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Are we reaching the downward slope in Medicine?

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puahate

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Looking at posts about not matching and SOAP on here and reddit has me thinking, is medicine worth it?

Schools growing, debt increasing, residency spots arent really opening to meet the growing amount of graduates.

Look at what happened to RadOnc for example.

Will medicine not be worth the squeeze soon?
 
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907914

If you are wondering if being a physician is finally a saturated market, the answer is an astounding no*. The asterisk is because it really depends on the field you enter. Primary care is still desperately short, both in rural areas and particularly in dense cities. In New York, for instance, it will be easier and more timely to schedule an appointment with a specialist than with a PCP. Primary care is where the massive physician shortage lies in the United States. Whereas with things like RadOnc, graduating students viewed it for over a decade as a 'cush' 9-5 type job with $250K+ prospects that just couldn't be passed up. Now the market is absolutely saturated (not just in that specialty, but in quite a few of the lifestyle and/or 'prestigious' specialties).

Medicine as a whole is not on the decline, however certain aspects of the field of medicine are becoming less and less worthwhile. I think we could probably blame students choosing specialties instead of PCP on the ever growing rise of midlevel providers. The area we need more care is PCP, but physicians as a whole stabbed themselves in the foot by NOT entering primary care in the numbers needed. Now, we have a field where primary care demands all time low wages because, in the sea of lacking physicians, administrators realized they could hire PAs and NPs for a lower price to 'do the same job,' and physicians in turn have over-saturated the market with specialists making many specialties have poor job prospects.

Overall, regardless of the field you choose, the unemployment rate for board certified physicians will never go above 1% because an MD in any specialty will always be in demand somewhere. However, the dream of graduating medical school, starting a practice and being independent of 'the system' is virtually dead. However, there is a growing trend of in-home physicians, telemedicine etc. so, you really never know.
 
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It’s not going downward but it is changing. The big metro areas are saturated with specialists. So there is a lot of effort into pushing providers to go into lesser served areas.

And there are plenty of residency spots for everybody. IMGs are taking a lot of them. But the problem is that a lot of US graduates are refusing to go into certain specialties and certain programs. And there are some very few graduates that have major red flags on their application who won’t match into any program even if the program has to go unfilled.
 

Dagrimsta1

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If you want to do medicine for money, it's not worth it. Bunch of easier, faster, and hella less stressful ways to do so.

Medicine is for sure changing with the encroaching NPs/PAs that are basically "replacing" family/PCPs as well as the slow death of private practice so the competition is ramping up for better specialist positions as if it weren't competitive enough.

Point is, if you do medicine, you gotta do it for reasons that will push you through to the end. Money helps but it can't be the only priority.
 
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Lucca

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I've been on sdn for five years now and there has not been a single instant that Medicine was not on the verge of total collapse somewhere on this forum. As far as I'm concerned the surest bet is that no, we arent.

will there come a time when the jig is up for folks just looking to cath ppl for 500k a yr in suburban LA? Probably.
 
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If you're questioning whether medicine is worth it at this point, maybe you should find something else to pursue.
 
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DexterMorganSK

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It's not real medicine until you're in debt, old, frustrated and spat on.
If any of this concerns you, quit now and never look back!
 
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Valtun

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If you want to do medicine for money, it's not worth it. Bunch of easier, faster, and hella less stressful ways to do so.

Medicine is for sure changing with the encroaching NPs/PAs that are basically "replacing" family/PCPs as well as the slow death of private practice so the competition is ramping up for better specialist positions as if it weren't competitive enough.

Point is, if you do medicine, you gotta do it for reasons that will push you through to the end. Money helps but it can't be the only priority.

I'm a little confused because I see this point being made a lot but never really sure what it entails.

What job can you make 250k+ about 7 years after college graduation? Genuinely wondering
 

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Engineering in Silicon Valley can. Also law, finance, entrepreneurship etc. Plus you can earn earlier and invest with these other jobs. It's a big opportunity cost to do med school and residency so the high pay won't get you as much when you're older without as much time for compounding interest.
 
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I'm a little confused because I see this point being made a lot but never really sure what it entails.

