my life, my pace

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.

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1. don’t become a doctor if you want money, power, and respectThis post is in response to a question from a reader about med students' motivations for pursuing medicine. You/I would hope that the people that we trust our lives to when we are sick and most vulnerable are saints--people who are in it because they truly desire to help people and not because they are greedy and power-hungry. Well, we all know (or at least I think we do) that not all doctors are saints. And I've wondered more than once how the "rigorous" screening process that is the medical school admissions process allows some of these less-than-saintly people to slip through the cracks. So how many of my classmates would I say are in it for less-than-saintly reasons? Maybe I have a skewed view because my ex-boyfriend was one of these people (don't even ask why I subjected myself to such a person in the first place) and was forever bashing my more altruistic motivations for medicine and searching for the holy grail of medical specialties (one that involves the least amount of training while allowing for the best lifestyle and the most money), but I would say that about 10% of my class had less-than-saintly motives for being there. Who knows how many others were just very good at hiding their less-than-saintly ways. Sure, I think that people who pursue medicine based on less-than-altruistic motivations do the profession and their patients a huge disservice. But at the same time, I don't understand how they came to the conclusion...
2. no reason (season 2, episode 24)FOREMAN: And why do we care? HOUSE: Because we’re human beings. That’s what we do. HOUSE: Where are you going? FOREMAN: You're an ass. HOUSE: I know. Where are you going? Judging by the oily buildup in your hair, I say you’re lying. I always say if you’re gonna get shot, do it in a hospital. I got shot. Diagnostically boring. Big fat tongue on the other hand. Endlessly entertaining. CAMERON: Lie down. You’ve got to be in pain. HOUSE: Not today. Today, I’m on morphine. You can’t because that would involve physically touching me and then things would get so sexually charged. I’m twice your size. Get your hands off me. Since getting shot is not an FDA-approved treatment for anything, it means something must have gone wrong in the surgery. MORIARTY: She lived. You cured her. HOUSE: I’m truly sorry I did that. Now I’ve gotta pay because you couldn’t keep your little killer in your pants. Don’t worry. It’s not insulting, at least not to you. Sevens marry sevens. Nines marry nines. Fours marry fours. Maybe there’s some wiggle room if there’s enough money or somebody got pregnant, but you’ve got at least three points on your husband and your frock says you didn’t do it for the money and your breasts say that you haven’t had any kids. I remember. I was there. If you kept your pistols in your pants— Here’s how life works. You either get to ask for an apology or you get...
3. of white coats and stethoscopes…Some medical schools have moved away from the white coat ceremony tradition to embrace a new tradition of presenting students with stethoscopes to symbolize the beginning of their journey to becoming physicians. The white coat separates doctors from patients by creating professional distance, whereas stethoscopes are tools that connect doctors and patients. A white coat is not necessarily essential to being a physician while a stethoscope is. Along the same lines, white coats are so prevalent in the health care industry that it diminishes the significance of the ceremony. Current ad campaigns depict pharmacists as “the other white coat.” What’s next? Physicians are so much more than a white coat. We are healers. We are patient advocates. We are lifetime students of medicine. So I think a stethoscope ceremony is a great idea—give us something that we can use to help us listen to patients’ bodies and not a rather useless coat that doesn’t really set us apart from any number of health care professionals. ...

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