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

macgyver22

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Jan 11, 2008
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  1. Attending Physician
    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.

    You've hit on a big part of the problem. First of all doctors are not allowed to unionize, but even in the few ways we are allowed to weakly organize its difficult. It's a bit like trying to form a cohesive group between airline pilots and police officers. They will obviously have very different goals and any agreement would inevitably benefit one group more than another creating discord among them all. Personally I think the huge disparity between physicians who perform procedures and those who provide cognitive services needs to be rectified, but without a doubt the plastic surgeons, interventional cardiologists and radiologists will disagree.

    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.

    I'm not exactly sure what your getting at but we are way beyond any hope of self regulation. Society has already decided that more regulation not less is the answer to all our problems. There are a lot of things already in place or coming soon that will increase the level of government and insurance company oversight. The era of self regulation is already a distant memory.

    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.

    There actually is some hope of improvement here for exactly the reasons you lay out. The government has decided that there are too few primary care docs and too many specialists with signs that its only going to get worse ( One quick scan of this forum certainly confirms that), and has started working towards a system that would pay more for primary care services and less for subspecialty work.

    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.
    This is a very big topic to cover here, but you are right that there needs to be malpractice reform. There doesn't seem to be much political will yet to do it though.

    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.
    This is a real problem. Currently if I want to argue with an insurance company to get a test approved I speak to someone who barely has a high school degree ( and in some cases its someone who speaks poor english sitting at a computer terminal in India). From the minute I get on the phone I am at a disadvantage. The meter is always running in business. Its only costing the insurance company $5/hr to put this poorly educated person on the phone to argue with me. During that same time I'm still paying $200/hr to keep my office open. Insurance companies should be required by law to put a doctor on the phone if a doctor wants to dispute something. The insurance companies would deny a many fewer requests and require far fewer pre-authorizations if that were a requirement.

    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?

    The AMA has truly lost most of its power since its heyday in the 50's and 60's. Although it may sound like a bit of a cop out, as a solo practitioner, I haven't the time to become involved with the AMA in a way that would make a significant difference. I already wear too many hats. I honestly think at this point that my efforts have more of a chance of effecting things if I go it alone. If I thought the AMA was moving in the right direction I might put more of my efforts there, but its not. I would literally have to become president of the organization and force it to change course and I don't have the time or the political talents to do that. You are right about that article being problematic, but the AMA is right in trying to prevent Nurse Midwives from encouraging home births. They are dangerous. People forget in this day and age how many mothers and babies used to die in childbirth. The numbers are horrendous. An accidental home birth is one thing, but to intentionally encourage it is down right criminal in this day and age. People will die needlessly.
     

    ChichiMD

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    Nov 5, 2008
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      Dr.M,

      Thank you so much for this thread. I am one of the pre-meds (class of 2013..yay???) who frankly speaking hasnt "seriously" thought about the debt and amount of time. Its kind of hard to grasp how bad being 250,000 in debt really is.

      Now my brother is an M3 and has severally warned me against studying medicine. He thinks if i really want to be in the field i should be a nurse or even dentist (I HATE teeth..inlcuding my own...dont judge me).

      I guess its a hard to admit that I always envisioned a very nice lifestyle as a physician. Its sad that this might not be the fact of life.

      Anyways, just wanted to say thanks. All the contributions even from some "silly" pre-meds (who are so bloody naive it seems) has sparked a re-think about the sacrifices I will be giving up.
       
      Anyways, just wanted to say thanks. All the contributions even from some "silly" pre-meds (who are so bloody naive it seems) has sparked a re-think about the sacrifices I will be giving up.

      Definitely. Thanks again, Mac -- food for thought for the more idealistic among us.

      Hell, food for thought for all of us. I know it's scaring me.
       
