<p>Actually, I'll just be a M1 this fall so I still have aways to go. So far, I have no interest in derm or plastics but that can change.</p>
<p>Just for clarification, susan and I are both correct. There are two routes to being a plastic surgeon:</p>
<ol>
<li><p>An integrated route that allows US seniors to match directly (these are 5-6 year programs)</p></li>
<li><p>An independent route which allows a resident who has completed 3 years of gen surgery or the whole otolaryngology/ortho surgery residency followed by 2-3 years of plastic surgery training.</p></li>
</ol>
<p>As for why derm is so popular: lifestyle. 40 hour work weeks, no call, good pay. US med students are shying away from traditional prestige specialties and gravitating towards the so-called lifestyle specialties (derm, radiology, anesthesiology, etc.). I believe the avg. USMLE score of plastic surgery last year was a smidge higher than neurosurgery, which used to be the expected specialty of top top med students.</p>
<p>Derm, like most non-shift scheduled specialties, does indeed have call obligations. Derm call, however, has few emergencies and virtually none that require immediate physical intervention by the physician.</p>
<p>Call for an anesthesiologist is much different from that for a dermatologist: c-sections, appendectomies and intubations all require prompt attendance.</p>
<p>My D was thinking of med school at one point but we know several doctors (some big time ones) who all said the same thing. Much of it is do to how insurance and malpractice works. They say it is not like the old days.</p>
<p>Oh I wish I had a dollar for every hs kid who thought they were going to med school.</p>
<p>My advice? Study what you love. If during the course of 4 years your kid maintains an interest in medicine then make sure that the requirements for med school are being covered off. If like most kids, something else crops up as a current interest-- then there's your answer.</p>
<p>I know former physicians who burnt out and crashed; I know current physicians who love what they do but concede that the field has changed drasticially since they completed their education, and like everyone else, I know dozens of adults doing other things who were once pre-meds or thought they were going to med school or whatever.</p>
<p>Keep your options open. And on the subject of outsourcing- my radiologist is also in India. go figure. And when I needed physical therapy last year for a chronic condition I was shocked to discover that the payment from my insurance company was $55 per session. How this covers the costs of the Orthopedic surgeons who run the PT practice is anybody's guess.... the center has state of the art equipment, staff out the wazoo, and a fantastic team of providers. This in a neighborhood where it costs $150 to get your hair highlighted.... and the PT session (about the same amount of time) is worth $55??? What's wrong with this picture???</p>
<p>This thread certainly has become doom and gloom.</p>
<p>For the balance: My husband is a doc. His best friend from way back is a doc. Many, many of our friends (naturally) are docs.All of them love their jobs. None of them are demoralized, discouraged, depressed, or any of the other things mentioned. None of them are struggling for money, at least (as Opie has pointed out) not in the way the average American would describe struggling. All complain about managed care, but everyone has to complain about something in their job. Rarely is managed care something that directly impacts their jobs.</p>
<p>Now, there are exceptions, particularly in psych. Psychiatrists often have a difficult time getting managed care to cover necessary drugs, emergency hospitalizations, etc. I know of one that dropped a particular company because they refused to pay for a suicidal kid's hospitalization. But all in all, it is not that bad.</p>
<p>Yes, the hours are often long. Docs also make a whole lot of money for those long hours. If you're pulling six figures, you're doing OK. Not to say that docs don't deserve it. But I pulled the same number of hours per week when I was a teacher, and I definitely wasn't compensated for it!</p>
<p>In short, many, many docs are very happy with their jobs. I've not encountered more than one - really - who has said he would not do it over. This is out of, oh, the 150 or so we've known well enough to make that statement. Of course, if a person is in medicine to make money, they'll always be disappointed. There can never be enough money for them. And as I said, managed care frustrations are real. But a huge majority of disaffected docs? I think not.</p>
<p>What specialty is your husband in, and is he in practice, research, academics? How about your happy doctor friends? What area of the country are you in? What is the age group of all of your friends who are doctors? </p>
<p>It does seem that the doctors who are posting here are not as happy. There must be a big difference between your friends and these doctors on CC and in the surveys of doctors. </p>
<p>To what do you attribute the difference? Age? Specialty? Location?</p>
