Concerns with the future of medicine?

[danielslee]

I've been highly contemplating a career switch into medicine, but there seems to be so much doom and gloom around here. I just separated from the military and am currently deciding between medicine, public service (LEO, FF, federal law enforcement), and finance. To be honest, I'm leaning more towards the first two options since I have an inclination towards service and helping others.

But my concern is with the future of medicine and all the uncertainty involved. To name a few:

• The overall trend of more difficult patients, malpractice lawsuits, etc. Granted I don't have first-hand experience or a source; I'm merely listing this based off of several physicians who have seen the shift over the past 20-30 years
• Unseen workload involving paperwork for insurance companies and resulting less patient contact
• Medicare for all and falling physician salaries. The overall impact of single payer health care. Some suggest this will mainly hit specialties and most primary care positions will be less affected, but who knows? Large discussion here
• I'm particularly interested in EM and there seems to be concern that EM relevancy will diminish in the future with the drastic increase in residencies among other reasons here
• Particularly in military medicine (which I'm also considering), the shift under DHS is proving to be very unclear and many military physicians are pushing students away because of the uncertainty

How are all you non-trads maneuvering these concerns - or are you simply just pursuing medicine and focusing on your passion? Perhaps I'm focusing too much on the negatives, but I think it's fairly reasonable to be concerned about these things considering the price tag and opportunity cost of med school.

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[Ultimax]

Hi, saw your post on the other thread ao Ill just reply here. Medicine is constantly changing, and like other fields, will continue to evolve. In regard to military medicine, and since you are also in the military, you know that the military owns us. If you are dead set that you want to pursue fellowship, it will be problematic if the military reduced the slots or decide to deploy you. Second, residency programs are limited in the military. Third, one you join the dark side (commissioned as an officer), you dont technically get out like when you were enlisted. Specifically, you will be assigned either to the reserve or to the IRR, and you will get mobilized if they need you (maximum is 3 months every 2 years). Now, some will say that they dont get mobilized at all. Well, the truth is you will, as several physicians in my unit were recently.
For me, i wouldnt do HPSP if I were you. You will likely deal with lazy soldiers who want days off and not encounter adequate interesting medical cases if you were practicing as a civilian physician. And once you get promoted, you may get assigned to administrative positions with limited patient contact.
From my perspective as a nurse and a nurse practitioner, physicians will always be leaders. I am sure other NPs will chew me out as NPs are pushing for independent practice, and I am proud that I do deliver high quality care and patients love me; my knowledge is superficial in comparison to that of physicians. I scored in the 97th percentile for my board exam, and I was surprised of gaps in my medical knowledge when I discussed complicated cases with my mentor/supervising physician. Practice medicine because it is something you love to do, that advice never goes wrong. If you are a competent physician and with good bedside manner, patients will follow you.
Nevertheless, medical malpractice will always be here, regardless of how good you are as a physician. Remember that the purpose of law suits are mostly money, and not because they want to bring you down. I have testified in front of the court (not because of my negligence), and I can tell you that it is not easy to lose your license. Just do the right thing, and follow the principles of medical ethics.

 

[danielslee]

Hi, saw your post on the other thread ao Ill just reply here. Medicine is constantly changing, and like other fields, will continue to evolve. In regard to military medicine, and since you are also in the military, you know that the military owns us. If you are dead set that you want to pursue fellowship, it will be problematic if the military reduced the slots or decide to deploy you. Second, residency programs are limited in the military. Third, one you join the dark side (commissioned as an officer), you dont technically get out like when you were enlisted. Specifically, you will be assigned either to the reserve or to the IRR, and you will get mobilized if they need you (maximum is 3 months every 2 years). Now, some will say that they dont get mobilized at all. Well, the truth is you will, as several physicians in my unit were recently.
For me, i wouldnt do HPSP if I were you. You will likely deal with lazy soldiers who want days off and not encounter adequate interesting medical cases if you were practicing as a civilian physician. And once you get promoted, you may get assigned to administrative positions with limited patient contact.
From my perspective as a nurse and a nurse practitioner, physicians will always be leaders. I am sure other NPs will chew me out as NPs are pushing for independent practice, and I am proud that I do deliver high quality care and patients love me; my knowledge is superficial in comparison to that of physicians. I scored in the 97th percentile for my board exam, and I was surprised of gaps in my medical knowledge when I discussed complicated cases with my mentor/supervising physician. Practice medicine because it is something you love to do, that advice never goes wrong. If you are a competent physician and with good bedside manner, patients will follow you.
Nevertheless, medical malpractice will always be here, regardless of how good you are as a physician. Remember that the purpose of law suits are mostly money, and not because they want to bring you down. I have testified in front of the court (not because of my negligence), and I can tell you that it is not easy to lose your license. Just do the right thing, and follow the principles of medical ethics.

