Notes from informational interviews with doctors

[Meridian32]

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Hi everyone,

I've been thinking about going into medicine for the last couple of years (I currently work in technology), more seriously over the last few months. I know very little about what being a practicing doctor is like, since I'm not from a medical family and all my friends who went into medicine are still in med school or residency, and none have finished training yet. My goal is to learn more about this over the next few months, both by volunteering (I'll be starting at a local hospital soon) and doing informational interviews with practicing physicans and former physicians.

I've done five informational interviews to date and thought I would share my notes here in case folks find it useful. I've grouped this into four sections - upsides of medicine, downsides, general guidance/thoughts, and suggestions from the people I talked to on what to do before taking the plunge and applying to med school.

Note that I was more interested in learning about the "bad and ugly" of medicine than the "good" because I think I already have a decent sense of why I might want to become a doctor, but know very little about the downsides of being a doctor these days. As a result, the downsides section below is significantly longer than the upsides. This doesn't indicate that most of the folks I talked to are cynical/jaded 🙂, but rather that I asked them to focus more on the downsides, to help me get a more balanced perspective on what being a doctor is like.

Also note that these notes are rough and unfiltered. They are also not "synthesized" notes but rather each bullet point reflects the views of one person, so many of the bullet points below are quite subjective. Let me know if there's anything I can clarify.

I would love to hear any thoughts folks have on the below. Also, please feel free to contribute notes from informational interviews you've done so far to this thread, as I would find that quite useful and I'm sure others here would too.

Thanks!

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Upsides

• Gratification from helping people in a very direct way
• People contact – and as a pediatrician, you get to be a child’s doctor throughout their childhood, and see them grow and change
• As pediatrician, it's fun to teach parents, you get lots of questions
• Hard cases can be stimulating

Downsides

• Insurance – lots of paperwork, insurers impose restrictions on how you can provide patient care, rates are going down all the time
• B. knows many doctors who get bored of the same procedures and routines after 10-20 years – many doctors are discontent and can’t take it anymore because of the routine and work/life balance. Surprising number of people say they would love his job (in medical technology)
  • This is divided into those who hate medicine and those who want a break to try something new
• Not everyone who goes to med school finds a specialty that meets all their needs and this can be frustrating – do due diligence into specialties and make sure there is one you enjoy and want to pursue with a right mix of $ compensation, work/life balance, interesting work, intellectual challenge
• Intellectual challenge is not so much day to day, but every now and then you get a challenging case, and you definitely need to keep up with your field through conferences and journals
• Work/life balance usually never ideal – “married to medicine”
• At a large HMO, you have quotas, processes - it’s like being a salesperson in a corporation
• Gratification is delayed and training is horrendous – “the carrot is constantly out there”
• People in medicine tend to be slower, more change resistant, more conservative than in technology
• Being on call is really hard
• Compensation is not what is used to be – money is a poor reason to go into medicine these days unless you specialize
• Litigation/malpractice insurance is frustrating, though not so much an issue in pediatrics
• Being a primary care pediatrician was too ordinary and not interesting enough – R. left after a year to go into academic medicine
• In academic medicine, you are always part of bigger local institution with hospital and university politics

General guidance/thoughts

• Tradeoff is breadth (internal medicine) vs. depth (specialty)
• Med school is about how many hoops you are willing to jump through
• Being a GP is good because you get to see everything
• Emergency medicine is exciting, but at the expense of work/life balance
• Lots of autonomy in private practice, but downside is you need to be responsible for a lot of things your employer would otherwise take care of, like 401k
• 7a-7p day, including 1-2 hours dictating each day
• Can never escape call – occasional evening/weekend call
• Different $ compensation plans in private practice - can be comp based on workload (“eat what you kill”) or flat comp for everyone
• Academic medicine is more bureaucratic, but better hours
• Some parts of general internal medicine are irritating and more tedious, but not GI
• Procedure/patient consultation mix is 50/50
• Can volunteer to be attending physician at teaching hospital if you are in private practice

