Lawyer thinking about MD: any structural issues with medicine I should be concerned about?

Feb 20, 2021
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I’ve been working at a large law firm after graduating from a “top” law school (one of Harvard/Stanford/Yale). I originally wanted to go to law school because I really love learning how complicated systems work and was hoping that gaining specialized knowledge of the legal system would allow me to make positive difference in people’s lives. In practice, I came to feel that (a) the vast majority of the “positive differences” you can make as a lawyer are much more symbolic than practical and (b) the law isn’t really a coherent system that someone can gain “specialized knowledge” of in a meaningful way.

I had hoped that some of my concerns about the field’s awfulness would be resolved once I started practicing, but actually working in the profession has only made me even more convinced that many lawyers are in fact deeply amoral people who are totally indifferent about whether they make the world a worse place. Switching to something more "public interest"-oriented would be less revolting, but I don’t think it would resolve the deeper structural issues I have with the law. Namely, even the “good guys” don’t seem to have a great understanding of what exactly they think the legal system is supposed to be accomplishing in the first place.

I really just want to fulfill my original career goal (i.e. work on understanding complex systems in order to help people in an intellectually honest way), and I haven’t been able to think of anything other than medicine that seems to match that requirement so well. I particularly value the moral clarity that comes from being able to reduce someone’s suffering (currently going through the process of trying to donate my kidney and it’s the most enthusiastic I’ve ever been about something), but I’ve gotten the impression on here that people who want to go into medicine in order to “help people” are, like, super naïve in some way? I’m not totally clear on why this is the case—most of the complaints I've seen from disillusioned physicians seem to relate to increases in paperwork, “insufficient” pay, long hours, fear of being exposed to litigation, etc.

Anyway, I’m pretty optimistic I would enjoy the day-to-day work (well, at least a lot more than I would enjoy any other normal career), but obviously it’s a bit tricky to get meaningful shadowing opportunities right now to confirm that. At this point, I’m mainly wondering if there’s anything I’m failing to think about from a theoretical level—like, is there anything structural about the practice of medicine that should make me skeptical that I’d be able to find fulfillment here?
 
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I don’t think there is, I think if you go into it understanding that yes hospitals and administrators will try to exploit you and make you work harder for less pay, NPs with very little education/competence will try to take your job, but at the end of the day you are helping people and your number one priority is the patient so it makes it all worth it
 
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Goro

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I’ve been working at a large law firm after graduating from a “top” law school (one of Harvard/Stanford/Yale). I originally wanted to go to law school because I really love learning how complicated systems work and was hoping that gaining specialized knowledge of the legal system would allow me to make positive difference in people’s lives. In practice, I came to feel that (a) the vast majority of the “positive differences” you can make as a lawyer are much more symbolic than practical and (b) the law isn’t really a coherent system that someone can gain “specialized knowledge” of in a meaningful way.

I had hoped that some of my concerns about the field’s awfulness would be resolved once I started practicing, but actually working in the profession has only made me even more convinced that many lawyers are in fact deeply amoral people who are totally indifferent about whether they make the world a worse place. Switching to something more "public interest"-oriented would be less revolting, but I don’t think it would resolve the deeper structural issues I have with the law. Namely, even the “good guys” don’t seem to have a great understanding of what exactly they think the legal system is supposed to be accomplishing in the first place.

I really just want to fulfill my original career goal (i.e. work on understanding complex systems in order to help people in an intellectually honest way), and I haven’t been able to think of anything other than medicine that seems to match that requirement so well. I particularly value the moral clarity that comes from being able to reduce someone’s suffering (currently going through the process of trying to donate my kidney and it’s the most enthusiastic I’ve ever been about something), but I’ve gotten the impression on here that people who want to go into medicine in order to “help people” are, like, super naïve in some way? I’m not totally clear on why this is the case—most of the complaints I've seen from disillusioned physicians seem to relate to increases in paperwork, “insufficient” pay, long hours, fear of being exposed to litigation, etc.

Anyway, I’m pretty optimistic I would enjoy the day-to-day work (well, at least a lot more than I would enjoy any other normal career), but obviously it’s a bit tricky to get meaningful shadowing opportunities right now to confirm that. At this point, I’m mainly wondering if there’s anything I’m failing to think about from a theoretical level—like, is there anything structural about the practice of medicine that should make me skeptical that I’d be able to find fulfillment here?
You're facing 2-3 years of preparing for med school, 4 years of med school, and 3-5 years of residency. That's s a big chunk of change out of your life.

You could be a public defender, or a social worker, or patient addvocate instead.

Start volunteering with patients to see if this really is for you. I get that you want to help people, but really have to run TO Medicine, rather than merely run AWAY from Law.
 
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FutureInternist

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Also, as a lawyer in a class full of potential doctors, you will be hated from day one..... 🤪

Seriously though... LONG commitment so given your age, life issues (spouse, kids, mortgage etc), pay cut for next 7 years minimum, its a tough sell.

