Second-Chance Med School
nytimes.com
nytimes.com
A long time ago I was in pre-med. Similar to the article, I got a 35 on my MCAT. I know a lot of physicians. They're all very smart (because you have to be to get into medical school). The vast majority of them are bored with medicine. They do anything they can other than see patients. Some invest in real estate, some manage other physicians in a group practice--there's one guy who built a small datacenter and runs a business selling electronic medical records systems as a service to other medical practices!
The point is--the practice of medicine kind of sucks. It's mostly the same things over and over, with a lot of paperwork thrown in. Med school lures in the young with the prestige attached to the magic letters "M.D." and because med school is an ultra-exclusive club for smart people. The sick joke is that after all the work and sacrifice and expense the job usually isn't worth it. If you want to be a doctor, imagine yourself working in subsaharan Africa helping the neediest, poorest people imaginable. If it doesn't sound like something you'd want to do, you don't like medicine enough for the career path to be worthwhile to you.
She wishes that a particular mutual friend of ours had chosen physics instead of medicine in undergrad, because said girl excelled to the degree that the Princeton physics department reached out to ask her to major in physics (though this was probably partly motivated by the fact that the physics department had zero female majors that year). We feel that in a way, a great mind was put to poor use by her choosing medicine.
If anyone wants to become a doctor, please volunteer at a hospital or clinic for more than a year to see the working conditions.
I think it's very hard. It takes a lot of discipline and hard work to master all the prerequisites, all the knowledge necessary for the basic science component and then the clinical component, and then put in all the hours per week during med school rotations, post-grad residencies (especially internships). That said, it's mostly about the hours and volume of information and not so much about the intellectual difficulty, which you state... and then say all physicians are "smart". So instead of saying every physician is smart, I'd say most physicians have a good memory and the ability to work really hard. If you can get reasonable grades in Comp Sci, you can certainly handle medicine if you are willing to put in a lot of hours.
I remember feeling so depressed watching the sun rise through a window next to an OR, having put in another really long day with not much sleep during a rotation. At least in Comp Sci, you are building something, actively solving problems while doing an all-nighter. In medicine, particularly at the med school level, you are doing something more trivial like holding a clamp for a while or asking people about their history.
IMHO the practice of medicine indeed sucks if you want a creative job. Almost by definition, the practice of medicine requires you to not be creative unless you want to be sued for methods outside accepted practices. There are a few truly gifted individuals who combine scientific research with a limited clinical practice, but to be at the forefront of both requires more talent and time management skills than I had.
these days i just go to urgent care and tell them what's wrong with me and how i want to fix it, they're glad to have me out of there as soon as possible.
The article doesn't specifically cite boredom (that I remember) as a cause of unhappiness, but it wouldn't surprise me if it was.
I'd like to attack the counterpoint in #2, as I don't believe it to be in the spirit of free market economics. The argument basically presumes that if someone attains their medical education, they will have no career prospects except in those careers that already exist. Anyone with even a slight entrepreneurial bend must realize the ridiculousness of this. Ditto for anyone who understands the concept "creative destruction".
Imagine for a second a parallel universe without an artificial cap on medical students, where MD numbers overflow such that a bunch of MDs don't get residency positions. Is it impossible to imagine new institutions, businesses and services forming as a result? Another question then is how much innovation could we be missing out on?
There are some instances where artificial caps are a good idea. I don't believe education is one of them.
http://static01.nyt.com/images/2014/08/03/education/edlife/0...
Note that the currencies are local, and costs are listed up front.
As for the safety concerns about Grenada. Its one of the fastest Caribbean islands. You should be pre-cautious since as a foreigner you may be more of a target but you wouldn't find yourself walking down a dodgy street at night in your home country then why do it here in Grenada?
Didn't know these islands can run. :)
I presume you mean fastest growing.
But like you said, if you are careful you'll be fine and that applies pretty much everywhere even North Korea.
Yeah but I meant safest :)
Unions perform similar functions for blue-collar type work.
Once you factor in the levels of debt they have at that point, you may not be so envious: http://www.cbsnews.com/news/1-million-mistake-becoming-a-doc...
