What do you think... is med school worth it for the kids?

Parents Forum
1

<p>We have a HS senior in our family deciding what direction they want to go in college. For a long time they've been saying they want to go to medical school and have been quite enthusiastic about the whole idea and he's looking to do pre-med at college. However, recently things changed. The high school guidance councilor recently set up some visits with local physicians including a visit to a local hospital. They met with physicians from a variety of different practice areas and even had the chance to sit in and watch a minor surgery. He was really taken back because when he asked many of the physicians if they had to 'do it all over again' would they still choose the same career path, many said no. Many of the physicians actually encouraged him to rethink going to medical school citing low morale within the field (generally blamed on HMOs and Insurance Companies). He has all the right reasons for wanting to be a physician (likes helping people, interest in the field), but many of the physicians told him that they too had those ambitions but now felt like they were reduced to, as one put it, 'monkeys with little intellectual input that are forced to do what our HMO master tells us to do' and thus both the 'interest in the field' and 'helping people' desires remained somewhat unfilled. </p>

<p>Not surprisingly, there are now some second thoughts regarding the whole medical school thing. So my question is then what experiences does anyone else have on this forum with their children going to medical school? What about 10-15 years after med school... what were things like then? </p>

<p>Do the above comments sound valid or is it nothing to worry about? It struck me that so many people in a profession didn't actually truly like what they were doing. I read an article a while back about low career morale in the medical profession, but it struck me to hear such an example in real life. I'm glad that the various physicians were willing to meet with him, and were so honest and forthcoming, but am confused about what should happen now.</p>

<p>Obviously he's now torn, confused and worried... what should I tell him?</p>

2

<p>I would tell him that he does not need to make up his mind anytime soon.</p>

<p>Pre-med is typically not a major but a program that is completed in addition to a regular major. Your son can major in anything he wants to and explore other career options in college before he has to commit to med school 4 years down the road.</p>

3

<p>Well, perspective's a funny thing. Mine's in his first year med school and it kicks his butt everday... Some of the hardest work he's ever done. However, each day he gets a little brighter, things click a little better and he is figuring out the "game" speed. </p>

<p>There are far worse things in life and careers than medicine. I think sometimes folks forget their blessings and focus on their irritations. </p>

<p>And you can practice just about anywhere. No state is turning doctors away cause they have too many.</p>

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<p>I would never discourage anyone from going to med school per say, but I would certainly make sure they fully understood what they were signing up for. The differences between the perceived and actual nature of a medical career can be quite drastic. </p>

<p>For starters, I would just say PLEASE don't let him major in “Pre Med.” Make sure he leaves college with an actual college degree in an actual major. Pre Med is not a major. Many people that want to attend medical school will major in the sciences, but some major in the liberal arts or something else. Make sure he uses those 4 years to get a proper education in something. That degree should be able to stand on its own, not just a pre-requisite for what comes next. When I see a “Pre Med” degree it says 'I really don't care about college and just want to go to med school so I've taken this random hodge podge of courses and want to get out of here ASAP.' That doesn't impress me at all.</p>

<p>That said, I guess a few points about the medical profession would be the following. Again, I wouldn't want to discourage anyone from going to med school just making sure they fully grasp what a medical career entails and what they're signing up for.</p>

<p>Financial Aspects:
The situation is quite dire. The AMSA (American Medical Student Association) reports that the average medical school debt per student is well into the six figures with almost half having more than $150k debt and amounts over $300k not uncommon. And that's just for medical school, so tack on the debt from undergrad too and it's quite normal for a freshly minted physician to be a quarter million dollars in debt. Yeah, but right after med school I'll be making the big bucks so no problem right? Wrong. After med school you have to do a residency, usually 3-5 years although occasionally even longer for some specialties. Medical residents get paid a shockingly low salary considering the amount of training they have. Most start off at around $40-45k per year (sometimes a bit higher depending on the market) with minimal, 3-4%, increases each year. Oh yeah, and expect to work at least 60 hours per week for that paltry salary and 80 hours per week (the legal max) is not unheard of. </p>

