And the survey says…..
A physician friend of mine recently posted a link on twitter to a national survey by Jackson Healthcare that indicated that 59% of the physicians surveyed were “somewhat unlikely” or “very unlikely” to recommend a young person to enter the medical profession as a physician. While the survey methodology is scantily described in the appendix of the report, we don’t know what the response rate was or if the questions were designed to eliminate bias. Also, they use a 4-point scale, at least for this particular question, instead of the academically acceptable 3- or 5-point Likert scale.
Regardless of the potential methodological flaws of the survey, it sparked an interesting twitter conversation between my friend, a young woman considering medical school, and me about whether or not we would recommend the medical field to someone else. This also sparked a memory of a conversation I had with my mother when I first told her that I was taking a year off professionally. After I bemoaned the long hours and high level of stress, I told her that I needed a break from my career as a pediatric hospitalist. She then asked me a question that stopped me in my tracks, “Do you regret having gone to medical school to be a doctor?”
Is it worth it?
After a long pause, I responded with confidence, “No. I do not regret going to medical school or choosing medicine for my career.” The reasons are obvious. If you look at the average household income in the United States, most physicians fall in the 90th percentile or higher. When you factor in that many of my colleagues came from two-physician families….well you get the idea. None of us were starving.
As I had mentioned in an earlier post, I worked to the point of burning myself out fairly early in my career. Reflecting on that though, I realize that if I had not done that, I would not have two jobs waiting for me while I frolick carelessly in the highlands of Costa Rica for the next 1-2 years. Also, we probably would not have been able to save enough money to embark on this expat adventure if I had not earned as much as I did as a physician.
Corny as it sounds, I became a doctor for altruistic reasons as do many wide-eyed medical students. A career in medicine provides a platform to serve others in a meaningful way. I truly loved my job. Pediatric medicine is a rewarding, valuable, and satisfying career. I loved my patients. I loved making a difference in people’s lives when they were at their most vulnerable. I loved working with different people and interacting with the nurses and therapists. I loved teaching in hopes to make a difference in the next generation of young physicians. When someone would ask Kara, what her mother did for a living, she would respond, “My mom takes care of sick babies.” I smiled with pride whenever I heard her say that.
Personally, I would never discourage a young person who wants to go to medical school from doing so. There are few careers that have the same trifecta of reliable source of high income, inspiring respect, and healthy job outlook. Computers can’t replace physicians. Regardless of what the media says about telemedicine and remote doctoring, people want to see a physician who is in the same room as they are, who can reach out and touch their hand if they deliver bad news, who can hug their child once its time to leave the hospital and go home. Other than myself, I don’t know any unemployed physicians! So yes, a career in medicine is worth it, but you have to know that it comes with a hefty price.
Are you selling your soul the Devil?
No, you are not selling your soul to the Devil by becoming a doctor but you will have to make some sacrifices. You do, however, have to be prepared for the sobering fact that medicine is first and foremost a business. When you graduate with $250,000 in debt, making money becomes a priority. While Hollywood makes it seem like all doctors have private yachts and mansions on the hill, most of us are really just trying to pay off loans and bills. In San Antonio, my colleagues and neighbors who were doctor’s wives shopped at Target and had their hair done at Fantastic Sams. They took their kids out to eat on Wednesdays when many of the local restaurants had “Kids Eat Free” Night. Remember that as a physician, we delay generation of income for much longer than our non-physician peers. So while many of our peers start making money at the tender age of 24 (assuming they got a master’s degree), most of us continue training into our late 20’s and early 30’s. By that time, our contemporaries live in gated-communities and have 2 luxury vehicles in the garage of the cookie-cutter suburban house. To top it all off, banks are more than happy to lend you money when you have an M.D. or D.O. next to your name. This means that it is very easy to get the doctor mortgage and doctor lifestyle before you actually start making good doctor money to pay for it. And you haven’t even started cutting into your medical school debt at that point.
I have seen many physicians who planned to provide service to the poor after they finished training (myself for example), but life, kids, and bills got in the way. If you are in private practice, you also have your staff to look out for. If you do not make money, you can’t pay your rent, pay your staff, and pay for all the fancy equipment in your office.
I cheated and got around this by going into academic medicine directly after residency. This meant that I had no overhead and was able to provide necessary care for my patients regardless of their ability to pay. I also by default became a social worker because while I could take care of patients in the hospital, discharging an unfunded or underfunded patient who needed medicine or follow up care was not easy. It was frustrating and time-consuming, but at the same time I found it rewarding. I was never frustrated with my patients, I was frustrated with the system that treats healthcare as a privilege, not a basic right.
There is also an ungodly amount of paperwork involved with practicing medicine. I hated it more than anything. I used to tell my boss (who was a good friend also), that I could handle the sickest patient, most difficult mother, and toughest diagnostic dilemma, but I hated filling out my billing sheets. I hated writing notes to appease some insurance coder that knew nothing about my patients or my skill as a physician. I hated paperwork. I will not miss that at all.
As a physician, you also have to accept the fact that you will miss family dinners, your kid’s birthday party, or the school play sometimes. I once had to leave the house while I was putting my little boy to bed because one of my patients in the hospital took a turn for the worse. Many of my colleagues also delayed child-bearing and marriage to be able to focus on their careers. If you want to go to medical school, you have to prepare to face these realities.
What do you tell your children?
Personally, I have never encouraged my children to be physicians. I want them to be whatever they want to be. Kara has clearly told me that she would never be a doctor or a nurse because what we do is “Gross”. She is not a fan of blood and pus and other body fluids, and I have mentioned to her that I tell medical students that if they are squeamish about poop, pee, puke, pus, or snot, they cannot be a pediatrician.
But in the back of my mind, I have often wondered, “What if they grow up to be something outside the medical field, and they do not earn enough to continue the lifestyle Chris and I have provided for them?” Frankly, that is one of the reasons I wanted them to experience living a simpler life in a developing country. That way, they can grow up to choose a career based on their passions, not on income potential and the pursuit of a materialistic lifestyle. I also half-jokingly tell both of them that they should marry doctors when they grow up…….
So what do I tell young people interested in a career in medicine?
As an academic pediatrician, I would of course recommend to my advisees to enter the field of pediatrics. But if they did not want to be pediatricians, I would tell them to pick a field that would allow them to enjoy the lifestyle they planned for themselves. This means choosing a field that not only provides the income they needed for said lifestyle, but also provides flexibility for them to enjoy what they earn. I would also tell them to prioritize what’s important in their lives and not spend their whole life working for “stuff” that they really did not need.
In the end, I have no regrets because I would most likely not be living the life I have now if I had not become a doctor. Today, I spent all morning blogging at Cafe Orchid while the kids are at summer camp. Even if at the end of this expat experience in Costa Rica I have to return home with my tail tucked between my legs to go back to the exact same life I had before, at least I will have countless memories that I will never forget. What could be wrong with that?
So, those of you who are physicians (or something along those lines) what would you tell a young person who wants a career in medicine?