Both of my parents are doctors. In high school I had real thoughts of going into medicine. They strongly discouraged me towards going into that field. In college I was pushed towards a MD/PhD program by my lab's PI. I thought about graduating at 28-30 and decided against it.
Jr year I interned at Amazon after that experience I knew I made the right decision. It is a really, really hard sell for this current generation to do another 5 years of school with residency and then specialization when you can quickly make 100k+ at a tech company. All of my friends who went into medical school are working hours like 6am-6pm or 8pm-8am. They get like two days off every two weeks. I think there are a bunch of possible solutions but the easiest one is making 5 year medical programs (2 years undergrad, 3 graduate) more common in the US.
My father was a MD and he discouraged me as well of pursuing that path.
My friends who are now doctors make much more money that I do, they are more respected, they don't have to deal with some annoying hierarchy, and their job is meaningful. As for working hours, it really depends on the speciality, and the hours they chose to work. I know some dermatologists who work 4 days a week for instance.
In the end, I don't regret that I chose a different path as I loved maths and programming and I did some interesting things as well. But nowadays I feel just like a worthless pawn, developing crappy programs, who is starting to suffer from age discrimination...
As an MD, I can tell you that your view is extremely skewed. There absolutely is an annoying hierarchy. Endless departmental rules that get in the way of your practice, constant messages from the billing department asking you to edit old notes so the hospital can bill for more, fighting with insurance companies, fighting with pharmacies, fighting with patients...it doesn't really end.
For your friends in derm, I would ask them how hard they had to work to earn their careers. Dermatology is consistently one of the few hardest subspecialties within medicine to get into. You may be able to work 4 days/week later on in your career, but you'll be working non-stop through medical school pumping out research papers and studying for top board scores just to get in to derm. These days, a huge percentage of medical students end up taking an extra year just to get more research out before applying to derm.
FWIW, my current dermatologist, the best I've ever had, has to stitch together a living by working two separate (world class) clinics as well as reviewing pathologies as a side hustle.
It isn't just the time and money side. I personally feel the solution is that most of the time we don't really need a doctor. How many appointments at a primary care are for colds/flu?
We have to switch to largely seeing mid-level providers like PAs or RNs and maybe push even lower. The doctors can be there for the tough cases and to consult and monitor. It is already starting to happen and is one way we can reduce the cost of health care.
Doctors, by way of Boards, limit supply as a way of keeping up wages. They are not overworked because of some lack of sufficiently interested individuals — they are overworked because few others are let into the club.
I love this in theory, but there's a lot of externalities that prevent that from happening. Apologies if I'm missing something, I'm a medical student (soon to be resident) that tries not to think about this too hard. I've thought to comment on this in the past, as this conversation pops up on HN relatively often.
I think we need a solution to two problems: First, figure out how to pay people (the hospital, the students/residents themselves, and the hospital attending physicians who spend their time teaching) to train physicians. Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This is more of a problem for surgeons, as they need x number of cases before they feel comfortable doing that procedure on their own.
For the first problem, there are smarter people than myself who pose solutions. CMS (and DHHS) pay for most of this in the US, and is a fixed amount each year with few changes since 1995. So an obvious solution without trashing our current system would be to just have Congress authorize more funding, about $100k/yr/new resident they are willing to pay for. Hospitals should also consider adding their own funding to pay for more residency spots, which is already happening. Note that hospitals bid on the hahnemann hospital (drexel) residents for about the $100k asking price ($55m for ~550 residents).
For the second, you have to decide how many years you want doctors to be training for, at their reduced salary. If you increase training time, you can achieve the clinical/surgical volume needed to become proficient, at the risk of keeping residents at the hospital for longer than they really want. You could seek out more volume at satellite clinics, but then you force the trainees to have to travel, which makes that specific training program less desirable (at least, it does for me)
I have 2 friends in their 40s who are primary care physicians at Kaiser (one in Bay Area, one in Sacramento). Both have dropped down to 60% time (3 days per week), explaining that 60% time is actually 40 hours. In the last few years Kaiser has added both EHR work and e-medicine work without reducing the number of appointment slots. So, it's about 7 hours per day of appointments and then catching up on all of the deferred paperwork and emails.