What job can you make 250k+ about 7 years after college graduation? Genuinely wondering

If you go to the right UG? Many. Mostly in tech and finance. Classmate of mine is making 400k this yr after doing 2 yrs on Wall st to transfer over to private equity.
 
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Matthew9Thirtyfive

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Engineering in Silicon Valley can. Also law, finance, entrepreneurship etc. Plus you can earn earlier and invest with these other jobs. It's a big opportunity cost to do med school and residency so the high pay won't get you as much when you're older without as much time for compounding interest.

You’re not making that money in law right out of law school, and you aren’t making it with significantly less stress than medicine. If you want close to $200k in law right out of school, you are looking for a biglaw job, which you have almost zero chance of getting unless you go to a T14 school (and no that is not an exaggeration). Once you do have that job, you are expected to work upwards of 80 hours/week, to miss family events, etc. And partnership is not guaranteed.

Law is definitely not an easier path to lots of money. Most attorneys out of law school or even 3-4 years out of school are not making that kind of money.

So yes, you can make that kind of money, but most aren’t and it is usually pretty stressful and requiring a lot of work. It is much easier to make that kind of money in medicine, as it is essentially guaranteed for most specialties.
 
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Once you do have that job, you are expected to work upwards of 80 hours/week, to miss family events, etc. And partnership is not guaranteed.
It's more like up to 80 hours a week some of the time and more than 80 hours a week a lot of the time. It's kind of like being a resident for way longer than you need to be. There's a reason why most lawyers hate their jobs/lives.

It's also a job where millions of dollars are at stake over a freaking comma, where re-trials rarely happen, where at the appellate level the facts are taken as facts from the trial level, and nobody is ever really satisfied.

Just read through this guy's blog and you'll see: The People's Therapist
 
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kepler16b

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In terms of making money, there's still no career that compares to the low risk and high stability of medicine. Once you are in medical school, you are more or less guaranteed to get a high paying, stable job SOMEWHERE.

Yes you can land a high paying job in engineering, finance, or law, but that is not the norm for these careers and often requires going to a highly ranked undergrad/grad school with excellent connections.

The point remains: doctors will always be in demand. Even if we have a total collapse of society following a nuclear war with NK, we will still need physicians.

(You still shouldn't go into medicine for the money, I'm just countering the argument that other fields have comparable compensation and stability.)
 
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Lucca

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The issue I always have with this is that the amount of people who actually get these extremely high paying positions is very low. Only the best of the best computer engineers end up in Silicon Valley. The vast majority will not. Same with law, finance, business, etc. Many law school grads now are struggling to find jobs, and many of those who do find jobs won't even break $100K after years of school.

You're absolutely right about the opportunity cost and compounding interest though. It takes a while for doctors to catch up financially, but they inevitably will if they're smart about their finances.



Again, this is an extreme example. For every one finance or business major making $400K you'll have a hundred more who are making 10-20% of that. Also, I doubt your classmate got there without putting in resident-like work hours.

Here's the thing everybody ignores in this conversation when they say things like "you'll have a hundred more who are making 10-20% of that..."

In this country, it matters a lot where you go to school and who you know. In any prestige, white-collar profession it is basically the most important thing. Doing X at Wharton? Drink the kool-aid, say the right things, shake the right hands, move in the right social circles, do the right internship and your place in the 1% is completely secured. Whatever else happens in UG is basically noise. Go to a semi-target school? Do all of that but also work hard to distinguish yourself from classmates and the same will be yours. Basically same story in Tech except replace target and semi-target w/ T10 CS dept or not.

What sets medicine apart from basically every other profession is that all of that stuff does not matter nearly as much. It matters, but it is nowhere near the most important thing. For the average person in this country, if you work hard and meet expectations you will have a lucrative career in medicine. For every other job, 'meritocracy' is basically a joke rich people are playing on everyone else and indeed if you only look at things from a birds-eye view it will look like for every 10 Wall St bankers, theres 100 doing mid-level consulting in the midwest (which is still a fairly lucrative, comfortable gig...). The big open secret of US higher Ed is that for 9/10 of those bankers there was never much of a question where they would end up. This is difficult to understand until you spend time at the kind of school where this is the norm, where entry into certain societies depends explicitly on who your father is.
 
