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Best Time to Enter Medicine?

Discussion in 'Pre-Medical - MD' started by Luxian, Jun 17, 2008.

  1. Luxian

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    Okay, maybe I'm insane, but this could be the best time to enter medicine. These days you see nothing but stories of dissatisfied doctors, overbearing HMOs, shrinking payments, and increasing workloads. Something's gotta give, right? I mean, the state of American health care is in crisis and I think there are going to be a lot of changes in the next 20 years. If we're lucky, those changes won't take quite as long and by the time we finish our residencies we'll be right on the cusp of a new wave of medicine.

    Buy low, sell high, right? So couldn't we be entering just as it's at its worst and in seven or eight or twelve years when we're done we'll finally be on the upswing, and rewarded well for it?

    Naively Hopeful,
    Luxian
     
  2. MILK07

    MILK07 Silence, I kill you!!
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    Love the optimism! :D

    Unfortunately, I think it will get much worse before it gets better. But here's hoping all the kinks will be worked out in 8 years or so!
     
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  3. Dirt

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    Not even close.
     
  4. TheRealMD

    TheRealMD "The Mac Guy"
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    Life is not like the stock market. We take for granted the highs, and feel the pain twice as much at the lows.
     
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  5. MonkeyNuts!

    MonkeyNuts! Even Kal has bad days...
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    HAHAHAHHHAHAHAHAHAHHAHAHHAHHAHROFLMAO

    no.

    epic fail.
     
  6. zpiff

    zpiff Spaceman
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    I like this! :hardy:
     
  7. TehDoc

    TehDoc What a pain...
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    Great thinking. Lets hope you're right.
     
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  8. FutureTexasMD

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    To the o.p. - your optimism is refreshing and I hope this type of trend does take place in the next decade or so!
     
  9. Jolie South

    Jolie South is invoking Domo. . .
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    have we even hit rock bottom yet? i thought things would get worse before they got better.:confused:
     
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  10. Chuckwalla

    Chuckwalla Junior Member
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    Yes, it is insane.

    Doctors can't unionize and their lobby does crap. People won't demand change until doctors are leaving the profession by the thousands and people have to wait a month or more to see their primary care doctor.

    HMO's are organized and incredibly powerful, same with Medicare and Medicaid. They will continue to nickel and dime doctors out of their pay and autonomy until it begins to really effect the American public.
     
  11. Law2Doc

    Law2Doc 5K+ Member
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    Funniest post on SDN this week. Wait, you're joking right? Salaries are losing ground against inflation while hours for many specialties are increasing. The insurance stranglehold on the profession is causing reimbursements to be reduced, making many physicians' incomes decrease.

    Sorry but physicians are very likely going to get hit hard in the efforts to fix health care. They are the easy bad guy -- joe public already thinks doctors make too much money.
    I recently went to a talk where the panelists, all physicians in academia, were estimating that physicians should expect a decline in income of about 10% in coming years. Your logic of buy low sell high assumes that it has bottomed out. It likely hasn't. So you are going to buy low, and sell (out) lower. The folks who entered medicine a few decades back, when loans were reasonable, and inflation adjusted salaries were higher got rich. Folks entering the field now are more likely to max out at "comfortable". So no, this is not the optimal time to enter medicine if financial reward is your goal. You are more likely to start out your career closer to the middle of a very deep downswing rather than the upswing. So go into medicine only if you think you would enjoy practicing medicine. Because if reward is your goal, you may be timing it very badly.
     
  12. Luxian

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    Well, it was a little tongue-in-cheek, hence the "naively hopeful" ending. I mean, I do have some hopes but I don't think it will magically get better. Here's what I see are the real drivers and the change we're seeing take place.

    >Hours: We've already seen them put in an 80-hr max for residencies. This was unheard of 10 years ago. So this is already an improvement in lifestyle. Check one for the positive.

    >Lending practices: With foreclosures on the rise and rapidly rising tuition, regular joes are stuck in the middle with no money for college. Now that college has become ubiquitous (instead of just for the "elite") people won't stand for it being out of reach. I see the trends that have started at Harvard and CCLM continuing, if not offering free tuition, then offering reduced tuition. Tuitions have been artificially inflated for prestige and by the easy availability of loans. We're gonna see this rapidly decreasing.

