<p>Opie, in my husband's experience, the difficulties with managed care are not the "side noise," they're the whole freaking concert. Please don't diminish practitioners with many years in their fields by presenting them as whiners. My husband is not a "My caviar isn't beluga" kind of guy. </p>
<p>Like your son, he was happy during medical school, and also during his residencies. I hope your son will continue to feel great satisfaction in medicine. My husband, thirty years in, does not. My husband has been where your son is. Your son has not yet been where my husband is.</p>
<p>yuiop and others: my dD is expecting to graduate with an MD this year. During the four year process of studying, clerkships etc. she decided that she does not want to continue toward a clinical medicine career. She did a summer of research in a lab and does not wish to pursue a research career either. What does she want to do? That is currently the QUESTION. HOwever, she couldn't have possibly made this decision in high school or during her pre-med years (she majored in a humanities subject as an undergrad while taking requiring pre med classes) - so I agree with earlier posters that your S should keep all options open while he is figuring this out. Does anyone out there know what alternate career paths may be available to a newly minted MD who is not licensed (no internship) and has no desire to go beyond the MD? Thanks for the input. And, Yuiop, if you want more details regarding my D's journey, I'm happy to answer a PM.</p>
<p>What is it like for doctors who work at Kaiser or similar companies?</p>
<p>Don't get me started. This varies by specialty and position in the organization but for me, it meant being face to face everyday with the reality of mental health services being a loss leader that survives because of the short term benefits of viewing the human experience as being defined as a "chemical imbalance."</p>
<p>My husband and I are 20 years out of medical school, discuss this often, and in general agree we can't imagine doing anything else. We consider ourselves fortunate, at least within the context of our families of origin. Looking back, I think school was the best time of my life. I was really good at it. I still find medicine fascinating to study but frustrating to practice and feel successful at. OTH, neither of our kids are aspiring toward a career in medicine, and we aren't telling them otherwise.In the context of our neighbors, and perhaps other medical specialties and people earning what we do, we Cmt help but think " what's wrong with this picture" or "what are we doing wrong: For the purposes of the college search, we are struggling with wondering how do we balance our own school loans, with our seniors college expenses, dreams of retirement ( Idon't know how much longer I can do what I do without compromising my values), and aging parents.</p>
<p>
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rocketman08, I like your analogy. You are not a doctor, though, are you?
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No, although I have several family members and close friends in the field hence it's something that gets talked about a lot.</p>
<p>
[quote]
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....
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In most other countries with universal care medical school is largely subsidized by the government so the graduates don't come out with massive amounts of debt. Salaries are still very good, relative to most people's income, they're just governed a bit more by the fact that it's mostly taxpayer funds so relatively speaking they're high but not extraordinary and generally based on nationalized pay scales and compensation structures for services. </p>
<p>I imagine here in the US we're might eventually be forced to move into that model and having the taxpayers pay for med school might be part of the compensation for putting physicians on an, effectively, government salary (even if the paycheck comes from the hospital the majority of the money would be coming from the taxpayer). The tricky part will be the transition... we can't just one day pack up and say OK now everyone in the medical field is going to be put onto a nationalized pay scale based on compensation rates set by Congress. That may not be the best solution, but it's perfectly clear that the current system is not sustainable for much longer.</p>
<p>Opie, I hear what you're saying and I hope it all turns out well. I would only say that I've heard countless stories like that, but when folks get out into the nitty gritty reality of practicing medicine at the whim of a corporate insurance company or HMO their opinion quickly changes. From discussions in our family, all to often the "mental challenge" you speak of is not about diagnosing patients or solving medical problems but banging ones head against the table because the physician wants to do one thing but the HMO has a different agenda... and the HMO almost always gets the final say not the physician. The physicians hands are largely tied when it comes to practicing medicine as the HMOs have forms and procedures outlined for just about everything, based largely on cost structure. If a physician performs to many tests that 'cost too much' they can see their own income effected as the HMOs meticulously track the financial performance of each physician and often base their compensation not so much on quality of medical care but 'how much money is this health care provider costing us'. These are the mental challenges that one faces all too often...</p>
<p>The key thing most practicing docs may not tell you is that there are many options for MDs. Clinical practice is only one of the options. MD is a minimum degree requirement for many positions in NIH, FDA, Pharmaceutical companies, or educational institutions where one can pursue medical careers without the noise of medmal or payments by insurance companies.</p>
<p>If your S or D really wants to pursue education in Medical Science, there are many options.</p>
<p>
[quote]
The key thing most practicing docs may not tell you is that there are many options for MDs. Clinical practice is only one of the options. MD is a minimum degree requirement for many positions in NIH, FDA, Pharmaceutical companies, or educational institutions where one can pursue medical careers without the noise of medmal or payments by insurance companies.</p>
<p>If your S or D really wants to pursue education in Medical Science, there are many options.
