My soap box - "So you want to go to medical school.."

[mmchick]

Hi all - I used to lurk this forum a lot back in the day prior to med school. And now I'm set to graduate this upcoming summer. I thought I knew what it meant to pursue medicine, but I think through the years this reality has really hit me in the face in ways it had not until I was facing residency. That's what this post is about. Talking to all the pre-meds here about if medicine (as a physician) really is the right route for you or not.

You work your ass off to get an application for medical school. Excel in college, do a bunch of ECs, research, make connections, shadowing.. perhaps even above and beyond with a Master's, postbac, DIY grade repair, you name it. At this point you've shelled out some tens of thousands of dollars about anywhere from 4-7+ years of your life. Then you take the MCAT, spend money on apps.. hope that a school takes you. Then your life changes drastically. You go from working or studying 25-30 hours/week to studying 60+ hours of week. What does that look like? You're in class M-F usually 8-5pm. Focusing all of those 9 hours. Then there's SIMs, clinicals, tests.. God the endless amounts of tests. I lost count of how many tests I had to study and sit for by the end of M1 alone.

Then you start your clinical years. I'm talking anywhere from M-F 8-5pm to M-Sat 4:30am-6pm. You show up to work (where you pay to be at) and your entire purpose is to make people like you and write nice things about you. The entire existence of a M3-M4 is you're bottom of the totem pole, constantly an extra annoyance/task for everyone on the floor, awkwardly an outsider in every environment where you have to meet and fit into a new team dynamic every few weeks. At some point, you're basically an intern.. again working while paying the hospital you're writing notes and seeing patients for. At this point, you're anywhere from $250-400K in debt. You pay for your own board exams ($1K/piece), residency applications ($1-3K total), likely moving expenses once you land a job.

Okay now you're a resident. You made it through medical school, man you thought that was hard huh? Now it steps UP a notch. You thought there was light at the end of the tunnel? There's not. Kiss away most of your free time if you haven't already. You're working 6 days a week, likely anywhere from 60-90 hours/week. If you don't know what that feels like, again imagine Mon-Sat or 7 days a week of 5AM-6PM. Interspersed 28 hours of call time. You stay up all 24 hours then have to round the next morning and chart until you can zombie drive your way home. That goes on for another 3-7 years.

At this point you're 6-10 years invested. A whole decade has gone by. You've been working your ass off full gears since you sat for that MCAT. It is hard to understand the reality of this decision until you are way too deep into it. This is one of the most toughest, challenging, demanding jobs you can sign yourself up for. You WILL give up free time, happiness, work-life balance, relationships at some point. It is not a matter of if, but when and for how long. It is up to you to figure out how to balance it and if you love it enough for it to be worth it.

I love what I do. I'm thrilled I'm in medicine and I'm one of the lucky ones. As I near the end of my schooling, I see the suffering of a lot of my classmates who did not realize what they got themselves into (I argue most of us don't actually understand) and now do not have that intrinsic drive to justify it. But it is too late because we're all saddled with debt that could not possibly be overcome unless you have a job like medicine (or law, finance, tech).

All of you bright eyed smart kids out of college think you want to be physicians. It sounds sexy, cool, powerful to be the head of a medical team making decisions about people's health, often abridging the line of life and death. But frankly, no one could possibly understand the personal sacrifice of this privilege until you are way too deep to financially recover should you change your mind. So the next time someone gawks at the "minimal clinical hours" required to apply to medical school.. or the service hours showing commitment to helping others.. I say lean into that, think about what the purpose of that is. Trying to force applicants to somewhat replicate a small fraction of the lifestyle that is required to do medicine for real.

I think it is important to really reflect on if you want to give up portions of your life in order to help others.. with their medical needs that is. We are essentially customer service. Patients can be demanding, entitled, quick to sue.. it is a litigation bloodbath in some fields where decisions are made out of fear more than medical necessity. But it is also incredibly rewarding and inspiring to see how the knowledge you acquire can change, save, or help a life in such a dramatically impactful way. It is important to realize there are many ways to help people however, going through thousands of clinical vignettes, listening to hundreds of abdominal complaints, and agonizing over whether to correct a sodium of 132 however is not for everyone.

What I'm trying to mostly say is.. if you're not sure you have the intrinsic drive to do this and give up parts of your life/self for this career.. for all that is good in the world DO SOMETHING ELSE. There are so many other sexy, powerful, rewarding jobs that don't grind you to the ground and then serve you up a bill for $250-300K.

I will get off my soap box now. If you love it, you will love it. This is not meant to scare the ones in it for the right reasons. But if I can steer away one person who isn't and save them years and $$$ of misery, that would be an essay and evening well-spent. GL this application season.

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[YCAGA]

There are so many other sexy, powerful, rewarding jobs that don't grind you to the ground and then serve you up a bill for $250-300K

Like what?

 

[pablo213]

Like what?

Can easily work 10 hours a week in FAANG and clear 500k bro. Just gotta wait for the engineer II promotion, trust.

 

[musicalfeet]

Hey man, I rarely ever go on the pre-med forums anymore as I'm actually about to finish residency and become an attending myself. As a way to give back to my institution, I voluntarily joined the screening portion of the adcom just to see what things were like sitting on the other side. And while you're not completely wrong that this entire process from beginning to end will demand lots of sacrifices that, perhaps to layman, seem excessive. BUT, I argue it's really NOT as bad as everyone makes it out to be, as long as you like what you do in (some) level. And you're right, it is virtually impossible for premeds to truly know if this path is right for them. But there are personality traits that can hint at whether or not someone is going to persevere and enjoy the field.

But medicine is a broad field and there is something for everyone. I'm pretty sure if you dig up some of my old sdn posts when I was a premed, I was all about that patient-facing and primary care experience. That is not what I ended up doing (if in fact, the opposite). Life changed, and I realized things about myself but that's okay--there is still space in medicine for someone like me.