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Valtun

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I completely agree with this. The appeal of "going into medicine for the money" (not that I'm encouraging it) is the money in medicine is virtually guaranteed as long as you put in the necessary work.

That's why I don't like it when people say things like, "Oh you could just go work on Wall St or Silicon Valley to become rich instead of going to medical school." Like you said, that's possible for students at schools like Harvard and other Ivy Leagues, but for the majority of undergrads going to a less prestigious public or private school, that's just not realistic.

That's exactly why I brought up the question in the first place. No other career allows you to go to virtually any undergrad and still have a shot at making that much money. When people bring up law, finance, engineering the only high end jobs that would pay that much are occupied by the students that went to top universities (which is a very small percent of those in the field).

A student going to a smaller less-known university will not be able to secure those positions (unless you have crazy connections, which would still only be the extreme minority) but medical school is still feasible going to this school, which would allow for this type of pay in the future. Now I'm not endorsing going to medical school to make money, but if you're willing and dedicated to go through the harsh 7ish years then it's worth it. The pay you get, the stability of your job, and the almost guarantee of having a job is not comparable to any other career.
 
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madlaham

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I completely agree with this. The appeal of "going into medicine for the money" (not that I'm encouraging it) is the money in medicine is virtually guaranteed as long as you put in the necessary work.

That's why I don't like it when people say things like, "Oh you could just go work on Wall St or Silicon Valley to become rich instead of going to medical school." Like you said, that's possible for students at schools like Harvard and other Ivy Leagues, but for the majority of undergrads going to a less prestigious public or private school, that's just not realistic.
This sentiment that you need to go to an Ivy League or similar to work in Silicon Valley is a bit exaggerated. Networking and nepotism do play a part, but plenty of people make it to Silicon Valley from public state schools.

Most start at a small company and gain experience that will propel them to larger more lucrative positions. Valtun's
question asked where can you make 250k 7 years out of school, and I know several who are doing that after 3 years out of a typical undergrad. If you have the temerity to get into a good med school and residency, you can probably make it as an engineer too. My point is that medicine isn't necessarily the easiest road to wealth out of all available.
 
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madlaham

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I agree with that for sure. The amount of lucky people I know is probably biased by my location, which also has a high cost of living so a dollar isn't worth as much.

Probably much of the risk in medicine will come from political changes, rather than a shortage of need, since physicians don't do quite as well in many industrialized countries.
 
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I’m curious to know: if you had to choose between free medical school and cost attendance provided with $30,000 to $50,000 less annually over the course of your lifetime versus what we have now, what would most people choose?

Or some kind of publicly funded thing like HPSP but the commitment is not towards military but commitment as towards working in a hospital under a federally funded position or working in an underserved area under a federally funded position etc.
 

Dagrimsta1

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That's exactly why I brought up the question in the first place. No other career allows you to go to virtually any undergrad and still have a shot at making that much money. When people bring up law, finance, engineering the only high end jobs that would pay that much are occupied by the students that went to top universities (which is a very small percent of those in the field).

A student going to a smaller less-known university will not be able to secure those positions (unless you have crazy connections, which would still only be the extreme minority) but medical school is still feasible going to this school, which would allow for this type of pay in the future. Now I'm not endorsing going to medical school to make money, but if you're willing and dedicated to go through the harsh 7ish years then it's worth it. The pay you get, the stability of your job, and the almost guarantee of having a job is not comparable to any other career.

But now you've technically brought up a different goal; job security, and even that won't be enough to push you through medical school and beyond.
I have so many classmates that would "go get that bread" every morning and talk about how they're gonna be caking it when they finish. Now most of them have different things pushing them, usually personal reasons and money isn't just as important anymore.

That 7 years post undergrad you keep mentioning includes 4 years of med school and 3 years of residency I'm assuming. What about a possible fellowship after that? What if you happen to take an extra year to graduate for whatever reason (not uncommon)? Plus most of the residencies that are 3 years are FM, IM, and Peds (arguably 3 of the lowest paying specialties) with some EM residencies as well. Not to mention the fact that you aren't guaranteed anything if you don't end up matching into a residency.

Also, with tuition on the rise, many students are still 350k+ in debt AFTER RESIDENCY! There goes another few years at the very minimum paying that back...
 