<p>I'm not a doc and can't provide first-hand experience, but one thing that seems to be occurring is the transition from "doc-as-entrepreneur" to "doc-as employee". While work as an employee of a physician group or other entity may be more controlled and not offer the upside opportunity that private practice does, the pay is competitive and a lot of the administrative tasks and other hassles of running a business go away.</p>
<p>I've been in business for myself and employed by others, and each has advantages. Both have disadvantages, too. With the increasing complexity of insurance billing and restriction of business to preferred providers, lengthy delays in payment, etc., the balance is swinging toward employment now. </p>
<p>Regardless, I think those who survive the rigors of med school and who enjoy practicing medicine will do fine for the forseeable future. The one thing I'd be a bit cautious about is really loading up on med school debt. Some in this thread have cited loan totals approaching $300K, and that could be quite a burden if we see downward pressure on compensation.</p>
<p>I haven't read this whole thread, but from what I have read, I'm glad I changed my mind and decided on the PA track. ;)</p>
<p>A lot of the physicians I've talked with have echoed many of the sentiments on this thread. Also, as a female, many encouraged me to look into becoming a PA because with no or little call, it would more easily facilitate me having a family someday.</p>
<p>Opie- yup, HSA, so the annual exam ONLY is set up where they waive the deductible for that and consider it preventative, but seeing the doc doesn't doa lot of good for young healthy people and I am not excited to pay that much for a lab. Interestingly I live in a new area now and the lab fees I called to get are no where near that- I have no clue why they were so crazy that time!</p>
<p>Jubajive raises a good point, the decision to become a physician is not just monetary, but also a lifestyle decison.</p>
<p>What if you are a female UG who is interested in medicine, fascinated even? Can you have a family life that allows you to be as involved with your kids as you want to be? Or are you obligated by debts to work crazy long hours? Is it practical to be a part time working physician?</p>
<p>I am able to work part-time, but it's easier with some specialties then others ( In some ways, it's a VERY good time to be a child Psychiatrist), especially during early career. Having babies during a fellowship (which I "accidently" did), or more difficult still, during a residency, was very trick in some specialties in my day. Waiting, and having kids late has it's downside as well. Even today on physician message boards, one gets the impression that women who work part-time are the subject of some.... disparagement.</p>
<p>I have a friend in geriatrics. She was able to have a job-sharing arrangement when the kids were young. </p>
<p>As for planning when to have kids, you can read about why Perri Klass decided that the middle of med school was as good as anytime in her book A Not Entirely Benign Procedure: Four Years As A Medical Student.</p>
<p>
[quote]
What specialty is your husband in, and is he in practice, research, academics? How about your happy doctor friends? What area of the country are you in? What is the age group of all of your friends who are doctors?</p>
<p>It does seem that the doctors who are posting here are not as happy. There must be a big difference between your friends and these doctors on CC and in the surveys of doctors.</p>
<p>To what do you attribute the difference? Age? Specialty? Location?
[/quote]
</p>
<p>I couldn't give you an attribution. However, I will say the specialties range across the board, as do the locations. I suspect by "ages," you mean "experience, as in how long out of med school. If that is the case, most are within 6 years out of med school. However, while the more experienced docs have complained more, they have certainly not regretted their career path.</p>
<p>
[quote]
A lot of the physicians I've talked with have echoed many of the sentiments on this thread. Also, as a female, many encouraged me to look into becoming a PA because with no or little call, it would more easily facilitate me having a family someday.
[/quote]
</p>
<p>You obviously didn't take it as such, but this is incredibly sexist. Funny how no one tells men that they shouldn't be docs because they will want to spend more time with their children. And, in agreement with another poster, I do know women docs who had children during med school and during residency. Med schools and residencies are extremely flexible with those situations (in my observations), as are hospitals and such. That's why the profession has had about an equal number of men and women entering med schools and residencies every year. Academia, by contrast, does a terrible job of this and drives women out regularly.</p>
<p>
[quote]
What if you are a female UG who is interested in medicine, fascinated even? Can you have a family life that allows you to be as involved with your kids as you want to be? Or are you obligated by debts to work crazy long hours? Is it practical to be a part time working physician?
