Why I don’t understand why everyone and their mom is a premed. Physician salaries decreased by 7% between 1995 and 2003, with primary care physicians being the hardest hit with a whopping 10% decrease in salary. In the meantime, the salaries of lawyers and other professionals rose by 7%. It’s true that doctors make a lot of money anyway and that we shouldn’t complain, but the average graduating med student has upwards of $100,000 in debt, which makes it hard for us to stomach the fact that we worked so hard and will continue working so hard for less money than our predecessors and our professional peers in such a high cost world. I have met my fair share of classmates who refused to go anywhere near primary care because of its “poor” pay. I used to turn my nose up at these classmates because money was never a concern of mine in choosing my career. I just wanted to do what would make me happy. Now if that turns out to be primary care (which thankfully, it isn’t), then so be it. But of course, I’m spoiled by the fact that I won’t be $100,000 in debt when I graduate.
As my thinking has evolved, I’ve come to see that my classmates’ money concerns are indeed valid (though I still don’t think that salary should be the number one deciding factor when it comes to choosing a specialty). We spend four years of our lives toiling away to get our MD, accumulating a mountain of debt while we’re at it. Then we spend 3-7 years in hell residency being paid a paltry sum for being worked to death. Finally, after all of that, we’re finally able to start making real money. By that time, how old are we? How far behind are we compared to our lawyer and other professional friends? We want to buy houses too. Have kids. Maybe buy a new car since that one we’ve been driving since the beginning of college is starting to fall apart. These things all cost money. Money that we don’t have, even though we appear to “make a lot of money.” On top of that, I think that primary care physicians work very hard and deal with more than their fair share of difficult patients. I can’t imagine dealing with patients like my mother-in-law and her “I had surgery on my ankle, now I think I’m going to die from a heart attack and I can’t breathe,” “there’s blood in my stool, scope me NOW even though there are plenty of other patients who need a colonoscopy more urgently than I do” and “doctors give me substandard care because I’m poor and I don’t speak English” antics. I know that difficult patients exist in every specialty, but I think (and I may very well be wrong) that there are far more in primary care because of the primary care physician’s role as a gatekeeper. If anything, primary care physicians should be paid more because of their indispensable role. But in real life, primary care physicians are not paid as much as specialists because of the lack of procedures in primary care. I get it—procedures are expensive. But should specialties that aren’t so procedure-based not be compensated as well as those that are? I have to admit that this reality has made me think twice about neurology because of its relative lack of procedures. It’s a good thing that my love for the brain and the art of diagnosis wins out (at least for now) or else I’d be considering something else. How many med students think that same thing and choose money? Some say that this is not and will not be the case, but I’ve already seen some classmates choose their specialties based on that very thinking. Will there be more in the coming years? Who knows. I’ve met physicians who are well into their careers and still have a whole lot of med school debt left even though they probably came out with half the debt of the modern med school graduate. They’ve hinted at regretting their career choice. There are (costly) seminars on “careers to consider when you don’t want to be a doctor anymore.” These kind of things almost make me think twice about what I’ve chosen to do, but only for a split second because I know that there’s really nothing else that I’d rather be doing. I know that I would still do this even if the salary were half what it is now. But you young premeds out there should think really, really, really hard about whether it’s really worth it. Depending on your goals and motivations, it just might not be.