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Matthew9Thirtyfive

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It's more like up to 80 hours a week some of the time and more than 80 hours a week a lot of the time. It's kind of like being a resident for way longer than you need to be. There's a reason why most lawyers hate their jobs/lives.

It's also a job where millions of dollars are at stake over a freaking comma, where re-trials rarely happen, where at the appellate level the facts are taken as facts from the trial level, and nobody is ever really satisfied.

Just read through this guy's blog and you'll see: The People's Therapist

Yep!
 

Matthew9Thirtyfive

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This sentiment that you need to go to an Ivy League or similar to work in Silicon Valley is a bit exaggerated. Networking and nepotism do play a part, but plenty of people make it to Silicon Valley from public state schools.

Most start at a small company and gain experience that will propel them to larger more lucrative positions. Valtun's
question asked where can you make 250k 7 years out of school, and I know several who are doing that after 3 years out of a typical undergrad. If you have the temerity to get into a good med school and residency, you can probably make it as an engineer too. My point is that medicine isn't necessarily the easiest road to wealth out of all available.

I don’t know about Silicon Valley but the idea that you need to go to a T14 to make that much in law is not exaggerated. A huge number of attorneys graduating from schools outside the T14 are unemployed or making $50-60k. The job market is awful.
 
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madlaham

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I don’t know about Silicon Valley but the idea that you need to go to a T14 to make that much in law is not exaggerated. A huge number of attorneys graduating from schools outside the T14 are unemployed or making $50-60k. The job market is awful.
It's an employee's market in tech, and companies compete hard for talent. That's why you can go to work in flip flops and a hoodie with your dog and eat free food every day.
 
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freedoctor17

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I don’t know about Silicon Valley but the idea that you need to go to a T14 to make that much in law is not exaggerated. A huge number of attorneys graduating from schools outside the T14 are unemployed or making $50-60k. The job market is awful.

I go to a middle level school and lots of my cs classmates are graduating with starting 6 figure jobs at big tech companies and that's besides the bonus stocks they get in the company. So not as important for cs and engineering. In those cases it's more about the work ethic, creativity, and experience people bring from what i can tell so far. Even one of my friends taking a government job in cs is getting starting pay around 80k.
 
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madlaham

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I’m curious to know: if you had to choose between free medical school and cost attendance provided with $30,000 to $50,000 less annually over the course of your lifetime versus what we have now, what would most people choose?

Or some kind of publicly funded thing like HPSP but the commitment is not towards military but commitment as towards working in a hospital under a federally funded position or working in an underserved area under a federally funded position etc.
This paper discusses the military specifically, but it plots how you might come out financially if you borrow vs taking a lower salary.

Borrow or Serve? An Economic Analysis of Options for Financing a Medical School Education
 
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This paper discusses the military specifically, but it plots how you might come out financially if you borrow vs taking a lower salary.

Borrow or Serve? An Economic Analysis of Options for Financing a Medical School Education
So basically, the HPSP or if there were a civilian service equivalent, would be worthwhile specifically for incentivizing and recruiting primary care as opposed to higher paying specialties. Being that specialties are oversaturated and PC is where we need physicians, I am surprised a program like this doesn't already exist! I can understand why there are a rash of state medical schools offering state scholarships for these sorts of things and a rise in the number of free or reduced tuition 3 year PC schools.
 

freedoctor17

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So basically, the HPSP or if there were a civilian service equivalent, would be worthwhile specifically for incentivizing and recruiting primary care as opposed to higher paying specialties. Being that specialties are oversaturated and PC is where we need physicians, I am surprised a program like this doesn't already exist! I can understand why there are a rash of state medical schools offering state scholarships for these sorts of things and a rise in the number of free or reduced tuition 3 year PC schools.

The NHSC does something similar to this but it limits where one can work for a certain number of years. The biggest issue with it is you won't know where you can work until they assign a certain value each year that represents the level of need of different places. Depending on the level they assign you could end up with limited options for where you'd want to be for 4 years out of residency while likely starting a family.
 
