that's all I need too. I don't need one other thing, not one - I need this. The paddle game, and the chair, and the remote control, and the matches, for sure. And this. And that's all I need. The ashtray, the remote control, the paddle game, this magazine and the chair.

Well, it was funny the first time I saw it, but whenever someone start talking about "all they need" I can't help but think of that scene. Not all, but most people on here who have posted similar comments have had limited experience in the real world. They have not raised a family or owned a home. In addition they are generally young. I suppose you could respond by saying I'm old and you would be partly right, but I'm also your future. When you're young living on macaroni and cheese in a one room apartment and driving a car that requires a push from your friends to get started seems like no big deal. Living in hostels while backpacking around Europe is cool. But those things lose their attraction after a while. You may not lose your sense of adventure but you do get tired of roughing it and denying yourself the things that other people have.

You don't need to make a million dollars, and you won't, but you should talk to some of the adults you know about what it costs to maintain the standard of living they have. My guess is it costs a lot more than you think.

 

[Jolt21]

You don't need to make a million dollars, and you won't, but you should talk to some of the adults you know about what it costs to maintain the standard of living they have. My guess is it costs a lot more than you think.

word. I'm taking 2 years off between undergrad and med school (in the 1st year right now) and the cost of living is kinda crazy. I live in rural NH, so I supposedly have it easier as well. after all my bills, i barely have enough for leisure. its depressing at times, but it has made me appreciate the little things in life.

 

[Lokhtar]

I don't think most people become doctors for the money.

Lolzers. Switch around what PhD's make with what doctors make and watch the flip in applicants overnight. Denying such a basic motivation is stupid. If you pretend you're not in it for the money, it's much easier for others to justify taking it away from you.

It's just another job, another career. And until doctors start treating it as such, they'll keep getting **** on. No one would do that to nurses, or they'd face a strike. Doctors don't go on strike, to their disadvantage.

Originally Posted by macgyver22
You don't need to make a million dollars, and you won't, but you should talk to some of the adults you know about what it costs to maintain the standard of living they have. My guess is it costs a lot more than you think.

On average, the kids who go into medicine have been upper middle class and upper class, so obviously their standard of living and expectations are different. I'm a non trad and I've been working and living on my own for several years, and I get along just fine, on resident like salary.

 

[circulus vitios]

Now that we have 11 pages of discouragement, what's a good reason to go into medicine?

 

[da8s0859q]

Now that we have 11 pages of discouragement, what's a good reason to go into medicine?

To help people.



I second what Lokhtar said. Denying the money aspect is absolutely ridiculous.

 

[phospho]

No one would do that to nurses, or they'd face a strike. Doctors don't go on strike, to their disadvantage.

Nurses work for someone... i.e. the hospital in most cases...

Doctors are independent contractors - it would be illegal for them to go on strike. I'm pretty sure it's considered collusion or something along the lines of that.

And Exi is right. I love helping people, but you'd be crazy to think I'd stay in medicine if it weren't for the money. After putting up with all this crap, I'd like to be compensated fairly, just like any other professional or skilled worker. I want what I deserve.

 

[da8s0859q]

And Exi is right. I love helping people, but you'd be crazy to think I'd stay in medicine if it weren't for the money. After putting up with all this crap, I'd like to be compensated fairly, just like any other professional or skilled worker. I want what I deserve.

I was poking fun at the statement, the abused "want to help people" personal statement spiel. But then again, most people going into this sort of field have some sort of interest in doing something for others, so I suppose there's some truth to it -- no matter how jarring that little phrase is.

 

[phospho]

I was poking fun at the statement, the abused "want to help people" personal statement spiel. But then again, most people going into this sort of field have some sort of interest in doing something for others, so I suppose there's some truth to it -- no matter how jarring that little phrase is.

I agree with you though... I once wrote a post on SDN about wanting the money, without prefacing my words with "I also want to help people", and it seemed that everyone started doubting my "loyalty" to the profession.

Money is an excellent motivator. It brings out the best doctors. If doctors were all getting paid the same thing, I don't think we can advance in medicine, or let alone excel at what we do as future physicians. We would become a comatose profession, doing the 9-5 shift and getting our asses back home because it's not worth putting more time or effort into a ******ed system.

 

[Katatonic]

I want what I deserve.

How dare you! What about a person's right to your labor? Sorry, I had to.

 

[Excelsius]

Lolzers. Switch around what PhD's make with what doctors make and watch the flip in applicants overnight. Denying such a basic motivation is stupid. If you pretend you're not in it for the money, it's much easier for others to justify taking it away from you.
...

Glint first, micturate second.