And yes, you go into lots of debt to go into medicine... but tons of people end up in student debt with not a very realistic way to pay it back. At least in medicine, you can virtually guarantee you can pay your loans back.

 

[YCAGA]

Hey man, I rarely ever go on the pre-med forums anymore as I'm actually about to finish residency and become an attending myself. As a way to give back to my institution, I voluntarily joined the screening portion of the adcom just to see what things were like sitting on the other side. And while you're not completely wrong that this entire process from beginning to end will demand lots of sacrifices that, perhaps to layman, seem excessive. BUT, I argue it's really NOT as bad as everyone makes it out to be, as long as you like what you do in (some) level. And you're right, it is virtually impossible for premeds to truly know if this path is right for them. But there are personality traits that can hint at whether or not someone is going to persevere and enjoy the field.

But medicine is a broad field and there is something for everyone. I'm pretty sure if you dig up some of my old sdn posts when I was a premed, I was all about that patient-facing and primary care experience. That is not what I ended up doing (if in fact, the opposite). Life changed, and I realized things about myself but that's okay--there is still space in medicine for someone like me.

And yes, you go into lots of debt to go into medicine... but tons of people end up in student debt with not a very realistic way to pay it back. At least in medicine, you can virtually guarantee you can pay your loans back.

I think a lot of medical students and residents really have no perspective on how hard people in other fields work, and also how a lot of the misery in medical training seems to be self-inflicted. Not saying I don't have bad days, but when I take a step back at the privilege and enjoyment I get from medicine, it normally seems worth it.

 

[musicalfeet]

I think a lot of medical students and residents really have no perspective on how hard people in other fields work, and also how a lot of the misery in medical training seems to be self-inflicted. Not saying I don't have bad days, but when I take a step back at the privilege and enjoyment I get from medicine, it normally seems worth it.

Also a lot of premeds/medical folk seem to think just because they got into med school and made it to becoming a doctor means that they have the ability to excel in anything else. Which.. is just not true.

It truly is one of the only fields with a very high floor for $$, good job security and you don't have to worry about not being able to pay your loans back.

Did everyone already forget the huge FAANG purge where they fired a bunch of people recently? That doesn't smell like job security to me.

 

[mmchick]

I think a lot of medical students and residents really have no perspective on how hard people in other fields work, and also how a lot of the misery in medical training seems to be self-inflicted. Not saying I don't have bad days, but when I take a step back at the privilege and enjoyment I get from medicine, it normally seems worth it.

People work hard in other fields. The difference is how locked in you are in medicine while not some of the others. Finance, tech, engineering.. does not result in 100Ks++ debt virtually locking you into the career path you've chosen. You can leave unscathed if you're fed up investment banking.

 

[mmchick]

But medicine is a broad field and there is something for everyone. I'm pretty sure if you dig up some of my old sdn posts when I was a premed, I was all about that patient-facing and primary care experience. That is not what I ended up doing (if in fact, the opposite). Life changed, and I realized things about myself but that's okay--there is still space in medicine for someone like me.

This is also true.. however another unique hurdle of medicine is the pressure to get it right with very little information. You spend 4-6 weeks on a service and are expected to commit to it for the rest of your life. Some fields, like pathology that would fit the bill you describe, you don't even get that experience until you stick a leg out and take up precious time before ERAS to figure it out. I've got friends that are getting ready to submit their application and still aren't sure about the field they're signing their whole career up for. And sure, you can change if you're unhappy.. but talk about another 2-3 years thrown out and $200K+ lost income.

 

[musicalfeet]

This is also true.. however another unique hurdle of medicine is the pressure to get it right with very little information. You spend 4-6 weeks on a service and are expected to commit to it for the rest of your life. Some fields, like pathology that would fit the bill you describe, you don't even get that experience until you stick a leg out and take up precious time before ERAS to figure it out. I've got friends that are getting ready to submit their application and still aren't sure about the field they're signing their whole career up for. And sure, you can change if you're unhappy.. but talk about another 2-3 years thrown out and $200K+ lost income.

IMO it's on the medical student themselves to start try and explore and do the self-reflection as to what they want to be in. There's enough information circling around AND current residents/attendings in each specialty that share the pros/cons/daily life/lifestyle of their specialty that you can find.

Example, I shadowed PMR as an M1 because I literally couldn't figure out what they did. Also I was one of those "couldn't decide until last minute and changed my specialty application last minute" people as an M3/M4. It's not just about how much you enjoyed a clinical rotation. And a big part of it is also "grass is greener" syndrome when you're in the pits of hell that is residency. I've joked (but sometimes I was kind of serious) that I should have gone into radiology multiple times-- but let's be real, I sucked at anatomy too much to be any real good at it.

 

[Plut0]

People work hard in other fields. The difference is how locked in you are in medicine while not some of the others. Finance, tech, engineering.. does not result in 100Ks++ debt virtually locking you into the career path you've chosen. You can leave unscathed if you're fed up investment banking.

Spoken like someone who never worked hard in other fields.

 

[Plut0]

Hi all - I used to lurk this forum a lot back in the day prior to med school. And now I'm set to graduate this upcoming summer. I thought I knew what it meant to pursue medicine, but I think through the years this reality has really hit me in the face in ways it had not until I was facing residency. That's what this post is about. Talking to all the pre-meds here about if medicine (as a physician) really is the right route for you or not.