    >Salaries: I'm among those who think doctor's are a little too well reimbursed. Everyone says "Oh, but we need it to pay malpractice insurance and our student debt." Well, how about we all accept a smaller paycheck if you put in place the malpractice award limits they have in Texas (maxing at $500k) which have already greatly reduced malpractice insurance rates and reduce student debt as seen above. I'd gladly walk out with $100k salary IF I COULD KEEP IT. The real push for higher and higher salaries is the squeeze, not the number itself.

    So basically, I just wish more people saw that real change is taking place now, that these are OUR problems to deal with, and if we just throw up our hands in despair, not a lot is going to change.

    My two cents.
     
  13. Nilf

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    Magical thinking FTL.
     
  14. Luxian

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    Actually, that sounds exactly like the stock market!

    When I was living it up in San Fran during the dot com boom, I never did get used to the sign-on bonuses and champagne brunches. I knew it had to end. When I got a public health Master's and its accompanying 30% reduction in pay (compared to my engineering degree), I just took it in stride. You do what you can with what you have. Luckily, I'm pretty happy if I'm surrounded by friends. Where I live or what I wear have never been that important.

    If I graduate med school, can pay my loans, and have a job that let's me see my spouse from time to time, I'll be happy.
     
  15. Law2Doc

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    Real change IS happening, but not in the direction you are proposing. Residency hours are capped at an 80 average, but nobody has been able to show thus far that it has benefited patient care, just that it forces hospitals to get "creative" about staffing. Will there be additional cuts of hours? Hard to say but the impetus isn't really there just now. Plus there is no restriction of hours once you finish residency, which is where the beatings are taking place these days. You can find articles about the primary care crowd having to work longer and longer hours these days to make the salaries they used to make a year ago, because they are paid per office visit and it now takes more patients to make the same amount. Insurance has a stranglehold on physician incomes (not though malpractice but through reimbursements) and is likely to get more of a grip under most of the healthcare plans being floated which generally result in more of the population being covered in some fashion. It will not be a boon to physicians, although it may be a necessary upgrade to US healthcare generally. Physician incomes have lost ground against inflation and most pundits see them going down over time. In the mean time patients are getting older and sicker and living longer, which results in hours having to go up. So yes, we are on "the cusp of a new wave of medicine", but this wave is crashing against a rocky shore.

    If you love what you do, none of this really matters. You will earn enough to pay your bills, and live a normal, non-lavish, life. But if you really think all the problems of the industry will go away just as you enter it, when common sense and the current landscape should tell you the opposite, then you are living in a very dangerous fantasy land.
     
  16. Law2Doc

    Law2Doc 5K+ Member
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    It's safe to say you should be able to get this. The rest of your hopes in this thread I wouldn't bet on.
     
  17. Luxian

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    Well, okay, I've only found solutions for the problems I've thought about thus far, but lets try to imagine new ones for these problems. After all, no one else is going to do this for us, so we have to be smart about what we advocate.

    Well, I think it's hard to believe that 80 hrs isn't better than 120 for all concerned (patients, residents, etc). The primary reason I think no one has shown results is that doing a study would open up hospitals to malpractice claims. Who wants to be the "control" study when everyone knows there will be more errors? It's kinda like saying we need a case-control study of skydiving with and without parachutes. But it's only been in place for four years. That really isn't very long.

    Serious problem here, but once again the problem is not working longer hours (which is a symptom), it's the reimbursement rate itself. Part of the trouble here is the interconnectedness of the system. People see ER costs going up and decide we need more ER doctors, when the real problem may be that no one can get a primary care doctor to see them for six months. We need further support of primary care doctors. Loan reimbursement helps. Standing up for reimbursement of well-baby/well-patient visits is another biggie.

    Yes and no. One of the prime problems now is that doctors have to choose treatments that correspond to the 8 different health plans that their patients have. Imagine how much easier it would be if everyone was on one. Paperwork costs just plummet. There's no more staff of six in the office charged with negotiating claims with eight different programs. Yes, it's still managed care, but the redundancies are removed.