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      Excelsius

      Carpe Noctem
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      Apr 6, 2008
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        You've hit on a big part of the problem. First of all doctors are not allowed to unionize, but even in the few ways we are allowed to weakly organize its difficult. It's a bit like trying to form a cohesive group between airline pilots and police officers. They will obviously have very different goals and any agreement would inevitably benefit one group more than another creating discord among them all. Personally I think the huge disparity between physicians who perform procedures and those who provide cognitive services needs to be rectified, but without a doubt the plastic surgeons, interventional cardiologists and radiologists will disagree.



        I'm not exactly sure what your getting at but we are way beyond any hope of self regulation. Society has already decided that more regulation not less is the answer to all our problems. There are a lot of things already in place or coming soon that will increase the level of government and insurance company oversight. The era of self regulation is already a distant memory.



        There actually is some hope of improvement here for exactly the reasons you lay out. The government has decided that there are too few primary care docs and too many specialists with signs that its only going to get worse ( One quick scan of this forum certainly confirms that), and has started working towards a system that would pay more for primary care services and less for subspecialty work.


        This is a very big topic to cover here, but you are right that there needs to be malpractice reform. There doesn't seem to be much political will yet to do it though.

        This is a real problem. Currently if I want to argue with an insurance company to get a test approved I speak to someone who barely has a high school degree ( and in some cases its someone who speaks poor english sitting at a computer terminal in India). From the minute I get on the phone I am at a disadvantage. The meter is always running in business. Its only costing the insurance company $5/hr to put this poorly educated person on the phone to argue with me. During that same time I'm still paying $200/hr to keep my office open. Insurance companies should be required by law to put a doctor on the phone if a doctor wants to dispute something. The insurance companies would deny a many fewer requests and require far fewer pre-authorizations if that were a requirement.



        The AMA has truly lost most of its power since its heyday in the 50's and 60's. Although it may sound like a bit of a cop out, as a solo practitioner, I haven't the time to become involved with the AMA in a way that would make a significant difference. I already wear too many hats. I honestly think at this point that my efforts have more of a chance of effecting things if I go it alone. If I thought the AMA was moving in the right direction I might put more of my efforts there, but its not. I would literally have to become president of the organization and force it to change course and I don't have the time or the political talents to do that. You are right about that article being problematic, but the AMA is right in trying to prevent Nurse Midwives from encouraging home births. They are dangerous. People forget in this day and age how many mothers and babies used to die in childbirth. The numbers are horrendous. An accidental home birth is one thing, but to intentionally encourage it is down right criminal in this day and age. People will die needlessly.

        By now I am very aware about the restrictions against unionizing. However, I am referring to organizing, rather unionizing. In other words, creating an organization just like AMA, except one that it more cohesive and efficient. This may not be easy to do, but I don't see doctors' problems being solved any other way. I know that if enough money is spent and enough high power lawyers are involved, the organization can come as close to unionizing as possible.

        It seems that you agree that the disparity between various specialties is a major stumbling block preventing doctors form working as a group. I think it is the largest problem facing doctors. The enemy is from within - you can't go after the insurance companies if you can't even stick together. So I often ask myself - why would an orthopedic surgeon spend his time to help the cause of primary care doctors? I doubt there are too orthos who are unhappy with their income. To me it seems that there can be two main solutions. One of them is creating perhaps two or three organizations each representing specialties that are alike, such as primary care, FM, pediatrics in one group and neuro, ortho, cardio in another group. Obviously, there has to be a lot of thought put into this as there might be some disadvantages to this (such as the groups fighting one another, etc). The other solution is creating one organization representing all MDs and DOs, BUT keeping sensitive topics like salaries off the organization's capabilities. As you can see from this forum, many future doctors are pretty tight about their incomes and I think there is no way for everyone to come around one table if some of them are going to leave with a loss. So, if the salary "regulation" is left off of the agenda, the organization can concentrate on issues like reforming insurance companies. Whether you are an ortho or FM, you deal with the insurance company and are affected by congressional decisions all the same. This should be a good motivation for the group to come together since everyone has something to gain. If insurance companies are reformed to streamline patient approval process, your salary will benefit indirectly without ever having to directly raise the issue in the organization. Constituents/patients will be behind this idea as well because it would mean that their treatments will be approved faster. And who doesn't want that? An advertising campaign could include all those cases where patients needlessly died because of the ignorance of the insurance companies. The public will be outraged if it learns about some of those cases, like that child who recently died and right after that the parents received the approval from the insurance. I was very angry about this. The worst part is that the public thinks it is the doctor who is responsible! Therefore, one of the most important goals is for doctors to disassociate themselves from the insurance companies and project the majority of the blame where it belongs - at the insurance companies.