You work your ass off to get an application for medical school. Excel in college, do a bunch of ECs, research, make connections, shadowing.. perhaps even above and beyond with a Master's, postbac, DIY grade repair, you name it. At this point you've shelled out some tens of thousands of dollars about anywhere from 4-7+ years of your life. Then you take the MCAT, spend money on apps.. hope that a school takes you. Then your life changes drastically. You go from working or studying 25-30 hours/week to studying 60+ hours of week. What does that look like? You're in class M-F usually 8-5pm. Focusing all of those 9 hours. Then there's SIMs, clinicals, tests.. God the endless amounts of tests. I lost count of how many tests I had to study and sit for by the end of M1 alone.

Then you start your clinical years. I'm talking anywhere from M-F 8-5pm to M-Sat 4:30am-6pm. You show up to work (where you pay to be at) and your entire purpose is to make people like you and write nice things about you. The entire existence of a M3-M4 is you're bottom of the totem pole, constantly an extra annoyance/task for everyone on the floor, awkwardly an outsider in every environment where you have to meet and fit into a new team dynamic every few weeks. At some point, you're basically an intern.. again working while paying the hospital you're writing notes and seeing patients for. At this point, you're anywhere from $250-400K in debt. You pay for your own board exams ($1K/piece), residency applications ($1-3K total), likely moving expenses once you land a job.

Okay now you're a resident. You made it through medical school, man you thought that was hard huh? Now it steps UP a notch. You thought there was light at the end of the tunnel? There's not. Kiss away most of your free time if you haven't already. You're working 6 days a week, likely anywhere from 60-90 hours/week. If you don't know what that feels like, again imagine Mon-Sat or 7 days a week of 5AM-6PM. Interspersed 28 hours of call time. You stay up all 24 hours then have to round the next morning and chart until you can zombie drive your way home. That goes on for another 3-7 years.

At this point you're 6-10 years invested. A whole decade has gone by. You've been working your ass off full gears since you sat for that MCAT. It is hard to understand the reality of this decision until you are way too deep into it. This is one of the most toughest, challenging, demanding jobs you can sign yourself up for. You WILL give up free time, happiness, work-life balance, relationships at some point. It is not a matter of if, but when and for how long. It is up to you to figure out how to balance it and if you love it enough for it to be worth it.

I love what I do. I'm thrilled I'm in medicine and I'm one of the lucky ones. As I near the end of my schooling, I see the suffering of a lot of my classmates who did not realize what they got themselves into (I argue most of us don't actually understand) and now do not have that intrinsic drive to justify it. But it is too late because we're all saddled with debt that could not possibly be overcome unless you have a job like medicine (or law, finance, tech).

All of you bright eyed smart kids out of college think you want to be physicians. It sounds sexy, cool, powerful to be the head of a medical team making decisions about people's health, often abridging the line of life and death. But frankly, no one could possibly understand the personal sacrifice of this privilege until you are way too deep to financially recover should you change your mind. So the next time someone gawks at the "minimal clinical hours" required to apply to medical school.. or the service hours showing commitment to helping others.. I say lean into that, think about what the purpose of that is. Trying to force applicants to somewhat replicate a small fraction of the lifestyle that is required to do medicine for real.

I think it is important to really reflect on if you want to give up portions of your life in order to help others.. with their medical needs that is. We are essentially customer service. Patients can be demanding, entitled, quick to sue.. it is a litigation bloodbath in some fields where decisions are made out of fear more than medical necessity. But it is also incredibly rewarding and inspiring to see how the knowledge you acquire can change, save, or help a life in such a dramatically impactful way. It is important to realize there are many ways to help people however, going through thousands of clinical vignettes, listening to hundreds of abdominal complaints, and agonizing over whether to correct a sodium of 132 however is not for everyone.

What I'm trying to mostly say is.. if you're not sure you have the intrinsic drive to do this and give up parts of your life/self for this career.. for all that is good in the world DO SOMETHING ELSE. There are so many other sexy, powerful, rewarding jobs that don't grind you to the ground and then serve you up a bill for $250-300K.

I will get off my soap box now. If you love it, you will love it. This is not meant to scare the ones in it for the right reasons. But if I can steer away one person who isn't and save them years and $$$ of misery, that would be an essay and evening well-spent. GL this application season.

Let me fix this for you:

I work in one of the most desirable and lucrative industries on planet Earth. The only comparable fields are other highly desirable elite professions in the US like tech and finance. But unlike tech and finance, working in medicine gives me perks like prestige, job security, the ability to work anywhere in the country and in different practice settings, and to actually derive meaning and value from one's work.

Indeed, I am so privileged that I ignored all the plebeian jobs that regular people hold. College-educated people working in mindless office jobs paying $40,000? PhDs living on post-doc stipends competing with hundreds of other post-docs for that one tenure-track position? Actual blue-collar jobs? I don't even bother comparing myself to them.

Despite being no more qualified or hardworking, I earn twice as much as physicians in other developed countries. And 10 to 100 times as much as physicians in developing countries, who treat far more patients in healthcare systems with far fewer physicians per capita.

Sure, I have to study and take a lot of tests. But I am not worried because US MD schools have a graduation rate of >95% and a match rate >90%. In industry, you can get fired for low performance. Or laid off for no fault of your own.

And realistically, I can't get a better job. I can't code at all, let alone be in the top 1% of programmers who could land a job at FAANG. Those coding interviews are just as hard as the MCAT; being in the 3% that passes is equivalent to getting a 520. And since I don't attend one of the ten or so elite universities, I effectively have no chance of becoming an investment banker.

At least with medical school, I could partially make up for lower objective metrics with things that don't require immense skill, like community service, shadowing, research, or writing essays. Tech and finance won't cut me any slack for low performance, nor do they care about life stories or hardships. An uncompetitive resume will be filtered before even reaching a human reviewer.

Thanks to state and federal policies, I don't have to compete against highly skilled and experienced immigrants. And my job will never be outsourced and is among the least impacted by a recession. Thanks to regulation, it will also be one of the last to be replaced by AI.

