In 1978, Waylon Jennings and Willie Nelson sang their classic country cover warning mothers to not let their children become cowboys because of the tough and busy life of cowboy culture. Japanese gastroenterologist Kojiro Tokutake wanted to be a doctor since he was a teenager. His grandmother bought him his first stethoscope when he was in medical school. A decade later, he helped her die. Today, this admonition from parents is more common for those wanting to become physicians. In a recent survey, nine out of ten physicians were unwilling to recommend healthcare as a profession. In 2014, the American Medical Association found that 47% of practicing physicians reported high emotional exhaustion, 35% saw less value in their work and 41% were satisfied (not happy, but satisfied) with their work-life balance. The survey went on to identify the three problem areas: Loss of autonomy (75% now are in hospital-owned practices) Mental exhaustion (listing heavy workloads and increased clerical work, due to cumbersome electronic medical records) Asymmetrical rewards (success is expected, but mistakes come with heavy punishments) And then there is the stress, as suggested by that asymmetrical rewards issue. When I was in medical school, an attending’s patient had a cardiac arrest and was in the last stages of a failing resuscitation. As a medical student, I was told to give a bolus of a drug during this “code” while he instructed others to shock the heart for what must have been the 15th time, in an attempt to stop incessant ventricular fibrillation. Instead of giving the medicine slowly, I injected it over a matter of seconds. “You just killed my patient,” he yelled at me. As a naïve med student, I thought I had. I was devastated for days until a more mature resident pointed out that the attending was just taking out his frustration on me. In business school you may have pressure but not like that. To become a specialty physician, it typically requires 4 years of college, 4 of medical school, 3-5 of internship/residency and 3-5 of fellowship, thus 7-14 years after college! And that doesn’t even account for time potentially spent in other education, work, childbirth or childcare. Thus, the typical physician finally enters the workforce close to age 40. Now, for comparison, a college graduate looking at alternative professions can graduate from law school or business school (MBA) with three years of training and begin gainful employment by their mid- to late-20s. Medical students pay a huge tuition for those four years (average $278,000 for private med schools, $208,000 for public schools), on top of prior college expenses and thus leave with an average debt of over $180,000, less only because many get help from their parents. When I graduated from med school in 1975, the average debt was $13,000 (adjusted for inflation, that would be $57,000 in today’s dollars, not $180,000). Today, the post-medical-school years (internship, residency and fellowship) typically pay these doctors still in training about $60,000 a year for 3-8 years. Don’t forget that the average post-graduate physician works 80 hours a week, so that translates to around $14 an hour! Thus, when you factor in the interest on the debt as well as the lost income, by their late-30s, doctors are about $500,000 (yes, a half a million dollars) behind a college graduate entering other professions. Even former Fed Chairman Ben Bernanke’s son graduated from med school with a $400,000 debt. Of course, there are still plenty of applicants to medical school these days. However, some of those are leaving without doing a residency, particularly those that live in med tech areas like Boston and the San Francisco Bay Area. Last year, nearly 60% of Stanford Medical school graduates said they plan to go into a business, research or consulting role rather than practice medicine. Those that go into clinical medicine are increasingly choosing areas where the lifestyle is more manageable with distinct shifts and no call, like emergency medicine or hospital medicine. The “entitlement generation” may actually have it right; often they will choose a specialty where their hours are limited, avoiding the greater stress and on-call responsibilities necessary in other medical specialties. However, as my generation retires, who will be there when we get sick? So, what do physicians recommend to that college student insistent on medicine? There are many areas in medicine with less rigorous educational demands. Work as a nurse practitioner (NP) and physician assistant (PA) offers an attractive option of patient care with only an average of 2-3 years training after college. Typically, these allied health practitioners start earning $85-$120,000 a year, more than their classmates still in medical residency training. The “curves” where the physician’s debt is finally paid off and the salary exceeds the NP or PA only goes to the doctor’s advantage when they reach their late-40s. As physicians are currently working longer due to diminished incomes, the aging physician is another problem currently plaguing medicine. Unlike our sister professions, law and banking, the senior physician does not have a guaranteed income enhanced due to seniority or prior contribution to the field (there are no senior partner positions for docs). Medicine is piece work; you make money only for work performed. In private practice, time off for vacation or illness is not paid. If you aren’t depressed enough, consider this: So are doctors. Older physicians’ suicide rate is 70% greater than the general population for men, 300% for women. One study found that one in three residents (doctors in training after med school) are clinically depressed. Now, so am I. Of course, the grass is always greener, if, that is, you are on the right side of the grass. As I mentioned, few professions allow you to directly help people, truly saving lives, and the satisfaction from that is priceless. When I get to the pearly gates where money won’t buy anything, I will have that to take with me, which is nice. That reminds me of the old joke of the lawyer who goes to heaven and is ushered in to a nicer room than a recently deceased Pope. St. Peter explains, “We have lots of Popes up here but this is our first lawyer!” Hopefully, as the new Administration reconfigures healthcare financing, they will also review the training requirements, compensation and debt load required to become a physician. Until then, Mamas, don’t let your babies grow up to be doctors, at least without understanding the necessary sacrifices. Source