        Those are just some ideas, but what really needs to happen is for doctors to have a forum where they can have regular meetings to brainstorm where the country is going and what is the most efficient way to deal with the problems. The impotency of AMA is pretty patent. Right now doctors do not have any representation.

        I understand that you are busy, but when the time comes and someone tries to jumpstart a new organization that stands for doctor's rights, how can it ever succeed if every doctors says "I' am too busy"? This is will never work. It is pivotal that as many doctors participate as possible.

        While I agree that there may be some merits to what AMA proposed about midwifes, I think it was still not necessarily a good idea. When your public relations department is almost non-existent, you should really lay low and not attack any other professionals, be it midwives, chiropractors, or other "quacks." All that does is alienate the public. I can understand how the public may feel that AMA made that decision to somehow maximize doctor incomes. I am really not familiar with all the details, but I think that at least the manner in which it was implemented did nothing but hurt doctor's image even more. AMA has a far bigger fish to fry and when it decides to go after insignificant things like midwifes it is angering an already irate public. Doctors are the enemies these days and absent an overwhelming need (such as extensive public awareness that midwives are very dangerous), it is wrong to take such extraordinary measures. How many midwifes are out there anyway? This is very similar to medstudents in the allo forum attacking chiropractors. Why would you do that? What do you have to gain from that? It is impossible to build a positive public image when the public feels it is constantly being attacked by an egocentric group. For the sake of good relations, some things should be left alone, at least until doctors regain the image they had some decades ago.
         
        Last edited:

        smq123

        John William Waterhouse
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          I understand that you are busy, but when the time comes and someone tries to jumpstart a new organization that stands for doctor's rights, how can it ever succeed if every doctors says "I' am too busy"? This is will never work. It is pivotal that as many doctors participate as possible.

          This is quite a demand, though.

          When you are older, married, with children, and ALREADY spending 60-80 hours a week at work, your spare time becomes tremendously important. You will want to spend all of that free time with your loved ones, or just catching up on sleep.

          I think it's easy to point fingers at people and say "I'm too busy isn't good enough," unless you've walked in their shoes. Once I started MS3 and saw how hard and how many hours doctors worked (and how few hours I was spending with MY loved ones), I started to realize that, actually, it IS a very real reason, and not just an "excuse."

          While I agree that there may be some merits to what AMA proposed about midwifes, I think it was still not necessarily a good idea. When your public relations department is almost non-existent, you should really lay low and not attack any other professionals, be it midwives, chiropractors, or other "quacks."

          You misunderstand what the AMA is saying.

          The AMA is NOT dismissing nurse midwives ("CNM" = certified nurse midwife) as "quacks." They are not quacks. But the AMA IS right to make its position known that home births are not as safe as hospital births.

          CNMs who practice mostly, or exclusively, in hospitals exist. They are wonderful, and are the first to alert an OB/gyn or an OB anesthesiologist if there is a problem. But CNMs who advocate home births are really putting their patients at risk. It is the practice of home births, and not CNMs, that the AMA is protesting against.
           

          SurgeonForLife

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          Feb 9, 2009
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            Are you aware of what's going on? What have you heard?

            Yes. Very aware.


            What are your expectations in regards to earnings?

            Enough to keep me going. And to keep me happy.

            What are your expectations for quality of life?

            Having a Medical career that I enjoy and eventually finding a partner. Eventually.
            Until then it's going to be crap.

            What kind of medicine to you hope to practice?


            Surgery. No doubt.
             

