Is the outlook of psychiatrists as bleak as that of other physicians?

Discussion in 'Psychiatry' started by bashir, Dec 9, 2008.

  1. bashir

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    I am applying to medical school this summer with the intent of becoming a psychiatrist. In general I am excited about this goal, but lately I've been hearing so much doom and gloom about how horrible things are getting for doctors in the U.S. and how grueling and dehumanizing the long training process is that it's hard to stave off the second thoughts. I know this question has been asked many times on this board, and I've read many of the responses, so forgive me if I ask again: knowing what you know now, would you do it again?

    These are some of my rationalizations as to why I'm not insane to be going into medicine; if anyone wants to disillusion me, feel free.

    1. Common complaint: Medical school is ridiculously hard and life-consuming.

    My expectations: The first two years of medical school should be manageable. I don't mind studying, and while I'm sure it will suck to study 12 hours a day at times, I think I can handle it. From what I've heard, there will be some pretty hellish times in the clinical years, but that's only two years, and only some of the rotations will make me want to wish I'd never been born.

    2. Common complaint: Residency is ridiculously hard and life-consuming (and soul-sucking).

    My expectations: This was a big concern for me. When I first started thinking about going to medical school I almost wrote it off completely because the idea of having no time to spend with what I predict will be my growing family during those years was untenable. When I found out that psychiatry residencies are typically not all that bad, especially after intern year, I reconsidered.

    3. Common complaint: Reimbursements are declining, and with the huge loans they take out and the loss of many productive (money-making) years of life, doctors get a raw deal financially.

    My expectations: I'm not in it to get rich. I want to be able to pay off my loans and support a family comfortably in my fairly-low-cost-of-living city. This seems like a reasonable thing to expect as a psychiatrist.

    4. Common complaint: After sacrificing eight years of their lives to training, doctors still have to work long hours, often with undesirable schedules.

    My expectations: I don't see this being as much of a problem for psychiatrists. If I don't want to work more than a regular work week, I can just get a salaried position somewhere, right? If I go into private practice I might end up working a lot, but ultimately I have control over that.

    The conventional wisdom today on the subject of becoming a doctor seems to be "Don't even think about it." I guess I just want to see if psychiatrists agree with the consensus. It seems like most of you who post here are fairly happy with your jobs, but I suppose that doesn't necessarily mean you would choose them again. I'd appreciate any thoughts on the subject.
     
  2. BobA

    BobA Member
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    I remember agonizing over these same issues while applying to medical school. (The funny thing is I'm agonizing about different issues while applying to residency - do I really want to suffer the "stigma" of being a psychiatrist when I could be prestigious cardiologist? do I want to not use often the medical knowledge i've worked hard to learn? do I want to see many patients I can't do anything for?) These are rhetorical questions and don't need to be answered here. I've come to terms with it! My point is that I struggle when I'm at a crossroads in life - thinking of all the possibilities, instead of being satisfied by what I've got.

    Back to your concerns/expectations - I think you're basically correct. But I'll add that I don't think doctors work substantially harder now than they used to. In broad terms, being a physician is a demanding job (with some exceptions) and it always has been and always will be.

    One practical piece of advice would be to try and go to your public university if possible to keep loans down. I'm daunted by the debt I've incurred at my private med school.

    Finally, keep your mind open to other fields while in med school.
     
  3. notdeadyet

    notdeadyet Still in California
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    Keep in mind that a lot of that doom and gloom comes from older physicians. Medicine used to fairly be a gravy train. Those days are gone. By all indications, imho, those days aren't coming back again.

    That said, medicine is still about the safest, best financial investment in terms of education. No other career path virtually guarantees you a $140K salary out of the gate with no big fear of finding a job and layoffs.
    Plan on the whole of your four years of medical school being entirely devoted to learning medicine. Then, any free time you find yourself will be a nice perk. I was surprised by how little time I had for staying in shape and spending the odd free night with my wife, but I'm also not necessarily the sharpest blade in the pack and have to scramble for every point.

    How much free time you'll have depends on how much/little you care about which residency you go into where and how naturally gifted you are. If you're expecting medical school (even the first two years) to be in any way an extension of undergrad, you'll definitely be disappointed.
    Ugh. I keep hearing this mentioned and wonder what sort of expectations folks have in life.

