Be a nurse or P.A. instead of a doctor: the underrated perils of medical school
jseliger.wordpress.com
jseliger.wordpress.com
Secondly, being a nurse is a HARD job. It's a blue collar job, and it should be (probably was) on Mike Rowe's Dirty Jobs. It's back breaking labor, stressful, and debilitating. Most of my family work in health care, and so far, my cousin has three herniated discs from lifting obese patients over the years, my wife had several blood tests done from being exposed to Hep C patients, and I've known several nurses who have suffered extreme burn out.
Being a PA is marginally better, I suppose, but you're dealing with the same garbage.
There are some definite pros about becoming a nurse over a doctor for sure. But, if you plan on staying on working the floor, become a doctor if you're smart enough. It's still in nearly every regard better than being a nurse on the floor. However, if you have more ambition, you can try to move up the ladder in management and administration as a nurse.
Finally, there are lots of other oppty's for nursing besides beside nursing. If one gets burnt out on patient care, one could move into case management, school nursing, teaching, etc...
Nursing school is much easier than medical school, and there are still perks to having that professional credential, and, as she and her colleagues always joke, they can "always go back to the hospital if things get bad". That said, my next door neighbors are both consulting radiologists and work from home. I barely see them, but by all appearances they're making bank while exerting hardly any effort. My childhood friends who've become doctors are a pediatrician and an ER doc, respectively, and they work much harder but they love the career they've chosen. To each his own: in every field there are ample opportunities for the top performers.
In cities around the size of Raleigh, NC a practice with one experienced dentist can generate 800k-1.2m in revenue and end up with a 250k-300k take home. Of course it takes a few years to build up the patient base. Starting salaries for dentist in Raleigh working for a larger practice is 150k-170k. (Source: My wife is a fourth year dental student).
edit: not to sound like a jerk, but I'm curious
Before being accepted (and before we were married), many people/admissions officers/etc made a huge deal that my wife would have to sacrifice our relationship to get through school. We even had a Dean of a dental school pull me to the side while touring with my wife and tell me that we would not make it if she was accepted. This was largely overhyped and I'd say the stress in our marriage has only increased 5%-10%.
Dental school itself is also a lot like medical school. Every dental school I know is roughly 8am-5pm with the first two years spent mainly in classes, and the last two years spent in a mix of classes and student clinic. You take many similar classes as you would in medical school, for example, gross anatomy (i.e. real dead bodies) of the entire body before spending a few extra weeks on the neck up.
One thing to be a dentist is that you have to be good with your hands as every dentist has to give injections, fill cavities, etc,
Socially, I think dentists have a perception problem. Many people think dentists are trying to cheat people out of their money (similar perception to chiropractors) and being a dentist is certainly less prestigious than being an MD.
This is really another argument _for_ becoming a dentist instead of some other specialty. The mouth is one of the nicest, least disgusting bits of anatomy you might aspire to work with as a medical professional (after optometrists, I guess). People go into medicine for all kinds of reasons -- money, prestige, religion, a desire to feel helpful -- but not because they're easily grossed out.
(You can't do anything if you're dead, after all.)
> High taxes are an obstacle to personal liberties, too.
No. Taxes are spread out among the population. Financial debt is burdening only one individual.
In Europe, in France and Belgium, we like to think solidarity is a good thing.
I actually had a classmate tell me the other day that me being able to get the medications I need to stay alive (because of the ACA) was going to drive the country bankrupt and (direct quote here) "destroy America." In my experience, my countrymen do not care for others very much--only themselves.
Well, that's true, but it doesn't change the truth of what I said. The people who never go to college have less money to spend on themselves because they're subsidizing people who will go on to make a lot of money.
So, not free, but it does, in fact, cost less.
Who do a startup, if you can do a PhD, it's not that strenuous. Why do a PhD if you can just do a Masters, it's not that strenuous. Why go to university, if you can just go to a community college, it's not that strenuous. Why finish high school, if you can just do an honest labor job, it's not that strenuous.
See the false assumption here? 5 years from now, these people will regret that they didn't start 5 years ago. Hard work is builds you as a person, it makes life more interesting, it gives you purpose and after these 5 years, you can decide your own pace. You have the OPTION.
Not going for higher education, limits your options FOREVER. You can't change it anymore, it's final. If you're not looking for meaning in life, go for the lesser option, if you are looking for meaning, go for the highest option you can think of and then even one more. The funny thing is, once you're getting closer to your highest option, you discover that there is still more to discover and that it is beautiful.
For that reason, shoot for the stars, don't listen to nay sayers, make your life awesome you only have 1 and then it's over.
I'm still cringing, hope I could get my point across.
I didn't go to college until I was nearly 30. They still let you in.
But awesome that you took the step.
>could have been much further already.