But overtime I think doctors will earn more than software engineers. Also doctors are more valued the more senior they are, while software engineers not as much, need to move to management, ageism, etc.
Compared to what's on levels.fyi, most specialties will earn less than software engineers. Only cardiologists, gastroenterologists, radiologists, anesthesiologists, and the surgical specialties will have a chance at out earning someone at FAANG.
On average, doctors earn far more than software engineers. Only a small portion of software engineers can compete with doctors and it's clustered in a few select regions of the US.
I ran into the oncologist that took care of someone close to me in a social setting and we ended up talking for awhile. We were talking about getting ready for the holidays, etc and she expressed a fairly significant guilt about being absent for so many things. That's no wa to live.
It struck me as very sad, as I've heard similar things from other physicians.
On the other hand, a friend of mine is a dermatologist who works three 8-hour days for week and makes 200k+, one yeah after residency. In the end I still prefer doing what I'm doing, but it's not an obviously bad choice.
Meanwhile my dad is an ophthalmologist and at the age of 66 he is talking about how he wants to keep working full time until 70 and then half time after that. Some people are just made for the lifestyle of a physician I guess...
I’m still not sure why most US medical schools want an undergraduate degree. I see lots of people trying to go pre-med doing research in the lab when we should really just cut out the middleman and have medachool admit straight out of high school or the military [in the USA not sure how other countries work]. This would really reduce the amount of time wasted of people that don’t want to go into research. Right now you can go to school for 4+2(MS degree) and make just as much [total comp] as a GP at FAANG+MSFT and get much, much better working hours.
Ideally we would increase the amount of Medicare residencies too. Then everyone could get a residencie and we would also be able to import MD from around the world.
I find this is a common refrain with any profession that regularly has to deal with insurance. I've seen it in medical, home repair and even long standing family auto shops.
The more layers get forced in between the people providing a service and the people receiving the service, the worse things seem to get.
But the flip side to tech is also ageism, which is a serious issue.
Maybe things will get better down the road, 20-30 years from now; But as it is now, a lot of the good paying companies will be very hesitant in hiring you once you're old enough.
It's not that tough of a sell when you consider that many/most medical students are math-phobic and would most likely be unable to obtain a high-paying SWE gig in lieu of becoming a doctor.
There is a significant difference between the skillset that produces a medical student (work ethic and drive) and a SWE (analytical reasoning).
That doesn't seem right to me. They have to get through chemistry and physics. They have to memorize a giant decision tree that they employee when evaluating people, questions to ask. They have to adjust that over time, then they get a speciality and they learn new things.
There's a difference in skill set that is developed over time, but doctors have to be able to have mental models of how bodies work, how things work in the body, "just like us".
Please lobby the AMA to not artificially limit the supply of doctors by creating regulations around residency. I personally know of many people with MDs from India who don't work here as physicians because they could not get a residency 'slot' in the Bay Area where their family lives.
Relevant thread with links on StackExchange: https://skeptics.stackexchange.com/questions/4561/does-the-a...
The AMA isn't limiting the supply of doctors. The actual limit is in the number of residency program slots funded by the US Federal government. If you actually want to increase the supply of doctors then lobby Congress for higher residency funding.
The AMA backs the residency requirement. In my opinion it potentially gives doctors bad habits: Tolerating a miserable sleep schedule, placing too much value on quick diagnosis, equating long hours with effectiveness, and perhaps not placing enough value on teamwork with nurses.
Apprenticeships in many (most?) fields are sponsored by the professional organization (akin to a guild) and paid for by laborers at lower-than-master wages. And yet, here is the AMA itself saying the problem lies with federal government funding. Curious. Seems like a convenient scapegoat.