    You invest $180K for a medical school education and you get a $150K/yr job at the end by going to a no-name medical school and graduating near the bottom of your class.

    Compare that to undergrad, in which you took out a $80K for a $30K/yr job at the end. If you go to a ho-hum business school or law school, expect to leave with $130K in loans for a $70-90K/yr job.

    If you think doctors get a raw deal, you may have unrealistic expectations. It ain't the gravy train it once was, but it's still one of the safest long term educational investments you can make. I know lots of lawyers who have trouble finding a job. I know lots of b-school grads you are effectively put out to pasture after their prime. I understand the principle of "opportunity cost", but if you do the spreadsheet and look at it over the course of a career, medicine is still one of the best financial gigs going.

    As a physician, you can have a stable income in the top 4% of your country, never have signifcant fear of unemployment and work as long as you want in life. There are better opportunities out there, but not many.
    If you want to earn six figures, you will work more than 40 hours per week at almost any job. Medicine is no different. In fact, it's better because in fields like psychiatry and EM, you can get away with working less than in most careers where you earn top dollar.
    This is the conventional wisdom of bitter doctors. Meet happier doctors. They're out there. The most jaded you'll find will be those in residency and those old enough to see the difference between now and what medicine was like in the 70's.

    Most interestingly, try talk to folks who went non-traditional paths to medicine. The most disgruntled doctors I've talked to inevitably never had second careers. The most jaded residents I've met that complain the most about their future went straight into medicine and seem so confident that the grass just MUST be greener everywhere else.

    I've yet to meet a doctor who came in from another career who felt that medicine was a rotten gig. The folks who most think it's a terrible career tend to be those who have absolutely no point of comparison.
     
    #3 notdeadyet, Dec 9, 2008
    Last edited: Dec 9, 2008
  4. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Agree with above.
    I think that bashir appears to have realistic expectations for the field.
     
  5. PeeWee137

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    :thumbup::thumbup:

    i think it can be alot harder to adjust to residency if you've never had a full time job before. many dont realize the amount of "office politics" that come into play, or think that medicine and residency is immune to it. its not.
     
  6. whopper

    whopper Former jolly good fellow
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    Another thing for you to consider is there are still several places where the old tradition of abusing residents & medstudents is alive & well. Its thankfully dying, but still exists.

    Medicine is great for job security. Its not the gravy train it once was, nor should you go into it for monetary reasons. IMHO, medicine is such a sacrifice in terms of work & devotion that you have to love what you're doing for it to be worthwhile.

    I don't see Psychiatry being adversely affected in terms of monetary income unless the economy tanks far worse than it is now. When that happens, the trend is to cut mental health services before physical health services--at least from what I've been told by older psychiatrists. This outlook may also not happen due to the passage of the parity laws.

    In pretty much all the industrialized nations that use socialized medicine, at least that I'm aware of, medical school tuition is paid for by the state. If medicine becomes socialized in the US, the US medical education may become much more subsidized by the state.
     
    #6 whopper, Dec 9, 2008
    Last edited: Dec 9, 2008
  7. peppy

    peppy Senior Member
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    Now that I am close to being done with medical school, I am happy I did it...but that might change again during residency. :)
    There were times in med school that were hard enough to make me kind of regret taking this path. It *is* a sacrifice in some ways.

    Are you interested in being a psychiatrist because you like psychiatry, or because you like the lifestyle it might provide?
    If you are just worried about having a good income and controlled work hours, there are other paths to take that you might find easier. Look at some of the other medical careers out there like being a CRNA or physician assistant.
     
  8. notdeadyet

    notdeadyet Still in California
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    Yeah, that's the one X factor that I wonder about. I wouldn't mind a socialized medicine model (lower salary/zero debt), but boy would it be a rough deal for those already saddled with large debt.
     
  9. masterofmonkeys

    masterofmonkeys Angy Old Man
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    You expect them to find the money to implement socialized medicine AND pay for our schooling? *snort*

    Medicine is a poor financial investment if you're really looking at it that way. You invest far more time and money than virtually any other field, and while your pay is pretty good afterward, you'd find it almost impossible to recoup the opportunity costs of your training and your debt load compared to going into any number of other professions.

    That said, there probably aren't any paths that lead to as secure AND high an income as you'd make in medicine.