[/quote]
</p>
<p>Yes, it's certainly true that there are other options for an MD, but given the extreme cost of med school I don't think it would be smart to go down the MD path initially unless the goal was to practice medicine as a physician. All those other options you described are equally filled by PhDs and the only thing separating a PhD and MD in that environment is that if the MD maintained a current medical license they could work in a clinical environment if necessary, but that's about it. </p>
<p>Most science PhDs are fully funded and often include a living stipend. We know someone that just completed their PhD which included fully funded tuition and fees plus a $30k per year living stipend paid by the federal government. If the up front goal is a non-clinical environment (e.g. research, admin or government policy) then I think a PhD, specializing in the field of interest, is the smarter choice although yes if that realization comes after ones already in med school then there are certainly a variety of non-clinical options still available afterwards.</p>
<p>"If becoming a doctor isn't lucrative, how do you get quality people to become doctors? "</p>
<p>You don't.
In Australia, where we have universal health care, quality candidates are turning to investment banking and corporate law. In the US, the number of applicants to med school has been static for some decades. That is why you have to import doctors from overseas to staff your less desirable jobs (ie: HMOs and jobs in the Deep South )</p>
<p>High quality candidates of Asian origin do still head into medicine. This is because in the countries of their parents origin, medicine is an extremely high status profession. Unfortunately, their parents have not understood the realities of their adoptive nations and are still advising their children poorly. Their bright children will spend their professional lives being bullied and pushed around by hospital administrators and junior insurance managers who graduated at the bottom of their non-target colleges.</p>
<p>guys replace HMO with Boss and you have any other job. I understand how you feel, but really is it any different for any intelligent well trained person who is commanded by a ceo, cfo or worse, the lousy child of the owner? It's irritating, it's anoying and it's everywhere in our society. No one likes to be told what to do by anyone we feel is not worthy of their position or if we feel they don't understand the situation. </p>
<p>However, again it's a matter of perspective.. no offense intended frazzled, but in this situation you're looking down the totem pole and I'm looking up at you. </p>
<p>As my kids considered med school, they both had alot of concerns really about being worthy of the job. "nobody in the family is a doctor on either side." </p>
<p>They felt they wouldn't belong..... you see their grandparents didn't finish HS on either side and scrapped through. Their parents (we) finished college and post grad and are doing OK, but everything we have we earned and admittedly, it's not all that much... Both my kids have turned out to be in that top 1% (please don't ask why, if they didn't look like me....I'd wonder) of students in America. My sage advice...</p>
<p>"well, somebody's got to be first." </p>
<p>So again perspective, from our side we long for some of your problems because not too long ago in the family tree the biggest problem was "am I going to eat tonight?" perspectives are different depending on where you're standing. So again, I do apologize, but what I would give for your problems....</p>
<p>And so Opie, I suppose we'll wait and see what your kids tell theirs. H and I are "first gen" in our family. Again, I can't say we have regrets . It feels like we have lifted our respective families into a new strata, even if we are at the bottom of it. FWIW, I think it's more frustrating when you have to take orders from someone who doesn't share any liability for bad out comes.</p>
<p>"If a physician performs to many tests that 'cost too much' they can see their own income effected as the HMOs meticulously track the financial performance of each physician and often base their compensation not so much on quality of medical care but 'how much money is this health care provider costing us'."</p>
<p>In Australia it is worse.