So bright-eyed smart kids out of college, understand that you are pursuing effectively the best overall career possible, with a lifetime expected income of over $10 million. And unless you are extraordinarily gifted and have an elite college pedigree, you can't land a better job anyway.

 

[j_diggity]

As a non-trad, former software engineer and >30 year old applicant who gave up >$150k/year to do medicine, I think I have a unique perspective here.

First of all, I believe that every pre-med should read a few posts like these to get a better sense of what they're getting into.

But while a little bit of exposure to the negatives is important to gain a more realistic perspective, these posts can also stir up a lot of anxiety. Unanswerable questions fill my mind: what if OP is right and I end up not enjoying medicine? What if I'm not cut out for it, and I find out too late? What if I struggle to build rapport and succeed in clerkships? What if my health fails me in med school or residency, forcing me to quit with a ton of debt and no ability to repay it? What if I regret sacrificing the remaining prime years of my life? what if what if what if?

After a while, reading posts like this encourages a negative outlook and makes me feel more jaded about the future, and I'm not even in med school yet. It makes it hard to stay optimistic and positive. There's already so much to worry about in the future, now I'm going to spend medical school and residency waiting for another shoe to drop?

To top it off, tech, law, and business all have major pitfalls as well. I couldn't imagine sitting in a chair working on convoluted codebases, writing software that had no tangible impact on the welfare of others (besides shareholders' pocketbooks) all day for the rest of my life. In my mind, nothing beats the rewards of using your medical knowledge to help patients in their time of need. The privilege of being able to face our shared mortality together, walking that walk with patients, sharing in vulnerable moments together, doing your best to advance the state of science for their benefit, there's nothing in this world that compares to it.

My advice to pre-meds: educate yourself about the risks, but live in the now. Expect challenges, but don't give your whole self away to the profession; keep some of "you" intact, to give to yourself and your loved ones. Don't lose your enthusiasm and don't become jaded. Keep the passion alive!

 

[Moko]

Let me fix this for you:

I work in one of the most desirable and lucrative industries on planet Earth. The only comparable fields are other highly desirable elite professions in the US like tech and finance. But unlike tech and finance, working in medicine gives me perks like prestige, job security, the ability to work anywhere in the country and in different practice settings, and to actually derive meaning and value from one's work.

Indeed, I am so privileged that I ignored all the plebeian jobs that regular people hold. College-educated people working in mindless office jobs paying $40,000? PhDs living on post-doc stipends competing with hundreds of other post-docs for that one tenure-track position? Actual blue-collar jobs? I don't even bother comparing myself to them.

Despite being no more qualified or hardworking, I earn twice as much as physicians in other developed countries. And 10 to 100 times as much as physicians in developing countries, who treat far more patients in healthcare systems with far fewer physicians per capita.

Sure, I have to study and take a lot of tests. But I am not worried because US MD schools have a graduation rate of >95% and a match rate >90%. In industry, you can get fired for low performance. Or laid off for no fault of your own.

And realistically, I can't get a better job. I can't code at all, let alone be in the top 1% of programmers who could land a job at FAANG. Those coding interviews are just as hard as the MCAT; being in the 3% that passes is equivalent to getting a 520. And since I don't attend one of the ten or so elite universities, I effectively have no chance of becoming an investment banker.

At least with medical school, I could partially make up for lower objective metrics with things that don't require immense skill, like community service, shadowing, research, or writing essays. Tech and finance won't cut me any slack for low performance, nor do they care about life stories or hardships. An uncompetitive resume will be filtered before even reaching a human reviewer.

Thanks to state and federal policies, I don't have to compete against highly skilled and experienced immigrants. And my job will never be outsourced and is among the least impacted by a recession. Thanks to regulation, it will also be one of the last to be replaced by AI.

So bright-eyed smart kids out of college, understand that you are pursuing effectively the best overall career possible, with a lifetime expected income of over $10 million. And unless you are extraordinarily gifted and have an elite college pedigree, you can't land a better job anyway.

Damn, ChatGPT is getting spicier every day. The AI revolution is really right around the corner.

 

[pablo213]

Damn, ChatGPT is getting spicier every day. The AI revolution is really right around the corner.

Is that really written by ChatGPT? Besides some of the sentence structure being potentially sus, I feel like it's authentic lol.

 

[musicalfeet]

Is that really written by ChatGPT? Besides some of the sentence structure being potentially sus, I feel like it's authentic lol.

I mean… that poster basically said in more clear terms what I was hinting at in prior posts too

 

[Nontrad_FL_LGBT]

As a non-trad, former software engineer and >30 year old applicant who gave up >$150k/year to do medicine, I think I have a unique perspective here.

First of all, I believe that every pre-med should read a few posts like these to get a better sense of what they're getting into.

But while a little bit of exposure to the negatives is important to gain a more realistic perspective, these posts can also stir up a lot of anxiety. Unanswerable questions fill my mind: what if OP is right and I end up not enjoying medicine? What if I'm not cut out for it, and I find out too late? What if I struggle to build rapport and succeed in clerkships? What if my health fails me in med school or residency, forcing me to quit with a ton of debt and no ability to repay it? What if I regret sacrificing the remaining prime years of my life? what if what if what if?

After a while, reading posts like this encourages a negative outlook and makes me feel more jaded about the future, and I'm not even in med school yet. It makes it hard to stay optimistic and positive. There's already so much to worry about in the future with climate change, political dysfunction, national decline and whatnot, now I'm going to spend medical school and residency waiting for another shoe to drop?

To top it off, tech, law, and business all have major pitfalls as well. In my mind, nothing beats the rewards of using your medical knowledge to help patients in their time of need. The privilege of being able to face our shared mortality together, walking that walk with patients, sharing in vulnerable moments together, doing your best to advance the state of science for their benefit, there's nothing in this world that compares to it. I couldn't imagine sitting in a chair working on convoluted codebases, writing software that had no tangible impact on the welfare of others (besides shareholders' pocketbooks) all day for the rest of my life.