    Personally, my only qualm with regard to becoming a psychiatrist is how I'm going to be a psychotherapist AND ensure that I'm seeing a broad range of patients from a socioeconomic perspective. Medicaid frowns on psychotherapy. You lose money doing it compared to the equivalent time spent in doing med checks, and there's a pretty low cap on the number of sessions that they'll pay for.

    I haven't read the mental health parity bill in full, but I would not be surprised if medicaid was specifically exempted.
     
  10. Doc Samson

    Doc Samson gamma irradiated
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    Yup, it is.

    Opportunity cost seems a self-defeating way of measuring success. I get paid a good salary for a job that I LOVE. I could've gone to Wall St like many of my peers, have made multiple millions and retired by 35 as they did, but now they're all bored and I get out of bed everyday and drive to work with a big sh!t eating grin on my face.
     
    #10 Doc Samson, Dec 10, 2008
    Last edited: Dec 10, 2008
  11. masterofmonkeys

    masterofmonkeys Angy Old Man
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    Absolutely. There is no place I'd rather be than in psychiatry. I can't think of anything that I'd find half as much fulfilling (ok, well I can think of a few things that'd be a little better than half as fulfilling, but they're medical too). Heck, I'm competitive enoguh to get into any number of specialties that pay substantially more without a problem. But this is where I want to be.

    But medicine is not a sound financial decision. And I'm hoping if I trumpet that enough, some of the money-grubbing so-and-sos who annoy me to death won't go into it.
     
  12. notdeadyet

    notdeadyet Still in California
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    It's do-able. Most industrialized countries do just that. It's a matter of priorities. But I don't think it's very high on our list of priorities.
    "Any number"? Nope. Folks who believe that logic pull up business examples of folks earning $180K/yr out of an MBA program doing this or that. What they don't realize is that the only folks making that are top students at top schools. The top 1% of B-school grads out there nationally.

    Medicine you can earn that being in the bottom quarter of a non-ranked medical school. Can't do that in law. Can't do that in business.
    It also depends on how realistic your expectations are. If you set them too high, you could justify never going to college because the opportunity cost of a bachelor's degree will get in the way of your entrepeneur ventures or basketball career.
     
  13. notdeadyet

    notdeadyet Still in California
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    Out of curiosity, for the sake of comparison, what would you specifically consider a "sound financial decision"?

    Your average MBA grad starts at $80K/year. And keep in mind that your average MBA grad has business experience before starting his/her MBA.

    Your average law school grad starts at $58K/year.

    Even with opportunity cost during residency, if you sketch out numbers on a spreadsheet, you find that you recoup this over time.

    Superstars in other fields such as business or law probably have higher earning potential than most physicians. But as a whole, your average physician is in a much better spot than your average MBA or your average law school grad.

    I'm not particularly salary-focused, but if you crunch the numbers, it becomes pretty apparent that med school is a very smart financial investment compared to almost any other education. I agonized over that for some time as I left a nice salary and career to pursue medicine late enough in life that I won't recoup my opportunity costs.

    Now if you're not happy, that's a whole 'nother kettle of fish. I'd rather be a happy public defender than a disgruntled dermatologist.
     
  14. BobA

    BobA Member
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    I also think medical school is a very sound financial decision. You have to factor in that it's essentially without risk, and being a physician offers a sound and steady return on your student loan dollar.

    Moreover, the people making big bucks in law or business are working 60-80hrs/wk for more years than residency. If you don't love law or business, that's a lot of time to spend missing out on life!

    Personally, I think if you're not happy making $100,000K a year the problem isn't money.
     
  15. masterofmonkeys

    masterofmonkeys Angy Old Man
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    http://www.er-doctor.com/doctor_income.html

    Very funny and very conservative analysis. Yeah it's incorrect on a number of assumptions, but it still makes a decent point.

    Factors in why i say what I say:
    1.Your adult years start at 18.
    a. we start getting paid at around 26
    b. we start earning 'doctor' salaries at a minimum of 29 but as old as 34. Even if we're traditional applicants
    2. At 26 you start with I believe an average of 150k in debt.
    3. At 26, savings you would have put aside at 18 have now doubled. You on the other hand are in debt.
    4. We 'work' 60-80 hrs a week from the time we're 18 to the time we're 26. Without earning any money for that.
    5. After calculating post-tax earnings, the income gap is not as big.
    a. post-tax earnings on 60k: 54k (this is what a UPS worker makes in a year)
    b. post-tax earnings on 150k: 116k
    6. After including benefits (a relatively fixed cost), the % increase in income narrows further
    a. This goes doubly so if you're private practice and/or have to save for your own retirement and pay for your own healthcare and vacation (in terms of lost wages for the latter).