This is propaganda by the AMA. They are the primary lobbying force on this issue to Congress and they help write most of the legislation. The AMA is the negotiating partner you'd deal with to get this issue corrected.
That's a common misconception quoted by the medical cartel (i.e. MDs), among other ones such as "we should pay doctors 3x the amount Europeans get[1] because they study and burn out so much", which is a self-imposed problem. Congress funding for residency slots is a small part of the puzzle. The larger issues is the medical cartel making it so expensive to go through residency in the first place through excessive requirements. Here's an incomplete list of anti-competitive behaviors of medical cartel that push healthcare prices up in the US:
1. Restricting scope of practice for NPs and other midlevels
2. Restricting new facilities through Certificates of Need
3. Restricting immigration of foreign medical professionals from OECD countries through NCFMEA
4. Increasing costs & duration of medical education
5. Restricting patient's ability to obtain their open record digitally with the purpose of switching providers, or taking control of their health (good luck getting your imaging data from Kaiser if you ever want to leave them and seek better alternatives)
6. Restricting OTC availability of simple drugs available without doctor middlemen in other OECD countries
7. Restricting development of AI systems through data BAAs
8. Restricting scope and speed of processing for de novo and breakthru devices that automate work performed by physicians
None of these have a valid patient safety counter-argument because essentially in every case there is a precedent of safe operation in other OECD countries.
Other honorable mentions include:
1. Fighting against surprise billing legislation
2. Fighting against government's ability to negotiate rates
3. Fighting against public option
4. Fighting against any mention of moving away from fee-for-service
to be fair, there are very few residency spots in the bay area in any specialty anyway. My wife went through the residency match program last year and the bay area programs are ultra competitive because it is a desireable place to live. Adding more residency slots is a good idea, but they're going to be spread across the US.
People underestimate how much of a problem is... There are so many qualified MDs who are underutilized or unable to go into the residency that they'd be most productive in simply because the supply of programs is kept artificially low
My wife just graduated medical school and started residency.
The burn-out affected both of us and we're just starting to get over it.
* Med school is a freaking grind. She was either at class, at rotations, or studying. Pretty much 80+ hours/week for 4 years.
* We had to move a lot, which has limited my social life. Ended up spending a lot of time just "working" while she'd study in the evenings.
* Major life impacting tests nearly every year. Low scores or failures on a single exam can kill any career aspirations.
* Insane debt load. We're looking at total payback costs around $310k. That was with no undergrad debt and my job paying for all living expenses. If you don't become an attending, you're fucked financially.
* Not enough residency spots for the number of medical schools. Less than 80% of candidates matched into a residency spot. Follow on matching is very low.
* That's right, pretty much 1 in 5 doctors will not go on to practice medicine because they cannot get a residency position.
* Residency salaries are complete shit. It's not unheard of for residents to have to take out loans to payback loans during residency.
* Resident have absolutely no leverage. They are literally slaves to the program they're "matched" to. Program director changes, hospital gets bought out, peers are insufferable - sucks to be you, you're stuck until you graduate.
* Financially being a doctor doesn't make any sense. Everyone looks at doctor's salaries, but completely forgets about the 8 to 10 years doctors (a) make nothing (b) pay for education (c) make pennies. Even with the "doctor salaries", it will take my wife well into our 50's to be financially ahead had simply pursued a career in her STEM field. There's a lot of life that can be live in 30 years that a "big house and a fancy car" doesn't make up for.
* Mid-levels and lesser credentialed, like PA's and NP's, providers are being allowed to take on more and more responsibility. For medicine overall, I think this is the right direction. I believe technology means mid-levels can function at a much higher level than in the past. For physicians, it sucks because it's killing any financial incentives.
I could rant for hours about all of the bullshit my wife went through (and, lesser myself).
If you're thinking of becoming a doctor, do yourself a favor and do something else.