My advice to pre-meds: educate yourself about the risks, but live in the now. Expect challenges, but don't give your whole self away to the profession; keep some of "you" intact, to give to yourself and your loved ones. Don't lose your enthusiasm and don't become jaded. Keep the passion alive!

Also signing this as another 30+ yo software engineer giving up buttloads of money to do something worthwhile with my life beyond making bull**** the world could do without.

 

[pablo213]

I mean… that poster basically said in more clear terms what I was hinting at in prior posts too

Great minds think alike

 

[mmchick]

Spoken like someone who never worked hard in other fields.

Yep, I waltzed into medical school with having never worked hard a day prior in my life.

Let me fix this for you:

I don't disagree with any of the points regarding the objective benefits of pursuing medicine. It is great for job security, pay, prestige.. all of that. I do disagree with pursuing this field for all of these external validation points however. When you're in the trenches, awake for your 25th hour rounding on patients and haven't had a chance to exercise, clean your apartment, or pet your dog all week, it's not the "man I'm eventually going to make 10-100x that of docs around the world" or "whew I'm so glad for job security" that's going to get you through that.

The miserable classmates, residents, and attendings I've come to know could care less about job security in their greatest moments of misery. The especially prevalent rate of SI and substance abuse in this population speaks to that point.

 

[Nontrad_FL_LGBT]

Yep, I waltzed into medical school with having never worked hard a day prior in my life.


I don't disagree with any of the points regarding the objective benefits of pursuing medicine. It is great for job security, pay, prestige.. all of that. I do disagree with pursuing this field for all of these external validation points however. When you're in the trenches, awake for your 25th hour rounding on patients and haven't had a chance to exercise, clean your apartment, or pet your dog all week, it's not the "man I'm eventually going to make 10-100x that of docs around the world" or "whew I'm so glad for job security" that's going to get you through that.

The miserable classmates, residents, and attendings I've come to know could care less about job security in their greatest moments of misery. The especially prevalent rate of SI and substance abuse in this population speaks to that point.

Sorry in advance, just realized I typed a bit of a rant.

I mean, I agree with all this too. You have to have internal motivation for anything that takes up most of your waking hours. I think this "medicine is just a job" thing is probably contributing to this feeling tbh. Sorry, but it's not and if you feel that way you're probably going to be miserable and hate it.

Any of the major "professional" jobs like being a doctor, lawyer, soldier, etc, you have an obligation to consider the greater good beyond yourself. In training that means cranking out the hours for the benefit of those reliant on you in the future. As an attending that means training future doctors, volunteering some of your time to free clinics, etc. This is a role that is supposed to benefit society, not just you.

Obviously times change, for example residents no longer literally live at the hospital so we should probably put stricter caps on work hours or at least include commute time in the current calculation. But I think that a lot of the reason people get burnt out is all the absolute nonsense forced into the profession by insurance companies, etc, and the overall failure of public health on the part of the FDA, etc.

75% of today's scutwork didn't exist 20-30 years ago. Residents were there for 100 hours a week, but the hours weren't as draining as they are now. They sat around in the lounge waiting for stuff to happen for hours at a time. People weren't nearly as fat, diabetic, hypertensive, etc before the Reagan admin gutted the FDA and appointed cronies who basically sold America out via high fructose corn syrup and refined sugar in literally everything.

Medicine won't get better until society as a whole does. More doctors need to get involved in politics and advocacy in a meaningful way. Until things change, medical professionals need to stand ready to keep the wheels rolling and unfortunately that means a pretty big sacrifice.

 

[HuskyMD Emeritus]

1. When you have family and obligations, a secure job is important, even if you might not like it. A Chinese (Cantonese) term for one's job, is literally "finding food." We all need to feed our families. Medicine is a job that allows that with good income and job security.
2. There are many occupations with high stress, divorce rates, and substance abuse. There are lots of occupations that put in as many hours as we do. Investment bankers live at their offices. Those that work with international clients have to accommodate for the time zone differences. Engineers not uncommonly sleep at the office when there are project deadlines looming. Law enforcement is not high stress?
3. I have been a doctor longer than most of you have been alive. Scut work from years ago and now may be different but we had a ton of them and didn't have case managers to help with dispo. We never sat around the doctors lounge waiting for stuff to happen. We drew our own labs, did gram stains, plated our own cultures, started IVs, drew ABGs and ran them, did EKGs, calculated GFR to dose antibiotics, drew INR and PTT to dose warfarin and heparin, we went to the lab to get lab results (they were on slips of paper). As a resident, I ran medicine services of 30+ patients. We were on call every 3rd in the ICU and every 4th on the ward (meaning long call, post call, short call, catch up). This list goes on. I am not saying residents today have it easy. Patients in the hospital nowadays are more complicated and sicker. The turnover of patients is also much faster so always new patients on the service. There is so much more to know, and with our phones and computers, there is the expectation for the residents to know all this information. It has always been hard to be a resident no matter which generation you belong to.
4. After all the ranting, I still have no regrets about being a doctor (undergrad was in EE). There is definitely satisfaction knowing you have helped patients and their families through difficult times and the relationships built around them. There is satisfaction in teaching. Even if you find medicine is not as great of a career as you had envisioned, look at it as a means to finance your true passions (I have colleagues who rebuild classic cars, climb Mt. Everest (and also summitted all the highest peaks in the world), play in orchestras, compete in ironman races, travel, do standup comedy, write books.
Sorry for the long post. I like my profession and the career I have been blessed with. Hope you all will also.