[/quote]
I know of one doctor, the D of a colleague of mine, who manages raising a family quite well. She works at Kaiser (HMO hospital in California) and has very regular hours. I'm not sure what her position is. She manages it so well that she can work a different shift than her H and manage to have a parent home for their kids at least most of the time. I expect she'd say being a doctor was great and as a female doctor could take care of her family just fine. </p>
<p>I know of another doctor, an anaesthesiologist, who is a single mom. Due to her irregular hours (lots of on-call duty), she had to hire a full-time live-in nanny for her D. We saw the nanny at more school functions and birthday parties than we saw the mom since she was always working. I expect she'd say being a doctor was challenging and as a female doctor had a difficult time taking care of her family.</p>
<p>It's really not that different than many other businesses/professions in this regard though. If one plans to be a high-level executive (president/executive vice president of a medium to large company) or have certain other positions, then it might be difficult to be around for the family. I know some executives who spend a huge amount of their time traveling internationally and when they're at HQ they tend to still work long hours. They routinely get calls from large customers at any time. Certain other lower-level positions have the same challenge. There are yet other positions that allow for a fair amount of working at home and time shifting (certain software development positions for example). </p>
<p>People need to try to understand the playing field, have a good understanding of the positions, choose their position well, and they'll likely do fine whether they want to be in the adrenaline charged atmosphere of the trauma doc in a big city or the fixed-hour position of the person working in the similar field but a different position.</p>
<p>No, I can definitely see the sexism in that statement...but at least I had both men and women telling me that, and not just men. I also had a female physician tell me that the extra work for the MD was worth it basically just for the extra money <em>rolls eyes</em> I'm sure it is easy to work around med school/residency and having children (I'm not envisioning children any time soon anyway!!) </p>
<p>But right now, I think I also just don't want to deal with the extra schooling involved with med school plus all of the problems which have been listed above. And I think the PA route will allow me more flexibility to have a life, whether or not I have children someday. Plus organic chemistry and physics have been kicking my butt ;)</p>
<p>"I couldn't give you an attribution. However, I will say the specialties range across the board, as do the locations. I suspect by "ages," you mean "experience, as in how long out of med school. If that is the case, most are within 6 years out of med school. However, while the more experienced docs have complained more, they have certainly not regretted their career path."</p>
<p>If they are 6 years out of medical school, then they are barely finishing residency programs. Their experience is more to do with medical school and residency programs and then they have very little, if any, experience in practice. This would not be very representative of doctors. Residency (and then fellowship training) is anywhere from 3 to 7+ years after medical school.</p>
<p>cbreeze - Doctors don't deal with managed care issues on a regular basis. Mostly their staff handles things and tries to work out any problems. The most frequent problem is prescriptions, and docs generally have alternatives that are fine. This is certainly more true for hospitalists and less true for people in private practice, but it is a good average approximation.</p>
<p>swatparent - I think you misunderstand what a residency is, and you are definitely overestimating how long it takes. Most of the docs I know spent three years in residency, giving them three years after. Certainly that's plenty of time to get a handle on the issues, and it certainly isn't "barely out of residency." Fellowship training is not required for most specialties. Additionally, a fellow is a board-certified doctor that essentially practices as an attending. They are simply given extra time to hone a particular skill set or gain more exposure to a certain group. The only exceptions are a very small number of fellowships that allow an additional board certification. None of the people I referenced were in such a situation. The vast majority of physicians don't spend more than four years in residency. Out of the people I mentioned, few are still in residency or fellowship. A few are even faculty at top med schools, and others are faculty at other schools or attendings at well-known hospitals. And some of them are people who, outside the norm for the group, have been practicing for decades.</p>
<p>Secondly, residents are doctors. They act as doctors, they deal with all the same stuff as attending physicians do. The only differences are:</p>
<p>1) They experience several different specialties, which, if anything, gives them a better perspective on the wide-ranging effects of managed care, and
2) They have an attending physician to check over their charts.</p>
<p>I would bet you that, if you have been in a hospital with a residency program, you may have been treated by a resident and not even known it. They don't always announce it. (They are usually supposed to tell you, but they often do not. The reason is that patients are more inclined to blow off the advice and follow-up appointments if they are broached by someone they see as "training.") And they certainly experience managed care issues during residency. To be honest, my husband experienced some of those issues while in med school on sub-i rotations.</p>
<p>In short, your dismissal of my information is based on faulty assumptions.</p>
<p>"Doctors don't deal with managed care issues on a regular basis. Mostly their staff handles things and tries to work out any problems. The most frequent problem is prescriptions, and docs generally have alternatives that are fine. This is certainly more true for hospitalists and less true for people in private practice, but it is a good average approximation."</p>
<p>LOL !
I am not sure what you are smoking, but I dont want any of it.
It appears to induce severe cognitive dysfunction.</p>
<p>On a more serious note, thank you for posting that.
I know not to give any credence to anything you post.</p>