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Is it reasonable to ASSUME that you will get into a high-paying specialty?

Discussion in 'Nontraditional Students' started by Gauss44, May 19, 2014.

  1. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012
    I was reading Dr. Midlife's first reply on this thread,

    and came up with the question in the topic in that context. A related question is, "Is it reasonable to assume you can get into a high-paying specialty IF... (fill in the blank)."

    -You study for the USMLE step 1 before your first year of medical school to help ensure a good USMLE step 1 score (and your GPA/MCAT completely qualify for an MD program or you're sure your getting in in the first place)
    -You also take medical school first year classes at an undergraduate level before attending medical school (to help ensure good grades in medical school)
    -If you do anything else?

    I'm sure I'm not the only one with this question.
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  3. theseeker4

    theseeker4 PGY 1 Physician 5+ Year Member

    Apr 20, 2011
    Suburban Detroit, MI
    No, none of those will even help you score higher on the USMLE, let alone guarantee a high enough score to "guarantee" a competitive specialty. If you only want to be a doctor if you can work in some exclusive specialty, you are better off not pursuing this at all.

    Step one studying is pointless before you have had the material in the course of your pre-clinical years. Studying for the step exams should be reviewing what you were already taught, not trying to per-learn things you haven't seen before.

    Don't rely on undergraduate courses to help with med school courses beyond the very basics. I am a few classes away from a biochemistry undergrad degree, and med school biochemistry was more difficult for me than physiology was (and I had never had a physiology course before med school). There is no way to ensure good med school grades by taking classes before-hand.

    There is nothing you can do to guarantee anything. Some people will struggle just to pass med school, even though they rocked great grades during undergrad. Others will be able to honor with relative ease without excessive studying during med school. You never know which you are until you get there. If you want to be a doctor, pursue this. If you only want to be a doctor if you can be in a highly-competitive specialty, think about doing something else.
    Pons Asinorum, Nasrudin and Inygma like this.
  4. LongTimeLurk

    LongTimeLurk first time post

    Mar 18, 2014
    right here, right now
    That's kind of like asking if I join my college intramural basketball team will I make the NBA.
    Nasrudin, Inygma and Mad Jack like this.
  5. Chip N Sawbones

    Chip N Sawbones Ship's Carpenter 7+ Year Member

    Jan 19, 2011
    62 degrees North
    Besides the excellent points Seeker brought up, you don't know for certain if there will be high paying specialties by the time you're done with residency. Nobody knows what direction U.S. healthcare policy will have shifted to by that point. Depending on which way the political winds shift, it's quite possible that we'll have some form of national health insurance and the government decides to dictate payouts or establish salary caps to cut their costs. I don't think we'll see anything this radical quite so soon, but it certainly is a possibility, and one you need to be prepared for.
  6. Mad Jack

    Mad Jack Critically Caring Gold Donor Classifieds Approved 2+ Year Member

    Jul 27, 2013
    4th Dimension
    Is completely unreasonable for two reasons. The first of these is that a lot of people overestimate their capabilities while underestimating their competition. If you scored a 30 on the MCAT, expecting a 270 on the USMLE is unreasonable. No amount of undergraduate studying is going to give you s heat edge when you're competing with many of the brightest minds this country has to offer. Unless you are quite exceptional, it is s safe bet that b in med school, you'll just be average.

    Now, on to the other big issue. Let's say you knock it out of the park and end up going into ortho. The government is pushing for bundled, rather than procedure based payments right now. Since you aren't directly billing, you don't get to set your own pay, and the hospital amin decides ortho is getting too big of a slice of the pie, so they reimburse you at rates 1/3 lower than you're used to- your 400k salary just dropped to 267k despite your perfect match and hard work. Or you're working rads and the government axes imaging by 20%. Well, your choice is do more reads, work more hours, or sick up that 80k pay cut. The point is, Reimbursements change drastically. You never know which high paying field is on the cutting board or which will take a serious hit from future technological advances. Do your best to get into a field you love, because you can't be sure the cash will be there once your training ends.
    Inygma likes this.
  7. gonnif

    gonnif Only 1021 Days Until Next Presidential Election Lifetime Donor Classifieds Approved 7+ Year Member

    Jul 26, 2009
    The Big Bad Apple
    this questions goes even further is there is no guarantee that you will get into the specialty that you want after 4 years of medical school. In fact much of medicine from the moment you apply to medical school until when or if (yes I said if) you get a permanent position is gamble or where you may wind up.

    I frequently have premedical nontrad students express that they only want to to be an orthopedist or ophthalmologist or whatever else. While USMLE is a major factor it isnt the only factor . Each year all of the directors of all residency programs are survey between when final match results are made by the programs and before results are announced to students These are arranged across specialty listing the top 20 factors in selecting a candidate to interview and they matching a candidate. With the working environment of a residency, small group dynamics plays a big part in selection.

    Additionally students often express that they only want a certain medical school or certain ones close to the home, etc. My question to them is are you saying that if you dont get into that specific school, you wont go into medicine? You cant in, any way shape or form, guarantee acceptance to a medical school much less a specific medical school.