I can't remember where I saw the statistic, but the number of years it takes for a physician to have a positive net worth after leaving medical school has been increasing dramatically. (This is because debt from medical school and undergraduate have increased nominally, while the expected income of a physician has dropped dramatically[0])
[0] Again, the magnitude of this effect varies by state, but it's a nationwide trend.
$166,000 is the average amount of debt upon graduation[0] from medical school. You spend several years training gruelling hours for a pittance as an intern/resident/fellow (3 minimum, but after that you're only qualified for the lowest-paying fields - the highest-paying ones require as much as ten years of training).
Even someone who just completed their residency is highly unlikely to make $270,000 (or anything close to that). It takes a long time to work your way up to those sums.
A doctor who has paid off his/her debt by the age of 40 is the exception, not the norm[1][2]. It's not unreasonable for a person considering medical school to have to plan on taking about 30 years to pay it off[3].
I don't know about you, but I'd consider that burdensome.
[0] http://sls.downstate.edu/financial_aid/AverageDebtofMedicalS...
[1] And this is assuming that they got a free ride for their undergraduate degree and didn't have to pay tuition or take out any loans there.
[2] http://forums.studentdoctor.net/threads/how-long-does-it-tak...
[3] https://pay.reddit.com/r/personalfinance/comments/17iuse/how...
Your first link does not show numbers much different from the previous article linked.
Your second link bemoans that a $100K income (which is below the median for qualified physicians) "goes pretty quick" -- try telling that to the average American worker.
The reddit link doesn't contain anything substantive.
You state that the pay during residencies and fellowships is really low, but in fact it is higher that the median US wage.
Qualifying as a physician in the US is one of the most secure ways to earn a comfortable well above average income worldwide -- US physicians really have nothing to complain about when it comes to finances.
Correct. I cited that link because it more clearly shows that those numbers refer to the debt upon graduation from medical school, not the date at which the income numbers in the previous article become relevant (which comes several years after the completion of residency).
I'm not sure why you selectively quote that one phrase from the second link (which in context is not saying that $100K isn't a lot; it's really just a warning about how much worse it is to triple the principal on a debt with compound interest), and yet ignore the clear evidence that it does, in fact, take decades to pay off the debt (and even then, that's just to break even). Even if you don't like those particular links, it's pretty easy to corroborate that elsewhere.
Earning a "comfortable income" on paper is not very meaningful when you could be well into your fifties and still be behind where you would have been at 25 had you dropped out of college at 20 and gone to work for Wall Street or a startup, or pretty much any other high paying job that someone of that caliber would also be capable of. On top of that, as I already said, the income statistics for private practice physicians don't factor in many of the costs associated with maintaining a practice, so it's more like talking about the revenue of a small business than the income of an individual.
Medicine isn't really that secure a job anymore, either, contrary to popular belief. That's why so many practices have had to close in the last ten years, and why physician salaries, for those not in private practice, have been on a sharp decline.
It's really popular to hate on physicians for supposedly making a lot of money for a supposedly cushy job. That may have been true once, but it's not really true anymore, and it's becoming even less and less true very quickly.
In no way conceivable is the debt incurred by medical students an irrational one, unless they hate medicine and wish they had chosen a different career.
The only way on which the debt incurred becomes an unusual burden is if they don't subsequently obtain positions commensurate with their training.
Comparing the income of Wall Street traders to physicians is bogus, the skills required are very different , and Wall Street is much more competitive and cut-throat than the medical profession is.
"It's really popular to hate on physicians for supposedly making a lot of money for a supposedly cushy job." Medicine is still a very well paid and cushy job: try asking qualified lawyers doing document review for $20 an hour with equivalent debt to newly trained physicians what they think of the matter.
It's really not a bogus comparison. Comparing to the average wage of all professions is meaningless, since a prospective doctor would be capable of getting a top paying job if he decided not to go to medical school. The proper comparison is between two jobs that a prospective doctor might choose.
