What do you want from a career in medicine?

I am often asked why I decided to pursue a career in medicine; starting at a later age and with many demands both mentally and physically. Quite simply, I knew that I would enjoy those mental and physical demands because I love working with my patients to identify and help solve their health problems. When a patient walks into your clinic, office or you encounter them in the hospital, the most amazing relationship develops that you will ever experience. A person walks into your life and puts their health and trust into your hands. This trust means that you give your best knowledge in terms of figuring out their needs and meeting them.Too many people will confuse what they see on the telly (House, Dr. Kildare, Gray’s Anatomy,Ben Casey, Scrubs, ER) with what is the actual reality of being a physician. There is little “glamor” in this job but there is loads of personal satisfaction in winning those hundreds of little “victories” that you will win over the course of a day. There is also the knowledge that if the health care system continues along the road that it has taken, you are going to make less money for every day that you work in the practice of medicine. The question that you need to ask is “am I willing to work this hard for this career?” If you can answer this in the affirmative no matter what the future holds, then likely you will have a satisfying career in medicine.

In no other career are you asked to be out of the work force for essentially 8 years just to be able to enter a job where you will be making less than minimum wage with an average educational debt of more than $150K. In no other career is your income totally dependent on the policies and regulations of private industry, government regulatory agencies, Congress and state governments. You have no control over what reimbursement will be for your services (those reimbursements have been cut every year in the name of holding down costs) while your costs of maintaining your practice have continued to increase dramatically. 

Primary care (Internal Medicine, Family Medicine, Pediatrics and OB-GYN) have seen their ranks shrink in popularity among graduates of American medical schools for a number of reasons not the least of which is the extremely high costs of medical education, rising interest rates on loans and decreased pay. Those people who are yet to enter medical school and those who are yet to graduate face even more challenges in terms of just being able to make a living (purchase a house, pay off educational loans, open a practice). If you are not yet in medicine/medical school, you are likely (unless you enter the armed forces) not going to be able to afford to enter primary care because of past educational expenses. Along with that, add the fact that if you are not a very strong performer in medical school, you won’t be eligible for residency in one of the “money” specialties and thus, you will be scrambling to make a living even if you are able to get into medical school.

The American Medical Association has been extremely slow to organize and speak for the needs of the young physician. Most of the people (and I am thankful for their efforts) that are able to lobby, have been established physicians in specialties such as opthalmology who can afford to take a day away from practice because their loans are paid off and their homes are purchased and their children have their college education paid for. They have little in common with the newly minted physician who has a young family, a 10-year-old car from residency and a $2,000 a month loan payment in addition to rent (mortgage if they are lucky)and office overhead expenses.  I remember my cousin, who is a neurosurgeon state back in the early 1990s that she had to make a minimum of $10,000 per week in order to keep her office door open.  I am sure that number has increased (increased malpractice costs and office costs) while her payments have been decreasing. In the face of this, why would anyone want to enter this career? How would anyone afford to enter this career?

The answer to these questions are not easy but they are expensive both in time and energy. The truth of the matter is that you had better know as much about the day-to-day practice of medicine before you enter your pre-med curriculum because by the time you have finished your first two years of medical school, you have racked up too much debt to be able to do anything else. Little is taught about practice management/investment/finance either in medical school or residency. Medical school  prepares you for residency and residency prepares you for practice.

Some people want residency programs to include more about practice management, marketing and finance but along came the 80-hour work week restrictions and thus, most residency programs are still scrambling to make sure that they can include all of the experiences that residents need to learn just to practice let alone add to what they need. The business of medicine is very complicated and growing more complicated daily with policy changes at both the federal and state level. It takes many hours to keep up and keep yourself informed.

This gets back to what do you want from a career in medicine? Financial/job security isn’t out there anymore. Definitely respect and admiration are not out there anymore. Hard work, long hours of study and personal and financial sacrifice are definitely out there and ahead. i caution anyone to look long and hard at this career because it’s not easy and there is no relief on the horizon.  Be very, very sure that you have a realistic idea of what day-to-day life is like for physicians who are coming out today and not what you see on the telly. None of those shows are remotely close.

Doctor of Medicine

It had been four long years yet I remembered the first day of orientation as if it were yesterday. On that first day, the Dean of Student Affairs called our names. I sat among 125 people who were to become my brothers and sisters over the next four years. The day had started with a breakfast and check-in where we received our little name tags that certified that we belonged there.

