<p>As a physician who has traversed all the education/training, and now been practicing for 16 years, I think I can speak to this issue. As long as you understand what you are getting into, medicine is a very fulfilling career. The problem is, most people don't understand what they are getting into, and idealism comes up to stark reality and many people are very unhappy and leave medicine. First, the massive educational debt is nothing to sneeze at. It will fundamentally change how you live your life - when you start a family, what field you can go into, if and when you can buy a house, etc. Training is long and hard and you (and your family, don't forget about them, because it's not always all about you) sacrifice a lot - sleep, holidays, weekends, significant events, etc. You take your family on this ride, and many cannot handle it - hence the high divorce rate among physicians. Insurance companies rule your life and when you pay a doctor's bill, and complain it is outrageous, keep in mind that out of that comes the office work staff salaries, the electric bill, your workers' insurance, benefits, the billing company, malpractice insurance - all which get more expensive every year, while insurance companies are constantly cutting what and how much they cover. And there are a significant number of patients who don't pay their bills at all. Nobody should have any delusions that this is the ticket to financial fortune, and many physicians are leaving the profession. There is a critical shortage of multiple specialties, which will only get worse as our population ages. Don't look to intensive lobbying to solve the problem - don't forget many politicians are lawyers or beholdant to lawyers. Medicare rate freeze is actually a cut, because of all the expenses involved in practicing today. Every medicare patient you take care of COSTS you money, because you take a loss on every single one. If after knowing all this, you still decide it is for you, then it was meant to be.</p>
<p>Very honest and accurate post zulu40.
From spouse of cardiologist.</p>
<p>agreed.....physicians will never be rich....but will always have a decent lifestyle and a job that they can be proud of.....</p>
<p>r-e-s-p-e-c-t</p>
<p>Hmmm... </p>
<p>I only want to be a doctor to live a grand lifestyle. It sounds bad, but I really only want money. I live in San Jose, and according to a friend of mine, doctors are extremely rich. Pharmacutical companies often bribe them with gifts to use their drugs and many take home over $200,000 after taxes + expenses while only working a few days a week. </p>
<p>Is this true? If I do become a doctor, I can't say I will care about my patients, but I can probably guarantee they will be getting top quality medical care and enough bang for the buck.</p>
<p>fastmed, please choose a different career path. Medicine is not your calling if you are representing your attitude accurately. For the record, it is illegal to give "gifts" or accept them in return for use of devices or drugs. About the most the companies can do now is provide lunch for the office staff along with their presentation and give a few pens or coffee mugs with their logos on them.</p>
<p>To become a physician and not care about your patients is to disgrace the profession. It is unethical and immoral.</p>
<p>maybe he was just being sarcastic,
but he/she does make a point, I had this optomatrist,(eye doctor) who was trying to sell me contacts that were really uncomfortable, I just wanted my usual contacts, It seems like he gets a bonus if sells that kind of contacts or something. BUT all in all I felt like he was disgracing the profession,</p>
<p>so maybe doctors can make the big bucks doing illegal things but theres bound to be consequences.</p>
<p>
[quote]
** from The Medical Professionalism Charter from the ABIM**</p>
<p>Fundamental Principles</p>
<p>Principle of primacy of patient welfare. This principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician–patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.</p>
<p>Principle of patient autonomy. Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients' decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.</p>
<p>Principle of social justice. The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.</p>
<p>A Set of Professional Responsibilities</p>
<p>Commitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.</p>
<p>Commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention and improvement strategies and for appropriate compensation to injured parties.</p>
<p>Commitment to patient confidentiality. Earning the trust and confidence of patients requires that appropriate confidentiality safeguards be applied to disclosure of patient information. This commitment extends to discussions with persons acting on a patient's behalf when obtaining the patient's own consent is not feasible. Fulfilling the commitment to confidentiality is more pressing now than ever before, given the widespread use of electronic information systems for compiling patient data and an increasing availability of genetic information. Physicians recognize, however, that their commitment to patient confidentiality must occasionally yield to overriding considerations in the public interest (for example, when patients endanger others).</p>