I get monthly printouts from our universal health insurer which tell me how much I have cost them in pathology tests, radiology, referrals, billings and prescriptions. The printouts rank me against other doctors in my area. I generally rank in the 30 to 40th percentiles. If I was in the top 90th percentile, I would get a warning letter. If I am in the 99th percentile, I would be investigated. This could escalate to being hauled before the Medical Tribunal and in principle, I could lose my medical registration.</p>
<p>Some years, ago when I had a large number of patients with deep vein thrombosis and pulmonary emboli, I had to spend some hours explaining to a brain dead, semi-literate bureaucrat from the Health Insurance Commission that I really did have to order several coagulation screens each week to prevent people from dying. The coagulation screens cost around $20 each and the number I did ( around 30 a month I guess ) triggered red flags in their datamining software. I estimate that having the Health Insurance Commission bureaucrat visit me at my offices, "counsel" me about the cost of the coagulation screens, write a report and then follow up with me 3 months later would have cost the same as around 100 coagulation screens.</p>
<p>I'm feeling happier and happier about being an architect. We moan and groan about how underpaid we are compared to the other professions, but that is less and less true. And over half of us are sole practitioners. I really like being the boss of me.</p>
<p>I'd also point out that much of this is dependent on the specialty. Hospitalists, for example, have far fewer issues with insurance, malpractice insurance, etc. Primary care docs seem to catch the brunt of the red tape.</p>
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[quote]
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.
[/quote]
</p>
<p>This did not answer the OP's question " Is med school worth it?" I can do the above without having to go to med school which requires lots of effort and hardwork than my career. Not to say one has to graduate with a lot of debt too. I would say no.</p>
<p>
[quote]
guys replace HMO with Boss and you have any other job. I understand how you feel, but really is it any different for any intelligent well trained person who is commanded by a ceo, cfo or worse, the lousy child of the owner?
[/quote]
</p>
<p>It's certainly a valid point that there are lots of other jobs out there with low employee morale. However, I don't think we're talking about average jobs we're talking about jobs for folks with extensive education and doctorate degrees... so these sorts of folks are usually in positions with a lot of independence over what they do. </p>
<p>Think about all these '21st century corporations' that are scooping up today's PhDs, paying them very decent salaries and putting them in a 'Google' style corporate world. Google, mind you has a company policy where employees should spend about 10% of their time just tinkering around on their own testing out pet projects and ideas. Other companies, especially those that hire a lot of PhDs or other highly trained staff have taken on similar new corporate cultures... knocking down the rigid heiarachy and replacing it with collaborative teams with a lot less red tape. In short, they treat their high asset highly trained employees like highly trained and high asset employees... not like monkeys being endlessly tracked with performance monitoring big brother software only to be told off if they don't fit the pre-determined mold assigned by some corporate HMO formulas.</p>
<p>Hmmm... I'll bite... what do you mean? It does help to know what other people put up with. It FEELS like nobody else has to carry 3 million plus dollars worth of insurance coverage ( cheap for a doctor, but hey, I just mess with peoples minds!).What do other professions carry? Tell me more...</p>
<p>As they say the grass is always greener on the other side of the fence... and their water bill must be huge..."</p>
<p>And as I said, to me, the grass is not greener; I have thought about doing something else and I realize I wouldn't.</p>
<p>Not my personal experience, but I have several physician friends who are happy working overseas in developing countries. Some work for large corporations, others at embassies, at local hospitals, or with NGO's (non-government agencies). They don't have to deal with a lot of the stuff that folks have complained about in earlier posts, and they seem to have a lot of job satisfaction. </p>
<p>I'm not sure how they ended up overseas, but if I was in the medical field, I would definitely look into it.</p>