1. If you read my posts, I am not the one suggesting that salary doesn't matter or that salary cuts are ok.
2. Salary always matters. The discussion was about doing something ONLY for the money.
3. Some people do certain functions only for the money, usually at the bottom of the food chain, trying to make ends meet. Going to school for eight years and then another 3-8 for residency requires a LOT of dedication to the given profession. If you have no interest whatsoever, it will be hard for you to make it though it all. Probably there are some in this group, but they would not make a majority. There is a small percentage that drops out, so perhaps...
4. Most of the time it is combination of salary and interest.
5. A lot of premeds are not cut out for Ph.D. work - many dislike research and abhor non-bio courses like physics. Premeds are far from being the smartest in college and your suggestion that anyone from that group could do PhD work involves a certain level of egocentrism. You can want to make all the money you want, but if you hate memorizing stuff just like one of my math teachers did, you are NOT going to go into medicine, just like you are not going to become a physicist if you don't like thinking too much (well, you might become crappy professional if you try hard enough). If all you care about is money, then go into entertainment. Will you? No. Because not everyone is cut out for that. And let's not go into the BS that you might not make a lot of money as an actor.

I probably should have said that "I don't think most people become doctors ONLY for the money," but then again, attempting to consummate even the most putative ideological sentence doesn't preclude someone with enough desire from taking the words out of context.

 

[premedmajor89]

Great thread! I hope to hear more from you and other physicians who are willing to give us pre-med students a better look at what were getting into! thank you

 

[phospho]

how dare you! What about a person's right to your labor?

screw them!!!

 

[Excelsius]

Actually I don't think most students do know the realities of medical practice in the real world. When you see the discontentment among practicing physicians ( not all but clearly a significant minority and perhaps even a majority in some of the most important fields) and the degree of enthusiasm among prospective medical students there is obviously a huge disconnect.

As for the graph, I would like to see where that information comes from and what they use as their source. I can tell you for a fact that were you to show that to any physician around here they would laugh at it. It might as well be a graph of the price of peas in China. It has no correlation what so ever with reality in my part of the country or most other areas that I know of. My wife is a Gynecologist at the busiest Ob/ Gyn practice in the area and I am telling you for a fact that their income is down 50% compared to what it was 10 years ago. They now get paid $3,000 for a delivery. 10 years ago it was $5,000 per delivery. They are currently paying $175,000/yr/doctor for malpractice insurance. 10 years ago it was less than half of that. Rent, payroll, supplies and everything you need to run a medical practice have gone up accordingly. The graph just doesn't jive with the facts.

As far as what I have done personally about the problem I guess you're right, I have not spent much time on that through out this thread, but then no one really asked. There have been a number of things that I and my colleagues have done. Some have had success and others have not. Personally I have spent a lot of time writing to federal and state representatives. Occasionally I have had success and gotten good feedback. I have been part of several organized physician rallies to protest malpractice rates and lobby for malpractice reform. I have written to periodicals and local newspapers trying to make the public more aware of some of the issues. These things often have no quantifiable immediate effects, but increasing awareness among the public and our representatives is a long term project and minds aren't going to change over night.

Other more immediate efforts have included the formation of a physician owned and run managed care organization that was started and funded by myself and several thousand local physicians. Unfortunately it failed, most likely because we came to the game too late to grab enough market share and because the idea was fundamentally flawed. we had hoped to set up a kinder better HMO, but employers cared more about cost than quality so the company eventually failed. The fact is we tried though.

In another effort to take some control back nearly 100 physicians from local Ob/Gyn groups banded together to form a single megagroup. By doing this they circumvented the antitrust laws that prohibit doctors from going on strike or negotiating as a single group. The jury is still out on whether this is working or not but again physicians are trying something.

One of the biggest disadvantages physicians face is the fact that their job is to take care of patients. Taking care of business is necessarily a side job that requires more time than most of us have. despite some misconceptions, most physicians really do care more about their patients than the money and the insurance companies know that and use it to their advantage.

My recommendation to you and all premeds is to be aware of whats going on. Watch what we are doing. Learn what works and what doesn't and build on that. To a certain extent some of the coming changes are inevitable. It will be more important than ever for young doctors to anticipate those changes so you can make decisions and adapt. That part at least will be easier for you than for me. You have few commitments and more flexibility.

I've posted this before but I'll say it again. There is a free add driven magazine called Medical Economics. This isn't The NEJM, but it will give you a real "ear to the ground" insight on where things are going in medicine. The graphs and data they often publish in there aren't filtered through government statisticians and bureaucrats, they come from doctors working in the field. Give it a look when you have a chance. I'm pretty sure a subscription is free, but if not your local library may carry it.

Thank you for the time you invest in this thread. I did not come back to respond for a while because I wanted to wait for the more experienced residents/medstudents to add their input. It is painfully obvious that there aren't a lot of viable ideas out there. For now, I really can't add much to what was already discussed, but I do have a few observations/opinions. First, as you see from the graphs of OncoCap, not all specialties have been affected in similar way. In fact, it seems the salary has increased for some of the specialties. It is likely that things look bleaker for you because your specialty was one of the hard hit ones. Second, when you see so much disparity among different specialties, it makes it harder for everyone to come together and act as a group.

