Are we reaching the downward slope in Medicine?

[aldol16]

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.

First of all, Medicare for All is never going to happen unless Bernie can somehow convince the majority of Americans to vote to give up their private health insurance which most Americans are satisfied with. What will more likely happen is a public option which will indeed help to rein in some costs but the private market will still be allowed to operate as it always had. So doctors aren't going to become beggars nor are they in danger of making $15/hr.

But I think that even in today's climate, one should never go into medicine thinking that one will make a whole lot of money because 1) that will depend on your specialty and whether you can get that specialty and 2) there will be a huge sunk cost up front. There are many easier ways to make a lot of money that don't involve sacrificing hundreds of thousands of dollars and up to a decade (or more) of your life.

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[madlaham]

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.

I never said that entrepreneurship is a way better way to make money. I simply said that many options exist. I'm not saying that any option is better than another, only that you should choose for passion and societal impact over profit.

A typical Apple engineer, for example, can make $500k including stock and bonuses. Many engineers also become managers or executives where $1M+ per year is achievable, if you want to consider outliers. But those people sacrifice a lot to get to that point and it isn't without risk, as you rightly point out.

https://www.quora.com/What-is-the-a...ftware-engineers-with-3-4-years-of-experience

And, yes, outlier physicians make a lot too. It's just weird to talk about medicine like it's the only option to make good money when the options are legion.

 

[dr_kateb]

passion and societal impact over profit.

That would be nice, but law, finance, etc aren't exactly forgiving career choices either. For the average person, money and passion are often times mutually exclusive. Of course you want to do something you enjoy, but if you can't pay the bills then you are still probably going to be unhappy. And if you're going to do something for the money might as well pick the one that pays a lot.

Money over passion every time for me.

 

[madlaham]

That would be nice, but law, finance, etc aren't exactly forgiving career choices either. For the average person, money and passion are often times mutually exclusive. Of course you want to do something you enjoy, but if you can't pay the bills then you are still probably going to be unhappy. And if you're going to do something for the money might as well pick the one that pays a lot.

Money over passion every time for me.

Of course no path to wealth is going to be easy, but it makes it easier if you enjoy what you do and you feel like you make a difference.

If you value the destination over the journey, you might have a rude awakening when you get there and find it wasn't what you bargained for when you took on hundreds of thousands in debt.

Considering the epidemic of physician burnout, it might be worth examining your expectations ahead of time.

 

[efle]

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.

Thing is, the other fields that frequently get mentioned also have huge filters, at least for the similarly desirable jobs. To expect decent success as a lawyer or expect your MBA to pay off, you really need to go to a top school. To be making doctor money in tech/compsci you need to get hired by one of the big names in Silicon Valley. To start seeing big paychecks in major consulting firms, you have to survive the up-or-out system for years while most people around you leave. If med students are outliers, so are all of them.

Say we take a hypothetical student who is 1) academically very gifted, 2) relatively cautious/risk averse, and 3) interested in making 300k+ while working reasonable hours. I think going for an MD followed by a highly paid, lifestyle specialty is pretty much an ideal career option for this student. And it's ideal even if their passion level for medicine is about the same as it would be for practicing law or writing code or whatever else. Even if someone views it as just a job, the same way consultants and lawyers and bankers view their work, it can make a ton of sense to go to med school.

 

[madlaham]

Thing is, the other fields that frequently get mentioned also have huge filters, at least for the similarly desirable jobs. To expect decent success as a lawyer or expect your MBA to pay off, you really need to go to a top school. To be making doctor money in tech/compsci you need to get hired by one of the big names in Silicon Valley. To start seeing big paychecks in major consulting firms, you have to survive the up-or-out system for years while most people around you leave. If med students are outliers, so are all of them.

Say we take a hypothetical student who is 1) academically very gifted, 2) relatively cautious/risk averse, and 3) interested in making 300k+ while working reasonable hours. I think going for an MD followed by a highly paid, lifestyle specialty is pretty much an ideal career option for this student. And it's ideal even if their passion level for medicine is about the same as it would be for practicing law or writing code or whatever else. Even if someone views it as just a job, the same way consultants and lawyers and bankers view their work, it can make a ton of sense to go to med school.