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As someone who struggled in CS classes and crushed pre-med classes, I think that there is a lot left unstated in the rigor that is required to be competent to get those Silicon Valley/six-figure jobs. Also, I have seen a lot of students treat CS classes as if they were an end-term professional degree and still struggle with them e.g. shadowing the classes, self-study, and dropping to learn. I had not really seen the same type of overall focus until fourth year virology or molecular biology courses where it seems like I was in a class with no other premeds and only people interested in masters/PhD oriented research science. I understand that some people are just programming super stars. But a lot of the applied mathematics used in CS/engineering was something that I was not built for and could not imagine pursuing a career in it.
 
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The NHSC does something similar to this but it limits where one can work for a certain number of years. The biggest issue with it is you won't know where you can work until they assign a certain value each year that represents the level of need of different places. Depending on the level they assign you could end up with limited options for where you'd want to be for 4 years out of residency while likely starting a family.
I mean, it is the same for the military. You have an equal chance of getting stationed at Madigan up by Seattle or Fort Polk in the middle of swampsville Louisiana.

The difference with a civilian equivalent, I feel, would be that people who are on the fence about potentially deploying would no longer have the threat of death and bombs (or sea sickness and cruise missiles?)

Is the NHSC thing advertised very well?
 

freedoctor17

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As someone who struggled in CS classes and crushed pre-med classes, I think that there is a lot unstated in the rigor that is required to be competent to get those Silicon Valley jobs.

Yeah it's definitely not easy, it requires a certain mind set. I've taken a few and really enjoyed them but couldn't imagine taking the full
I mean, it is the same for the military. You have an equal chance of getting stationed at Madigan up by Seattle or Fort Polk in the middle of swampsville Louisiana.

The difference with a civilian equivalent, I feel, would be that people who are on the fence about potentially deploying would no longer have the threat of death and bombs (or sea sickness and cruise missiles?)

Is the NHSC thing advertised very well?

I'm not sure. I came across it 2 years ago when i was searching for how to go to medical school for free lol. Came very close to applying for it but then last second decided not to since people kept telling me not to limit myself to primary care so early. I'm pretty sure i want to do primary care but just in case I've decided to leave my options open until i get more experience in medical school. You can always apply to it later on as well. They have another very similar program for loan forgiveness as well if you decide you want to do it after graduating medical school.
 

Matthew9Thirtyfive

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So basically, the HPSP or if there were a civilian service equivalent, would be worthwhile specifically for incentivizing and recruiting primary care as opposed to higher paying specialties. Being that specialties are oversaturated and PC is where we need physicians, I am surprised a program like this doesn't already exist! I can understand why there are a rash of state medical schools offering state scholarships for these sorts of things and a rise in the number of free or reduced tuition 3 year PC schools.

I believe @militaryPHYS did an analysis of how even in something like ortho you can come out ahead or break even if you get out after your commitment is up.
 
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As someone who struggled in CS classes and crushed pre-med classes, I think that there is a lot unstated in the rigor that is required to be competent to
I believe @militaryPHYS did an analysis of how even in something like ortho you can come out ahead or break even if you get out after your commitment is up.
especially, I suppose, that the residency years you are being paid far more military side than you would be civilian side.
 
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907914

I believe @militaryPHYS did an analysis of how even in something like ortho you can come out ahead or break even if you get out after your commitment is up.
I know personally, I would choose USHUS over the HPSP, however if I did the HPSP it would simply be the peace of mind not having to stress over basically what amounts to a second mortgage.

Even still, I know at least Army side there is no such thing as a non-deployable physician. In my reserve unit, one of our Urologists was still deployed acting as both the urologist for that region of the theater AND as a general surgeon for the FOB...Talk about reaching far back to your general surgery rotations as a 20 year attending... By the time I am through residency (Assuming I can get in round one) my daughter will be just about to enter high school and I am not willing to give up being there for her (and that is assuming I still just have the one child....)
 
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deleted938090

It's an employee's market in tech, and companies compete hard for talent. That's why you can go to work in flip flops and a hoodie with your dog and eat free food every day.

This is true. You don't need to come from a top school to get a job in big tech - all you need to do is outperform others at coding and on-site interviews. You don't even need to major in CS or have a degree in it; all they care about is performance.
 
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Matthew9Thirtyfive

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I know personally, I would choose USHUS over the HPSP, however if I did the HPSP it would simply be the peace of mind not having to stress over basically what amounts to a second mortgage.