    Financially, medicine does have some things going for it. It's a low-risk steady stream of significant income. But it is far from the most effective way to earn a lot of money, or even a decent amount of money.

    Finance PhDs from lightweight institutions are being offered salaries of 120k to become professors at lightweight institutions right out the gate. They start getting paid at 22 (about what a resident makes and a lot less time investment during grad school). They then make 6 figures by their mid-twenties.

    Law and MBA are both bad examples since the market is rather flooded.

    And once again, let me restate that I am completely happy with what I'm going to make (I'm gonna be an academic and not a med-manager, so I'm not even going to be average for the field in all likelihood). I am not by any means going home complaining at how little money I'm going to make, and I am not worried about sustaining my rather frugal tastes.

    Doesn't change the fact that if you're in it for the money, medicine is a poor choice (unless you go into interventional cards, spine, plastics, or MAYBE derm).

    On the other hand, I am going to buy into an imaging center and hire two dermatology PAs to work under me. Now THAT is a sound decision. (tongue mostly in cheek).
     
    #15 masterofmonkeys, Dec 10, 2008
    Last edited: Dec 10, 2008
  16. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Don't neglect the boxed update at the bottom!
    "UPDATE: Medicine just became a much more desirable profession, thanks to the economic crash that devastated our economy in 2008. The profession of medicine offers one thing—job security—that is nice in good times but as precious as gold in bad times. I needn't remind you that things are bad now, and almost certain to get much worse (if you doubt that, read this). When times change, it is important to change with the times. I've used a lot of ink warning students in the past about the drawbacks of a medical career, and all of those reasons were quite valid. The cons are still there, but the list of pros just mushroomed in importance thanks to the inherent job security in most medical careers. Good luck trying to find another career that offers comparable job security."
     
  17. notdeadyet

    notdeadyet Still in California
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    I'm waiting for a list of alternatives here. If medicine is far from the most effective way to make a decent paycheck, there must be dozens of examples of better ways, no? Given that physicians are going to be in the top 3% of wage earners, though, you'll be fighting an uphill battle here.
    I'll will give you points for this: you have to be the first person I've ever heard claim that medicine is a bad financial decision, and academia is where the money is at.

    Average starting salary for a Finance PhD is $105K. Average salary for full professor Finance PhD is $120K. Lecture gigs are easy to come by due to demand. Tenure track positions are competitive. The road to full professor tends to be long and hard and is not necessarily assured. You will have to have a lot of hard work, a fair bit of luck, and years and years of experience before you are earning what a psychiatrist will make at his first job. In fact, you have a very good shot at your first job as a psychiatrist making more than the Dean at a business school makes (about $150-170K).

    Disclosure: I loved teaching at the university level (lecturer, never tenure track). Other than politics, it's a great working environment. The downside is the pay and the competition for jobs, particularly in attractive locales.
    They make TA money at 22. You can earn much more moonlighting a shift or two each month during residency in Psych than you'll make grading econ papers for a prof.
    They will get their PhD at about 26. They have a very good shot at earning $105K as a PhD at that point. A psychiatrist can start full-time work at about 30. They have a very good shot at earning $160K at that point.
    I still haven't heard any suggestions for better choices yet. The academia thing doesn't really fly, even Finance academia. I taught at college for five years and if I mentioned to colleagues that they were on the gravy train and medicine was a mugs game, I think they'd pop the patches off their elbows.
    Good stuff. Loving what you do makes for a great paycheck and no paycheck compensates for hating your job.
     
    #17 notdeadyet, Dec 10, 2008
    Last edited: Dec 10, 2008
  18. notdeadyet

    notdeadyet Still in California
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    And masterofmonkeys, I hope you don't feel picked on. I just think that most physicians who bemoan what a terrible path medicine is financially haven't sat down and looked at alternatives all that closely.