<p>Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients, certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for any sexual advantage, personal financial gain, or other private purpose.</p>
<p>Commitment to improving quality of care. Physicians must be dedicated to continuous improvement in the quality of health care. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care. Physicians must actively participate in the development of better measures of quality of care and the application of quality measures to assess routinely the performance of all individuals, institutions, and systems responsible for health care delivery. Physicians, both individually and through their professional associations, must take responsibility for assisting in the creation and implementation of mechanisms designed to encourage continuous improvement in the quality of care.</p>
<p>Commitment to improving access to care. Medical professionalism demands that the objective of all health care systems be the availability of a uniform and adequate standard of care. Physicians must individually and collectively strive to reduce barriers to equitable health care. Within each system, the physician should work to eliminate barriers to access based on education, laws, finances, geography, and social discrimination. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession.</p>
<p>Commitment to a just distribution of finite resources. While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources. They should be committed to working with other physicians, hospitals, and payers to develop guidelines for cost-effective care. The physician's professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures. The provision of unnecessary services not only exposes one's patients to avoidable harm and expense but also diminishes the resources available for others.</p>
<p>Commitment to scientific knowledge. Much of medicine's contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.</p>
<p>Commitment to maintaining trust by managing conflicts of interest. Medical professionals and their organizations have many opportunities to compromise their professional responsibilities by pursuing private gain or personal advantage. Such compromises are especially threatening in the pursuit of personal or organizational interactions with for-profit industries, including medical equipment manufacturers, insurance companies, and pharmaceutical firms. Physicians have an obligation to recognize, disclose to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities. Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.</p>
<p>Commitment to professional responsibilities. As members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation, including remediation and discipline of members who have failed to meet professional standards. The profession should also define and organize the educational and standard-setting process for current and future members. Physicians have both individual and collective obligations to participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all aspects of their professional performance.
[/quote]
</p>
<p>Reasons why fastmed's stated goals are extremely unethical. In particular the very first tenet of being a physician which I've underlined and bolded - it's right there as a major part of the profession - the absolute basic foundation of what being a doctor is. Notice how it also includes a managing of conflicts of interest section that I've bolded speaks which directly to the pharmaceutical industries courtships that s/he speaks of.</p>
<p>If you are in medicine just for the money (or even just the respect) there are a thousand other ways that are all MUCH MUCH MUCH MUCH MUCH MUCH easier and less time consuming than medicine.</p>
<p>seriously, be a lawyer or go into business to make money.....medicine's not worth it unless you truly want to be a doctor.....</p>
<p>I was an econ major in college and have crunched the numbers.</p>
<p>I'm not going to argue that being a doctor for the money is unethical. (I happen to believe that, but I won't argue that here.)</p>
<p>I will argue that it is, financially, one of the stupidest possible decisions you could possibly make.</p>
<p>heh. Is it truly unethical if you want to be a doctor solely for money even if you will be a superior doctor in technique, knowledge, and experience? Your motivation may be different, but the patients will ultimately benefit more and it really is ultimately the patient that matters. I may rethink being a doctor then if the pay isn't so hot though. I've always thought you could rake it in like mad cause for a normal checkup most doctors spend a few minutes and collect 60 dollars.</p>
<p>I honestly think (and this may be the idealist in me) that the two (in it for money and being the best doctor one can be) are almost completely mutually exclusive. </p>
<p>In most specialties, you can earn much more by being shoddy (at a bare minimum doing enough to prevent you from getting sued) than by being the absolute best (the most notable exception being cosmetic plastics b/c you can charge more for surgical skill/artistry). I mean, paitents rave about my Internal Med preceptor and just absolutely adore him b/c he takes the time to talk to them. Most of his visits are scheduled for 30 minutes even if it's just a follow up. He could be making a lot more money (a LOT) if he was scheduling patients every 15 minutes or even every 8. Is he a great doctor? yes, but that's not what the patients praise him for. No it's always the listening, explaining and time he spends with them that they remember.</p>
