<p>It is scary. One thing that I think is going to happen, because all this is going to hit as a "perfect storm" with the aging of the population, is that fewer and fewer visits will actually be to a doctor - more will be to practice extenders like NPs and PAs. You will get more automated phone systems. Internists, FPs and pediatricians will provide less and less care in the hospitals - hospital visits are very inefficient for these folks, etc.
Because of the aging population, the opportunities and the job security wil be there in the future - what the compensation and job satisfaction will be like is anyone's guess.</p>
<p>jen: My sister (FP) has worked part-time since residency--first office only for a series of group practices, then doing pre-natal care at a charity clinic. Now she has six children (husband is a pediatrician) and works only 8-12 hours a week at an urgent care clinic and occasionally fills in for vacationing docs for hourly pay. She still does volunteer work and gives talks at conferences around the country. Another doc I know (FP) negotiated a four-day week (lower salary) right out of residency to have more family time.<br>
I'd say part-time work is possible, but these jobs are hard to find--you have to look for them or create them yourself--and are low pay, low status. You will always be able to find work, but might have a lot of career instability. </p>
<p>Regarding government service, we have a friend (FP) in the Public Health Service. He had his med school paid (earned a salary), was assigned a residency, and has worked on Indian reservations. We felt sorry about his 7-year payback, but he stayed in after that and will be retiring in just a few years (after 20 years, I believe). Now we're envious about that early retirement! My point is,
you don't necessarily have to go military. VA jobs are similar--maybe lower status and pay, but generous benefits--lower stress is my impression.</p>
<p>
[quote]
'no big deal - I'll just marry well.' ha!
[/quote]
</p>
<p>I'm encouraging both my kids to do the same thing.</p>
<p>Seriously, who you marry, what their ambitions are, has a huge impact on the final satisfaction. Medical marriages, more than most, need many sincere discussions about what is important and how this will work.
Atomom's sister has had the flexibility to do what she has because her husband is an MD, in a specialty, that, while not the best paid, has job security.
I'm the main breadwinner in our family, my income has freed my husband to do something he loves, is superb at doing, but gets paid very little for (high school teaching) - as my job has become less secure, on and off during the years, we have learned to count the days not to retirement, but until the day that we could live on his salary if necessary. I have to work, and I have to make a pretty good living, even though our lifestyle is not ostentatious by the standards of some of my colleagues.</p>
<p>When I was in med school, medical marriages were just beginning to be common - not Oh wow, two docs, but OK, two doctors. Now there is a branch of the match for couples - this was a big issue when I was a student, how did you end up in the same city, lots of compromises. Now we understand that after residency, 2 doc families, especially 2 generalists like Atomom's sister, have much more flexibility than many other physician/spouse combos.</p>
<p>Hubbell's dad:</p>
<p>Cangel,</p>
<pre><code> Your comment about a 'perfect storm' is very prescient. An article in our Sunday newspaper noted that 40% of all practicing physicans are over the age of 50. The retirement of the large baby-boomer cohort of physicians(of which I am a card-carrying member) will coincide with a huge demand for medical services(those baby-boomers again). Perhaps the law of supply and demand will ratchet up physicians salaries or cause a health care crisis in the country. I agree with you on this point-I see storm clouds gathering as well.
</code></pre>
<p>Hubbell's dad - yeah I'm skirting on the low side of 50 - tail end of baby boom. Something has to give - big bubble of MDs retiring, many MDs coming on who for many reasons may not have as many productive workdays as those they are replacing, increasing numbers of patients because of demographics, immigration being such a political hot potato - sheesh.</p>
<p>I am not discouraging my daughter from medicine, but I am trying to be realistic.
How do you teach a kid about what careers are available when teaching nursing farming and medicine are all your family knows?</p>
<p>As the demand in my high cost of living area increases, and fewer young doctors can even consider living here, I am watching doctors employ new business practices to make more money. It is now getting common here for good doctors to have nothing to do with insurance companies. You pay them in full and submit whatever bills you want to your insurance company. Their rates are such that you might get 50% back. They are also asking if you want to join their "networks" for several humdred dollars per month which entitles you to their cell phone number and other perks. Finally, house calls are now available for a premium. </p>
<p>I think many have had a hard time implementing such practices, but these people have families to support in a very expensive part of the Country. It's hard to say they don't deserve a decent upeer middle class income after all they've put in.</p>
<p>As I wrote previously, my sister-in-law & some of her friends are very happy with their part-time practices as dermatologists. She works MWF (maybe 24 hours/week) & has call or weekend work once every 5 weeks. She's married to an opthamologist who works for managed care (Kaiser) & he has a very good quality of life--is able to take vacation to help coach his 4 kids, takes vacation when the kids are on vacation, has guaranteed pension & good med benefits, etc. He works very sane hours & makes a good living. He doesn't have to deal with malpractice insurance or getting reimbursed. They're both in their mid-40s.
I know of another physician who is a pediatrician who "fills in" when other docs go on vacatoin. None of the other docs our family has seen are part-timers.</p>
<p>A fascinating thread. DS is about to start pre-med in August. I could show him the thread, but frankly it would be over his head. Let him make some "A's" and perhaps the thread will be useful in a few years. </p>
<p>When talking of school debts as a source of MD unhappiness, I do think that you should factor in the strictly unnecessary cost of expensive privates for future MD's, as undergrad can be as expensive as med school.</p>
<p>Hey, we've had the threads on lawyers and doctors. Can someone start one on engineers, or investment bankers etc. This is fascinating to see how people feel about their careers. I have been trying for 20 minutes to figure out how to start a new thread.</p>
<p>texdad, go to the parents forum page. Right above the threads is a small box that says new threads. Click on it.</p>
<p>jen - at least here in Birmingham,Al, it has been fairly easy to line up part-time work. We have a young woman with two infants that will be entering our GI call schedule soon. She will work a few days a week and take call 1 out of every 7th weekend. Pay will be so-so. Her husband is a doc also. Agree that you need a working spouse to help pick up the slack! As noted HMO's, VA's,etc. offer limited hours.</p>
<p>thanks, ds, I kept looking. You can't do it from the thread.</p>