If you really want to work in medicine, becoming an NP or PA is a looking like an increasingly attractive route.
Thank you so much for posting this. If you rant on about this for hours in this thread, I for one would be interested.
I have a feeling that your observation that, "Mid-levels and lesser credentialed, like PA's and NP's, providers are being allowed to take on more and more responsibility. For medicine overall, I think this is the right direction. I believe technology means mid-levels can function at a much higher level than in the past. For physicians, it sucks because it's killing any financial incentives." is dead on.
Further I think the technology side really has to start servicing the physician. A GP's office doesn't have to be the place to get an ECG, and a GP doesn't even necessarily have to see the readout barring some kind of change over time. So much of that should be automated and/or done in specialized clinics. I know how it's complicated by data format standardization, privacy, security, and regulation but it's a shame that we can help doctors be more efficient. I will spare the rant about slightly (and slighty justified if I'm being fair) Luddite tendencies among physicians.
Speaking as someone who quit after medical school and codes professionally (going on 10 years), I'd suggest temperance on the recommendation. Debt is high but so is salary, if they are in it for the long haul they'll be just fine. If you think you want to be a physician, shadow some. If you like what they do, you might like being a physician. I met many doctors who I think would be happier not being a physician, but also many that I think wouldn't be happy doing anything else. I'm happy with my decision overall but frankly i couldn't imagine going back as an NP, PA, Dentist... or anything in the field that wasn't an MD. Those all have much better work life balance, but you need to realistically understand what it means to do each if you want to be happy, and select the one that feels right. (And if it doesn't feel right, Dentistry has the absolute best work life balance, pay, and ability to help people who legitimately need it).
> Debt is high but so is salary, if they are in it for the long haul they'll be just fine.
This is exactly why I recommend against medicine. You have to be in it for the long haul. If you find you hate medicine in your 3rd year (when rotations typically start), you're already $100k in debt.
Hi, do you have an email I could reach you/your wife at? I'd like to include what you wrote above in a post on my career website (http://www.kareerday.com), with your permission, as well as ask you/her about her job.
FYI: posts on the site are anonymous.
If you'd prefer not posting your email here, you can reach me at steven@kareerday.com
My wife just got her NP. After her BSN an MSN/NP she has like $200k in debt. Last year was really busy with her training schedule plus school plus life with kids. From where I'm standing our picture isn't a whole lot rosier than yours.
I was interested in medicine in high school. I was able to shadow a few physicians and talk about career options. At the time I was shocked that most of the physicians I talked to said they would take a different career path if they could do it over again.
The common theme was that they felt it used to be a respected profession but now they’re broadly just cogs in a healthcare system that given them little freedom for professional discretion and lots of paperwork.
I would like to see the data sliced by employed vs independent physicians.
Independents (a majority of physicians) need to deal with all the billing and insurance headaches that now come with the industry, and have to deal with setting up their own EHR to deal with it.
Employed physicians in an integrated health system and plan (like Kaiser or Geisinger), in theory don't have to deal with those aspects as much, and can concentrate more on the patient.
Would be good to see if there is a correlation there.
>Employed physicians in an integrated health system and plan (like Kaiser or Geisinger), in theory don't have to deal with those aspects as much, and can concentrate more on the patient.
"Employed" physicians no longer deal with patients, they are called customers. Helps to keep customers happy and physicians focused on the profit motive.
Wouldn't the profit motive be stronger for an independent physician since they actually directly profit, rather than facing indirect pressure based on your employer's profit motive?
It seems like the days of the independent physician are drawing to a close. Many independent practices have become physician groups which in turn have been bought by hospitals. (Perhaps specialists are still largely independent, but general outpatient medicine seems to have become largely corporate.)