<p>Uh... while I'm not going to bother touching your main point (except to tell you that five years is clearly a preposterous estimate, and that the tech industry still has plenty of jobs here in the States), quick econ check here:</p>
<p>1.) Outsourcing is different from offshoring. Outsourcing means asking someone else to do it for you; offshoring is having it done outside of the US. They overlap but aren't identical, and neither is a subset of the other.</p>
<p>2.) It has nothing to do with efficiency and everything to do with the fact that purchasing power parity doesn't hold in a world of inefficient currency markets and high transactions costs. Oh, and because comparative specialties may vary for tradeable and non-tradeable goods.</p>
<p>
</p>
<p>Specialists depend on referrals from other docs. Unless you are the only specialist in your field in your area, referrals will go to the better doc (and, yes, practicing docs and their staff do figure out very quickly who does good work).</p>
<p>Ask your preceptor to which specialists does he refer patients and why.</p>
<p>(BTW, numerous studies have shown the likelihood of being sued to be a function of time spent with the patient and bedside manner, rather than medical acumen or even correct decision making; spending less time with patients will increase daily billing, but it will also increase liability exposure).</p>
<p>okay- i have three older brothers- 1 psychiatrist, 1 laywer, 1 doctor, im going for an MBA (harvard or wharton). </p>
<p>The reality is that medicine is extremely lucrative if you learn how to work the system. There are a million outside opportunities to make extra money moonlighting, lecturing, consulting. The money is there. It is also and extremely expensive field, beacuse of all the insurances, but also med school and residency tends to leave doctors extremely jaded, aggressive, and power/money hungry, because students have been someone else's lapdog for 10 years and now everyone kisses their butts. I've never met a doctor I could have a reasonable discussion with without their ego or need for dominant approval coming into play. Thats just my experience, however. It is a stressful job, very isolating, and frankly the idea that 'doctors want to help people' is usually propoganda. Doctors become doctors to make a lot of money, security, and bragging rights.</p>
<p>Lawyers also make a lot of money, but the lifestyle, when you have a steady job, is a little better. Work, go home. No insane 36 hour shifts, people calling you at 3am. There is a little more risk involved, because not all lawyers are the same, and some are just better at it. The thing to note here is that all doctors are basically viewed as being doctors, the person's personality is meaningless, the patient just wants a professional opinion. Law is risky beacuse its a little more centered on the individual rather than the degree.</p>
<p>An MBA is a crapshoot of sorts, beacuse yes many successful people aren't MBAs, and many are. Technically, CEO's are split 50/50 with having an MBA or not. The point here is if you have a strong sense of self, you may hate being a doctor or a lawyer, because the rules of conduct are very specific and theres not a lot of room to express yourself as an individual. Business is about network and hustle, so it really depends on the person to make it happen.</p>
<p>At the end of the day, the best and most successful doctors like being doctors (or love making money), and the best and most successful MBA's make a ton of money and love business. If you going for the moeny,you may actually get rich, but you'll be dead inside and end up divorced and dead at 55, so kiss that hard earned money goodbye anyway. A doctor here in NY last week divorced his wife and blew up his entire 3 story building so she wouldnt get it in the settlement. (watch out for gold diggers)</p>
<p>Figure out what really makes you tick- are you money driven, are you community focused, whatever. Get an advanced degree and work hard at something you don't HATE. By the way, most legitimate screenwriters in hollywood are lawyers, because law taught them to write fast and efficiently. GW Bush is the first US President to have an MBA. The degree is no guarantee, but yes medicine is 'safer' because you can practice anywhere. It can also be life draining and extremely boring, and that rubs off on your personal life. Law is very boring, but lucrative, safe, a little better lifestyle that medicine, but a little more risky. An MBA is very very risky, but successful MBAs absolutely love their jobs and make a fortune.</p>
<p>honest post</p>
<p>absolute drivel.</p>
<p>I agree with truthteller, even though people don't admit to it, that's how it really is.</p>
<p>Money can make it easier to accept a lifestyle. People will stay in job's they hate b/c the money is good. I still doubt that at least for medical students, money is really a motivating factor. I don't doubt that med school and residency can jade you b/c they are gruelling. But honestly I'd put prestige and ego as more likely reasons for heading into medicine than money.</p>
<p>He's right about the relative "safety" of the various professions.</p>