Also, 👏👏👏, for the kidney donation.
Wish you a speedy recovery.
 
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Mad Jack

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I’ve been working at a large law firm after graduating from a “top” law school (one of Harvard/Stanford/Yale). I originally wanted to go to law school because I really love learning how complicated systems work and was hoping that gaining specialized knowledge of the legal system would allow me to make positive difference in people’s lives. In practice, I came to feel that (a) the vast majority of the “positive differences” you can make as a lawyer are much more symbolic than practical and (b) the law isn’t really a coherent system that someone can gain “specialized knowledge” of in a meaningful way.

I had hoped that some of my concerns about the field’s awfulness would be resolved once I started practicing, but actually working in the profession has only made me even more convinced that many lawyers are in fact deeply amoral people who are totally indifferent about whether they make the world a worse place. Switching to something more "public interest"-oriented would be less revolting, but I don’t think it would resolve the deeper structural issues I have with the law. Namely, even the “good guys” don’t seem to have a great understanding of what exactly they think the legal system is supposed to be accomplishing in the first place.

I really just want to fulfill my original career goal (i.e. work on understanding complex systems in order to help people in an intellectually honest way), and I haven’t been able to think of anything other than medicine that seems to match that requirement so well. I particularly value the moral clarity that comes from being able to reduce someone’s suffering (currently going through the process of trying to donate my kidney and it’s the most enthusiastic I’ve ever been about something), but I’ve gotten the impression on here that people who want to go into medicine in order to “help people” are, like, super naïve in some way? I’m not totally clear on why this is the case—most of the complaints I've seen from disillusioned physicians seem to relate to increases in paperwork, “insufficient” pay, long hours, fear of being exposed to litigation, etc.

Anyway, I’m pretty optimistic I would enjoy the day-to-day work (well, at least a lot more than I would enjoy any other normal career), but obviously it’s a bit tricky to get meaningful shadowing opportunities right now to confirm that. At this point, I’m mainly wondering if there’s anything I’m failing to think about from a theoretical level—like, is there anything structural about the practice of medicine that should make me skeptical that I’d be able to find fulfillment here?
I think you're setting yourself up for a second round of disenchantment. Structurally, physicians often are servants of their health care system and insurance companies as much as they are caretakers of their patients, because these systems determine the options and resources we have available to us. It can be quite frustrating, and often you will find yourself questioning the morality and ethical principles of the systems you clash with. I've legitimately had to attempt guilting insurance companies into covering very basic medications that weren't on formulary because it put patients' lives at risk for them to not be on said medications and still had my claims rejected at times. It is disheartening at times but I do my best
 
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Feb 20, 2021
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Just want to emphasize that I'm "running away from the law" because I think the entire legal profession is structurally incompatible with what I care about (helping people in an intellectually honest way by understanding how complicated systems work), and my impression is that the medical field is less plagued by these structural problems. Explanations about whether that particular impression is/isn't correct would be great! I'm not super concerned about other reasons not to pursue medicine (age, family, finances, etc.)

I think you're setting yourself up for a second round of disenchantment. Structurally, physicians often are servants of their health care system and insurance companies as much as they are caretakers of their patients, because these systems determine the options and resources we have available to us. It can be quite frustrating, and often you will find yourself questioning the morality and ethical principles of the systems you clash with. I've legitimately had to attempt guilting insurance companies into covering very basic medications that weren't on formulary because it put patients' lives at risk for them to not be on said medications and still had my claims rejected at times. It is disheartening at times but I do my best

This is really helpful, thanks! Do you think there are any specialities that are less subject to these institutional pressures? And do you think most doctors are generally willing to acknowledge the flaws in this system? Like, one of the main frustrations I have with the law isn't just that the adversarial system is deeply unconcerned with truth/justice; it's that most lawyers (with the exception of some academics with philosophy backgrounds) are genuinely confused about why anyone would be concerned about that in the first place. I think I would be fine working in an inefficient system if the people who work in that system are at least honest about its deeper problems. Also, just wondering: even with the system's problems, do you ultimately feel like you're generally able to positively impact people's lives (at least more than you could if you were working in a different field)?
 
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Mad Jack

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Just want to emphasize that I'm "running away from the law" because I think the entire legal profession is structurally incompatible with what I care about (helping people in an intellectually honest way by understanding how complicated systems work), and my impression is that the medical field is less plagued by these structural problems. Explanations about whether that particular impression is/isn't correct would be great! I'm not super concerned about other reasons not to pursue medicine (age, family, finances, etc.)



