It's all I heard when I applied as well. On the one hand I don't regret my decision but on the other hand I would discourage others from doing it. For the most part, if you are smart enough to do medicine you are smart enough to do something else. The costs get bigger and bigger and the rewards are increasingly diminished. While to some degree things are cyclical, i.e. fields that weren't competitive previously suddenly became competitive and vice versa, I think the trend is only downward as boomers cash out to VC and big health care systems, reimbursements continue to diminish while the costs of doing business increase, and there is increasing encroachment from midlevel providers. Derm, Urology, EM, Radiation Oncology, Ophthalmology, ENT, Anesthesiology, and Radiology are all going this route so ask yourself what's left that's worth doing and realize that in 4 years you'll be competing with everyone else who has basically come to the same conclusion.
You guys got what you wanted
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It's all I heard when I applied as well. On the one hand I don't regret my decision but on the other hand I would discourage others from doing it. For the most part, if you are smart enough to do medicine you are smart enough to do something else. The costs get bigger and bigger and the rewards are increasingly diminished. While to some degree things are cyclical, i.e. fields that weren't competitive previously suddenly became competitive and vice versa, I think the trend is only downward as boomers cash out to VC and big health care systems, reimbursements continue to diminish while the costs of doing business increase, and there is increasing encroachment from midlevel providers. Derm, Urology, EM, Radiation Oncology, Ophthalmology, ENT, Anesthesiology, and Radiology are all going this route so ask yourself what's left that's worth doing and realize that in 4 years you'll be competing with everyone else who has basically come to the same conclusion.
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The reasons are myriad and prior posters echo a lot of my thoughts.
Personally, my main reasoning:
1) Being a physician in 2021 is not what it was even 20-30 years ago. When I was young, I had this impression that "being a doctor" meant being the leader of a healthcare team, making complex decisions to drive the care of a patient's health, holding the ultimate responsibility (good or bad) for the outcomes as you "practice medicine" over the course of your career.
The current (American) reality is that "administration" dictates a lot of policies and procedures for the patients under your care, insurance companies release their own "guides" about what they think the standard of care is and approve or deny based on that, not to mention the sprawling entity that is the NCCN guidelines (to be specific about Oncology) which is essentially a cookbook for the care of cancer patients (and if you deviate from them, a treasure map for malpractice lawyers to successfully bring suit against you).
What this means is that how a patient arrives in your clinic, what workup they have received and what workup you're "allowed" to do, what is the "correct" treatment and if you are going to be "allowed" to treat them that way - a lot of these things aren't really decisions. It's a pathway; you are the Shepherd of the Pathway.
2) An even bigger point which I didn't appreciate till I was on the other side: the investment of time and resources required to become a board-certified physician is incredibly tremendous (duh). If you have the ability to complete undergrad, get into medical school, complete medical school, get into residency, complete residency, pass all the licensing and certification exams required for your state(s) and specialty, you are likely able to be extremely successful in almost any career.
If you are interested in "helping people" from a "medicine" aspect, there are MANY other career choices that require far less upfront investment.
If you are interested in the "high salary" of many physicians, there are MANY other career choices that are likely more lucrative over a lifetime than most physicians.
That being said, I find my career/life interesting and enjoyable. I have seen and done things many people will never see or do, and I have helped thousands of people over the years, and plan to continue to do so.
Would I do it again if I had to? I'm not sure. The grass is always greener, so who knows what my experience would have been had I gone into another white-collar career, or if I had gone on to learn welding and opened up an autobody shop.
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I've never regretted being a physician. It's a stable, high income career, and I take a high level of pride and meaning in what I do.
I absolutely tell my children they should be doctors if they want to be. Of course they are currently too young to even understand what that means. Anyway, if that ever happens, I will counsel them to choose a specialty with good job prospects.
Sure, there are drawbacks to medicine. Everything has drawbacks. Grass is always greener.
I absolutely tell my children they should be doctors if they want to be. Of course they are currently too young to even understand what that means. Anyway, if that ever happens, I will counsel them to choose a specialty with good job prospects.
Sure, there are drawbacks to medicine. Everything has drawbacks. Grass is always greener.
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Very well said. But to your points, what are the careers that come to mind that encompass helping people and high salary?
Helping people - sure, could do social work, teaching, firefighter. In general, those are quite underpaid for what they do.
High salary - sure, many of those capable of med school can (and have!) done investment banking, consulting, etc. But as you know, those come with their own set of soul-sucking issues.
You could be CEO of a startup and help people with a fantastic new product, make millions! But... pretty low hit rate on that.
I would argue there are few careers that include 1. Helping people 2. High salary and 3. Pretty sure thing if you complete training - impending breadlines in our field notwithstanding. Like @Neuronix said, grass is always greener. Someone once told me: every job comes with it's share of shoveling ****, you just have to find the **** you don't mind shoveling as much.
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deleted969641
Easy. Go to the community college and get a degree in nursing. Screw around for a decade while schmoozing it up and earning an MBA online. Get a low level admin position then take your schmoozing to the next level at the country club with board members and get promoted. Get a CEO position at some rinky dink rural hospital, rinse and repeat with the schmoozing of board members at the country club, and get them to approve a 1.2M salary for you (don't worry, they will -- they're unpaid volunteers at your "non-profit" hospital, so they don't care about accountability). Leave at 3 PM everyday to go play golf at the country club convinced you are "helping" everyone in the community (just ignore the fact that your hospital refused to treat an illegal immigrant with colon cancer and told him to go back home to Guatemala to die). Bask in your position that you earn more than all the doctors and consider yourself their "boss." Not that I speak from personal experience or anything...