    Medicine isn't a great path to quick wealth. But there just aren't many careers out there that can match it in terms of a long-term investment. The problem with our culture is we tend to look at things much too much near-term.

    Medicine has to be the only field that at 22 years of age, you can be assured that you will be earning in the top 2-3% of American wage earners when you finish your training, even if you are going to be bottom quartile in one of the worst med schools in the country. I can't think of many fields like that.

    Medicine has a lot wrong with it and a lot of challenges, but it sure beats most work out there.
     
  19. Still Kickin

    Still Kickin Attending
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    This thread reminded me of something I read in Iserson's.
    (I think I have an older edition - "Isersen's Getting Into a Residency", 6th ed, 2003, pg 133):

    "It has been shown that primary care physicians have a substantially lower return on their investment in professional education than do medical or surgical subspecialists, attorneys, dentists, and individuals in business. Based on the costs of a medical education, the "hours-adjusted net present value" of the money invested in education is $10.73 for attorneys, $10.40 for procedure-based physicians, $8.90 for dentists, $8.27 for businessmen, and $5.97 for primary care physicians."

    Unfortunately he doesn't give more of a reference/explanation for where these figures came from.

    It's all on the same page as a table entitled "Mean Physician Annual Income after Expenses and Before Taxes", which it states is taken from an AMA report on Physician Socioeconomic Statistics 2000-2002:

    Cardiology - $300K
    Dx Radiology - $300K
    Orthopedic Surgery - $298K
    Urology - $270K
    Derm - $270K
    GI - $260K
    Path - $250K
    Anesthesiology - $236K
    General Surg - $232K
    Emergency Med - $214K
    All Physicians - $211K
    OB/Gyn - $203K
    Otolaryngology - $200K
    Ophtho - $200K
    Neurology - $170K
    General Internal Med - $160K
    Peds - $145K
    Psych - $140K
    Fam Practice - $135K
     
  20. masterofmonkeys

    masterofmonkeys Angy Old Man
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    not talking per year income but wealth building.
     
  21. doctalaughs

    doctalaughs Member
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    Pure economic anaylsis:

    If you are at a mid-tier college then med school is a good investment for you, esp if you go to a state med school right after college then move into a high-reimbursing specialty. You can come out with below-average debt (maybe 50 or 60k) and be making 200k easily at age 30.

    If, on the other hand, you are at an ivy league or you are a top student at a higher-tier college then med school is a bad investment for you. Law school is BY FAR the best economic decision. This is because you have a good chance of getting into a top 10 law school and doing well there. If you graduate from a top-10 law school in the top half of the class you are GUARANTEED to make 175 k just 3 years out of college (at age 25)plus a sizable bonus. After 7-8 years you'll be making 400k easy at which point you possibly make partner (at least 50% do,eventually) and average 750k except in San fran or NYC where you'll clear a million guaranteed (this is at age 33, when many of us are just finishing residency). Don't believe me? I know this first hand from many of my friends, but you can look at www.greedyassociates.com if you want.

    I would kill myself if I had to be a lawyer but if you like that sort of thing and are a good test-taker it's a guaranteed path to wealth. And yes, these top lawyers work hard on their path to riches but I would argue less hard than the q4 call overnight call most residents have to endure.
     
  22. BobA

    BobA Member
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    For the most part I agree with what you're saying. However, when meeting a deadline for a case or deal corporate lawyers work as many hours as possible (no 80wk restrictions).

    Furthermore, who would want to be a lawyer when you could be a psychiatrist?

    Has anyone else heard the figure that after 90K (when basic needs are met) there's no correlation between happiness and income?
     
  23. phorensic

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    You make it appear far more straightforward and predictable than it actually is.
     
  24. phorensic

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    ,
     
    #24 phorensic, Dec 11, 2008
    Last edited: Dec 11, 2008
  25. notdeadyet

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    Or if you're a top basketball player at a top school, ball is a far better financial plan.

    Talking about the top 1-3% of law school students (which top student at a high-tier law school/ivy law school would be) vs. how the top 1-3% of med students fare isn't probably that significant. Follow the career path of that dermatologist and hour by hour, they probably have your law partner beat.

    How the top students do isn't representative. When people talk about medicine being a poor financial decision, we're talking about the career path. Talking about the middle half is a lot more telling, and your average medical school grad is much more likely to be in a better financial position by the end of his/her career than your average law school grad.
     
