Scotty6278 said:
Hey guys,
I have had this inner debate with myself for about a year now. I am in sales and make good money...however the job is not satisfying at all. I was a heathcare major in college and always had thought about becoming a doctor. And now I am really thinking about it and doing my homework. I know the bottom line is you have to do what will make you happy...but from a "real life" point of view is medicine "worth it" So many MDs that I talk to flat out say DO NOT DO IT....mainly due to malpractice and HMO headaches. I am tring to figure out if this is just older doctors who have seen a major change just upset b/c medicine is not as lucrative as it used to be or are the right...is it just not worth it. I will finish residency in primary care when I am 36-37. That is a lot of years of no income and little income. Not that it is all about money but loans do have to be paid back. Just wondering what you guys thing. I know that at the end of the day do what you feel will make you happy but I just want to get a really solid idea of what I am getting into. Thanks
Scotty,
I just wrote a similar post, but I could not resist because I'm having a particularly bad day.
1. You're absolutely right: do what makes you happy. If it is being a primary care IM doc, then that's what you have to do. End of discussion.
2. But I plead, beg, and implore you to ask: Do you really know what you want? I.E., if you were a primary care MD, would you like it? Of course you can't know that without first being one, but take it from me, I don't think you'd like it. Start asking every single MD you know and ask them if it's worth it. Especially the primary care MDs. Take a poll, whatever you want. But in my own personal experience, basically an sizable majority say don't do it, they're not happy, it's not what it used to be, if I had only know, etc.
3. If you want to be rich, don't be a primary care MD. You have to specialize, and even then, I think there are easier ways to get rich.
4. Think about residency: can you really get up at 3 am in the morning for a new patient? If you can't, well too bad: you have to. There is something plainly wrong about knowing that no matter how tired you are, you just can not sleep or can not call in sick. There are very few jobs where you work 30+ hours straight and have no choice but to suck it up. the worst job in the world at least allows you the chance to say, "this day will end and I will go home to sleep." Not so with medicine. Very few MDs that I know of actually think of this as macho--not after years of doing it.
5. There is a marked lack of respect for primary MDs. By nurses, other specialists, patients, etc.
6. Will you be happy knowing that you've got all the added bureacracy that goes along esp with being a primary care IM doc, while your PA buddies make a little less than you overall but make actually the same hourly wage when calculated out? Will you be OK with a nurse anesthesist making as much as you or more than you for a higher hourly wage? Honestly, it doesn't sit well with me, not for ego purposes, but because MDs go through so much more B.S. and training.
7. I disagree with whoever said that he has worked harder for less money than md's pay their hired help. When did that person work 30 hours straight every 3rd day? If you're in consulting and making $$$, you're going home every night. Or you can decide when you want to sleep at least, in your office. You can't decide when to sleep as an MD on call. If you're an engineer meeting a deadline, you know it ahead of time and can preven the all-nighter. If you're a waiter and are working 7 brutal nights in a row, you're still sleeping. If you're an MD, you may have 1 month in a row where you NEVER get to sleep through the night because your beeper will go off in the middle of the night. Even if it's the wrong number, there went your sleep. You'll even sometimes wake up thinking you heard your beeper, when in fact, you did not. Trust me, you will work harder as an MD than you ever have in your life. But in terms of sheer demands on your life both physical and emotional, I can't think of a $30,000 job that is as demanding as the life of a resident or even as a PCP.
8. Are you ready to be cynical? In primary care medicine especially, you draw the hypochondriacs and other anxious folk who for whatever reason are just demanding and abrasive and come to you with nonissues that they think are the most important thing in the world. By definition because they don't have a physical problem, the best you can do is refer them to psych. Except they think they don't need psych help. So they keep coming to you,and you don't know what else to do. And you get abused. And for $10 a visit for people who are a timesuck on your patients who are sick and need some extra time. What about the person who had a back injury 10 years ago and is claiming disability, asking you for a handicapped placard for the 3rd time? What if you're busy and you know they don't need it, but your other 3 patients have been waiting for 45 minutes already and you're behind? You realize that it'd just be faster to fill out the form than to argue with the patient. You figure you'll just deal with it next time, but the problem is, next time rolls around and you're still behind seeing patients. And the cycle repeats itself. After awhile, very few MDs I know continue that wholesome idealistic attitude that they likely once had before being battle-tested in medicine via residency. They're usually cynical and antagonistic and bitter in their hearts. And the ones who have developed the nearly unattainable balance between healthy skepticism and genuine compassion, if they are female, I seriously find that as a highly attractive trait and would want to marry that kind of doctor. Because those people have hearts of gold, and Scotty if that's you, then I refer you to point #1: IM must be for you, so do it because everything I just whined about will be but a small coffee stain on the sleeve of your white coat. But the vast majority develop cynicism because it is a coping mechanism in order to distance themselves from patients or because they just see the dysfunctional nature of our species.
9. Finally, get ready to be disappointing to not a few of your friends. So many of your friends ask you questions that NO ONE would know the answer to, yet they ask you anyway because you're a doctor. And when you don't know, they are surprised or think they know more than you. Today's medical world is so specialized that an IM doc isn't going to know how to do a C-section or even remember what the procedure involves. So when your friend reads up on the procedure and tells it to you better than you remember it, red flags are going to go up in their head. If they know side effect #10 of Celexa is "dyspepsia" and you don't, their eyebrows raise. They don't care if you're focused on making sure that you don't stop it abruptly to avoid withdrawal syndrome, or if you're watching out for pancytopenia (super rare, and rarer than dyspepsia for sure). They just don't appreciate all the material you DO know and that you medical school equips you to deal with real problems, not the ones that people curbside you while warming up for your co-ed flag football team. You're more interested in worrying if that person's got an ACL tear, not how to treat a charley horse on the thigh. But the charley horse comes up way more often and when your advice is put some warm compresses and then ice on it a little later isn't any better than someone who didn't go to med school, it can cause some friction. And you'll say that the person will be just fine to most things, because in truth, most people are fine when you're curbsided by that. You ask a few questions and know from your training that your buddy is likely just having gastroenteritis, but when you say they'll get better in a few days, they are thinking that you're not taking them seriously. Then they go to their own MD who says the same thing, and they're fine with it, and their MD is more "caring."
I'm serious that this happens. Expectations go up. Salary goes down (per hour than a lot a jobs) Emotional stress goes up. Physical pain increases. Rewards start high and steadily decrease for most (except those select angels). Social life suffers, and so does balance in your life.
So, that is my two cents. I would never do it again if I had the choice. That is the honest truth. It is utterly not worth it. I joke that I truly help someone every other month. But I'm not joking. If you can live with every other month, then primary care is for you.