Thank you for your insightful response. I certainly do understand the downsides of serving in the military on both enlisted/officer sides. I guess I am intrigued by the idea of being a military physician. If I were to go this route, I would try to volunteer for Rangers or SF Groups, but I understand that these are fairly vanilla and lack the depth of cases you'd see on the civilian side.

The point of malpractice being money vs. bringing down the doctor is a viewpoint I didn't really consider, but makes sense. I think if I'm being completely honest with myself, I'm a bit scared of taking the plunge and commitment for something I won't truly understand until I'm right in the middle of it.

 

[Goro]

As a medical educator, here's what I have to say about your concerns:

• The overall trend of more difficult patients, malpractice lawsuits, etc. Granted I don't have first-hand experience or a source; I'm merely listing this based off of several physicians who have seen the shift over the past 20-30 years

While malpractice suits are common, patients winning them is not, and many stats have caps on award. Patients have and always will be difficult. It's part of the job.

• Unseen workload involving paperwork for insurance companies and resulting less patient contact

Yup, it's an issue.

• Medicare for all and falling physician salaries. The overall impact of single payer health care. Some suggest this will mainly hit specialties and most primary care positions will be less affected, but who knows? Large discussion here

It's not a reality yet, not is it likely to be be. Public option is still more doable. The median salary right now for doctors is > $200K. That's 2x what I make so I can't feel too sorry about that.

• I'm particularly interested in EM and there seems to be concern that EM relevancy will diminish in the future with the drastic increase in residencies among other reasons here

Are people to stop shooting themselves, driving drunk, or having ruptured appendix???? This concern seems the least likely. Path is having trouble right now.

 

[deleted859689]

I've been highly contemplating a career switch into medicine, but there seems to be so much doom and gloom around here. I just separated from the military and am currently deciding between medicine, public service (LEO, FF, federal law enforcement), and finance. To be honest, I'm leaning more towards the first two options since I have an inclination towards service and helping others.

But my concern is with the future of medicine and all the uncertainty involved. To name a few:

• The overall trend of more difficult patients, malpractice lawsuits, etc. Granted I don't have first-hand experience or a source; I'm merely listing this based off of several physicians who have seen the shift over the past 20-30 years
• Unseen workload involving paperwork for insurance companies and resulting less patient contact
• Medicare for all and falling physician salaries. The overall impact of single payer health care. Some suggest this will mainly hit specialties and most primary care positions will be less affected, but who knows? Large discussion here
• I'm particularly interested in EM and there seems to be concern that EM relevancy will diminish in the future with the drastic increase in residencies among other reasons here
• Particularly in military medicine (which I'm also considering), the shift under DHS is proving to be very unclear and many military physicians are pushing students away because of the uncertainty

How are all you non-trads maneuvering these concerns - or are you simply just pursuing medicine and focusing on your passion? Perhaps I'm focusing too much on the negatives, but I think it's fairly reasonable to be concerned about these things considering the price tag and opportunity cost of med school.

Personally, I am focusing on my passion of helping others. I am mostly concerned about the increase in paper-work and the barriers to ordering tests needed to treat patients when you know they need an MRI or further diagnostic testing. Most of the time, insurance won’t cover it until conservative management has been tried. While decreasing salary may be an issue, 100K+ is more than enough for me as money isn’t the main reason why I am entering the health profession.

I am a non-traditional student (pursuing a PhD in chemistry before switching) and am not really bothered by the possible changes besides the red-tape to treating patients. However, you should definitely know the changes to be knowledgable in the field you are working in. If you are passionate about the healthcare field, I see no reason why you shouldn’t pursue it. As a military vet, schools will definitely look at you with a positive look. Best of luck wherever you choose to go!