  26. notdeadyet

    notdeadyet Still in California
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    Most lawyers I know would get a good laugh at this.
    q4 ends a few years after medical school. Most well paid lawyers I know work crazy hours for the rest of their career.
     
  27. wolfvgang22

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    And psychiatry is even cushier than that. Q4 usually only lasts a year at most during resdiency! Most places I've interviewed, you only do in house Q4 call on medicine months in intern year. Not too shabby if you ask the medicine residents.
     
  28. doctalaughs

    doctalaughs Member
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    1. Have you talked to some of these lawyers coming out of mid-tier law schools? They aren't very good academics... and, there are a lot more law students then med students.

    2. A significant portion of people who got into any medical school could have gotten into a top law school. I know I could have easily gotten into a top 10 as could have many of my classmates.

    3. Partners work hard, but "crazy" is not true. They work about 60 hrs/wk with some variability of course. Most attendings work about this (maybe not psych) but certainly don't pull down a mill/yr.

    4. Nothing you said contradicted my statements... you can't compare "the top 1-3%" of med to law... cause gaining admission to a top 10 law school is about as hard as gaining admission to a top 50% med school; and you are golden from there on if you just work hard.

    5. It's true that most lawyers would laugh at my statements... because they went to mid-tier law schools and don't know about the market for those that were smart in college (which almost all med students were).

    6. Btw I dont think many of us could play pro basketball no matter how hard we tried, whereas many of us have the intellect (though definitely not the desire) to go practice law.
     
  29. notdeadyet

    notdeadyet Still in California
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    We'll have to agree to disagree. Whenever talk veers to how obviously godly we are by the fact that we made it in to medical school, I get a little embarrassed and step away from the table slowly.

    Please don't take offense, but I wonder if you might be drinking a little deep from the medical school Kool-Aid. By getting in to med school, it means that we all got good grades and did well on a single standardized multiple choice test. That's it. I know they pound in how amazing med students all are at the commencement ceremony and faculty sometimes pour it on a bit thick about how we must save humanity as we're the best and the brightest of the world.

    But I'd guard against that going to anyone's head. Med school is neither NASA nor the priesthood. It's graduate school. That's it. A lot of the general public thinks doctors are raging egoists and the amount of med students that assume "I got in to medical school therefore I could have been successful at anything" makes it a little more clear where this comes from.

    "I could have gotten into a top business school." You hear that a lot. But most doctors I've met are truly rotten business people. Look at the stats of the number of new solo practitioners that drive themselves into bankruptcy. But many of them assume, hey, I got into med school, how hard an business be? They pay their ego's price.

    "I could have gotten into a top law school." The type of intelligence needed to problem solve in medicine and law are pretty different. Most med students do the bare minimum of liberal arts and focus on science as much as possible. They work very hard on their science chops to get in to medical school. That doesn't always translate well to critical thinking or outside-the-box problem solving. That becomes really clear very soon into medical school when the solution isn't arrived at by recall or finding the answer in a book.

    I wish you the greatest success and happiness in medicine. But the whole "I could have been better at _____ than Bobby, but I just didn't want to _____" rings kind of false. If you haven't walked a mile in someone's moccasins, it's a little inaccurate to assume you know how they fit.

    I wouldn't want most lawyers or businesspeople I know as doctors and I wouldn't want most doctors I know as lawyers or businesspeople. How successful one feels they could have been at the other is more about ego than any kind of experience.

    That said, I should have learned to play the guitar.... Money for nothing and the chicks for free...
     
    #29 notdeadyet, Dec 13, 2008
    Last edited: Dec 13, 2008
  30. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Really it's more of a high-priced vo-tech.
    I've been to graduate school. There's really no comparison between the two when it comes to needing to think creatively and independently vs. memorizing piles of trivia and learning how to perform repetitive tasks competently.
     
  31. notdeadyet

    notdeadyet Still in California
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    I was pretty shocked when I arrived at medical school and found out how much little critical thinking and deep problem solving was involved. If John Q. Public realized how much of medical training was based on rote memorization and algorhithmic flow-charts, I think they'd be a lot less enamored with doctors.
     
  32. Moxie Floxacin

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    Bashir, you are asking extremely good questions. I hope my response is helpful to you.

