I Wouldn’t Choose Medicine Again #illumedati 1

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Hi everyone, it’s Medicine Mondays and I’m here to ponder “I wouldn’t choose medicine again”.

Not me…. but for those who wouldn’t.

Stock Photo from: Pexels

So @KeeblerOrganElf posted this on Twitter on Sunday:

My response was:

Her response was:

She’s right. It IS odd.

As you may recall from my prior post – Would you do it again? For me, yes I would do it again.

However, during training (residency especially), it would have been difficult for me to recommend medicine. All that said now, I will neither push or pull my children to go into medicine.

So let’s discuss…

Why wouldn’t you choose medicine again?

I’ve alluded to some of these reasons in my past posts.  But let’s try to discuss them in more detail:

The Track is Long.

It may not seem all that long when you just talk about it in passing.

“7+ years of postgraduate education”

However, it’s not just the time.

It’s the part of your life that you lose control of.

The two more common scenarios would be getting out of college and starting a job at 22 versus finishing postgraduate training at 29+. Even if you took the shortest path through medical school (barring accelerated BS/MD programs), essentially all of your 20s will be devoted to medicine. You won’t have your first real job until you’re 30.

Then there is being behind in saving for retirement:

For example, let’s say you finished undergraduate with an engineering or computer science degree. Regardless of how the job market is doing at the time, if you are knowledgeable and flexible, you should be able to find a job.

So a normal entry level engineering or computer science degree job begins at around the age 22. At 22, you should have access to the company 401k and start saving your retirement. If you fast forward 7 years, you should be a mid-level or senior level engineer or programmer. You will gained a lot of on the job experience and are working toward mastering your trade.

If you contrast this to someone on the medical student track, they will have just finished their training (if a 3 year residency). They will be starting their first job in which they will make more than the engineer/programmer above. However, they are also 7 years behind on saving for retirement. Unless they were able to contribute to a Roth 401k/403b in Residency.

“7 years behind doesn’t sound like much”

…but let’s just calculate it: Compound Interest Calculator

If we assume both of these individuals work until they are 60, then the engineer will have worked for 38 years and the physician will have worked for 31 years.

So, 1, $1500/month ($18000/yr), 38, 6% =$2,446,284.86

So, 1, $1500/month ($18000/yr), 31, 6% = $1,526,436.28

In this particular example, that 7 years is worth ~ $1 million.

Student Loans are huge.

Average Student Loan Debt continues to increase. This is even worse for physicians since we have 4 years of postgraduate schooling, and then an additional 3+ years of training. This allows the compound interest to accrue as it is difficult make a significant dent in them on a resident’s salary.

I talked about this a little bit in my post The New Meta of Medicine. I talked about how the average student loan debt has increased significantly since 1979, even when adjusting for inflation. However, physician salaries have remained relatively stagnant when adjusting for inflation.

As a small side project, I asked Twitter what the average student loan debt for 4th year medical students and interns this year will be:

Results were interesting. It was a relatively even spread. Granted, I forgot to specify that I meant US Medical Students, but I don’t think that skewed the poll that much.

I honestly expected more to be in the >$300k category, but after looking at some prices, the $200k-$300k makes a lot of sense.

Physician Suicide is a real, but silent problem.

Unfortunately, the culture of medicine is “suffering in silence” culture. For some reason, there is this culture of not wanting to appear weak. For this reason, I believe that depression and other psychiatric diagnoses go underdiagnosed, especially within the medical community.

It also doesn’t help that every time you try to get a medical license or do a credentialing application you have to disclose if you have a psychiatric diagnosis, and if it has ever effected your work.

As I stated before, physicians are a high risk population with a high success rate.

From the American Society of Suicide Prevention:

Physicians who took their lives were less likely to be receiving mental health treatment compared with nonphysicians who took their lives even though depression was found to be a significant risk factor at approximately the same rate in both groups.

The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced — 2.27 times greater than the general female population.

Source

Physician Burnout is increasing.

I eventually want to dedicate a whole post to Physician Burnout, because it’s a hot topic that isn’t very well understood.

It has been attributed to many, many things, but I think burnout is different for different people across different specialties. However, as I’ve previously stated, I don’t think Physician Burnout is a mid-career issue. I honestly think it is an early career concern, and the seeds of this may even occur during medical school.

To be honest, this may even be the normal progression of our training. (this is a little bit exaggerated, but is to illustrate a point)

  • Start as a bright-eyed medical student ready to change the world.
  • Keep your nose in a book for 2 years and shut out communication with the outside world to get the top grades and highest USMLE score.
  • Start clinical rotations and spend every day trying not to make a mistake. Study like crazy for the shelf in fear that you may not get honors.
  • Get into residency and work 80 hour weeks like clockwork until residency ends, 3-7+ years later.
  • Start your job where you may even work harder than residency.
  • Do your best to help as many patients as possible under a time crunch and budget crunch.
  • Get called to a meeting about your Press-Ganey scores being low because a patient was angry that you wouldn’t prescribe what they wanted.
  • 30+ years old, $300k in debt, 7+ years behind in retirement, trying your very best to help patients despite the weight of the world on your shoulders.
  • Then some big media outlet calls doctors “overpaid” and the “problem with healthcare”.

I think that’s enough to extinguish any light.

Some of our best and brightest aren’t continuing on to residency.

I think if you asked anyone about a prestigious medical school, that Stanford and UCSF would definitely be on that list.

However, why are only 68% of Stanford medical school graduates (and only 79% of UCSF grads) continuing on to residency? Source (npr.org 2011)

Yes, I do understand that this may be the “Silicon Valley effect”.  So maybe it just easier for medical students to consider a job in digital health tech and start-ups, but is that all that is happening here? We’re talking about probably the best and brightest of our generation not practicing clinical medicine. Instead they are leveraging their experiences in healthcare during medical school to do other things to change medicine.

Excerpts from the article include:

“I realized that the system isn’t designed for doctors to make the real change you would like to for the patient.” Eichstadt concluded that she could make a bigger impact elsewhere.

“I never thought I would leave medicine,” said Eichstadt, who now works at Grand Rounds Health, a San Francisco-based startup that helps patients access second opinions from top medical experts online. “But there’s such a rich opportunity at companies here.”

As Sean Duffy, the CEO of Omada Health and a Harvard Medical School dropout put it: “I wanted to understand what’s in the trenches, so I could redefine the trenches.”

“I loved working with patients but I looked around me and realized that I didn’t want the jobs of anybody who had ‘succeeded’ as a clinician,” said Rebecca Coelius, who graduated with a medical degree from UCSF.

Anything else?

Yes.

Even with all the above reasons, many, many physicians are still very fulfilled individuals. I for one can’t imagine doing anything else.

However, I do understand those that question whether they would do it again.

I questioned it for much of my residency to quite honest, and even during my first few years as an attending. It’s a combination of all the factors above. We are all just trying to push forward, hoping that the next step is better.

I think we are looking for that point where it “all comes together” and it “was all worth it”. For some it is/was. For others, it isn’t/wasn’t.

Going into medicine is like gambling 10 years of your life on the tortoise. Sometimes, no matter how much you believe in your tortoise, you look over at the hare. He is miles ahead of you and wonder why you made that choice. For some the tortoise “catches up” at the end. For others, he doesn’t.

I was lucky.

TL;DR

How much is your 20s worth?

How much debt is too much debt?

How many physicians must commit suicide before we change our culture?

How many physicians must burn out before the light is gone?

At what point we will push all of our best and brightest out of medicine?

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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