    I think the real issue here is an ethical one. As everyone knows, the majority of your healthcare costs occur at the end of your life. But there's a point at which we are no longer prolonging life, we are prolonging death. We have the technology to keep people "alive" for months at a time, using machines to run each individual organ. Either we accept the price for that, or we come to accept that death is not the worst possible outcome. DNRs are one step in the right direction. I'm sure many would choose a peaceful death over the months of agony we inflict on so many of our elders.

    Yes, these are difficult issues. They are ethical issues, monetary issues, and issues in complicated interconnected systems. But we need to stop complaining about them and start imagining solutions. That's the only way that we will be able to resolve the crisis going on today.
     
  18. 8744

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    Aarrrrggg! No, no you won't. If one day ten years from now all you can get is some crappy job as a low-payed pediatrician or an overworked family physcian bringing home only slightly more than an experienced plumber you will be desperately unhappy and view your career as a huge failure.

    Your attitude is part of the problem. I have never heard a nurse, a PA, a respiratory therapist, a tech, or even the janitors who give the crappers in our hospital a truly righteous glow ever say anything like, "Gee, I'll be happy with less pay as long as I can pay my debts and see my spouse."

    Can all of you ****ing pre-meds resist the temptation to give away the farm before you actually work on it a little and see what's involved in slopping the metaphorical hogs and bringing in the rhetorical crops?
     
  19. 8744

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    And listen, I am not an ambitious guy or even particularly driven but even I got my ass in gear to switch from what is probably the lowest paying and most boring specialty into something that pays twice as much and is infinitely more interesting.
     
  20. datdood

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    Yes it is, definantly
     
  21. MsJLewis

    MsJLewis Retired Pre-med
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    Word.

    I've worked for a year and half as a medical assistant in a small private pediatric practice with 3 docs and while I loved it, I don't think I could sustain the rate at which they saw patients on a daily basis. Everyday involved a handling a slew of patients (up to 20 per doctor!), hearing the head office manager yell on the phone with insurance companies to dispute claims, and thinking of creative extra charges (i.e. $200 visit charge, $40 vaccine charge, $20 administrative charge for administering the vaccine, etc..) to add to the bill we send to the insurance company so we could reimbursed the full cost of the visit.

    I have friends who are becoming nurses and PA's and they would laugh at the thought of just accepting a lower salary. If we want to stop the hemorrhaging of this profession, its going to start by ridding ourselves of the notion of complete altruism (I'm altruistic to a point) and thinking of creative systemic solutions.
     
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  22. Narmerguy

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    While we all fully expect premeds to shed their excessive altruism and their self-sacrificing ideology-and they will shed it-I am much more excited about the prospect of working alongside doctors who atleast started with this happy optimism than with the self-serving materialistic prick that has come to identify many pre-meds and that was that way even before the reality of medicine hit them. Imagine what the process does to them.
     
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  23. Asp

    Asp
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    You mean the realists? I think they do fine thank you very much.
     
  24. Law2Doc

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    Yeah, actually it's the folks who show up with unrealistic expectations of medicine, either based on unbridled altruism, or based on TV exposure, who end up feeling the most angst when they realize that it is a (poorly run) business where lots of patients don't do so well, it has a ton of paperwork and scut work, people play the CYA and pass the buck games, and you aren't as valued and revered as you might think. So you kind of have to enjoy it despite this, not expect it to be better than this. It is not a path for everyone, and not the best path to get certain things.
     
  25. Doctor D

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    I was waiting for someone to say this. Optimism is baseless however pessimism is just being a realist and has a strong foundation. Nevertheless, I love medicine and will continue my dream.
     
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  26. 8744

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    Happy optimism is fine. Just stop giving away your salary before you even earn it.
     
  27. WellWornLad

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    (Disclaimer: I'm an idiot)

    In the next twenty years, there are going to be two huge pressures acting on medicine: decreasing reimbursement, and a shortage of physicians. I wouldn't be surprised if a two-tier healthcare system erupted in this country that further exacerbated the physician shortage. You can see the beginnings of such a stratification with "boutique" or "concierge" physicians:

    http://bmj.bmjjournals.com/cgi/content/full/324/7331/187/a

    Obviously, as a disporpotionate number of physicians begin caring for a small proportion of the population, the outlook only gets worse for the rest of the system.