Many physicians I know have a boss, and have to meet metrics about how many patients they see ever year in order to get their incentive bonus. Physicians who work for hospitals are viewed as "loss leaders", and find their appointment times squeezed to twenty, fifteen, or even twelve minutes per patient. (The idea is that for every n visits, a patient will be referred to a profitable service provided by the hospital.)
You can't be independent anymore and bear the cost of electronic records, so the options are to stop accepting insurance (cash only) or join a large practice, usually run by, or at least associated with, a hospital, for access to their records system.
I know it's only anecdotal but my brother in law is a doctor at a large hospital (employed physician) and he sees patients 9-5 but he's at the hospital from 7am-8pm doing prep, research and patient notes. That also doesn't count the nights/weekends when he's on call for the ER (usually takes calls from home but occasionally has to go in too). He basically only sees his kids on the weekend.
I worked similar hours for a few years while coding and I expect he will (but hope he doesn't) burn out eventually. It's obviously not sustainable.
I realize from the comments here that I wasn't as clear as I intended. I conflated "employed" with "employed in an integrated system with a health plan." Having an integrated insurance plan run by the provider in theory aligns incentives to keep patients healthy rather than fight over billing.
Strangely, this "report" is a set of slides. It would have been useful if there was more information about how the Medscape authors conducted this study. On slide 28, it says the sampling size was "15,181 physicians across 29+ specialties met the screening criteria and completed the survey". What was the screening criteria and how many physicians did Medscape initially reach out?
I'm sure this isn't the case for every doctor, but what I've observed is that scale seems to be killing everything. When you have 10 minutes with a patient, have no long-term relationship, ship them off to a specialist that has even less context of their overall health, and ultimately just prescribe them meds to treat a symptom, that person does not get healthier. Over thousands of patients that starts to challenge any sense of moral obligation you originally had when entering the field. Then you become disillusioned and burn out.
The irony is the part about everyone becoming less healthy. That creates more demand for medical services. Rinse, repeat. We truly have the worst system imaginable in the US. It evolved over time. It's nobody's fault. It's everybody's fault. It needs to be burned down and rebuilt. It seemed like we had a chance with the ACA but it was pretty clear early on that it wouldn't fix the root causes and it hasn't.
There’s a few doctors in my city who charge a $50 a month fee for a 30-39 year old and you can call and see them whenever. Insurance doesn’t cover it at all. I’d also imagine if you tried to really abuse the relationship and show up constantly for no reason the doctor might fire you. I feel like it’d encourage a relationship of respect both ways.
I interviewed a couple of them and one talked to me for an hour about health and diet and exercise, just a friendly chat to see if I wanted to use him. He said he was getting ready to retire from medicine after years of ER work when his doctor friend encouraged him to try direct primary care. It was so different than the regular medical system, cutting out all the middle men.
My parents have a concierge medicine relationship with their physician. It's fantastic. He is a complete professional who cares deeply about all of his patients (he works nights and weekends, does research outside of business hours, works around insurance and exploits every legal loophole possible to help them) but holy crap is it expensive. They are paying for their normal insurance plus this service ($3000 annually). This is what it's come to in the US---to be able to have a semblance of a relationship with your physician you need to pay a premium on top of the gouging that your "insurance" already charges you.
Note: My parents are not* rich, they scrape by on social security and my dads part time work fixing sprinkler systems.
"I’d also imagine if you tried to really abuse the relationship and show up constantly for no reason the doctor might fire you." My worry with something like this would be the doctor firing me as a patient as soon as I became unprofitable for any reason. Sure if the doctor is good you'll be fine, but how can you really know until you need to know?
> When you have 10 minutes with a patient, have no long-term relationship, ship them off to a specialist that has even less context of their overall health[...]
If you see the same primary care physician and the same specialists (or is it just a random specialist in the US?), wouldn't that establish a long-term relationship with each? Plus your medical file should give any of them more context on your preconditions, history and general health.
