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.
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.
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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!