I had finished up some paperwork and needed to drop it off in the Administration building so I treked over to this building before my “orientation”. When I passed the Office of Admission, I saw five people sitting there with papers in hand. It occured to me that they were waiting to see if any of us did not show up and that they might slide into our seats. I spoke to one of the gentlemen who was sitting there with his father. He said that he was on the waitlist and that he didn’t see where he could lose anything by coming here today to see if he could snag a seat. He looked at my nametag and said that he guessed that he wouldn’t be getting the one that I held.

One by one, the Deans introduced themselves and gave some words of encouragement. We would be the second class of the new century. We would be molded and shaped into caring physicians who would be on the frontlines of cutting edge healthcare. We were told that for everyone of us standing there, twenty five people wanted to be in the same position. It was heady stuff for some of us who just wondered if we really wanted to be physicians after all. It still wasn’t too late to back out and give that young man over at the administration building my seat in medical school.

The doubts took a back seat to all of the preparations. We were photographed (official IDs) and picked up our microscopes, lockers and slide boxes. We also received our syllabi for our first semesters classes. The syllabi were thick and heavy. I also met my “big sib” who was a second-year student who presented me with every one of her books from first year, her notes and used syllabi (all filled in) and her old exams. She said that her apartment was tiny and that she knew that these things would help me. In retrospect, she was my savior that day. I ended up not having to purchase anything for the first day of class except a heavy sweatshirt (The AC was freezing even though the outside temp was broiling).

My big sib walked me through the first semester pointing out every pitfall. She gave me strategies for doing well in every course (especially Anatomy) and reviewed her system for mastery of first year. Others in her class did much of the same when we had our first class meeting. I ended up taking the job of running the noteservice since I had been a graduate student and had some experience with getting volumes of notes out. It turns out that my notes are still used at our medical school especially the physiology notes. I became infamous.

The first day of orientation went by and the first day of classes went by and the first semester of medical school went by. Thanks to my big sib, I had done well and survived. The first two years went by and then the first rotation went by and soon medical school went by. I found myself standing in line wearing my black robe with doctorial hood (draped over my arm) and my doctorial hat trimmed in green complete with gold tassle. I was about to graduate and become a Doctor of Medicine.

We marched into the graduation hall (to the strains of Pomp and Circumstance) that was packed with family and visitors. My father who had been a physician had died before I had applied to medical school. He always knew that I would be a physician even though I had stubbornly refused to consider medicine as a career. I had been a research scientist because I wanted to discover new truths. Little did I know but medicine was about truth every day.

My uncle, who had been an Batallion Surgeon in the Korean War, placed the hood over my head. He stood at his finest military attention as he and the Dean pronounced that I was now a Doctor of Medicine. I distinctly remember a chill as my name was pronounced with “Doctor” in front of it. I was so different from that woman who stood in orientation on that first day with fleeting thoughts of giving up my seat in medical school.

When the ceremony was over, I looked at my degree (the thing is huge) which was written in Latin. I still have to look at it from time to time to convince myself that I had actually finished four years of medical school. All of the tests and all of the experiences had molded me into to a newly minted physician. I had two months to move and get ready for internship (the time of my life).

When I think back over some of the things that got me through medical school: First, I don’t complain. Complaining doesn’t get the problem solved and only prolongs the agony. I identify the problem and think of several solutions. I never present a problem without presenting at least two solutions as I see them.

Second, medicine is very difficult and I wouldn’t have it any other way. Nothing good comes without sacrifice and struggle. This job is a day to day learning experience that never ceases to amaze me. I often feel as if I have a “window on the world” as I treat every patient. My patients have been my teachers and my links to all humanity.

Third, any medicine is always my job. When a colleague drops the ball, I pick it up as quickly as I can. When something is not done, I get that something done as quickly as possible. We are here for the patients and not for ourselves. Instead of getting angry, I get busy and get the patient taken care of. I practice medicine because I WANT to practice medicine. The patient comes to the hospital because the NEED to come to the hospital. I have the choice, the patient does not have a choice. On my service and in my practice, there is no room for laziness or excuses. Things have to be done and on my watch, they GET done because after all, I am their “Doctor of Medicine”.