Sure, they certainly all have filters, and I think medicine is a good choice for many people, albeit not every talented person. Fortunately, we have a society with many talented people of different interests so that the economy can function and we can eat. It would just be tough to pass the filters and consistently make 300k+ without burning out if you don't enjoy it and find meaning in it. Not to say that's impossible, just maybe not recommendable for everyone if you can otherwise make a good income with something you enjoy.

 

[ArdorAyurveda]

First of all, Medicare for All is never going to happen unless Bernie can somehow convince the majority of Americans to vote to give up their private health insurance which most Americans are satisfied with. What will more likely happen is a public option which will indeed help to rein in some costs but the private market will still be allowed to operate as it always had. So doctors aren't going to become beggars nor are they in danger of making $15/hr.

But I think that even in today's climate, one should never go into medicine thinking that one will make a whole lot of money because 1) that will depend on your specialty and whether you can get that specialty and 2) there will be a huge sunk cost up front. There are many easier ways to make a lot of money that don't involve sacrificing hundreds of thousands of dollars and up to a decade (or more) of your life.

First of all, when did I say that doctors would make $15/hr? or that they would become beggars???

I agree that a public option is more likely. We’re basically gonna become Australia, I guess.

@madlaham I agree with you, you gotta find meaning in the journey of becoming a doctor as well as the destination. Beautifully put.

Another thing to worry about is whatever specialty you end up matching into may not be a “lifestyle” specialty in 20-30 years, so you really gotta have a long-term perspective.

 

[Lucca]

First of all, when did I say that doctors would make $15/hr? or that they would become beggars???

I agree that a public option is more likely. We’re basically gonna become Australia, I guess.

@madlaham I agree with you, you gotta find meaning in the journey of becoming a doctor as well as the destination. Beautifully put.

Another thing to worry about is whatever specialty you end up matching into may not be a “lifestyle” specialty in 20-30 years, so you really gotta have a long-term perspective.

Last point is worth thinking about some more. Pathology was one of the most competitive and well paid specialties several decades ago. RadOnc was considered one and was very competitive but 5 years ago...

 

[puahate]

Last point is worth thinking about some more. Pathology was one of the most competitive and well paid specialties several decades ago. RadOnc was considered one and was very competitive but 5 years ago...

Its so sad what happened to rad onc

 

[Walter Raleigh]

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.

Agreed. Harvard graduate? MIT graduate? If you're connected and brilliant, yes, you can get $300K/year. Podunk State grad? Not so much, unless you are very talented at networking or world-class brilliant.

 

[madlaham]

Silicon Valley hires the most alumni of these 10 universities, and none of them are in the Ivy League

Here are the schools with the most undergraduate and graduate alumni hired by the 25 biggest Silicon Valley employers in 2016:

1 University of California, Berkeley
2 Stanford University
3 Carnegie Mellon University
4 University of Southern California
5 The University of Texas at Austin
6 Georgia Institute of Technology
7 University of Illinois at Urbana-Champaign
8 San Jose State University
9 University of California, San Diego
10 Arizona State University

 

[madlaham]

11 University of Michigan
12 University of California, Los Angeles
13 North Carolina State University
14 California Polytechnic State University-San Luis Obispo
15 Cornell University
16 University of Waterloo (Canada)
17 Texas A&M University
18 University of Washington
19 Purdue University
20 Massachusetts Institute of Technology
21 Santa Clara University
22 University of Phoenix
23 University of California, Santa Barbara
24 University of California, Davis
25 Penn State University

 

[aldol16]

Here are the schools with the most undergraduate and graduate alumni hired by the 25 biggest Silicon Valley employers in 2016:

Obviously Silicon Valley is going to employ graduates of highly technical schools and schools that are in the Silicon Valley. If you're interested in tech, that's just what you do. While many students at Ivies are interested in tech jobs, most are not. Ivies tend to send graduates into finance and consulting careers and students who are interested in those kinds of jobs would do well to go to an Ivy.

The best universities for getting a front-office job at Goldman Sachs
The top 25 universities for getting a front-office job at Morgan Stanley