Even still, I know at least Army side there is no such thing as a non-deployable physician. In my reserve unit, one of our Urologists was still deployed acting as both the urologist for that region of the theater AND as a general surgeon for the FOB...Talk about reaching far back to your general surgery rotations as a 20 year attending... By the time I am through residency (Assuming I can get in round one) my daughter will be just about to enter high school and I am not willing to give up being there for her (and that is assuming I still just have the one child....)

Yeah, the Navy has non-deployable specialties. But they typically get a deployment out of you by requiring a 2-year GMO tour between pgy-1 and pgy-2. As for family, it's a sacrifice. I've been active duty for 7 years and have spent a lot of time away from home. I have a great relationship with my kids, and I've been non-deployable for the last 2 years. It's been great. When I have to start going away again, they'll understand and we'll make it work.

But this thread isn't really about this, so let's not keep being off topic.
 
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Yeah, the Navy has non-deployable specialties. But they typically get a deployment out of you by requiring a 2-year GMO tour between pgy-1 and pgy-2. As for family, it's a sacrifice. I've been active duty for 7 years and have spent a lot of time away from home. I have a great relationship with my kids, and I've been non-deployable for the last 2 years. It's been great. When I have to start going away again, they'll understand and we'll make it work.

But this thread isn't really about this, so let's not keep being off topic.
SDN needs the ability to sub thread like reddit lol Okeydoke, off topic done
 
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863168

It's true that medical specialties are becoming more competitive to the point where poor self-selection will punish you more heavily to the point of having to SOAP for placement if the applicant has a poor grasp of Step score, clinical evals, nature of residencies, and not being realistic enough about chances when setting themselves up for match.

However, to compare the situation currently to law school would be absurd because law schools are in a place where adcoms have been accused of fraud on multiple fronts for gaming post-employment data. For a further explanation, there is an exit survey data that is submitted 9-months by U.S. News to evaluate whether students have found gainful employment within legal practice. In order to game the surveys, schools regularly reach out to students to see if they have found a job and if not, offer a 9-month legal internship doing case review in which they deem this time to be a "transition period." However, this enables the school to file these students as still working within their capacity of their J.D. therefore resulting in them reporting this back to U.S. News as their grads having secured legal employment.

There are other stretches that are even more ridiculous which I won't go into, however painting law as a better alternative from a law of averages perspective is pretty inaccurate. Other red flag indicators are not just drops in applicants, but also a consistent decrease in LSAT scores by two deviations or more indicating that schools themselves are desperate to fill in L1 classes rather than having any standards of ensuring their students will be able to find legal jobs.

Tl;dr Medical students may have to compromise their specialty selections, but will likely still be able to practice medicine. Law students may have to accept that their three years were a waste and look for an entirely different career.

Post-note: I would argue though that COCA continuing to allow DO schools to expand and add more & more students into the match without the growth in residency positions will result in a similar situation to the rapid expansion of pharmacy schools and the difficulty PharmD students are having finding employment as pharmacists. Selling a DO degree without a residency promise is far too analogous to the current model used by Caribbean schools.
 
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907914

This may be a silly question but:

Can a do, Caribbean grad, low stats MD etc. simply match in to a 1 yr intern year, get their MD/DO and then still practice medicine as an independent? Like at home, teleconference, medical consultant etc?
 
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ArdorAyurveda

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With the current political climate (Medicare For All), if you go into medicine thinking that you can making a lot of money, I would say that is...naive*

*Unless you are interested in being a health care executive or doing private practice

I think if you want to go into medicine because you’re interested in learning about the physiology of the human body and you want to be the one responsible for taking care of people’s health problems, medicine is a good option.

Yes, doctors will always be in demand, but if everyone has health insurance, health care utilization will increase, administrative costs will increase (due to more billing staff required to look over claims), and physician salaries will be slashed to compensate for costs.
 
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907914

With the current political climate (Medicare For All), if you go into medicine thinking that you can making a lot of money, I would say that is...naive*

*Unless you are interested in being a health care executive or doing private practice

I think if you want to go into medicine because you’re interested in learning about the physiology of the human body and you want to be the one responsible for taking care of people’s health problems, medicine is a good option.