Suggestions

• Do the math – what would be the financial consequences of becoming a doctor? How much money are you giving up, how much debt would you incur
• Get shadow opportunities through hospital volunteering and asking your primary care physician
• Shadow across different specialties
• Consider volunteering in research labs

 

[nu2004]

cool, this is a great resource for SDN. there are quite a few 17-20 year-olds out there that could benefit from reading this, too.

there's one thing with which i'm not sure i agree:

Emergency medicine is exciting, but at the expense of work/life balance

the attendings at the ER where i worked did three 12-hour shifts a week. that, combined with a mere 3-year residency, seems like just about the best work/life balance imaginable!

 

[Isoprop]

the attendings at the ER where i worked did three 12-hour shifts a week. that, combined with a mere 3-year residency, seems like just about the best work/life balance imaginable!

browse through the EM forums and you'll see a lot of people say that EM has one of the highest burnout rates of any specialty.

 

[neurologist]

there's one thing with which i'm not sure i agree:

the attendings at the ER where i worked did three 12-hour shifts a week. that, combined with a mere 3-year residency, seems like just about the best work/life balance imaginable!

Right, but keep in mind that those shifts might be the sucky night shifts, or your shifts might keep rotating around for a long time until you build up seniority and can pick your shifts. . .

 

[nu2004]

i can certainly see reasons why people would burn out of EM, but i certainly can't see that it would be the hours or the "work/life" balance. even if you have three crummy 12-hour shifts a week, it's still only three crummy 12-hour shifts a week. i would think that it's more likely that EM docs burn out at a higher rate because they see the same (boring) complaints over and over again, or the same patients abusing the system over and over again, and that life in the ER is not quite as exciting as it seemed from the outside... but i don't know.

this is just anecdotal evidence, but i'd be interested to see some data on the subject of which specialties have the highest burnout rates in general. i really enjoyed working in an ER for a year and a half, and i haven't eliminated it as a possible specialty.

 

[Law2Doc]

...
[*]Compensation is not what is used to be – money is a poor reason to go into medicine these days unless you specialize
...
[*]In academic medicine, you are always part of bigger local institution with hospital and university politics
[/LIST]General guidance/thoughts

• 
  ...
• 7a-7p day, including 1-2 hours dictating each day
• Can never escape call – occasional evening/weekend call

I like this post very much, but there are a few things that need to be clarified.
(1) compensation isn't what it used to be in the (lifestyle) specialties either; it's just better than primary care. To a large extent how you do in med school and on the boards will dictate what specialties you have a shot at. So don't go to med school assuming you will get to these; the majority of med school grads won't be in the top X percent of their class.
(2) there is a ton of politics in medicine and not just in academic medicine. Expect significant office politics even in a relatively small practice group.
(3) 7-7 is not unusual but certainly there are worse schedules out there, particularly if you want to go into something like surgery. 7 is a late start for some things -- medicine is an early bird profession.
(4) Call can be worse than occasional evening/weekend. During your training it might well be every 3rd or 4th night.

 

[Blade28]

(1) compensation isn't what it used to be in the (lifestyle) specialties either; it's just better than primary care. To a large extent how you do in med school and on the boards will dictate what specialties you have a shot at. So don't go to med school assuming you will get to these; the majority of med school grads won't be in the top X percent of their class.
...
(4) Call can be worse than occasional evening/weekend. During your training it might well be every 3rd or 4th night.

Good post. I just wanted to reiterate the points above.

(1) This is a good thing to keep in mind - know that med school can be very competitive, and getting into those tough residencies can be VERY difficult.

(2) Q3 or Q4 call is to be expected for many residency fields, unfortunately.

 

[ITtoMD]

Wow, funny how different I look at some of these things. 3-12's would be my dream shift. Heck I would be excited with 4-10's. (this is in my current job at least, I might actually enjoy going to work as a doctor).

Also, again perhaps it is coming from IT, but the oncall thing doesn't even phase me in the slightest.