(That's the case here in Israel and -- after googling -- the US too, but feel free to correct me)
Physician practices get absorbed by large national corporations and patient care gets reduced to metrics that administrators can tweak to extract more revenue and profit. The benefits get paid to administrators as bonuses, while physicians see their salaries stagnate.
The corporitization of physician practices is destroying the profession.
The country also wants more supply of healthcare, at lower prices, while the supply of doctors remains constrained via the restriction on number of residency training spots each year. This is the root cause, insufficient supply in the face of demand, and it is manifesting itself in these various side effects.
This is incorrect. There is no supply/demand relationship for pricing services. Doubling the number of trained physicians will not decrease healthcare costs, it will simply drive down physician annual income.
The main driver of inflated healthcare costs is administrative waste: hospital management, insurance management, government management.
Readit News
Jr year I interned at Amazon after that experience I knew I made the right decision. It is a really, really hard sell for this current generation to do another 5 years of school with residency and then specialization when you can quickly make 100k+ at a tech company. All of my friends who went into medical school are working hours like 6am-6pm or 8pm-8am. They get like two days off every two weeks. I think there are a bunch of possible solutions but the easiest one is making 5 year medical programs (2 years undergrad, 3 graduate) more common in the US.
My friends who are now doctors make much more money that I do, they are more respected, they don't have to deal with some annoying hierarchy, and their job is meaningful. As for working hours, it really depends on the speciality, and the hours they chose to work. I know some dermatologists who work 4 days a week for instance.
In the end, I don't regret that I chose a different path as I loved maths and programming and I did some interesting things as well. But nowadays I feel just like a worthless pawn, developing crappy programs, who is starting to suffer from age discrimination...
For your friends in derm, I would ask them how hard they had to work to earn their careers. Dermatology is consistently one of the few hardest subspecialties within medicine to get into. You may be able to work 4 days/week later on in your career, but you'll be working non-stop through medical school pumping out research papers and studying for top board scores just to get in to derm. These days, a huge percentage of medical students end up taking an extra year just to get more research out before applying to derm.
Even MD's still have to deal with some annoying hierarchy or another, unless they own their own practice.
You can join open source. For example, at dlang.org we don't care how old you are, and we won't pull crappy code.
We have to switch to largely seeing mid-level providers like PAs or RNs and maybe push even lower. The doctors can be there for the tough cases and to consult and monitor. It is already starting to happen and is one way we can reduce the cost of health care.
EDIT: > It is already starting to happen and is one way we can reduce the cost of health care.
To the downvoters, I'm replying to this part of the comment, not the overall thread.
I think we need a solution to two problems: First, figure out how to pay people (the hospital, the students/residents themselves, and the hospital attending physicians who spend their time teaching) to train physicians. Second, figure out how many clinical/surgical encounters a physician in training needs to truly be competent when they complete their training. This is more of a problem for surgeons, as they need x number of cases before they feel comfortable doing that procedure on their own.
For the first problem, there are smarter people than myself who pose solutions. CMS (and DHHS) pay for most of this in the US, and is a fixed amount each year with few changes since 1995. So an obvious solution without trashing our current system would be to just have Congress authorize more funding, about $100k/yr/new resident they are willing to pay for. Hospitals should also consider adding their own funding to pay for more residency spots, which is already happening. Note that hospitals bid on the hahnemann hospital (drexel) residents for about the $100k asking price ($55m for ~550 residents).
For the second, you have to decide how many years you want doctors to be training for, at their reduced salary. If you increase training time, you can achieve the clinical/surgical volume needed to become proficient, at the risk of keeping residents at the hospital for longer than they really want. You could seek out more volume at satellite clinics, but then you force the trainees to have to travel, which makes that specific training program less desirable (at least, it does for me)
Grossly over-simplified, I know.
It struck me as very sad, as I've heard similar things from other physicians.
Ideally we would increase the amount of Medicare residencies too. Then everyone could get a residencie and we would also be able to import MD from around the world.
The more layers get forced in between the people providing a service and the people receiving the service, the worse things seem to get.