More than half of all medical school applicants take a year or more off in between college and medical school, and Wall Street and medical schools are indirectly competing for a lot of the same talent - a person who decides medical school is too heavy of a financial burden may very well choose to work in finance instead. Students graduating from top-tier engineering schools, for example, are prime candidates for both fields (and it is not uncommon for someone with an engineering degree to work for a few years in finance before deciding to go to medical school)
As I said before, it easily takes 30 years or more before medical school starts to look like a good financial decision, and that's assuming you make it that far without burning out and leaving the profession (as many do). That time frame is increasing, not decreasing, which means medicine is becoming a less attractive or sensible financial decision for the top-tier candidates, who are theoretically the very people one would most want to be performing one's open-heart surgery twenty years from now.
This is not strictly true. To make an analogy, a marathon runner is not the best athlete for cycling, and most physicians would make lousy engineers. The biggest advantage of the medical profession is how secure it is relative to other highly skilled white-collar jobs, where climbing the ladder is a much less certain endeavor than medicine is.
I don't believe the 30 year figure for specialists (Being a physician isn't that great).
As always going to a top school changes the calculus significantly compared to everywhere else.
If you're in private practice, maybe, but that's really not the case anymore. And in any case, private practices are a dying breed. If you're an employed doctor, you have essentially zero autonomy with regards to your practice, your work hours aren't that flexible (or forgiving), and you don't get that much vacation time.
What you describe certainly did apply to doctors one or two generations ago, and still applies to some of the outliers today, but it's not true for the vast majority of doctors anymore, and the direction of the trend is very clear and has been for many years.
> As always going to a top school changes the calculus significantly compared to everywhere else.
Not as much as the residency and/or fellowship does. The top schools charge more, but ceteris paribus, the residency is a better predictor of how much money you can make. Both of those effects, however, are swamped by whether or not a doctor actually lasts long enough after their fellowship to become one of those incredibly lucky high-earners. As much as people might not want to believe it, specialty medicine is a very competitive and cut-throat world, and there's a reason that so many would-be doctors burn out before ever seeing the thick paychecks referenced in this thread.
> I don't believe the 30 year figure for specialists
It's true, though if you choose not to believe it, I'm not going to argue the point further.
Don't look at the salary of a physician, because not all doctors are salaried, and even for the ones that are, net worth is a much more meaningful measurement. $250K is a little high for some specialties, and it depends heavily on the part of the country. In any case, once you factor in the massive debt from medical school (plus the amount of time that physicians spend making essentially minimum wage while training in residency), the answer is that many doctors can't afford to make much less than they currently are[1].
(Also keep in mind that most statistics you see for "salary" for private practices are really more equivalent to revenue, since physicians in private practice obviously aren't salaried. Oftentimes, these numbers include only some, not all, of the costs of maintaining a practice.)
[0] This is a trend that is over a decade old (depending on the part of the country) but accelerated in recent years (before the ACA, though the ACA has also contributed to this trend as well)
[1] http://www.cbsnews.com/news/1-million-mistake-becoming-a-doc...
Secondly, the real limiting factor now is not the AMA but the AAMC[1]. They serve as the current bottleneck for increasing the number of people who receive the MD degree.
However, getting an MD doesn't mean that you can practice medicine. Technically, you haven't even been trained to practice yet - that happens during residency[2]. The bottleneck for the number of practicing physicians (as opposed to the number of MDs) is what is really relevant. That is capped by the number of residency positions available. These are funded through Medicare, so the real limiting factor is the government spending allocated towards Medicare which funds residency positions.
So, blame the AAMC, blame Medicare, blame the government, or blame Congress, but don't blame the AMA, since they aren't the bottleneck for increasing the number of practicing physicians. (And one can easily make the argument that increasing the number of medical school students while keeping the number of residency positions open constant is a waste of money).
As for reducing the costs, that's easier said than done. The amount of time it takes to train someone to (e.g) be a good cardiologist is significant, and the length of time alone makes the costs very significant - trying to shave off a few pennies here and there is really just a drop in the bucket.
The only way to lower these costs appreciably would be to lower the amount of time it takes to train in these specialties, but that comes with a number of risks. Already there have been a number of lawsuits arising from overworked and sleep-deprived residents making mistakes, and it's a tough sell politically to say "Your cardiologist spent 33% less time training to receive a bargain degree. Any loss in quality that impacts your health is just a side-effect of keeping health costs low."[3]
[0] It's also misleading to imply that the AMA seeks to keep income for doctors high. The relationship between doctors and the AMA is complicated, but fairly rocky and sometimes downright acrimonious. Keeping incomes high is (if anything) a side-effect of the AMA's practices, not a goal. (And if it were, the AMA would be failing heavily at this goal, as physician income has been declining steadily for many years now in most states).