But thanks for the post, it is always good to keep the reality checks in mind as I gear up towards leaving an established and growing career. Thankfully it still doesn't change my mind.

One last thing, how competitive of a residency is Neurology? I've yet to see it mentioned as one of the hard ones to get into, and it certainly is what I intend to do (who knows if something else will grab my attention along the way, but neuroscience fields in general fascinate me, and have for the past 6 years).

 

[Law2Doc]

One last thing, how competitive of a residency is Neurology? I've yet to see it mentioned as one of the hard ones to get into, and it certainly is what I intend to do .

It's sort of lower middle ground. Definitely not one of the more competitive fields. Keep an open mind going into med school. Most med students will change their mind at least once about specialties during med school. Neurology is certainly one of those fields that (in my experience) a lot of people going into med school say they are interested in, but after neuroscience and the neuro rotation lots of people seem to lose that interest, and a very small minority of your school will actually apply for it.

 

[Blade28]

Also, again perhaps it is coming from IT, but the oncall thing doesn't even phase me in the slightest.

Not sure what the call is like in IT, but the reason call can be tough (besides being able to work under stress and pressure) is because you're so sleep-deprived.

 

[Law2Doc]

Not sure what the call is like in IT...

Yeah, I think some people picture "call" as something different than others. It's not like you are home unless you get called in. On call nights, you are in the hospital, with lists of all the teams patients, and you will be called and paged potentially the entire night long while various folks try to die on you. If you are lucky you get a few unbroken hours during which you can sleep, but conceivably you'll get none.

 

[Blade28]

Yeah, I think some people picture "call" as something different than others. It's not like you are home unless you get called in. On call nights, you are in the hospital, with lists of all the teams patients, and you will be called and paged potentially the entire night long while various folks try to die on you. If you are lucky you get a few unbroken hours during which you can sleep, but conceivably you'll get none.

👍

"Home call" is maybe what other people picture, which does happen - usually by the PGY-2 year. But getting called in multiple times any given night is so incredibly painful - plus then no post-call the next day! 😱

 

[Monkeyguts]

It's sort of lower middle ground. Definitely not one of the more competitive fields. Keep an open mind going into med school. Most med students will change their mind at least once about specialties during med school. Neurology is certainly one of those fields that (in my experience) a lot of people going into med school say they are interested in, but after neuroscience and the neuro rotation lots of people seem to lose that interest, and a very small minority of your school will actually apply for it.

Within any specialty it depends on the program. With Neurology there are very competitive programs and not-so-competitive programs. Same with family, IM, surgery, etc.

The initial post is incredibly subjective, obviously because they come from interviewing physicians independently (ie: internal medicine much is tedious except GI, well depends on who your talking too of course, I thought it sucked dealing with parents in peds, Interesting cases are stimulating not necessarily hard ones, many people in primary care think it sucks etc. etc. etc.) and should be taken with a large grain of salt. Go out and interview a new set of physicians and you'll get a new set of answers.

 

[Law2Doc]

Within any specialty it depends on the program. With Neurology there are very competitive programs and not-so-competitive programs. Same with family, IM, surgery, etc.

The initial post is incredibly subjective, obviously because they come from interviewing physicians independently (ie: internal medicine much is tedious except GI, well depends on who your talking too of course, I thought it sucked dealing with parents in peds, Interesting cases are stimulating not necessarily hard ones, many people in primary care think it sucks etc. etc. etc.) and should be taken with a large grain of salt. Go out and interview a new set of physicians and you'll get a new set of answers.

I agree there's a range of programs in every field with overlap, such that eg the best IM program is probably harder to get than the "worst" of something more competitive. But as a field, you can say one field is more competitive than another. This notion of course assumes you are willing to move to wherever you get in.

Rather than talking to physicians regarding their subjective opinons, I suggest folks hold off making final decisions about what specialty they want to go into until they get through 3rd year of med school. Your rotations will give you a much more informed idea about what many of the fields of medicine are like.