<p>So picture this... assuming you did college and med school straight through without breaks when you're a resident and 30 years old. At that point many of your friends from college are making decent salaries (perhaps several multiples more), own their own nice home, drive a nice car and have little debt apart from their mortgage. Meanwhile you're getting paid the hourly equivalent of a factory worker and are hundreds of thousands in debt living in a small rented apartment. Sure after residency you'll hopefully be able to get a decent position making a decent salary but in relative terms the financial picture still looks dire for a while. It takes time to pay off all those loans, not to mention additional things like a mortgage down the line. By the time the loans are all paid off, you have a decent house and back onto a 'normal' healthy financial track you could easily be 40. From that point out you should be making a decent salary and, if you play the cards right, should have enough time to catch up for lost ground and have a decent retirement... but relative to many other professions for those with graduate or professional degrees the financial situation is quite poor through and through. About the only good news would be that, as mentioned, you can probably work almost everywhere in the country as most places are always hiring. </p>

<p>Lifestyle Aspects:
Something for some people to consider. Unless you have a very understanding wife/husband who can do most of the parenting and somehow still provide additional income for the family don't even think about kids until you're early 30s at the absolute earliest. </p>

<p>Public Perceptions of the Medical Profession:
I think the medical profession has seen a reputation downfall second to perhaps only the legal profession (lawyers will always be despised). Physicians were once the pinnacle of the community, highly respected with their word and wisdom taken without question. To follow on from the original post, these days physicians have largely become the robo-monkeys of the HMOs, who often refer to physicians by the, in my opinion, derogatory title of 'healthcare providers.' The healthcare industry is now essentially a service industry. People shop around and often view the 'service' provided with a high degree of skepticism. There's also an extraordinary amount of pressure placed on the physicians to think a lot more about the financial aspects of providing health care and, as a result, a lot less about heath care. All to often it's a 20 year old with a high school education in an insurance call center telling the physician what to do and not the physician deciding themselves what's best for the patient. Obviously that's incredibly demoralizing. </p>

<p>Again, I'm not trying to discourage anyone just point out the reality. Being a physician is nothing like it's portrayed as on TV shows so do your research, talk to current physicians, and know what you're getting into. It's not glamorous, it doesn't pay well (relative to other options with that amount of education) and the medical field is in a bit of a tailspin at the moment thanks to the HMOs and the issue of the uninsured. It's unclear what the solution to that will be, but in all likelyhood it will have to involve at least a partial government control of healthcare expenses... something that will only further tighten the screws on physician salaries. </p>

<p>Overall all, it's just not that pretty, but for the right person it can still be a very rewarding career.</p>

5

<p>He should visit more Doctors, perhaps some who are doing what he might like to do. See if he can go to a teaching hospital at a nearby university. Have him talk to med students in their junior or senior years. It will give him a broader taste of what it is all about. </p>

<p>If he has a long view of things, is a hard worker, a fast learner, and ambitious, willing to take some risks and bounce back from some difficult situations (patients unfortunately don't always do well, people make mistakes, not all practices succeed) then maybe he will do well. </p>

<p>Malpractice concerns, competitive pressures, declining re-imbursement are all causes of a demoralized MD workforce, and the horizon shows a lot of uncertainty. You are 30 something before you earn any real money and as others have said, your debt load can be enormous. As more people get on the government run services, and taxes become a larger proportion of the re-imbursement pie, MD salary pressures will all be downward. </p>

<p>From my perspective, I like what I do to a large extent. The money is good but the stress and risk is high. It is a formidable challenge, but it can be a very rewarding profession. It is still a noble profession. You can save lives. I still have people come to me saying how I helped after 20 years, how I fixed something on their child, how I saved them. No monetary reward can surpass that.</p>

<p>Added comment: I should add that my older son is a junoir in molecular genetics, wants to be a scientist, but not a physician: his choice... my other son is a HS senoir, looking for a chemistry program. Again, his choice. I try not to steer my kids, they make up their own minds.</p>

6

<p>
[quote]

For starters, I would just say PLEASE don't let him major in “Pre Med.” Make sure he leaves college with an actual college degree in an actual major. Pre Med is not a major. Many people that want to attend medical school will major in the sciences, but some major in the liberal arts or something else. Make sure he uses those 4 years to get a proper education in something. That degree should be able to stand on its own, not just a pre-requisite for what comes next. When I see a “Pre Med” degree it says 'I really don't care about college and just want to go to med school so I've taken this random hodge podge of courses and want to get out of here ASAP.' That doesn't impress me at all.

[/quote]
</p>

<p>What do you mean by "Pre Med" degree?</p>

7

<p>
[quote]
What do you mean by "Pre Med" degree?

