Medicine and Money: Why Lie?

<p>In a sign that the apocalypse is truly nigh, I wholeheartedly agree with MiamiDAP. And while the great majority of medical school graduates can become family practitioners if they so desire, only a handful of law school graduates will become “corporate attorneys” at the indicated income level and an even smaller percentage of econ/business majors will end up in the “corporate finance” category listed above - including a lot of graduates with stellar academic achievements and work habits. </p>

<p>It’s not just that the floor is high in medicine, it’s solid. Pretty much every other field of endeavor is dog eat dog, with lots of “dogs” falling through the cracks along the way. In an apples to apples comparison, I believe that a medical career wins handily in terms of economic return on personal investment for the overwhelming majority of graduates, and I think the OP is not at all off the mark in acknowledging that fact.</p>

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I agree the great majority of them can. I have no doubt about that. But I am curious: How many percents of them (esp. those from a top-20 private medical school) graduated from US medical schools will actually choose to become family practionioners? 40 percents? 30 percents? I heard the higher the research rank of a medical school is, the lower percentage of its graduates will become family doctors. Many family doctors seem to be graduated from a foriegn medical school (Come to think of this, many of the family doctors of our family members in the past 30 years were graduated from a FMS. Maybe it is because we live in a large city?)</p>

<p>Hm. Nationally I think it might be something in the range of 2400, which is about 14% or so.</p>

<p><a href=“http://residency.wustl.edu/medadmin/resweb.nsf/L/3B05B89E4C4DC03986256F8F007184C6?OpenDocument[/url]”>http://residency.wustl.edu/medadmin/resweb.nsf/L/3B05B89E4C4DC03986256F8F007184C6?OpenDocument&lt;/a&gt;&lt;/p&gt;

<p>Yeah, it’s just interesting. If Professor Kotlikoff had been correct, then I would have responded: “Oh come on. You’re telling me a little bit of risk is worth (1) the misery of medical school and (2) a 21% drop in lifetime income relative to a plumber?” I had assumed that his work was much more rigorous than mine.</p>

<p>It turns out that my work was very similar to his (e.g. totally hypothetical), and I turned up a figure where a family practitioner does 13% better than a mechanic, and absorbs less risk.</p>

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<p>I will say that from my experience – and I actually have slightly more in the business of law than in medicine – law risk (like medical risk) is very predictable up front. You take the LSAT, and your score comes back, and you have a pretty good idea what your lifetime income floor is going to be. Medical school risk is similarly up-front: you get into medical school or you don’t, and you have a pretty good idea what your floor is.</p>

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<p>That’s because 40-50% of our pediatric, internal med, and family med residents are IMG’s right now. </p>

<p>Keep in mind, it is a lot harder to get into the average medical school than it is to get into an average law school. The bottom 2/3’s of law and business schools are not very good in quality which is not true for medical schools. The question is opportunity cost. The average medical student wouldn’t be otherwise attending an average business or law school. Heck, the acceptance rate at low end med schools (like Drexel, etc.) are usually lower than at many T14 law schools. In reality, an average medical student can probably get into some pretty good law schools.</p>

<p>Physicians of ALL specialties will make less than the above quoted salaries with our “new and improved” healthcare system. However, we will still make a comfortable living and are able to find work any where in the world. Also, many/most graduates from a top 20 medical school tend to stay in academia and their salaries are not as high as a private practioner. It is not as simple as go to a top 20 medical school/top 20 residency and you will make the most money. The wealthest physicians in my town have some questionable indications for surgery. Do you want to do the best for your patients or make the most money? I like practicing the best and most ethical care for my patients. I make a nice living and have the added satisfaction of knowing I am a good, caring, ethical and compassionate physician. I sleep well at night and never plan on retiring as I find great satisfaction in my job.</p>

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<p>From what I have heard, that is because certain more competitive residency programs (derm, cardiology, etc) don’t like taking IMGs. They want US doctors. As a result, many of these IMGs have no other options.</p>

<p>I had forgotten to mention the hours differences (especially as compared to “normal” jobs like the mechanic I discussed), but I don’t have any kind of hard data on them.</p>

<p>Many in different professions are working many hours per week. They might not be at the office, they might be working from home, being on whatever electronic device even while traveling or on vacation. When you talk about deadlines, there is small cushion, then it has to be done. Business will not tolerate loosing major customer because somebody did not do his part. But still the major difference is having a job vs. being unemployed. Unemployed is a foreign terminology in MD’s language. Income is secondary consideration. Living style could be adjusted to any income, adjustment to being unemployed is harsh.</p>