            Slack3r

            Sicker than your average
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            Jul 23, 2008
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              Are you aware of what's going on? What have you heard?

              Yes and no. I've talked to quite a few physicians, all of which seem to be pretty unhappy with their position. I know health care reform is coming down the pipes, though I don't know what yet (not sure anyone does). I do know insurance reimbursements are falling, tuition is rising, and the most needed fields (i.e. family practice/general practitioners) are looking more and more bleak to graduating medical students. I know this could either be a very good time to go into medicine (reform that will help reign in insurance companies and give greater quality of care w/o ****ing doc's salary) or a very bad time (reform that ends up ****ing the doctor more than he already has been).


              What are your expectations in regards to earnings?

              I want to not have to worry. I've watched my father stress himself into severe cardiac problems over money. I've watched him work his ass off in a job he hates for years so he could provide the best life possible for his children. And I never want to be that person. I want to provide for my family without killing myself. I'd like to put my kids through college, live in a safe, quite neighborhood, and still have enough for an emergency when it comes up.

              What are your expectations for quality of life?

              I have a gf that I hope will someday become my fiance. I want to have enough time to spend with her and our kids (whenever we have them). I'd like to love my job, or at least tolerate it. I'd like to be able to go into work 5 days a week and still be home in time to see my wife and kids before I have to do it all again the next day.

              What kind of medicine to you hope to practice?

              One that will afford me the two conditions above. If no field of medicine will support that, well maybe medicine isn't for me. I've wanted to be a doctor since I was 8 years old and honestly, I don't even remember why anymore. But at the end of the day, it is just a job. And if my job is going to drain the life out of me and leave me no time for my family, well that's not a job I care to stay in, no matter how much I do enjoy it. I do know, So that's the direction I'm currently headed....and there is nothing else I would rather be pursuing.
               

              dukemed22

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                I'm just curious, what career would you would propose is better than medicine? Let's assume that you still want to make decent money, and work a reasonable amount. It seems to me that every profession has its downsides, so you might as well do what you enjoy...
                 

                smq123

                John William Waterhouse
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                  I'm just curious, what career would you would propose is better than medicine? Let's assume that you still want to make decent money, and work a reasonable amount. It seems to me that every profession has its downsides, so you might as well do what you enjoy...

                  Well, if you want a career where you help people, make decent money, and work a reasonable amount, physical therapist/occupational therapist isn't that bad. They tend to work only on weekdays, there are no emergencies, and they're usually out the door by 5 or 5:30. They make less than physicians do, but again, they face less schooling and have significantly less debt.

                  Pharmacists also make a lot of money, and generally don't work crazy hours like doctors do. Their hours tend to be more in the 8-5 type schedule; again no real emergencies.

                  Dentistry is also not a bad option.

                  PAs and NPs ("physician extenders") have less responsibility, face fewer lawsuits, and work better hours. They may work on weekdays, but rarely (if ever) work 7 days a week like many physicians have to do. Again, very little call.
                   

                  Excelsius

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                    This is quite a demand, though.

                    When you are older, married, with children, and ALREADY spending 60-80 hours a week at work, your spare time becomes tremendously important. You will want to spend all of that free time with your loved ones, or just catching up on sleep.

                    I think it's easy to point fingers at people and say "I'm too busy isn't good enough," unless you've walked in their shoes. Once I started MS3 and saw how hard and how many hours doctors worked (and how few hours I was spending with MY loved ones), I started to realize that, actually, it IS a very real reason, and not just an "excuse."

                    You misunderstand what the AMA is saying.

                    The AMA is NOT dismissing nurse midwives ("CNM" = certified nurse midwife) as "quacks." They are not quacks. But the AMA IS right to make its position known that home births are not as safe as hospital births.

                    CNMs who practice mostly, or exclusively, in hospitals exist. They are wonderful, and are the first to alert an OB/gyn or an OB anesthesiologist if there is a problem. But CNMs who advocate home births are really putting their patients at risk. It is the practice of home births, and not CNMs, that the AMA is protesting against.