Yes, doctors will always be in demand, but if everyone has health insurance, health care utilization will increase, administrative costs will increase (due to more billing staff required to look over claims), and physician salaries will be slashed to compensate for costs.
Along with the transition to medicare for all, will there not also be a decrease or elimination of tuition for medical schools? If the monetary incentive is not as strong, won't the need for 'less debt' be there in order to maintain the attracting of highly qualified applicants?
 

ArdorAyurveda

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Along with the transition to medicare for all, will there not also be a decrease or elimination of tuition for medical schools? If the monetary incentive is not as strong, won't the need for 'less debt' be there in order to maintain the attracting of highly qualified applicants?
I genuinely think that med school tuition will remain outrageously high as long as we students can take out federal loans. Or until people stop applying to medical schools.

Med schools charge whatever they want because there is an oversupply of applicants who can pay, either through federal loans or through personal wealth.

Although if they stopped giving out federal loans, that would increase the income disparities in the medical field, and that’s just a whole nother can of worms.
 
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907914

I genuinely think that med school tuition will remain outrageously high as long as we students can take out federal loans. Or until people stop applying to medical schools.

Med schools charge whatever they want because there is an oversupply of applicants who can pay, either through federal loans or through personal wealth.

Although if they stopped giving out federal loans, that would increase the income disparities in the medical field, and that’s just a whole nother can of worms.
The silver lining, I suppose, is that the political backings that support universal healthcare are the same groups that also support universal higher education.
 

puahate

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That thread is pretty hard to follow if you are out of the loop. I couldn't figure out why radonc residencies weren't being matched or why "this is what SDN wanted."

This is a good summary.
People are referring to this recent match as a wake up call. I would have thought that the ABR screwing over an entire class of residents on their physics and rad bio exams would have been a wake up call but our leadership did absolutely nothing and the ABR won. What makes us think this is any different? People taking to twitter won’t solve the problem and we are doing this to ourselves.

Just in case anyone wants a refresher on the ludicrous events of the ABR Rad Bio/Physics fiasco here as a brief summary:

  • Dr. Amdur/Lee write an article in PRO noting that residents are spending an inordinate amount of time studying for Rad Bio and Physics minutiae rather than focusing on clinically relevant training
  • The ABR (Dr. Wallner and Kachnic) write a reply--which can be found on this thread several pages back-- in which they state with no supporting evidence that residents aren’t getting smarter, they are actually getting dumber. They blame small programs for this.. Again, with no supporting evidence.
  • Rad Bio/Physics Exam 2018: 3 months later current PGY-5’s take the Rad Bio and Physics exam. Scores come out with a Physics pass rate of 70% and Rad Bio Pass rate of 74%. These scores are 3-5 standard deviations off of what they have been in the past 15 years for Rad Bio and Physics.
  • The ABR accepts no responsibility that the exam they administered may have been at fault. They instead shift the blame claiming that is multifactorial. They blame worse teaching as a cause (Worse teaching which occurred in ONE YEAR and would have to occur in nearly ALL the programs in the country?) and say the angoff scoring method is flawless and could not have played a role. They additionally do analysis to look at ‘small programs’ to show that they performed worse (albeit with some likely twisting of the numbers, and it was only programs of 4 or less, which make up 6% of the resident pool). This ignores the fact that large programs have question banks, but that is a conversation for another day. Resident programs with 6 or more did not do worse to any statistically significant degree yet are being lumped in as ‘small programs are worse’.
  • The end result of this debacle: no resolution, no changes are made. The ABR publishes what they refer to as a ‘new Study Guide’ for Rad Bio and physics in March of 2019 which is simply nothing more than a list of all the major textbooks and topics in the field (McDermott, Hall, Kahn, etc).
  • Match Day 2019: we have the worst match in recent memory. The most obvious thing that has happened in the last year is the ABR Rad Bio and Physics exam and the pathetic handling of it. But rather than crediting medical students for recognizing a sinking ship we blame SDN for our woes as a field. Med students likely said, ‘I’m smart and have great scores, why would I bust my butt for 5 years in Rad Onc and only be guaranteed a 70% pass rate on TWO of the qualifying exams.. only to have to then take a written AND oral board exam? I can just go into another specialty…’. On Twitter our leaders are again refusing to acknowledge the source of the problem. They instead blame a lack of exposure to our field (something that hasn’t changed in decades.. it didn’t change all of a sudden) and that SDN was the culprits.
  • Currently:
    • This has sparked some good debate as to the issues in our field. Residency expansion is certainly one. However, small programs are not the only ones to blame for the excessive numbers of residents. Some small programs may need to be shut down— but others are high quality programs and these are the institutions that train our Rad Oncs taking jobs in rural and undesirable locations (how many MSKCC, MD Anderson, UCSF grads end up in small town Missisippi, Kansas or West Virginia?). Large programs should also be trimming the fat and potentially reducing their numbers of residents.
    • Our Leadership: Our ABR leadership has already hurt our field. They have caused serious damage to our current PGY-5’s and now it is reflected in our incoming residents at this last match. Maybe it is time for a change.
    • Our Qualifying Exams: Maybe now is the time to reassess our qualifying exams. Should they be consolidated? Medical oncology only has 1 written exam (after passing Internal Medicine), do we really need 4 including oral boards?