I do well. If this is peak income for me, it's an excellent peak income. I'm not looking to go "further" unless random events happen to drag me there. To be clear: if I had it to do all over again, I would have waited just as long to go to college. Out of all of the things I would change, that's not one of them.
edit: also, people who go to college do not have the monopoly on hard work. As a person who did an awful lot of manual labor in my life, what I do now doesn't even feel like proper work. I feel like I'm stealing a paycheck for doing puzzles all day.
* Nursing sucks. It's terrible work. On top of that, you have to deal with jerk doctors and jerk patients. Not a single one of my many doctor friends would ever have considered nursing over med school. (Side note: if you meet a good nurse, thank them! Truly good nurses are rare.)
* PAs generally do not know all that much about medicine. With very few exceptions, it was frankly terrifying signing out my service to them every night, and never fun cleaning up their messes in the morning. But with resident work hour rules, there is no alternative.
* The bottom tier of medical students/residents aren't very good either. Pay doctors less and the smart ones will realize that maybe there is some other way to achieve life satisfaction, because money won't be a differentiator any more. Care will get worse but the general public won't notice or care. They will keep getting fat, diabetic, and ever sicker, insist on keeping their essentially vegetative elderly relatives alive at all costs, and then complain that healthcare is expensive.
For example, at the University of North Dakota, the PA school tuition is $34,287 per year, with no discount to in-state residents. In contrast, the medical school tuition is $24,998 per year for out of state students, and $12,815 for in-state students.
Truck drivers aren't allowed to drive if they haven't gotten any sleep, but your doctor in the ER making the decisions that will either keep you alive or let you die will almost always insist that 36 hour shifts are essential. There's a lot of ego involved, as can be seen in the way that that same physician will usually support limitations on truck drivers but will readily believe in their own inability to make mistakes--even in the face of scientific research showing otherwise.
For the record, attending ER shifts at my hospital are closer to 8 hours, and residents do 12 hours.
It doesn't seem like you care much about it ("scientific research"), but IMO it's much more likely to put programs in place to help doctors learn basic literacy/documentation skills than to subvert the basic biological truth that staying up for as long as most medical students/residents/etc are forced to do puts them in a state equivalent to drunk driving. (http://archives.cnn.com/2000/HEALTH/09/20/sleep.deprivation/) I do NOT want someone crashing my health into a ditch because they were too tired to miss something important. Also if you don't have enough doctors? Maybe you should start training more of them, instead of artificially limiting supply. (Residency placement slots are a whole other issue, of course, but still not something that should stymie a first world country so.)
I've had way too much experience with rude, sleepy, and grumpy residents who bungled my medical care in the last two years of frequent ER and inpatient stays to have much trust in the profession as a whole. I mean, if you're going to charge me $50,000 for your crappy medical care, could you at least not snap at me? Or forget me in an observatory room for over 12 hours waiting for a scan? They "lost" me in the system somehow until a nurse wondered why I'd been sitting there so long, called radiology, and left the room to bitch them out about forgetting me. Since the doctors couldn't be bothered to tell me what they were checking for, I only found out 13 or so hours later that the scan was to rule out a carotid artery dissection. I was in extreme pain the whole time, which they did nothing to even try to alleviate. Incredible lack of empathy.
I'm glad to hear that your hospital has gone to at least trying to adhere to reasonable shift limits; it's a sign that at least some people in some hospital systems have decided that policies leading to killing or crippling patients is something that should be prevented, not encouraged. It's certainly not something I've seen in the major medical systems in my state. :(
The information is there; there is simply too much of it to go over with the next person in the limited time available. I understand your point about commenting code - I meticulously document all my own code.
> Also if you don't have enough doctors? Maybe you should start training more of them
The training itself requires a huge amount of time and exposure to a large variety of situations. There are only so many opportunities for learning, and only so many hospitals which both can provide an appropriately varied case load, have attendings willing to teach, and can afford it.
I'm sorry to hear you had a bad experience. I don't shout at my patients, or leave them for 12 hours without any information.
> policies leading to killing or crippling patients is something that should be prevented
It's not clear to those of us actually doing the work that this is actually true, when we examine our own personal experience.
Here are a few counterpoints worth considering.
* The example used by the article for salaries is for primary care doctors, one of the lowest paid (and by any account underpaid) specialties. According to the Medscape physician compensation report [1], the highest paid specialties brought in between $350K and $400K 2012. I don't think there's many PAs or nurses making that.
* Yes, medical school and residency are hard. My wife regularly put in 90+ hours during a couple years of her education as a physician. But I'm certain there are plenty of developers on HN that put in 90+ hours during certain phases of their careers. Working very hard for a couple years won't ruin your life. By the time they're practicing - 52% of physicians see patients for 40 or less hours per week.
* The article says that, "nurses start making money when they’re 22, not 29", glossing over the fact that physician residents and interns do in fact get paid. Not a ton of money, but usually around $50K/yr. So really, doctors start making about the same amount as nurses by the time they're 25, and substantially more just a few years later. And yes, medical school loans are expensive, but nursing school is far from free.