    I am happy with my job, but honestly, I don't think I would do it again. My reasons largely have to do with your Common Complaint 1. I should probably mention that I went to the medical school where I felt the students seemed the most happy and well balanced. My cohort fell victim to a culture change that strongly affected the tenor of our experience. It is a rather hierarchical, hazing-prone place. Many people have left, and most of them have been great people who would have been wonderful physicians.

    If you were my cousin, and you wanted to know if medical school would damage your soul, I'd first ask you how you felt about your pre-med classes and classmates. For example, If you genuinely enjoyed Cell Bio, looked forward to lab, and wanted to do that for two years, 60 hours a week - in the service of providing medical care to humans - basic science is probably less likely to hurt you than say, someone who thought that the pre-meds were less friendly or interesting than the folks in their Studio Art, English and Religion classes.

    I was extremely surprised to go to medical school and find that the most popular activity - by far - every non-exam weekend, was getting completely wasted. I was also surprised by how many of my classmates chose to spend most all their waking time studying, with 90 minutes scheduled for the gym three times a week. People lived lives of anxious studying, punctuated by weekend drinking, evenings of crappy television (and crappier magazines) and very occasional (2x a season) weekends of skiing. You will have the option to spend social time with people outside the medical school community, but it will come at a cost of a being somewhat removed from people who can understand what you're going through.

    If you were my cousin, I'd ask you what you wanted out of medical school. Let's say - I don't know - you like working with others and are interested in Helping People. The great thing about being right out of college in 2009 is that the world needs you. Half of Zimbabwe is threatened by cholera and doctors are certainly necessary. But half of Zimbabwe is threatened by cholera, and way more than doctors are needed. We are clearly going to run out of oil, and history tells us that nations behave extremely badly under these circumstances. Many places have already run out of water. Bangladesh will probably drown. While countries of people have been dying of hunger for eons, last year, normal people in several different nations died trying to buy cooking oil/ rice /staples from a store because of global food insecurity. At home, people who don't have jobs are still being stalked by predatory lenders. Several states in our nation have decided that gay people should be denied the right to marry. Pick your battle; we need really good minds that can solve complex problems tackling these problems from a thousand angles. A thoughtful, intelligent person can do a lot of good in a non-profit environment, serve humanity, and maintain healthy relationships with friends and others. I certainly look forward to interacting with people on a one-on-one level, which is one of my favorite things in the world, but I think the world we live in needs the careful application of intelligence in response to pressing, complex questions

    Is there something else you can consider doing? If so, do it. Not because medical school is so demanding that you should avoid it, but because you probably won't go wrong if you pursue what you find fun and rewarding. If you are not certain about medical school, there isn't any reason to lock yourself up for 8-10 years, and take on a mortgage worth of debt. Your MCAT scores will be good for a few years. Med school will still be there. Wait two years, get an apartment, fall in love (run a marathon, learn to cook, make your own catapult) then do it.

    I tend to believe things happen as they are supposed to. If you're meant to practice as an MD or DO, you will.

    When asked this question, one of my best friends tells if she had the chance (and knew about the option) she would have become a physician's assistant (PA). I may have the particulars wrong, but PAs do four years of school, write prescriptions, care for patients, don't take call, have a lot less debt, and go home on weekends.

    -----

    I worked for several years after college. Even with the problem solving, and the art of medicine, I am not valued for my brain as I was before medical school, and I don't anticipate the same kind of challenges I had for years, if ever. As a 23 year old in not particularly glamorous non-profit jobs, I did more interesting problem solving than I have so far in my four-years of medical school. My friends who stayed in the non-profit world now have assistants who will be paid more than I will my intern year. While they have their fair share of grunt work, they get to think about interesting problems with interesting people a lot of the time.

    In contrast, when I'm on a new service, I don't have opinions until I know it is safe to have them. My experience is hopefully not representative, but as a third-year, a course director told me "medical students should be seen and not heard." This was about the most valuable advice I got clerkship year (WAAAYYY better than "the residents love to teach, so ask a lot of questions.") At work, I do not discuss interesting things about myself if they might show up a senior. In general, I do not expect to be respected for who I am as a person.

    This may be different during residency, or after residency, but the good stuff you pour into the art of medicine can also be channeled into other ways of serving the community that I found more rewarding when I was doing that. I will agree with OldPsychDoc, and notdeadyet - independent creative thinking isn't really all that valued in medicine or helpful. My mentor often says dumb people can do medicine. Patience is probably as important as intelligence in what we do.