    While there are enormous pressures on physicians, I also believe that there will be even more pressure on hospitals and government to find physicians in the coming years. A two-tier system is a broken system, but it gives physicians leverage. Perhaps if there is enough leverage, some common-sense changes can come down the pipe, such as the tort caps that have been so successful in Texas, or realistic discussions and expectations about end of life care.

    I'm not sure if I'm being optimistic or pessimistic, but I do think that physicians still hold some cards. How they will play out I'm not sure...
     
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  28. Not even close.
     
  29. waldenwoods

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    Ok to address the OP, I agree with many other posters here that we probably have more to decline. As far as I know, no one has done anything yet to derail the scheduled Medicare SGR cuts to go into effect on July 1.

    The article is ~6 years old, but I think that one of the points made is relevant to the healthcare discussions we'll be having with the upcoming election. Specifically, with respect to the uninsured:

    I wonder if anyone will bring up the issue of trying to balance high-volume, low-reimbursement practices that take many (or all) forms of insurance and rely on seeing lots of patients per day to get enough reimbursements, compared with smaller practices (I think they are called micropractices these days? I'm not sure) that provide patients with more time with their physicians and, in my view, is closer to the ideal that many people have for what they expect from their doctors. To summarize, it would be the 15-minute office visit model compared with a model where patients get more access to their physicians and that is financially attainable in spite of insurance reimbursement practices (in the form of annual fees, low overhead, etc.).
     
  30. Law2Doc

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    I don't think you are an idiot, but these boutique/conceirge ideas have floated around for a number of years and basically have been shown to only work if you practice in a very wealthy region without other people also competing with you for such patients. Very few people can afford to go outside of their health insurance benefits and pay for their medical needs out of pocket. The market isn't big enough to support many doctors unless you are practicing in a luxury field not covered by insurance, such as cosmetic surgery. So no, the UK article got it wrong, and this system can only support a tiny percentage of folks who might want to do it, and poses no threat to the system. Look at it this way: When you become a physician, and negotiate a nice package of health insurance benefits with your employer, are you seriously then going to go out of pocket to pay for your own healthcare needs with your hard earned salary, even though there is a payor standing ready to cover this if you go to an approved provider? Of course not. And you would be toward the higher end in salaried employees. So you can imagine that pretty much every worker earning less is going to be even less likely to go outside the system. This might change if a healthcare plan comes along that disallows certain expensive lifesaving/lifeenhancing procedures -- for that folks might go out of pocket. Eg If you really need an MRI and your plan doesn't pay for it, you might go out of pocket. But just to provide for regular health care, there's no way this flies for other than the first 1% of the industry. Physicians may hold cards, but it's not clear what they are, and they are too disorganized to win the hand. I'm betting they fold.
     
  31. Tyc00nman

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    Holy ****! i am truly gay for Panda Bear! that guy is e-awesome.

    All this pseudo-altruism needs to stop.
     
  32. WellWornLad

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    .
     
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  33. WellWornLad

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    True, but I think the boutique system is a symptom of a wider problem and not necessarily how a significant two-tier system would look.

    It could be that Medicare, and insurers who adopt the same Relative Value Unit schedule, will be increasingly dumped by physicians, while "higher end" insurers who negotiate directly with providers will be able to offer more responsive service for a higher premium. Corporate America loves it's benefits after all, and I could see "premium" insurance gaining significant ground in a stratified system.

    Actually, I saw something similar when I lived in New Zealand. Although the country enjoys universal health care (socialized insurance), 40% of the country invests in private insurance to avoid long waits for elective procedures. Considering that the vast majority of private insurance in NZ is bought by individuals rather than provided by employers, that's a fairly significant number. As a result, many doctors will only deal with private insurance, and the debate over there is on how to raise physician reimbursement within the national framework.
     