As a premed interested in rad onc early on I had the opportunity to meet a rad onc resident. The resident actually told me about the bad leadership in rad onc years before this occurred.
 
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efle

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The weirdest part of this grass-always-greener debate is that we always try to compare the average physician to the extraordinary, outlier performance in other fields. Can you make 250k+ or even 500k+ by your 30s if you land the right jobs in other fields like finance? Sure. But they're way up at the high end of their job.

Try looking at what the top paid physicians are making sometime. It's ludicrous. If you want to compare similar patches of grass to see what's really green, and you want one patch to be the Wharton grads on wall street, then the medical grass to compare with needs to be booming practices in Mohs surgery, cosmetic plastics, retina, etc...

There are people making insane money on our side of the fence just as much as tech, finance/banking, consulting and so on. Gotta remember to compare average with average, and outliers with outliers. And if you look at the average young lawyer, or low level consultant, or comp sci grad, I don't think the average American medical student should be turning green with envy from looking at their grass.
 
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863168

I'm sorry if this violates the TOS, but there is just so much B.S. being smeared over this thread that I don't even know where to begin a constructive response.
 

madlaham

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The weirdest part of this grass-always-greener debate is that we always try to compare the average physician to the extraordinary, outlier performance in other fields. Can you make 250k+ or even 500k+ by your 30s if you land the right jobs in other fields like finance? Sure. But they're way up at the high end of their job.

Try looking at what the top paid physicians are making sometime. It's ludicrous. If you want to compare similar patches of grass to see what's really green, and you want one patch to be the Wharton grads on wall street, then the medical grass to compare with needs to be booming practices in Mohs surgery, cosmetic plastics, retina, etc...

There are people making insane money on our side of the fence just as much as tech, finance/banking, consulting and so on. Gotta remember to compare average with average, and outliers with outliers. And if you look at the average young lawyer, or low level consultant, or comp sci grad, I don't think the average American medical student should be turning green with envy from looking at their grass.
I'm not sure anyone is saying the grass is greener. Just that there are many options to choose from, and your career should be chosen for passion. With the amount of premeds who are filtered from becoming physicians, it's already a career of outliers whom I can reasonably assume are capable of being very successful in other fields.

The grass is greener in medicine for those who are passionate for it. But, if profit is a primary motivator, it's not the be all end all, and you might find a better fit with an open mind.
 
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dr_kateb

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Engineering in Silicon Valley can. Also law, finance, entrepreneurship etc. Plus you can earn earlier and invest with these other jobs. It's a big opportunity cost to do med school and residency so the high pay won't get you as much when you're older without as much time for compounding interest.

The highest paid engineers (200k a year) make less than what an average IM attending (220k) makes in a year. The average lawyer makes about 150k a year, and finance majors make the difference between the average lawyer and doctor.

With about 95% of US med students matching to a residency, it's hardly an opportunity cost/investment since you pretty much know that it will pay off. Investments can go south quick. Medicine is low risk, high(ish) reward.

Funny how you mention the "opportunity cost" of medical school but somehow say entrepreneurship is a better way to make money. Most new businesses fail within a few years. Sure if you make it you make it big but to say it's a better route than medicine is *****ic.
 
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