                    I know that AMA did not imply that midwives are quacks, but my point was that the positive impact of that legislature on patient health is likely much more negligible than the negative impact on doctors as a group. The better way to do this would be to raise public awareness first, and propose such a drastic measure, if any, second. I am not saying that this measure was necessarily wrong as I don't know much about it. I am just saying that the public was not approached properly about it.


                    Look, I understand that doctors are very busy. There are times when I get so busy that all I can do is come home, sleep for four hours, and then repeat my day at 2 am. On top of that, I have also simulated the call during the summer, so I have at least some idea what it means to be so busy that you have to take a clock with you when you shower or you have to post notes on your shower and bathroom walls. But here is the point: this organization must be formed to obtain representation for the doctors. It is the difference between allowing the doctor image to completely corrode in public view within a few decades or preventing the erosion now. Whenever I hear people say that they don't have time for something, to me it sounds that they just don't want to do it; I recall one of my mentors inculcating into my head that a week has 168 hours and there isn't a single person on earth that can't spare at least an hour per week. Even 5 hours/week constitutes only 3% of your time. Given how strongly doctors are impacted by people who have zero training in medicine telling them what to do, isn't that cause worth 1-3% of your weekly time? Only few of the doctors, mainly the leadership, would have to spend more weekly time on this, but the organization would be very powerful if a lot of doctors donated just 3% of their weekly time to this cause. It is not too much to ask. In the long run, you are in fact fighting to reduce the hours you work and have more time with your loved ones, while in the process fighting for patient rights. How much more can this erosion continue? Really, how much authority should doctors lose until they decide that it is enough? The unfortunate answer to that is infinity. What ends up happening is doctors don't stand up for what is right and their privileges erode. To compensate, they just slave harder. The insurance companies realize that and squeeze them even more passionately. The end result? Doctors drop out! Just look at primary care and the looming ER disaster. Doing nothing will mean to wait until every single specialty is affected and doctors completely lose control, by which point socializing medicine won't only be a probability, but a necessity. If there is no one to kick medschools' arse demanding that they expand, of course you are going to have professionals like chiros and CRNAs fill that gap. This is capitalism. Many doctors and medstudents don't seem to understand that by not expanding the medical school system they are NOT actually keeping the salaries of doctors high. What they are doing instead is allowing other professions to fill in the voids until there is a complete take over. So don't complain about CRNAs or chiros. They were created because MDs did not step up to their responsibilities. It is my understanding that this is exactly how DOs came to exist. Years ago they were treated like chiros. Years from now CRNAs and chiros will likely be treated the same way as DOs are treated today - equivalent to doctors. This is why I don't buy "lack of time" as a good reason to not help and fix the system. No one wants to spend those extra few hours, but it is something that has to be done. If you're unwilling to help, then you have no right to complain about anything. There should also be an option to donate money if you really don't want to donate your time. Ideally, there should be a membership that requires annual payment. If the organization sets itself up properly and comes across as a champion of patient rights, doctors can be indirectly coerced to contribute to the cause if the public is aware that it is in its best interests to only select doctors who are members of the club, almost like "board certified." If you think that I am completely wrong, I would love to hear as to what is your idea about the solution (and I don't mean just you, smq).

                    The generation before us did not do much. If this generation is unable or unwilling to learn from the past mistakes, then we are all in deep ****.
                     

                    Slack3r

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                      Does anyone else see 12 pages to this thread but can only access to page 11?

                      smq said:
                      Dentistry is also not a bad option.

                      I feel like their days are numbered as well. It's only a matter of time before insurance starts covering alot of these "big ticket" procedures, and then they're in the same boat as physicians.
                       

                      Habeed

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                        Do not try and reach page 11. That's impossible. Instead...only try to realize the truth.
                        exi : What truth?
                        There is no page 11.
                        exi : There is no page 11?
                        Then you'll see, it is not your web browser that fails to load the page, but yourself.
                         
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