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  34. Dirt

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    Physicians hold the trump card, people literally cannot survive without them. The problem is, physicians have no idea how to use said card. It is somewhat reassuring to know that it is there, but unfortunate that it is not going to be played until it is too late. Eventually, when people can't find an ER or a PCP within 100 miles, they will realize, "oh crap, where are all the doctors?" Then they will bitch and moan to their senators and to the president that "this doctor shortage needs to be taken care of" and "How could we let this happen?" Sadly, we still have a long way to fall to get to that point.

    I am just hoping that some degree of tuition remuneration, and/or loan forgiveness comes about around the time I hope to graduate, and that it is not limited to those who work in incredibly underserved areas. Considering that my father has been working in a nice middle class suberb as an internist for 25 years and makes less than 200K, I don't see how someone just starting out with 200K in loans and a mortgage and perhaps a family doesn't deserve some help with his loans.

    Simply put, the biggest problem with medicine for me (considering the stage that I am at) is the amount of money invested in a physician's education. If tuition were free, you would find a hell of a lot less bitching from me about doctor's salaries. If you eliminated student loans, I would be perfectly happy to make 30-40K as a resident followed by low six figures from the age of around 30 on.
     
  35. Dirt

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    everyone likes panda, you don't have to stroke his e-peen though.
     
  36. Tyc00nman

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    oh man i would stroke his e-peen for days. Panda, 12 oclock, my e-room...be there or be s-queer.
     
  37. Law2Doc

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    They hold no such card. There are thousands of people who don't get into med school each year, and thousands of offshore folks who don't match each year. It would be trivial to replace physicians in fairly short order. And you also have PAs, NPs, etc chomping at the bit for more autonomy. So yes, people will survive without these particular doctors. What they get might not be as good, but never underestimate the ability of the country to accept mediocrity if the price is right and you push too hard.

    Plus not all physicians stand together on these issues. you will see your brethren in the profession turn their back on you fairly quickly when you walk out.

    So plan on paying those loans -- there is no sympathy for doctors out there amongst Joe Public, and nobody is going to step up and reduce your tuition so you can earn your six digit salary in peace.
     
  38. Tyc00nman

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    LOL! so you would be willing to get low-balled if you no longer had to pay 1500$/month in student loans? :laugh:

    join the pseudo-altruists my e-peen friend
     
  39. Dirt

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    Still not so sure what constitutes a pseudo altruist.

    I would also be perfectly happy making 50-80K as a construction worker or a plumber if I thought it was intellectually stimulating in the least.
     
  40. Law2Doc

    Law2Doc 5K+ Member
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    Well, lots of people say that ortho and uro are really just carpentry and plumbing on the human body, respectively. Take the easy union pay, save the student loan debt and read a book during your lunch break. :laugh:
     
  41. Tyc00nman

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    :smuggrin::thumbup:

    while you're at it Dirt McGirt, can you loan me 1500$/month? you seem like a very giving person.
     
  42. Dirt

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    I like to think that there is some breaking point, some point at which NPs and PAs can't do the job of a doctor. If no such point exists, then what the hell do they have Med Schools for? Doctor's have to be good for something. Anybody in any job could be replaced, but I don't see people settling for mediocrity in their Army, or their Police Departments or their Fire Departments. Doctors play a crucial role in the lives of just about everyone, and I have to believe that at some point, things will get bad enough such that people realize it.

    If there is one thing I do know it is that John Q. Public is one fickle son of a b*tch. Eventually the current problems in health care will come to a head. All it takes for John Q. Public's opinion to change is some stories on the ABC Nightly News and 60 Minutes, and perhaps a Time cover story or two.
     
  43. LucidSplash

    LucidSplash Bloody Plumber
    Physician Classifieds Approved 10+ Year Member

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    Well I choose Panda. Working alongside someone who started out with excessive altruism/self-sacrificing ideology, who later shed it, generally means working alongside someone who's had their hopes crushed and is bitter and disappointed. I'd rather someone who has been a relative realist with his feet on the ground from the beginning. I've worked with the dreams-crushed, trapped in their job type before, and they're some of the worst coworkers you can have.
     