 

[paperjam]

Hi all - I used to lurk this forum a lot back in the day prior to med school. And now I'm set to graduate this upcoming summer. I thought I knew what it meant to pursue medicine, but I think through the years this reality has really hit me in the face in ways it had not until I was facing residency. That's what this post is about. Talking to all the pre-meds here about if medicine (as a physician) really is the right route for you or not.

You work your ass off to get an application for medical school. Excel in college, do a bunch of ECs, research, make connections, shadowing.. perhaps even above and beyond with a Master's, postbac, DIY grade repair, you name it. At this point you've shelled out some tens of thousands of dollars about anywhere from 4-7+ years of your life. Then you take the MCAT, spend money on apps.. hope that a school takes you. Then your life changes drastically. You go from working or studying 25-30 hours/week to studying 60+ hours of week. What does that look like? You're in class M-F usually 8-5pm. Focusing all of those 9 hours. Then there's SIMs, clinicals, tests.. God the endless amounts of tests. I lost count of how many tests I had to study and sit for by the end of M1 alone.

Then you start your clinical years. I'm talking anywhere from M-F 8-5pm to M-Sat 4:30am-6pm. You show up to work (where you pay to be at) and your entire purpose is to make people like you and write nice things about you. The entire existence of a M3-M4 is you're bottom of the totem pole, constantly an extra annoyance/task for everyone on the floor, awkwardly an outsider in every environment where you have to meet and fit into a new team dynamic every few weeks. At some point, you're basically an intern.. again working while paying the hospital you're writing notes and seeing patients for. At this point, you're anywhere from $250-400K in debt. You pay for your own board exams ($1K/piece), residency applications ($1-3K total), likely moving expenses once you land a job.

Okay now you're a resident. You made it through medical school, man you thought that was hard huh? Now it steps UP a notch. You thought there was light at the end of the tunnel? There's not. Kiss away most of your free time if you haven't already. You're working 6 days a week, likely anywhere from 60-90 hours/week. If you don't know what that feels like, again imagine Mon-Sat or 7 days a week of 5AM-6PM. Interspersed 28 hours of call time. You stay up all 24 hours then have to round the next morning and chart until you can zombie drive your way home. That goes on for another 3-7 years.

At this point you're 6-10 years invested. A whole decade has gone by. You've been working your ass off full gears since you sat for that MCAT. It is hard to understand the reality of this decision until you are way too deep into it. This is one of the most toughest, challenging, demanding jobs you can sign yourself up for. You WILL give up free time, happiness, work-life balance, relationships at some point. It is not a matter of if, but when and for how long. It is up to you to figure out how to balance it and if you love it enough for it to be worth it.

I love what I do. I'm thrilled I'm in medicine and I'm one of the lucky ones. As I near the end of my schooling, I see the suffering of a lot of my classmates who did not realize what they got themselves into (I argue most of us don't actually understand) and now do not have that intrinsic drive to justify it. But it is too late because we're all saddled with debt that could not possibly be overcome unless you have a job like medicine (or law, finance, tech).

All of you bright eyed smart kids out of college think you want to be physicians. It sounds sexy, cool, powerful to be the head of a medical team making decisions about people's health, often abridging the line of life and death. But frankly, no one could possibly understand the personal sacrifice of this privilege until you are way too deep to financially recover should you change your mind. So the next time someone gawks at the "minimal clinical hours" required to apply to medical school.. or the service hours showing commitment to helping others.. I say lean into that, think about what the purpose of that is. Trying to force applicants to somewhat replicate a small fraction of the lifestyle that is required to do medicine for real.

I think it is important to really reflect on if you want to give up portions of your life in order to help others.. with their medical needs that is. We are essentially customer service. Patients can be demanding, entitled, quick to sue.. it is a litigation bloodbath in some fields where decisions are made out of fear more than medical necessity. But it is also incredibly rewarding and inspiring to see how the knowledge you acquire can change, save, or help a life in such a dramatically impactful way. It is important to realize there are many ways to help people however, going through thousands of clinical vignettes, listening to hundreds of abdominal complaints, and agonizing over whether to correct a sodium of 132 however is not for everyone.

What I'm trying to mostly say is.. if you're not sure you have the intrinsic drive to do this and give up parts of your life/self for this career.. for all that is good in the world DO SOMETHING ELSE. There are so many other sexy, powerful, rewarding jobs that don't grind you to the ground and then serve you up a bill for $250-300K.

I will get off my soap box now. If you love it, you will love it. This is not meant to scare the ones in it for the right reasons. But if I can steer away one person who isn't and save them years and $$$ of misery, that would be an essay and evening well-spent. GL this application season.

you worked or studied 25-30 hours a week as a pre-med?? Everyone I know, myself included, saw a huge reduction in hours after matriculating into med school. Pre-med averages were around 80-100 hours between work, study, and volunteering. Most med students are now doing 40-50 hours a week total.

 

[Angus Avagadro]

Sorry in advance, just realized I typed a bit of a rant.

I mean, I agree with all this too. You have to have internal motivation for anything that takes up most of your waking hours. I think this "medicine is just a job" thing is probably contributing to this feeling tbh. Sorry, but it's not and if you feel that way you're probably going to be miserable and hate it.

Any of the major "professional" jobs like being a doctor, lawyer, soldier, etc, you have an obligation to consider the greater good beyond yourself. In training that means cranking out the hours for the benefit of those reliant on you in the future. As an attending that means training future doctors, volunteering some of your time to free clinics, etc. This is a role that is supposed to benefit society, not just you.

Obviously times change, for example residents no longer literally live at the hospital so we should probably put stricter caps on work hours or at least include commute time in the current calculation. But I think that a lot of the reason people get burnt out is all the absolute nonsense forced into the profession by insurance companies, etc, and the overall failure of public health on the part of the FDA, etc.