[/quote]
</p>

<p>Some colleges offer 'pre med' as a degree generally formed from a mixture of various science courses with a few other bits thrown in. Personally, I don't think such a thing should exist.</p>

8

<p>I am not a physician but am a very grateful patient of several. My primary doc discovered my breast cancer in a clinical exam during a routine physical and I am sure she saved my life -- got me to a mammogram & ultrasound that day and a biopsy very soon after. Since then I have felt blessed by the excellent medical attention I have received, and have often expressed my deep appreciation to my doctors. As fandoc says, it is certainly an honorable profession.</p>

<p>However, I have been dismayed when I get my insurance explanations of benefits and see how little my doctors have been reimbursed for their time and expertise. My BC/BS plan really knocks down their billed charges and they are reimbursed only a small fraction of what was charged - and must, by contract, accept that. </p>

<p>I went "out of system" for my surgery to a "top doc" who no longer accepts insurance at all -- patients pay half his fee upfront and the remainder a month later. (His practice bills the insurance company so patients are then reimbursed whatever the insurance provides.) He can do this because he has a tremendous reputation in his specialty. But he has been in practice for several decades. I can appreciate why he does this but feel bad that it limits his practice to those who can afford to pay the difference between his fees (which I actually thought were reasonable for what was involved) and what insurance covers.</p>

<p>The paperwork must be a real pain to doctors. Plus they must pay for staff, malpractice insurance, etc. There is lots of overhead. Then there are the constant time and psychological stresses of being responsible for patients' lives. Oncologists, for example, work knowing that a high proportion of their patients will die. It is draining. </p>

<p>I know several doctors who have left the field and several who have advised their kids not to consider it under the current climate. It is not the career it used to be.</p>

<p>But it is still a very meaningful career for those who are interested in it for the right reasons. Plus you will probably never be "outsourced."</p>

9

<p>But it is still a very meaningful career for those who are interested in it for the right reasons. Plus you will probably never be "outsourced."</p>

<p>Don't count on it. I am an Internist and many of the "easy" office visits ( sore throats, colds, back aches) are now being 'cherry picked' away by Walmart and others who are setting up urgent care clinics staffed by Nurse Practitioners and Physicians Assistants. They get paid the same fee I would have been paid for those visits even though they have only a fraction of the education and experience I have.</p>

<p>In some areas radiology procedures are now being read by 'doctors' in India who read images sent to them over the internet.</p>

<p>Its a brave new world out there. Even physicians can be outsourced.</p>

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<p>My son is very interested in science and has expressed that he may want to go to medical school. We suggested to him to get his degree in something that he could "use" if he decided not to go to medical school, since after four years of college, he may decide he has changed his mind. He is majoring in chemical/biomolecular engineering. He seems to be much more interested in the research side of medicine than in the "practicing" side of it.</p>

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<p>rocketman, your post #4 above is exceptionally insightful - thanks for taking the time to write it.</p>

<p>My husband wanted to be an MD from the time he was in 4th grade. I remember how ecstatic we were when he was accepted to med school (during the height of the baby boom application years, when the percentage of available slots was particularly low). The happiest he's ever been was during med school and his pediatric residency. The hours were killer, the demands even more than he'd anticipated, but he was doing work that truly made him happy.</p>

<p>Flash forward almost 30 years. He has become one of the many docs who, given a choice today, would go into another field instead - chemical research, maybe (his bachelor's is in chemistry), or engineering. I've witnessed this first hand, and I know that, in my husband's case, the managed care system is primarily responsible for his disillusionment - and the medical establishment's own bureaucracy is responsible for the rest. He'll still spark in an emergency, or when the new technology provides him a chance to do a procedure that makes a difference. But he's tired of talking to insurance companies and HMOs each day, explaining his treatment plans and begging for leeway. He's tired of feeling as if the managed care system is making the medical decisions.</p>

<p>He amassed almost no debt by going to school at his state university (in the 70s), so repaying massive loans was never an issue for him. I actually clicked on this thread thinking the discussion was going to be about repaying med school loans, which are horrendous today. Is that worth it? Not for the faint-hearted.</p>

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<p>My husband went to med school at one of the top med schools in the country. About half his class had graduated with a non-science undergrad major. Encourage him go to whatever college he likes best, take whatever major he likes best, and take the few requisite pre-med courses. Almost no one in med schools nowadays takes "pre-med" as a major (in fact, an official "pre-med" major is often detrimental to the med school application).</p>