 

[danielslee]

As a medical educator, here's what I have to say about your concerns:

• The overall trend of more difficult patients, malpractice lawsuits, etc. Granted I don't have first-hand experience or a source; I'm merely listing this based off of several physicians who have seen the shift over the past 20-30 years

While malpractice suits are common, patients winning them is not, and many stats have caps on award. Patients have and always will be difficult. It's part of the job.

• Unseen workload involving paperwork for insurance companies and resulting less patient contact

Yup, it's an issue.

• Medicare for all and falling physician salaries. The overall impact of single payer health care. Some suggest this will mainly hit specialties and most primary care positions will be less affected, but who knows? Large discussion here

It's not a reality yet, not is it likely to be be. Public option is still more doable. The median salary right now for doctors is > $200K. That's 2x what I make so I can't feel too sorry about that.

• I'm particularly interested in EM and there seems to be concern that EM relevancy will diminish in the future with the drastic increase in residencies among other reasons here

Are people to stop shooting themselves, driving drunk, or having ruptured appendix???? This concern seems the least likely. Path is having trouble right now.

Thank you for taking the time to addressing some of my concerns! It's great to hear from people that are closely intertwined with the sector. I suppose I get trapped in certain rabbit holes and don't have the experience or knowledge to convince myself otherwise.

 

[danielslee]

Personally, I am focusing on my passion of helping others. I am mostly concerned about the increase in paper-work and the barriers to ordering tests needed to treat patients when you know they need an MRI or further diagnostic testing. Most of the time, insurance won’t cover it until conservative management has been tried. While decreasing salary may be an issue, 100K+ is more than enough for me as money isn’t the main reason why I am entering the health profession.

I am a non-traditional student (pursuing a PhD in chemistry before switching) and am not really bothered by the possible changes besides the red-tape to treating patients. However, you should definitely know the changes to be knowledgable in the field you are working in. If you are passionate about the healthcare field, I see no reason why you shouldn’t pursue it. As a military vet, schools will definitely look at you with a positive look. Best of luck wherever you choose to go!

Thank you for your response and best of luck to you as well! It breaks my heart to hear some stories of docs failing to save lives due to documentation and/or political red tape. I would like to believe that these stories are rare, but I'm not sure how I would personally process that.

 

[Type2Fiber]

I've been highly contemplating a career switch into medicine, but there seems to be so much doom and gloom around here. I just separated from the military and am currently deciding between medicine, public service (LEO, FF, federal law enforcement), and finance. To be honest, I'm leaning more towards the first two options since I have an inclination towards service and helping others.

But my concern is with the future of medicine and all the uncertainty involved. To name a few:

• The overall trend of more difficult patients, malpractice lawsuits, etc. Granted I don't have first-hand experience or a source; I'm merely listing this based off of several physicians who have seen the shift over the past 20-30 years
• Unseen workload involving paperwork for insurance companies and resulting less patient contact
• Medicare for all and falling physician salaries. The overall impact of single payer health care. Some suggest this will mainly hit specialties and most primary care positions will be less affected, but who knows? Large discussion here
• I'm particularly interested in EM and there seems to be concern that EM relevancy will diminish in the future with the drastic increase in residencies among other reasons here
• Particularly in military medicine (which I'm also considering), the shift under DHS is proving to be very unclear and many military physicians are pushing students away because of the uncertainty

How are all you non-trads maneuvering these concerns - or are you simply just pursuing medicine and focusing on your passion? Perhaps I'm focusing too much on the negatives, but I think it's fairly reasonable to be concerned about these things considering the price tag and opportunity cost of med school.

your concerns are good ones. I can't speak to lawsuits, but I've seen multiple private practice setups that manage paperwork well and it doesn't consume the day-to-day of the physicians. I've generally had positive experiences with patients so far fwiw

As far as M4A and other government interventions, I'm certainly concerned about it. If it's going to happen, hopefully it gets done while I'm in training and then implodes before I'm done. But the reality is that trying to predict the future is not helpful. Physicians provide actual value to patients and will be able to generate an income that reflects that