75% of today's scutwork didn't exist 20-30 years ago. Residents were there for 100 hours a week, but the hours weren't as draining as they are now. They sat around in the lounge waiting for stuff to happen for hours at a time. People weren't nearly as fat, diabetic, hypertensive, etc before the Reagan admin gutted the FDA and appointed cronies who basically sold America out via high fructose corn syrup and refined sugar in literally everything.

Medicine won't get better until society as a whole does. More doctors need to get involved in politics and advocacy in a meaningful way. Until things change, medical professionals need to stand ready to keep the wheels rolling and unfortunately that means a pretty big sacrifice.

I'm going to throw a flag on the scut work and less draining comment. 20 - 30 yrs ago, everything was hand written. Consults, progress notes, admit notes ,H&P's, admission orders, verbal orders,etc.. All had to be physically signed. If you dictated a note, you would have to physically go to the medical records dept and sign them. Get behind? The Med Director wouldn't pay you until you did. We put in miles a day in large city hospitals as.they were often a collection of old buildings. No laparoscopy, wounds were bigger and length of stays longer. No outpatient surgery back then. D&C's and tubal ligations were admitted to the hospital, so more scut work. There was PLENTY of scut work then. I'm not saying it is better now, but just different scut work. Think it's bad now? Wait until you are an attending.

 

[chssoccer7]

I would have loved to only work resident's hours when I was out at sea, or to be paid as much as a resident was when I was working resident hours in port, or for the ability just to bring my phone with me to work so I could talk to my family even sparingly on my 32 hour shifts. Many professions have things about them that suck, medicine certainly isn't alone in this regard. It's all about perspective.

 

[PikminOC]

I would have loved to only work resident's hours when I was out at sea, or to be paid as much as a resident was when I was working resident hours in port, or for the ability just to bring my phone with me to work so I could talk to my family even sparingly on my 32 hour shifts. Many professions have things about them that suck, medicine certainly isn't alone in this regard. It's all about perspective.

How about the level of responsibility

 

[chssoccer7]

How about the level of responsibility

What about it? I'd need to see whatever point you're trying to get at here before responding. I responded to the points of the original poster, none of which included responsibility. My job also included a fairly high level of responsibility. I fear you may be missing the point though, which was not "this job is worse/harder/more stressful than this one!" which is often what I read here. My point is that medicine is not the only profession in the world with long hours, high stress, and high responsibility, and one's perspective on it certainly gives a different level of appreciation.

 

[musicalfeet]

you worked or studied 25-30 hours a week as a pre-med?? Everyone I know, myself included, saw a huge reduction in hours after matriculating into med school. Pre-med averages were around 80-100 hours between work, study, and volunteering. Most med students are now doing 40-50 hours a week total.

Meh I did about 55-60 in med school—this is as someone who wasn’t particularly smart or talented but at the time wanted to try for derm.

So I imagine you could do less if you weren’t trying to be AOA or score really high on boards.

 

[mmchick]

you worked or studied 25-30 hours a week as a pre-med?? Everyone I know, myself included, saw a huge reduction in hours after matriculating into med school. Pre-med averages were around 80-100 hours between work, study, and volunteering. Most med students are now doing 40-50 hours a week total.

College was a breeze compared to med school. I feel like I hardly studied in undergrad. Can't pull that so much in med school. Not to mention the required activities outside of didactics that take up your time.. anatomy lab, clinical sims..

 

[Splenda88]

Medicine is GREAT.

I am not aware of that many jobs out there that would pay me a ton of $$$ when I know what I have to do 99.99% of the time.

 

[RangerBob]

The entire public is envious of us. We're one of the most respected (if not the most respected) fields. We're intelligent. There is purpose in what we do. We get paid phenomenally (and can still get paid phenomenally working part-time). People dream about marrying one of us (because we are/are seen as being more respectable, altruistic, and wealthier than most fields).

I'm pretty sure we're better looking too. Or maybe I've watched too much Gray's Anatomy. (OK, I've only seen two episodes. Scrubs was my choice of medical shows, but even there, they were still an attractive group)

With regards to other areas being greener financially, if you have access this NYT link is pretty telling. Just look at the percent of physicians in the top 1% compared with other professions. There may be almost as many lawyers in there from an absolute perspective, but a significantly smaller proportion of lawyers make actually it into the top 1%. CEO's actually do pretty lousy overall too.

The Top 1 Percent: What Jobs Do They Have?

Explore the occupations and industries of the nation's wealthiest households.

archive.nytimes.com

I found pre-med to be the hardest/busiest time. I never dedicated so many hours of my life as I did when I was a post bac and working/volunteering all at the same time. Also, having worked a few full-time jobs (mostly desk-based), life is so much better now. Though I do look fondly on my days as a janitor--there was just something rewarding about seeing instantaneous results from manual labor. That, and my mistakes never caused anyone harm.

 

[LunaOri]

Sorry in advance, just realized I typed a bit of a rant.

I mean, I agree with all this too. You have to have internal motivation for anything that takes up most of your waking hours. I think this "medicine is just a job" thing is probably contributing to this feeling tbh. Sorry, but it's not and if you feel that way you're probably going to be miserable and hate it.

Any of the major "professional" jobs like being a doctor, lawyer, soldier, etc, you have an obligation to consider the greater good beyond yourself. In training that means cranking out the hours for the benefit of those reliant on you in the future. As an attending that means training future doctors, volunteering some of your time to free clinics, etc. This is a role that is supposed to benefit society, not just you.

Obviously times change, for example residents no longer literally live at the hospital so we should probably put stricter caps on work hours or at least include commute time in the current calculation. But I think that a lot of the reason people get burnt out is all the absolute nonsense forced into the profession by insurance companies, etc, and the overall failure of public health on the part of the FDA, etc.