For reference, there are 6,000 hospital CEOs in America. There are 5,000 radiation oncologists in America.
Done. See...? Easy. (caveat... only works if you are a white male).
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I have never questioned my decision to go into medicine and would do it again. Today, would probably choose IM and fellowship.
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It all depends on how you define "helping people". We, in medicine, are programmed with a very narrow definition of what "helping people" means.
@Turaco's post (while clearly in jest, haha) brings up a good point. I'm obviously guilty of this, but we universally dump on "admin" and "insurance execs" as "the enemy" or whatever. Are they ALWAYS, though? There are policies set by the administration at my institution that I agree with and I think are beneficial. If you do some sort of nursing/MHA combo training, be done by age 22-24 in significantly less debt, start working up the ranks of various clinical/admin positions, sincerely tying to do your job for the "benefit of patients", aren't you helping people? Won't you be making a good salary (especially over your lifetime) doing that?
If you go into finance and pull down a giant salary, but are heavily involved in philanthropy and volunteering, aren't you helping people?
Yes, if you want to define this as "having a job that pays well while administering medical intervention directly to other humans with probable benefit", then it's tough to rival "physician" for "inside the box" jobs.
My thesis is more...that there's more to life than how we're trained to think about our impact on society via our jobs. Over the last 15 years, I am acutely aware of what I have invested to get to this point, what the "cost" has been. Compared to when I started down this road as a teenager, I have seen significantly more of the world and am often left wondering: "if I had put the same time, money, and effort into a different path, would I be a more positive force in the world? Would I make more money? Would I be happier?"
All unknowable questions, of course. I just think that the system to become a doctor in America breeds very dogmatic/"inside the box" opinions and ideas, and people often tie up their personalities and self-worth into these ideas and then view the rest of the world through that lens.
Join me next week for another episode of "Elementary Existential Crisis".
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No one knows what the future holds. The trajectory for doctor job satisfaction ain't exactly trending up though (same could probably be said for the rest of society, but that's another story). If you're applying to med school now, you're probably about a decade out from real life. Things could be better, but my money is on worse, i.e. less pay for more work, less autonomy, more administrative bureaucracy, less job security, less patient contact, etc...
It's a huge investment (time, money, emotion) for an uncertain future, IMO. I don't regret my decision as it has provided an amazing life for my family and I, and moreover I feel good about the people I've helped, but I'm not sure that it's always going to be that way.
It's a huge investment (time, money, emotion) for an uncertain future, IMO. I don't regret my decision as it has provided an amazing life for my family and I, and moreover I feel good about the people I've helped, but I'm not sure that it's always going to be that way.
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Welcome to pathology.
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I'm pretty much with you here, and I get that the long haul takes it out of all of us. And I know we're way off on a tangent here, but hey, boards are over for now. A few points,
I'd say this option is still open to all of us that want to go down this road. Target your rural hospital, get on some committees, get an admin job and you're well on your way. You may even skip a few rungs that this hypothetical Nurse-MBA had to climb up. If schmoozing isn't your jam, then this wouldn't be for you even if you went back in time and did the RN-MBA route.
Totally agree. Can the finance boss convince themselves they are helping the world tremendously with their new wing of the downtown Boys and Girls Club? Absolutely. Conversely, can we convince ourselves that we are in fact doing the opposite of helping when we draw MS Paint circles around pancreatic tumors? Already there!
Again, right with you here. I subscribe much more to "this is a job" not "this is an identity." But it is nice to enjoy what you do and derive at least some fulfillment from it when you have to pay the bills. My thesis would be that if you're looking back with the existential questions, you may find that you're in that mindset no matter what you get into. I would wager the hypothetical RN-MBA may look back and wonder "What if I had pulled the trigger and went to med school? I could have probably been a doctor. Maybe I would have liked that better." But they would never know.
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Is there.... still time to do this even if I'm already a radiation oncologist?
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deleted969641
A better option in this case would be to find some god-forsaken armpit of the US without RT nearby and drop a refurbished linac in it. Get 10 patients under treatment, be on site 2 days a week, hire an NP to cover the rest and fly home. Very few paths to owning your own LINAC anymore. This is one of them.
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I’m sure a 21c clinic is already doing this somewhere.
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A few companies have tried and failed. I remember when this job got posted several years ago...
Elko oncology center to close, citing lack of support
Rural northeast Nevada cancer patients will have to travel to get radiation therapy after an Elko oncology center closes its doors.
www.rgj.com
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Wow they avg 4 patients/month!A few companies have tried and failed. I remember when this job got posted several years ago...
Elko oncology center to close, citing lack of support
Rural northeast Nevada cancer patients will have to travel to get radiation therapy after an Elko oncology center closes its doors.www.rgj.com
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The Elko, NV, job used to be staple of the Astro Career center. I bet in today’s environment if you could get up to 10 patients being treated daily it would be considered a desirable position if you got to buy into the center.
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deleted969641
Yeah, it doesn't take a lot to make a radiation center profitable. 4 patients/month is not going to cut it though. Somebody really screwed up the pro forma on that one.
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Yup.
"Officials with the center say the company lost $10 million and treated about 140 patients in the three years it was open."