[1] https://skeptics.stackexchange.com/questions/4561/does-the-a...
[2] Which only gives you the ability to practice in a limited capacity - any specialties or subspecialties will require a fellowship, which can be as much as 10 years of training after receiving the M.D.
I'd assume they can charge whatever they want for resident's time, and add enough peer review to keep malpractice costs down. I'd also assume it's much cheaper to use a resident than a (not sure of the term) practicing physician (?)
Residents are certainly cheaper than attending physicians, and this is what they already do (Scrubs is, I have been told by many, a very accurate depiction of what a hospital actually looks like in this regard). Residents are already paid what amounts to minimum wage or less when you factor in the amount of time they spend. (Keep in mind that they are also paying back medical school loans off of this same stipend).
I'm not sure what you mean by "add enough peer review", but attending physicians are already responsible for residents, but even then the threat of malpractice is already incredibly high.
The short answer is that, as any engineer who's ever hired a bunch of interns at once knows, no matter what you do, training residents costs more money on average than it saves. That's why the government has to foot the bill already - if hospitals could find a way to keep their costs lower with this strategy, I guarantee you it'd be one of the first things they did.
If there is a shortage of attending physicians, then we need more residents.
Why do we fund it through the federal government in the first place?!
Why? No other professionals get this guarantee. What about physics or history Ph.D.'s?
I wrote my MCATs, got a 33S, which I was super proud of. Had a 3.5 GPA. Not stellar, but I thought it was good considering my workload and degree choice. I applied all over Ontario, in hopes of getting in. I never even managed to get an interview. I guess I shouldn't have bothered to believe the medical schools when they said they look at each applicant holistically. They just care about the raw numbers. I mean, it explains why the entrance average at some Ontario medical schools is higher than even Harvard.
I gave up. Sure, I looked at the Caribbean schools. Plenty of my friends in the sciences went there. My sister is there now. I looked at going to the US. I didn't want to do that. I wanted to study in my home country. I mean, I am who I am because of the investment of my fellow Canadians in me through their tax dollars. I wanted to try and start to pay that back, while also continuing to reap those benefits.
I lost hope in my Master's degree. I didn't see the point anymore. I became depressed. Things were going downhill. I left the program, and took a few months to pull myself together. I sought out help. I tried to go back to my Master's program, but it was all for naught; I couldn't get back into it.
I tried going back to what I loved: creating things. I fleshed out my mobile payments startup idea, went through a whirlwind ChallengePost competition, lost, but had a ton of fun. Then I taught myself to create Android apps, and took on a contract for a friend in San Francisco. Proposed to my girlfriend in Rome with the money from that contract. Took on another contract doing Android development in Palo Alto. Decided to go full-time, moved to Palo Alto. Facebook bought us, and I worked at Instagram for a while. I left to pursue my own ideas back in Toronto, having tremendous amounts of fun and success doing it. Got married. Have an amazing wife, an amazing place, and amazing family.
Like I mentioned, my sister went to a Caribbean school. She's in Chicago right now doing rotations. She went straight out of high school, so she'll be a doctor before she's 26.
The Caribbean schools can definitely give a second-chance to folks really keen on becoming a doctor. If you're truly passionate about helping the sick and injured, do it. I decided I ultimately wasn't passionate enough about it. I found my passion in my old love of software. And I'm grateful that I did.
That's a really really long time for a person to have to grind through the competition, the residency politics, etc in order to be able to finally make it to a place where they can actually practice medicine. Apparently 95% of doctors wouldn't recommend someone to pursue medicine today. It's disheartening.
(Don't take the above as a slight against the quality of graduates from non-Canadian schools, but as evidence that we've constrained supply of local education spots at the expense of our own people)
I am working on another medical idea at the moment, a crowdsourced medical expert system. I hope to unveil it on HN by the end of the summer!