75% of today's scutwork didn't exist 20-30 years ago. Residents were there for 100 hours a week, but the hours weren't as draining as they are now. They sat around in the lounge waiting for stuff to happen for hours at a time. People weren't nearly as fat, diabetic, hypertensive, etc before the Reagan admin gutted the FDA and appointed cronies who basically sold America out via high fructose corn syrup and refined sugar in literally everything.

Medicine won't get better until society as a whole does. More doctors need to get involved in politics and advocacy in a meaningful way. Until things change, medical professionals need to stand ready to keep the wheels rolling and unfortunately that means a pretty big sacrifice.

As one who trained in the days before work hour restrictions, I can assure you that (at least in general surgery) we were NOT sitting around for hours waiting to be needed. We took care of services that ran 40-60 patients, and were plenty busy putting in tubes and lines, drawing blood, checking labs, looking at imaging studies, talking with families, and making sure all those patients were doing okay, in addition to going to the OR, doing pre-op H&P’s, rounding on postop patients, writing orders, and taking new admissions (no limit on how many). If you think it “wasn’t as draining”, you have NO IDEA what it was like.

 

[deleted1095841]

Medicine is awesome. But physicians and residents have the highest rates of depression and burnout of almost any profession. Why?
I think it's not the actual practice of medicine that bothers them, but the healthcare system they have to practice within: documentation, insurance, administrator, the pressure to see more and more patients in the same amount of time, etc.

 

[Nontrad_FL_LGBT]

As one who trained in the days before work hour restrictions, I can assure you that (at least in general surgery) we were NOT sitting around for hours waiting to be needed. We took care of services that ran 40-60 patients, and were plenty busy putting in tubes and lines, drawing blood, checking labs, looking at imaging studies, talking with families, and making sure all those patients were doing okay, in addition to going to the OR, doing pre-op H&P’s, rounding on postop patients, writing orders, and taking new admissions (no limit on how many). If you think it “wasn’t as draining”, you have NO IDEA what it was like.

I can admit to being wrong. This is just what I've heard around the block, obviously I wasn't a doctor 30 years ago so I don't have firsthand experience. Surely you can agree that people are fatter and less healthy than they were back then, though?

 

[PikminOC]

Medicine is awesome. But physicians and residents have the highest rates of depression and burnout of almost any profession. Why?
I think it's not the actual practice of medicine that bothers them, but the healthcare system they have to practice within: documentation, insurance, administrator, the pressure to see more and more patients in the same amount of time, etc.

And the stress from the liability

 

[LunaOri]

I can admit to being wrong. This is just what I've heard around the block, obviously I wasn't a doctor 30 years ago so I don't have firsthand experience. Surely you can agree that people are fatter and less healthy than they were back then, though?

Fatter, yes, but rates of smoking are down and cancer screenings are up, AIDS is much less prevalent.

 

[DO2015CA]

Yep, I waltzed into medical school with having never worked hard a day prior in my life.


I don't disagree with any of the points regarding the objective benefits of pursuing medicine. It is great for job security, pay, prestige.. all of that. I do disagree with pursuing this field for all of these external validation points however. When you're in the trenches, awake for your 25th hour rounding on patients and haven't had a chance to exercise, clean your apartment, or pet your dog all week, it's not the "man I'm eventually going to make 10-100x that of docs around the world" or "whew I'm so glad for job security" that's going to get you through that.

The miserable classmates, residents, and attendings I've come to know could care less about job security in their greatest moments of misery. The especially prevalent rate of SI and substance abuse in this population speaks to that point.

Referring to your statement on 24h+ shifts and rounding… they suck and all of the Apt uncleaned, etc is true but I have actually thought I’m glad for job security during those times lol. But hey I was leaving high school and starting college during the housing market collapse in a manufacturing town where everyone’s parents were losing their jobs. The job security is the biggest draw to medicine for me (especially now that the naive “I just wanna cure the world” sentiment has faded). It wasn’t the large student debt that made me not quit after a particularly brutal 24 but rather knowing that residency is short term and then I would have ultimate job security.

 

[RangerBob]

Referring to your statement on 24h+ shifts and rounding… they suck and all of the Apt uncleaned, etc is true but I have actually thought I’m glad for job security during those times lol. But hey I was leaving high school and starting college during the housing market collapse in a manufacturing town where everyone’s parents were losing their jobs. The job security is the biggest draw to medicine for me (especially now that the naive “I just wanna cure the world” sentiment has faded). It wasn’t the large student debt that made me not quit after a particularly brutal 24 but rather knowing that residency is short term and then I would have ultimate job security.

This is vastly underappreciated by the majority of folks.

Very occasionally we hear about physicians losing their job. Most often it's because they're incompetent/unable to get along with others or because the hospital/clinic got closed/bought out.

I've never heard of any physician in that group, aside from the ones with the most egregious offenses, not being able to find a job again (as a physician) in a relatively short amount of time.

Most Americans do not have that luxury. People that lost their jobs in manufacturing when those jobs were outsourced had to learn a new trade. The finance folks who lost their jobs in the crisis took on low-paying manual labor jobs, management at fast food places, etc.

 

[PikminOC]

This is vastly underappreciated by the majority of folks.

Very occasionally we hear about physicians losing their job. Most often it's because they're incompetent/unable to get along with others or because the hospital/clinic got closed/bought out.

I've never heard of any physician in that group, aside from the ones with the most egregious offenses, not being able to find a job again (as a physician) in a relatively short amount of time.

Most Americans do not have that luxury. People that lost their jobs in manufacturing when those jobs were outsourced had to learn a new trade. The finance folks who lost their jobs in the crisis took on low-paying manual labor jobs, management at fast food places, etc.

There are very few physicians due to the rigors of training one so supply versus demand will win. Lots of finance/ mba out there.