Maybe things will get better down the road, 20-30 years from now; But as it is now, a lot of the good paying companies will be very hesitant in hiring you once you're old enough.
There is a significant difference between the skillset that produces a medical student (work ethic and drive) and a SWE (analytical reasoning).
There's a difference in skill set that is developed over time, but doctors have to be able to have mental models of how bodies work, how things work in the body, "just like us".
https://www.ama-assn.org/press-center/press-releases/ama-fun...
https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
1. Restricting scope of practice for NPs and other midlevels
2. Restricting new facilities through Certificates of Need
3. Restricting immigration of foreign medical professionals from OECD countries through NCFMEA
4. Increasing costs & duration of medical education
5. Restricting patient's ability to obtain their open record digitally with the purpose of switching providers, or taking control of their health (good luck getting your imaging data from Kaiser if you ever want to leave them and seek better alternatives)
6. Restricting OTC availability of simple drugs available without doctor middlemen in other OECD countries
7. Restricting development of AI systems through data BAAs
8. Restricting scope and speed of processing for de novo and breakthru devices that automate work performed by physicians
None of these have a valid patient safety counter-argument because essentially in every case there is a precedent of safe operation in other OECD countries.
Other honorable mentions include:
1. Fighting against surprise billing legislation
2. Fighting against government's ability to negotiate rates
3. Fighting against public option
4. Fighting against any mention of moving away from fee-for-service
[1] https://www.medscape.com/slideshow/2019-international-compen...
The burn-out affected both of us and we're just starting to get over it.
* Med school is a freaking grind. She was either at class, at rotations, or studying. Pretty much 80+ hours/week for 4 years.
* We had to move a lot, which has limited my social life. Ended up spending a lot of time just "working" while she'd study in the evenings.
* Major life impacting tests nearly every year. Low scores or failures on a single exam can kill any career aspirations.
* Insane debt load. We're looking at total payback costs around $310k. That was with no undergrad debt and my job paying for all living expenses. If you don't become an attending, you're fucked financially.
* Not enough residency spots for the number of medical schools. Less than 80% of candidates matched into a residency spot. Follow on matching is very low.
* That's right, pretty much 1 in 5 doctors will not go on to practice medicine because they cannot get a residency position.
* Residency salaries are complete shit. It's not unheard of for residents to have to take out loans to payback loans during residency.
* Resident have absolutely no leverage. They are literally slaves to the program they're "matched" to. Program director changes, hospital gets bought out, peers are insufferable - sucks to be you, you're stuck until you graduate.
* Financially being a doctor doesn't make any sense. Everyone looks at doctor's salaries, but completely forgets about the 8 to 10 years doctors (a) make nothing (b) pay for education (c) make pennies. Even with the "doctor salaries", it will take my wife well into our 50's to be financially ahead had simply pursued a career in her STEM field. There's a lot of life that can be live in 30 years that a "big house and a fancy car" doesn't make up for.
* Mid-levels and lesser credentialed, like PA's and NP's, providers are being allowed to take on more and more responsibility. For medicine overall, I think this is the right direction. I believe technology means mid-levels can function at a much higher level than in the past. For physicians, it sucks because it's killing any financial incentives.
I could rant for hours about all of the bullshit my wife went through (and, lesser myself). If you're thinking of becoming a doctor, do yourself a favor and do something else.
If you really want to work in medicine, becoming an NP or PA is a looking like an increasingly attractive route.
I have a feeling that your observation that, "Mid-levels and lesser credentialed, like PA's and NP's, providers are being allowed to take on more and more responsibility. For medicine overall, I think this is the right direction. I believe technology means mid-levels can function at a much higher level than in the past. For physicians, it sucks because it's killing any financial incentives." is dead on.