    Lastly, being a medical student, a resident and a physician is in many ways being a journeyman apprentice. For example, the founder of OldPreMeds, who started on this path about 1995 and who is now a dual-board certified anesthesiologist and critical care specialists and ICU director, has had 10 interstate moves from his premedical days until now, where his permanent position is in upstate New York but his family lives in Arkansas. In medical school he had rotations that were at times 200, 300, 400, 500 miles away for 12 weeks. Residency was another move to the cold Northeast. Then finally attending physician, where he spent several years as a locum tenens or a "rent-a-doc". He would love a position in his hometown, a medium sized southern city with his wife, kids, parents and in-laws. But there are very few positions in his field and he basically has to wait for someone to retire to get a spot.

    Basically if you want to be a doctor, you are putting alot into the "luck of the draw" or where you will go to school, where you will go for residency, what specialty you may windup in, and where you may get a permanent position, and how long you it may take you to get there.

    Besides that, its perfectly predictable, well maybe reimbursement, insurance rates, hospital affiliation, and a 1000 other things might be a tad iffy
    Inygma likes this.
  8. postbacpremed87

    postbacpremed87 5+ Year Member

    Jan 26, 2011
    All specialties are high paying if you are fiscally responsible and know how to budget. The difference between Neurosurgery and FM is vast, but comparing something that makes 200k vs. 250k or 250k vs. 300k isn't a good way of going about it. Those incomes allow one to live a similar lifestyle. The person who makes 250k and lives modestly will be more wealthy than the 300k guy who has spend it as you earn it syndrome
  9. gonnif

    gonnif Only 1021 Days Until Next Presidential Election Lifetime Donor Classifieds Approved 7+ Year Member

    Jul 26, 2009
    The Big Bad Apple
    But isnt that the American Way?
  10. postbacpremed87

    postbacpremed87 5+ Year Member

    Jan 26, 2011
    If you mean living beyond your means, yes...most Americans do. I have known so many physicians that get into trouble financially. I would also add that one of the ways to be well off as a physician is to A) Not get married or B) Not get divorced. The name of the game is being financially responsible. As long as you are shoving enough away for a sound retirement and your basic necessities, then that Beamer is no problem.
  11. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting.... Administrator Physician PhD Faculty Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 12, 2004
    Don't have much else to add to the good points brought up by others already, but I want to emphasize this point: if you wouldn't be happy in family med, internal med, or peds, then don't bother going to medical school. Because about 40% of residency applicants end up matching into one of those three specialties (more like 50% for DO students).
    Pons Asinorum, Nasrudin and Law2Doc like this.
  12. Goro

    Goro Faculty 7+ Year Member

    Jun 10, 2010
    Somewhere west of St. Louis

    Is it reasonable to ASSUME that you will get into a high-paying specialty?
  13. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

    Dec 20, 2004
    Strongly agree. I always say if you are going to med school to be a specific competitive specialty (eg derm) rather than merely just to become a "physician" (and decide on the specialty as things play out) don't bother with med school. In most cases you won't be getting derm or ortho and driving that Ferrari. You will very possibly be faced with the choice of being a very average salaried primary care clinician who can live in the location he wants and drive an old Camry versus move to a less geographically desirable part of the country and drive a new Accord. And that's assuming healthcare doesn't get hit with more drastic cuts.

    You (OP) have to realize that college gives you a very warped view of your abilities. A lot of the high grades you got in college were only good by the virtue of the fact that there were weaker people in the class who pulled down the curve. Med school admissions culls away all the people who made you seem smart in college. In med school you realize everyone in the room got mostly A's, and every one of them has the potential to blow away curve and leave you in the dust. All if the people in med school came in thinking they were superstars, yet half of them are going to graduate in the bottom half of their med school class. And it's against this dismal backdrop that you have to realize that only the top X% will get into something competitive.

    There is nothing you can do in undergrad that will help. Seriously. To some extent you actually end up having to "unlearn" things you learned in college because often having the superficial understanding you get in college courses is going to hurt you on graduate level tests, or keep you from studying the details (your brain shuts off when you think you've heard something already). Lot of med school professors prefer that med students come in with a clean slate, which to some extent is why the prereqs really don't include much of what you will see in first year. In many cases, the guy who isn't stressing out in early med school because he's already had a lot if the first year courses is the guy who ends up at the lower end of the curve.

    That being said there's a lot you can do once you are IN med school to pave the way to a desired specialty. Research and shadowing in a specific target specialty in your "spare" time during the first two years of med school isn't a bad idea. It's easier to get a Strong recommendation from someone if you've been working with them while in med school, and connections are everything in this business. And study hard. Open and close the library. Pre-read before and review after every lecture daily. Never fall behind. Use the weekends wisely (those are optimum times to review the weeks material again because they are the only days of the week that you don't get new material). Do active, not passive studying. See if studying alone or in groups work better for you. Don't get distracted from what others are doing or not doing. And whatever grades you get, pat yourself on the back knowing you did the best you could and let the chits fall where they may.

    There's two schools of thought in terms of actively studying for step 1 IN early med school. (NOT before). Most advise focusing on your coursework and that should give you a strong background when you finally get to the summer after second year and start studying. But I've certainly met a few people who focused on board materials and less heavily on the lecture notes throughout courses, cknowledging that it's better to get average grades and a High step 1 than honors and a Low step 1. Both groups had winners and losers. I'd go with the tried and true method of studying your lecture notes. If your school has done it's job, the tested material should be high yield.
    Nasrudin likes this.
  14. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012
    Exactly, that in addition Dr. Midlife's post in the forum I provided a link to in the OP, are the main reasons for my question.


    Thank you everyone for all of the excellent information.

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