This is really helpful, thanks! Do you think there are any specialities that are less subject to these institutional pressures? And do you think most doctors are generally willing to acknowledge the flaws in this system? Like, one of the main frustrations I have with the law isn't just that the adversarial system is deeply unconcerned with truth/justice; it's that most lawyers (with the exception of some academics with philosophy backgrounds) are genuinely confused about why anyone would be concerned about that in the first place. I think I would be fine working in an inefficient system if the people who work in that system are at least honest about its deeper problems. Also, just wondering: even with the system's problems, do you ultimately feel like you're generally able to positively impact people's lives (at least more than you could if you were working in a different field)?
Oh we are all pretty well aware of the problems and discuss them frequently. We're pretty aligned in our frustrations, aside from a gaggle of suits at the top that serve to benefit from the system remaining as it is. Overall I feel that it is more rewarding than most jobs I have worked (medicine is my third career). I still feel like if I had enough money to retire I wouldn't continue in medicine because while the work is fulfilling, the headaches, liability, and day-to-day hassles are personally not rewarding enough to keep going in the long term. Keep in mind I'm just about to wrap up residency, so my opinion may be a little less generous or a little more generous than an attending. It is hard to say.
 
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I'm a hematology/oncology fellow (i.e., adult blood and cancer specialist in training) who worked as a hospitalist for a couple of years between internal medicine residency and fellowship. I really enjoy the work I do, and I do feel that sometimes my colleagues and I are able to make a meaningful difference in people's lives, and, every now and then, even save their lives. To me, this is the most rewarding aspect of medicine. However, I do agree that at the end of the day being a doctor is just a job, and all jobs have their frustrations - and while to some degree your choice of practice setting can attenuate these frustrations (e.g., at the large academic center where I worked as a hospitalist, I was well insulated from any financial pressure to do anything other than what I felt was best for the patient), the frustrations are always there. Another important thing to know is that while we sometimes are able to make a difference, in many cases the impact we have is small to zero - e.g., because we can't fix the underlying social issues like financial or housing insecurity that lead to poor health outcomes, or because even though it is 2021 there are so many cancer types where there is not much we can do to alter the overall trajectory of disease.
 
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Dral

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Maybe consider some other things as well such as health policy, public health careers, etc. You can get to them though medicine via preventive medicine residency s/p med school. However, you could likely get to a similar place with your background with an MPH.

If you are ok with feeling like you make an overall difference, then that may be the way to go. If you prefer to have direct daily satisfaction, then not as much (I have patients who thank me personally, or those who refuse to see anyone but me, or tell me how much I've made a difference for them).

A lot of systems in medicine are broken, but we realize they are broken (unlike what may be the case with law based on what you are saying). By that logic, I believe they are somehow fixable. You may be more satisfied somewhere in medicine (not necessarily as a physician) due to that.
 
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Dral

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Another important thing to know is that while we sometimes are able to make a difference, in many cases the impact we have is small to zero - e.g., because we can't fix the underlying social issues like financial or housing insecurity that lead to poor health outcomes, .
This is an important point. Our brains tend to idealize things. Before medical school, one may think they will be able take that homeless person, figure out what is wrong with them, make them better so they get a job and do well...then they come back 10 years later and shower us with thanks and praise.

While that could happen, it just doesn't in general. We have so much to do in a day, that we do not have the time for that. On my clinic days I see a patient every 15 minutes. I remember doing so much social work during my intern year...but most of it is just getting someone to their next immediate place after d/c opposed to actually fixing what is wrong that forced them to have to go to that next place I found for them in the first place.

For many in healthcare, I believe they get to the point...maybe in med school, maybe in residency, maybe as an attending/practicing physician where the idealism becomes reality and they realize they may not change every patient's life. That can be a disappointing realization.

Just remember, OP you don't need an MD/DO to make a difference in healthcare. MD/DOs do make a difference, but often not in an idealized way many may think of. You'll just need to figure out where you may fit into it. Just really think about what it might entail to be a physician before jumping in. I know that is difficult, but for the amount of resources one puts into getting to the place of a practicing physician, it can be a hard pill to swallow when you realize your daily life isn't all helping and fixing, without bureaucratic roadblocks, willing and able patients who have no issues paying for your services or the procedures/meds you prescribe to them.
 
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samc

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I think you're setting yourself up for a second round of disenchantment. Structurally, physicians often are servants of their health care system and insurance companies as much as they are caretakers of their patients, because these systems determine the options and resources we have available to us. It can be quite frustrating, and often you will find yourself questioning the morality and ethical principles of the systems you clash with. I've legitimately had to attempt guilting insurance companies into covering very basic medications that weren't on formulary because it put patients' lives at risk for them to not be on said medications and still had my claims rejected at times. It is disheartening at times but I do my best

Listen to Mad Jack. The structural issues in medicine, at least as it is practiced here in the US with insurance and pharmaceutical companies being what they are, are too numerous to mention. Take a look at the New England Journal of Medicine and JAMA for more detail. They both have a lot of articles that are not about research.

I was 37 when I started M1. I would not have left an intellectually challenging career to pursue medicine. (My previous work was in social services—rewarding but not intellectually challenging.) In hindsight, I DEFINITELY would not have left another such career. Medicine is also full of colleagues who DGAF about the larger issues in the field. Plus, it is not a scientific pursuit. It is a craft informed by science.

I’m not saying don’t do it. I’m saying that you would almost certainly be replacing one set of structural problems with another, at the cost of lots of years of life and lost income.
 
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