Further I think the technology side really has to start servicing the physician. A GP's office doesn't have to be the place to get an ECG, and a GP doesn't even necessarily have to see the readout barring some kind of change over time. So much of that should be automated and/or done in specialized clinics. I know how it's complicated by data format standardization, privacy, security, and regulation but it's a shame that we can help doctors be more efficient. I will spare the rant about slightly (and slighty justified if I'm being fair) Luddite tendencies among physicians.
This is exactly why I recommend against medicine. You have to be in it for the long haul. If you find you hate medicine in your 3rd year (when rotations typically start), you're already $100k in debt.
FYI: posts on the site are anonymous.
If you'd prefer not posting your email here, you can reach me at steven@kareerday.com
The common theme was that they felt it used to be a respected profession but now they’re broadly just cogs in a healthcare system that given them little freedom for professional discretion and lots of paperwork.
I ultimately didn’t pursue medicine.
Independents (a majority of physicians) need to deal with all the billing and insurance headaches that now come with the industry, and have to deal with setting up their own EHR to deal with it.
Employed physicians in an integrated health system and plan (like Kaiser or Geisinger), in theory don't have to deal with those aspects as much, and can concentrate more on the patient.
Would be good to see if there is a correlation there.
"Employed" physicians no longer deal with patients, they are called customers. Helps to keep customers happy and physicians focused on the profit motive.
Is this still true?
It seems like the days of the independent physician are drawing to a close. Many independent practices have become physician groups which in turn have been bought by hospitals. (Perhaps specialists are still largely independent, but general outpatient medicine seems to have become largely corporate.)
Many physicians I know have a boss, and have to meet metrics about how many patients they see ever year in order to get their incentive bonus. Physicians who work for hospitals are viewed as "loss leaders", and find their appointment times squeezed to twenty, fifteen, or even twelve minutes per patient. (The idea is that for every n visits, a patient will be referred to a profitable service provided by the hospital.)
Independents likely have it easier as their EMR are less complex and they have fewer people to coordinate with.
EMRs in general have little to do with patient care. They are glorified billing systems.
I know it's only anecdotal but my brother in law is a doctor at a large hospital (employed physician) and he sees patients 9-5 but he's at the hospital from 7am-8pm doing prep, research and patient notes. That also doesn't count the nights/weekends when he's on call for the ER (usually takes calls from home but occasionally has to go in too). He basically only sees his kids on the weekend.
I worked similar hours for a few years while coding and I expect he will (but hope he doesn't) burn out eventually. It's obviously not sustainable.
Strangely, this "report" is a set of slides. It would have been useful if there was more information about how the Medscape authors conducted this study. On slide 28, it says the sampling size was "15,181 physicians across 29+ specialties met the screening criteria and completed the survey". What was the screening criteria and how many physicians did Medscape initially reach out?
I wish the WSJ asked these types of questions.
The irony is the part about everyone becoming less healthy. That creates more demand for medical services. Rinse, repeat. We truly have the worst system imaginable in the US. It evolved over time. It's nobody's fault. It's everybody's fault. It needs to be burned down and rebuilt. It seemed like we had a chance with the ACA but it was pretty clear early on that it wouldn't fix the root causes and it hasn't.
I interviewed a couple of them and one talked to me for an hour about health and diet and exercise, just a friendly chat to see if I wanted to use him. He said he was getting ready to retire from medicine after years of ER work when his doctor friend encouraged him to try direct primary care. It was so different than the regular medical system, cutting out all the middle men.
Note: My parents are not* rich, they scrape by on social security and my dads part time work fixing sprinkler systems.
If you see the same primary care physician and the same specialists (or is it just a random specialist in the US?), wouldn't that establish a long-term relationship with each? Plus your medical file should give any of them more context on your preconditions, history and general health.
(That's the case here in Israel and -- after googling -- the US too, but feel free to correct me)
The corporitization of physician practices is destroying the profession.
The main driver of inflated healthcare costs is administrative waste: hospital management, insurance management, government management.
So they’re applying “agile project management” then?