<p>Here is my reason why I want to go to med school, I was accepted to a decent school last year but had to defer because I was very ill, it has taken 6 months to get a correct diagnosis of my symptoms, yes SIX months, during the time that I was running back and forth between hospitals around the country I was involved in a car crash that severly damaged my face and how I looked. I wanted to kill myself. My nose was literally deformed. At times I was not even thankful that I survived the crash. During the time from running around the country looking for a plastic surgeon while trying to diagnose my symptoms my father discovered a tumor in his liver. </p>

<p>I do not have the luxury of doing anything else other than pursuing this career. Without my health I have nothing, without my FACE I have nothing, without my father I have nothing. I was at a place in which I did not know what to be more upset about, my father or the fact that the trauma to my face made me so horribly ugly. Do I have the natural tendency to place the wellbeing of myself and my family before patients in africa and other countries. Yes. All I want out of life now is to not be helpless in this most miserable of situations, all I want is for my fathers quality of life and my own quality of life to improve. I do not want to suffer any more and I think this is enough for one lifetime. I dont want there to Ever be a chance for me to ee unemployed. Ever to be low on money. Ever for my family to not be able to afford healthcare ever if anything else were to happen. The luckiest are those in good health and those who have their vitality. I understand this career may be more grueling than other jobs but there is no other career that seems to have a point.</p>

<p>A few observations - there’s a considerable difference in income when you compare employed physicians with those who are partners or have their own practice. It’s not uncommon for primary care physicians to employ PAs and NPs to expand their practice, and for specialists like cardiologists, GI, etc., to own their own echo/ultrasound/scope labs where they collect both the facility and professional fees, and this boosts their overall income by a huge amount. It really doesn’t make sense to lump them with employed physicians to check average salaries. </p>

<p>A second point is regarding hospital assists. If a physician is willing to go where there is a market, such as rural locations, it is not at all uncommon to have their debts paid off by the hospital recruiting them in return for x years of service. Sometimes they may do joint ventures with a hard-to-find specialist and put up the initial cost to set up a center that the physician will partially own. There are other ways hospitals support physicians such as having jobs that take small amount of time, but for which they get compensated well, sponsoring a loss-leader clinic run by the hospital for indigent and underinsured patients where the physician is paid by the hour, but is then free to have a private practice catering to those with commercial insurance.</p>

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<p>I agree. Thats kind of what my uncle does. He is neurologist with an MRI machine in his office. He also does a lot of other procedures with other machines. One of his friends is a cardiologist with his own practice does the same thing. He has an echo/ultrasound/etc machines in his office.</p>

<p>The health reform bill prohibited a couple of things which were sort of similar to this. So if this is your plan, keep a careful eye on the legal landscape – these might be next.</p>

<p>Life is too short to worry about money beyond having enough to live a modest lifestyle. Seriously, imagine yourself in 50 years, retired and reflecting on your career and how you’ve spent your life. How much money you’ve earned will seem petty in the grand scheme of things. You’ll ask yourself what you’ve contributed to the world, and if your only answer is that you’ve found a way to make lots of money, you’ve failed. Being a physician presents a unique opportunity to make a difference in the world, and if all you take out of it is making money, you should really reconsider your life goals.</p>

<p>As I’ve often said: Every profession helps people. Nobody would give you money if they didn’t feel helped.</p>

<p>(Obvious exceptions for stealing and con schemes and whatnot.)</p>

<p>"Life is too short to worry about money beyond having enough to live a modest lifestyle. "</p>

<p>-Exactly my point. If you are not an MD, PA or maybe a nurse or pharmacist (I am not much familiar with jobs security of the last 2), your goal of living a modest lifestyle will be in danger many times in your life. I am lucky to be married to professional who was somehow (again pure luck) to stay on the same job for over 25 years. This is a miracle that you absolutely cannot rely. I have lost my job 9 times and had extansive periods between my jobs. If I was not married, I would be in great trouble. Do not wish it on anybody. Forget income, job security is your primary goal, yes, just “to live a modest lifestyle”. Very few live in luxury anyway, including MD’s. I know many families of MD’s, they are not very different from my own.</p>