13

<p>"My primary doc discovered my breast cancer in a clinical exam during a routine physical and I am sure she saved my life -- got me to a mammogram & ultrasound that day and a biopsy very soon after."</p>

<p>Yeah sure... whatever...
Your thanks plus $5 will buy your doctor a cup of coffee.</p>

<p>Just last week, I diagnosed a mediastinal lymphoma in a patient and a bronchogenic carcinoma in another. My wife ( a physician too ) found a recurrence of a breast carcinoma 10 years post treatment in another person. They are all fatal unless detected early and treated aggressively. The person with the carcinoma of the lung is too advanced, but we can probably help the other two to have years of quality life.</p>

<p>Episodes like that are pretty common with the kind of medicine I practice . It gave me some minor intellectual satisfaction knowing that I had cut through a few diagnostic Gordian Knots. I was also mildly pleased to know I had made some difference to a few lives.</p>

<p>However, the severe downsides of medicine ( well discussed by other posters ) more than negate these satisfactions. I am delighted that one son is studying law and the other plans to go into finance. I stay in regular touch with most of those who did medicine with me. Most of them share my deep cynicism and have directed their children away from medicine.</p>

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<p>"In some areas radiology procedures are now being read by 'doctors' in India who read images sent to them over the internet."</p>

<p>LOL !
Yes, non-interventional radiology is rapidly being outsourced.
I know of a board certified radiologist who trained at Yale who decided to turn entrepreneur; he now runs a team of radiologists ( all board certified) in Bangalore who read diagnostic images online for several American emergency departments, including Yale's.</p>

<p>His company makes money.
Yale gets rapid radiology reporting for a fraction of the cost of having an American consultant do the work.</p>

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<p>One thing to remember is that college students change their minds about majors all of the time. Just because your HS student feels this way now, doesn't mean that he/she will feel this way in a month, year or two years. Things change...and so do the decisions of college students.</p>

<p>Re: premed. Typically (as others have pointed out) this is NOT a major. The student could basically major in anything as long as they take the required courses in the sciences and math along the way. </p>

<p>Also, keep in mind that for some students, just the NOTION of staying in school for almost 10 more years after high school (including hospital residencies) is a daunting vision. BUT once they are along in their college programs, this is not so daunting.</p>

<p>I guess my best advice is that students should enter college with a somewhat open mind. This is why so many schools have reinstituted Core Course requirements (something that was taken away in the early 70's)...thus giving students the opportunity to explore multiple options.</p>

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<p>Many thanks for these response so far... keep 'em coming. Also, a special thanks to the physicians that have posted. It would seem that the comments received during the hospital visit and interviews were not just a case of isolated dissatisfaction. </p>

<p>Regarding outsourcing, the medical profession is hardly isolated from this phenomenon. While I doubt that robo-surgeons controlled by an overseas doctor will come online anytime soon, I have heard of things like sending radiology work over the internet for others, who will work for much less, to read. Combine instances like that with the endless paperwork, constant threat of potentially career ending lawsuits and an HMO telling the highly education and trained physician what they can and can't do and I guess it should have been no surprise that many are disgruntled. The whole way that for-profit corporations essentially managed to take over control of the medical profession from right under the feet of the physicians is quite extraordinary. </p>

<p>Regarding HMOs and the uninsured, something clearly has to be done or the whole system and profession will implode. It would seem the only possible solution is either a partial government takeover of the system or a strict government monitoring of the system (these are the only two things that have ever worked elsewhere for providing health care for everyone). </p>

<p>Neither of these things would bode that well for physician salaries as, pointed out earlier, as more and more tax money goes towards paying for healthcare there will be severe downward pressure on health care salaries. The government, via the taxpayer, won't stand for those funds being used for what the average american sees as a very high salary (not realizing the reality of that situation as pointed out by rocketman08). I suppose one potential upside is that, if the system is partially nationalized, med school could be highly or fully subsidized by the government to in part make up for less attractive salaries (again, what almost always happens in other countries where everyone has healthcare).</p>

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<p>the problem for current premeds is guesstimating what the future holds wrt to single payor/universal coverage. Yes, sure, it will streamline paperwork if it happens. But, once the states/feds start controlling 95% of all payments, it will be extremely easy for them to adopt a Medicare-style fee schedule for everyone. An earlier poster commented about standard BC/BS contract rates -- unfortunately for docs, Medicare is really low.</p>