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  44. WinterLights

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    I agree. Doctors cannot be so easily replaced. Were it true, it would have been done a while ago. I doubt that a NP can perform an extensive surgery; nor would they have enough expertise to properly diagnose some medical conditions that it takes years to learn about. At best, they would be able to provide basic care for patients and safety would be a major factor in dissuading such a change. And were such a transition to occur and doctors were faced with thousands of dollars of debt and no viable job; you can be assured that a major law suit would be filed against the Federal Government. Wages may decrease, but gloom and doom is unjustified at this point in time.
     
  45. 8744

    8744 Guest

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    ****ing A, Bubba. Accepting mediocrity is exactly what people will do because most people, most of the time, don't need and don't see doctors. Everybody I see needs a doctor but, and call me Captain Obvious, that's because I work in a hospital where people who need doctors tend to concentrate. The majority are more concerned with the idea of having access to medical care rather than the actual access itself which is why politicians are able to work people into a lather about health care and why anybody in a white coat can be used in a bait-and-switch to give people the illusion that they are getting not just access but quality.

    As for the public knowing the difference between a well-trained physician and a mid-level provider or some Junior College graduate in a fancy white coat, if mid-levels don't know enough to know what they don't know (the distinguishing characteristic of Nurse Practitioners), what makes you think the public does? My patients are mostly good people and intelligent enough but their knowledge of medicine is rudimentary at best and while you and I both know that the outcome is the most important thing, many patients judge the quality of their medical care by its theatrical aspects. In other words, if they like their "provider" and he puts on the usual Marcus Welby song-and-dance they think they are ****ting in high cotton.

    Compounding the problem is the inexplicable tendency of pre-meds, at least on SDN, to preemptively capitulate to people who tell them that being a doctor is no big deal and, except for the six to twelve extra years of training over, for example, the two years required to be a Physician Assistant, there is really no difference between any particular flavor of "provider."

    That and the other tendency to preemptively accept financial martyrdom, settling for a low salary before you have even smelled your first cadaver.
     
  46. SoupWithAFork

    SoupWithAFork Inertia Creeps
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    This is a sad thread.

    Just do what you love and be happy!

    The end.
     
  47. ManualEvac

    5+ Year Member

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    Point taken, Panda. Anyone who has been on this forum more than a couple of weeks is well acquainted with your acidulous realism with regard to the medical profession. I get it already! Now, how do you propose that those just entering the field move to change it. "Accepting financial martyrdom" is de facto for students and residents like yourself. The impetus for change, if it exists, must lie among established professionals in conjunction with outsider lobbyists, activists, and advocates. Give us a real counterpoint based on your extensive experiences rather than simply condescending to those who are not yet in your shoes.
     
  48. Law2Doc

    Law2Doc 5K+ Member
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    There are some things that are negatives about this field that simply aren't that likely to get changed. I think Panda's point is more that you need to know what's ahead and that it isn't the fantasy-land some people on here seem to think. It's hard work, lots of long years of debt and training, you will be woefully underpaid per hour as a resident, and the public is still going to think all doctors are fleecing them because they can get the "same" service from the NP down the hall for half the price. So folks should go into this career with their eyes open. Not to fix things, but to know what you are signing on for. Because based on some of the posts, it's not always clear folks do.
     
  49. ManualEvac

    5+ Year Member

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    Sure, it's important to know the dark reality of what we are getting into. EVERY thread I've read alludes to this, so it is out there already in force. Much more importantly, however, is what does the next generation of med students need to do differently to order to push back against the system? Physicians are indispensable, but like teachers and many other "helping" types, they often allow themselves to be walked all over in the name of helping the patient. The current batch of docs seems complacent and politically helpless in my experience. Everyone's bit$%ing and moaning about the sky falling and the demise of evidence-based medicine, but I don't see any grassroots solutions being proposed.

    The coming generation will obviously have to fight much harder throughout our careers just to break even, especially in primary specialties like FP, where I'd like to be in 10 years. I don't see any advice on these posts about how to be an active participant in the legislative or regulatory process. DNPs have made time for this type of activism, and they are bogarting the white coat as a result. As a pre-med, I am much more likely to have time and energy to learn about and act on the policy side of the profession than when the fire hose opens up in about two years (knock on wood :D).
     
  50. leftmid

    2+ Year Member

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    My buddies had been so confident that it was the best time for them to enter medicine.........until they ran into those adcoms......:eek:
     

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