* The success rate for physicians who start their own practice is very high. I've been shocked at the amount of unsecured credit that banks are willing to extend to my wife to start a practice. It's like we've stepped into a time-warp back to 2006.
* If you're interested in living someplace rural, you can, without any negative financial repercussions. In fact, you'll probably make quite a bit more money practicing medicine in a rural area than an urban one. There aren't many careers where that's true.
* If they had to do it all over again, 51% of physicians would start again in medicine (again, the Medscape compensation survey). I don't how how that compares to other careers, but it sounds fairly reasonable to me
Being a doctor certainly isn't easy, but there are some definite benefits. One of the biggest is that it's one of the few careers left where you're pretty much guaranteed to be well-compensated so long as you do well in school.
There are certainly pitfalls, and I wouldn't advocate it to anyone who's doing it solely for financial reasons. But, if you have a passion for medicine, there are still plenty of rewards to be had by being a physician.
[1] http://www.medscape.com/features/slideshow/compensation/2013...
1. An entirely unpredictable work load, with no mechanism to compensate for excessive demand. 2. Dealing with problems for which you have not been properly trained. 3. Dealing with other doctors that are also extremely busy and stressed, and therefore limited in how much they can help you. 4. Having to work while physically and emotionally exhausted or actually genuinely sick, with no recourse to get help. 5. Having to do all this while studying or taking exams. 6. Not being paid fully for the hours you work. 7. Sometimes being sworn at, racially vilified, spat at, threatened or attacked. Depending on which job you do, this could come from your colleagues, nursing staff, admin or the patients.
I think that certain other professions such as the police or military personnel encounter similar situations, but I would hazard that they are better trained, better supported and rostered better than doctors ever are. So although many other people might work 90+ weeks, I doubt it is under these conditions. Because that would be a dumb thing to do right? And only doctors with their misguided sense of duty and high pain tolerance are willing to front up again and again. Nurses can suffer the same problems, but in general they are much better at protecting themselves.
The hand waving to say "you will be a primary care physician" is the worst part. Maybe you don't get our pick of specialty, but assuming you will be a pcp against your will seems silly, too, since you'd know going in roughly how good you are, and a lot of pcp are because they wanted to be.
It ignores one of the easiest/best ways to become a doctor -- the military. You give up a bit of your early career salary in exchange for a different/more interesting lifestyle for your early 30s. Still great pay.
If I were picking a career as a smart 18 year old, md/phd to go into research, or something amazing in clinical practice like a trauma surgeon or neuro radiologist, would be high on my list, independent of income issues.
* I agree with the overall theme of the article. That is, a lot of people go into medicine thinking that they will be "rich". And when they come out at the other end of the tunnel, they realize that the promises of job security and a comfortable lifestyle aren't really true.
Many of my classmates from medical school went into all of this with the false impression that they will make a lot of money. This misperception is because they see physicians from decades ago do really well, living in nice houses in expensive neighbourhoods, driving nice cars, etc. But unfortunately that is because 20-30 years ago, doctors' salaries were much higher relative to inflation. If a doctor made 200k in the 80's, the purchasing power "back then" was enormous. Not so today.
* The article does miss the point, as atourgates mentioned in the comments, that being a doctor is "one of the few careers left where you're pretty much guaranteed to be well-compensated so long as you do well in school."
I know a few guys who -- through brute effort -- bills upwards of 500-800k per year. Now this is gross billing, not net take home pay, but that is impressive nonetheless. It is, without a doubt, very hard work. You would have to work pretty much 6 to 7 days a week, and really convince yourself that you like money to make it all worthwhile.
* The last thing that the article barely touches upon which is important is how tough the job can be when dealing with (some) patients. Nowadays, the job is 90% customer service, and 10% medicine. Maybe less medicine -- certainly some days feel like that.
All this comes with the job's territory, but day-in and day-out of this can cause a lot of psychological stress/burden/fatigue for the physician himself.
This kind of job is not for everyone. Quite literally you have patients upset at you because they think the medication you prescribed for them doesn't work, and in the end it turns out they were not adherent on the medication (ie. they didn't use the medication or they didn't use it properly). It always reminds me how close a certain scene from House MD (http://www.youtube.com/watch?v=dMAS2S51bM8) approximates real life.
* Would I want my kids to go into this kind of a job? Only if they realize what it involves. I really do think some of the happiest jobs out there are ones where you get to be creative solving different problems every day.
Although I'm happy I'm making an impact on other people's lives, it involves very little creativity. A long time ago a specialist told me that "medicine makes you dumb." Medicine today is algorithmic: if this, then check this, then do that.
I don't think there is a simple answer whether medicine is "worth it." It is different for everybody, and it really boils down to what your personality is.