In my opinion, the solution, or at least part of it, depends on the doctors' ability to self-regulate their field, just like they do it in law. Given the disparity among different specialties and how individual and selfish some doctors can be, I don't see this problem being solved unless one governing body forces all the doctors to comply with the same rules and regulations. The governing body should be made up of doctors and the implemented regulations should include codes of conduct and ethics. For example, there should be a general guideline as to what kind of life support options should terminally ill patients get or what types of diagnostic tests are enough to identify a certain types of diseases. This way if a doctor follows the guidelines and gets sued, the case will be dismissed. I think that there can be some basic regulations that can help both doctors and patients avoid litigation based on ambiguity of ethical procedures. There should also be a standardized cap on malpractice based on the specific type of injury.

Another major area concerns the insurance companies. If doctors can't find a way to regulate the insurance companies, no one will. As advocates of patient health, I think that the responsibility can be pitched the right way to congress to demonstrate that insurance companies have a conflict of interest when they are trying to decide whether they cover a procedure or not and that a better solution would be to have one doctor recommend a treatment and if the insurance company is going to question that decision, it needs to consult with another, independent doctor and upon confirmation the insurance company should approve the treatment without any additional paperwork from the doctor. What I don't know is whether this system will be more efficient than having individual doctors fight with the insurance company until the treatment is confirmed; or whether it should be the insurance company responsible for paying for the second opinion. Certainly another good outcome of the second opinion will be higher quality of care and smaller chance of mistakes and misdiagnoses. Right now doctors are forced to argue with clueless businessmen whether a procedure should be done or not. This process is so wrong that I can't even understand as to why it still exists.

You writing a letter to the government is not going to have as much weight as an organization writing a letter. AMA should either be disbanded and a new organization formed or the entire leadership there should be changed. The public opinion of doctors has been slipping and that's part of the reason why doctors have no support in congress. If the public is unaware of the problems, there will not be enough constituents to force the congress to act. AMA has completely failed in public relations aspect. It is probably run by those few egocentric students who did not mature after getting their degree and are now grumpy old demigods. Articles like this don't help AMA either. I don't know why that organization persists. Somebody needs to put it out of its misery. Macgyver, what is your opinion of AMA? I can't imagine it to be positive since you had to write those letters yourself. Did you ever think about getting into AMA and advancing in ranks? What does it take to become a leader in that organization?

I know that it would help to have a database where all the mistakes and successes were documented so that doctors don't have to invent the wheel over and over again, individually. This is why a powerful organization will be able to do what individuals like you can never achieve by themselves.

 

[applicantfailur]

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

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

What are your expectations in regards to earnings?

What are your expectations for quality of life?

What kind of medicine to you hope to practice?

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

I look forward to your responses.

1. Most doctors that I have met are very happy with their jobs. Even the family practitioners who make $150k at a hospital (vs. making more at your own office).
2. I heard that the salaries of the specialists are bound to go down. Familiy physicians are not affected because they already make no more than australians or canadians. I want to be a specialist and if the income goes down a bit(or in half), i'll survive. They still make much much more than the drs in europe.
3. I want to be a radiologist (EM is a backup). That's why although I got rejected this cycle, I am not going to apply to DO schools.
4. Regarding the quality of life, I intend to get me a woman like Christie Brinkley. Whatever it takes. But my life is far from glamorous right now. I dont know if i should sign up for a job doing lab research or just be a lifeguard or what? I hate wasting my life like this. If i had gotten into med school, I would've been in Prague right now.

 

[applicantfailur]

To add to my response: I would never marry a female physician. They do not look like Christie Brinkley.

 

[applicantfailur]

Also my favorite movies (for today, i watched them just now) are National Lampoon's Vacation and Species.

 

[macgyver22]

1. Most doctors that I have met are very happy with their jobs. Even the family practitioners who make $150k at a hospital (vs. making more at your own office).

It's interesting. I have seen others make similar comments on this thread and yet in my own community I know few physicians who feel that way. It could be geography or it might be that some physicians are a bit reluctant to be "completely' honest with young people who are interested in the field. I'll admit that I tend to restrain myself a bit when discussing these issues face to face with students. Partly because in person my opinions will tend to carry more weight and have more impact then they do on a message board like this one and I don't want to take advantage of that position. I think some doctors also prefer to let students figure it out for themselves rather then prejudicing them with their own opinions, but I think they underestimate a students ability to weigh each doctors opinion fairly. Besides, how is a student going to "find out for themselves" if they can't get honest input from practicing physicians.