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<p>The fundamental issue causing the current train wreck, and impending implosion, of the healthcare and medical profession in the US is the fact that those in charge (e.g. HMOs) are trying to run a capitalistic system when healthcare dosen't fit that model. Let me make an analogy between healthcare and car sales. </p>

<p>Everyone needs a car. Cars come in all shapes sizes and price ranges. You can by an old used car for a few thousand bucks (or less) all the way up to a brand new custom luxury car for six figures. The decision is led largely by personal preference and, indirectly, the buyers wealth. However for each market (rich and poor) the car, no matter how much it costs, serves the need of the buyer (namely it gets them from A to B). Those selling the cars, the dealers, can meet the needs of each market whilst still making a profit. They can sell expensive luxury cars and cheap used cars, thus meeting the demand of each market, and still maintain a profitable business. Thus there can be competition at all levels of the market, all the customers get served with their needs met and all the providers (dealers) stay in business and make money.</p>

<p>Now lets look at the healthcare market. Again, there are different segments of buyers (rich and poor) but this time everyone requires the same product. If you need a triple bypass you need a triple bypass. You can't just say 'Oh, I can't afford the new Lexus bypass so I'll get the '92 Chevy bypass.' All of the products provided to customers, in order to meet their needs, cost the same regardless of how rich or poor they are. Because of that, the dealers in this case, the hospitals and HMOs, of which many are for profit companies, will only want to deal with those they can make a profit on. They're not going to sell a Lexus to a factory worker because that person can't afford to pay for it (nor to they have insurance that would pay for it). A capitalistic healthcare system like we have at the moment will only ever be able to serve those that are better off. The only way around this issue is to have a government subsidy of healthcare by using taxpayer dollars to (as some put it) take from the rich and give to the poor by paying for medical care that some would otherwise never be able to afford. Personally I think this is the right thing to do since I believe access to quality healthcare is a right (as it is in almost every other major western nation) and not a privilege (as it is in the United States). We're slowly moving in that direction with programs like CHIP and Medicare but far too many hardworking people are still falling through the cracks.</p>

<p>If the taxpayer is going to be footing the bill then it's going to take some tough love to make sure that everyone can get coverage. Physicians will still be 'well paid' relative to the general workforce but it's unlikely to be considered a 'highly paid' profession instead being the sort of thing that one does out of a love for helping people and a love for the profession and hence willing to work for less than their open market rate... in essence the situation that many 'government executives' are in. In a few decades the idea of 'marrying a doctor to get rich' will be foreign (I think that reality has largely been lost already in many cases). Again, that's what we see in other countries that provide healthcare for everyone because really high salaries and providing everyone with universal access to healthcare are simply not compatible no matter how you slice it. Historically physicians were never a highly paid profession, it was just during this commercial takeover of the system over the last few decades that things got all out of wack and now we're almost certainly going to have to return to the original situation where physicians are providing more of a service to their community with limited benefit to their pocketbooks.</p>

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<p>What is it like for doctors who work at Kaiser or similar companies?</p>

<p>For a little less money, don't the doctors have less headaches?</p>

<p>rocketman08, I like your analogy. You are not a doctor, though, are you?</p>

<p>"Again, that's what we see in other countries that provide healthcare for everyone because really high salaries and providing everyone with universal access to healthcare are simply not compatible no matter how you slice it."</p>

<p>So how much do doctors make in countries that provide universal health care?</p>

<p>If becoming a doctor isn't lucrative, how do you get quality people to become doctors? It costs a fortune to become a doctor and the time that is spent getting educated....</p>

20

<p>"It would seem that the comments received during the hospital visit and interviews were not just a case of isolated dissatisfaction."</p>

<p>I would NEVER take what is posted here as the norm. </p>

<p>You know folks, every job s ucks at one time or another... EVERYJOB has it's problems, pitfalls, setbacks and what not. </p>

<p>You're a Doc, you don't live in a card board box house, you can afford vacations, you can pay for private school for your kids if you choose, You can live above the "average" american, your respected my the vast majority of people in this country and you have a job where you can use your brain everyday.</p>

<p>Is it really that bad? Is it? Or are you the person who bemoans my caviar is not buluga? </p>

<p>Sure your job has bad days, want to trade? </p>

<p>Opie jr, is in med school and not for how many bucks he wants to make, he wants to have a job where the "job" itself provides a mental challenge every day. You guys aren't complaining about the job, just the side noise. You can do things to take care of the surrounding noise if you want... the question comes down.. do you still enjoy the job?</p>