I am avoiding EM, personally. It was near the top of my interests, but the proliferation of residencies is a terrible thing for future income prospects and hospital based specialties seem especially exposed to whatever changes the government makes. Overall, I enjoy learning medicine and am optimistic about the future. The technology and ways to help patients keep getting better, you just will have to get comfortable with the uncertain landscape because I don't see politics and healthcare becoming less intertwined

 

[danielslee]

your concerns are good ones. I can't speak to lawsuits, but I've seen multiple private practice setups that manage paperwork well and it doesn't consume the day-to-day of the physicians. I've generally had positive experiences with patients so far fwiw

As far as M4A and other government interventions, I'm certainly concerned about it. If it's going to happen, hopefully it gets done while I'm in training and then implodes before I'm done. But the reality is that trying to predict the future is not helpful. Physicians provide actual value to patients and will be able to generate an income that reflects that

I am avoiding EM, personally. It was near the top of my interests, but the proliferation of residencies is a terrible thing for future income prospects and hospital based specialties seem especially exposed to whatever changes the government makes. Overall, I enjoy learning medicine and am optimistic about the future. The technology and ways to help patients keep getting better, you just will have to get comfortable with the uncertain landscape because I don't see politics and healthcare becoming less intertwined

I have heard of streamlined private practice setups, so that is good to know. I've always wondered if it was possible to get AI or a good program written up to make it as efficient as possible.

That's unfortunate about EM... I know many students change their minds going into med school, but my gut just screams EM and it's a bit worrisome. I guess I can look into other route of EM like tactical medicine or EMS, but it won't be nearly on the same scale as a board certified EM doc... decisions decisions.

 

[Bonne Nuit]

That's unfortunate about EM... I know many students change their minds going into med school, but my gut just screams EM and it's a bit worrisome. I guess I can look into other route of EM like tactical medicine or EMS, but it won't be nearly on the same scale as a board certified EM doc... decisions decisions.

Out of curiosity, what clinical experiences have you accumulated so far? (shadowing, clinical volunteering, etc.)

 

[danielslee]

Out of curiosity, what clinical experiences have you accumulated so far? (shadowing, clinical volunteering, etc.)

I have very limited shadowing and clinical experience which understandably makes my opinion pretty uneducated. Still, I know myself and my desire for a dynamic workplace. Again, this is not to say that other specialties don't have this, but I have interests in tactical, wilderness, and austere medicine. I have experience on the tactical side with my military experience and shadowing/questioning military docs as well as a combat deployment. Those personal experiences of mine are what drive me towards EM. Nevertheless, I certainly understand the very likely possibility that if I were to pursue medicine that my interests can and probably will change. I could also not get the residency of my choice and should be okay with FM, IM, etc.

 

[Cornfed101]

While decreasing salary may be an issue, 100K+ is more than enough for me as money isn’t the main reason why I am entering the health profession.

I agree with this, and most of the politicians pushing for M4A also push for eliminating, or significantly reducing, student loan burden. Paying back loans is the main reason why a salary cut would suck. Look at the dentists making $100k with $500k in debt. It's not pretty!

 

[Bonne Nuit]

I have very limited shadowing and clinical experience which understandably makes my opinion pretty uneducated. Still, I know myself and my desire for a dynamic workplace. Again, this is not to say that other specialties don't have this, but I have interests in tactical, wilderness, and austere medicine. I have experience on the tactical side with my military experience and shadowing/questioning military docs as well as a combat deployment. Those personal experiences of mine are what drive me towards EM. Nevertheless, I certainly understand the very likely possibility that if I were to pursue medicine that my interests can and probably will change. I could also not get the residency of my choice and should be okay with FM, IM, etc.

Fairly extensive shadowing and clinical experience (volunteering or paid) is essentially a requirement for medical school. I suggest that, while making your decision on what career to pursue, that you shadow physicians in various settings. Aim for 40+ hours in FM/IM/pediatrics and add on additional specialties that are interesting to you (like community EM, for example) from there.

Would you be able to see yourself in any of these roles? Would you still be OK with medicine if your initial interests don’t pan out? It’s a big decision, and shadowing and spending hundreds of hours in a clinical setting will help you decide.

I work with one young man who has decided to pursue an alternate career after shadowing a FM physician. He said that medicine wasn’t what he thought it was, and left the premed track. That’s OK, because that’s what shadowing is for. Good luck.