    I say this as someone who loves patients. Every patient has individual needs and challenges. Each an opportunity to problem-solve, every medication decision requires a boatload of information about interactions, and every moment is another chance to be fully present for another human. But people don't like change, and if changing behavior were easy, I'd floss every day. Heck, I'd brush my teeth three times a day!

    It is probably telling that I'm not comfortable using my normal posting name to share these thoughts with you. Even here on SDN, saying something negative to doctors about something they do feels unsafe to me. Sometimes medical school feels like the Church of the Biomedical. Anything that isn't frankly supportive can be interpreted as a direct ego-challenge, and we doctors can be explosively reactive and defensive. When advising a little-sib on how to approach a problematic service, my honest advice was "assume everyone has a personality disorder until proven otherwise." I worked with extremely big egos and strange people in non-profits, but I didn't waste as much of my time "being pleasant" or engaging in a strained calculus to determine whether it is appropriate to tell a joke or safe to advocate for a patient. In general, I approached others as grown-ups, which I don't do in a hospital environment. You can call it paying your dues, but if you are at a cross-roads, compare it to places where you can pay your dues by working hard, demonstrating excellence, and navigating politics which are generally less hierarchical.

    Medical school is often about learning Exactly How It Is Done So You Can Do It In Your Sleep At Three In The Morning Because This is The Quintessential Work Skill. Alternately, your bosses will often be very happy that they have figured out Just How To Do Something, and your job will be to tell them how you hope to be like them. On the first day of my Humanism in Medicine course, we were asked to brainstorm the qualities of a leader. After the brainstorm, the instructor referred to her cheat sheet, wrote "the answers" on the board, and told us to copy them down. We did soul-numbing sh** like this for two years - in the service of remaining human. If this bothers you, don't attend my medical school.

    I'm a fourth-year medical student, so I can't say much about Common Complaints 2 -4, except that I am not worried about them. I feel like I can make decisions that can mitigate those concerns. For example, I'm looking at residency programs where people appear genuinely happy, and I'm giving more weight to that than proximity to friends and family. However, the truth is that I may have to choose between those things. While people in every job have to balance work and play, and a zillion different factors when making job decisions (pay, work environment, location) there is something a little different about your options as medical student.

    That is a little vague and hard to understand, so here is what it feels like. Imagine being in a grocery store, and picking breakfast cereals based largely on fiber content. It is required that the cereal comes in the standard cereal box shape. There are lots of different boxes to choose from, and occasionally someone is going to package an oatmeal that fits the box requirement. You are going to meet your needs and it won't be a problem, but the people you went to college with are at the yummy brunch place every Sunday, having interesting conversations about society over coffee and eating sausage. Those people still have to make decisions regarding what is best for them, but the menu is sexier.

    Obviously, I'm speaking in strong terms. If I were a better writer, I could pin down my answer to your questions without doing so. I hope this helps. I'm just one data point. When I have done away rotations, I have felt much more supported and encouraged. I think my cohort was victim to an unfortunate environment. But it is 2008, and it is what I got when I looked for a people-friendly place.

    Please PM me if you'd like to talk by phone.

    Good luck!
     
    #32 Moxie Floxacin, Dec 13, 2008
    Last edited: Dec 13, 2008
  33. whopper

    whopper Former jolly good fellow
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    One of the reasons why I found House very entertaining though I don't watch it much anymore because its become a bit forumlaic.

    I think any doctor worth his/her salt should not give up no a case he/she can't solve that's not falling within the standard of care to solve. This happens as you probably already know more than we think. I've seen too many doctors give up without really spending a brainstorm session, or putting a lot of brainwork on the diagnosis.

    Medical school is tough, residency is tough, after that, and its unfortunate, a lot of doctors can get away with substandard care.

    Managed care to some degree has worsened this. If a doctor can't solve a patient's problem, that doctor often times will not get paid to spend a few hours doing literature searches & consulting with other colleagues.
     
  34. Doc Samson

    Doc Samson gamma irradiated
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    Right - they say it's "psychiatric" and consult us - which is why House is obviously a CL psychiatrist (well that and all the smart-ass comments).
     

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