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

Parents Forum
141

<p>Desp, your experience and that of your friends sounds great but it is certainly not representative of the aprox. 20 or so physicians I have dealt with (speaking medical dealings, not friends or neighbors) in the last few years regarding my own medical issues plus that of elderly parents. Every single one has had occasion to describe a medical procedure or treatment plan which was likely to yield a better outcome but the hassle with the insurance company rendered the course of action moot. These were not always prescriptions and the MD's themselves were involved personally (not their staff or receptionists) to the tune of several hours a day.</p>

<p>My own OB/GYN who is definitely old school and runs a medical practice like those of the 1950's has recently given up obstetrics, much to his regret and that of his patients. The combination of his malpractice rates and the continuing involvment/hassling of the HMO's made delivering babies a lose/lose proposition. Even the decision to put a pregnant mother of twins on bedrest caused a firestorm when a med review board determined that "she could stick it out" another few weeks despite some cervical complications.</p>

<p>I envy you and your friends but I do not believe your experience is representative of most medical specialties. My mother's neurologist would love to know where you live so she could move there.</p>

142

<p>I think you guys are misunderstanding. As I said, dealing with managed care is not and overwhelming, day-to-day, minute-to-minute thing. And yes, the docs do not generally deal with insurance issues unless there is a major problem. They have staff. If any of you have had an insurance issue, you know that the first person that handled it was either a secretary or a biller. Docs simply do not have the time to do so, and definitely not several hours a day. If they are, they have not hired staff to do so, which is a penny-wise but pound-foolish thing that some physicians do. If the doc is doing billing and insurance negotiations, s/he can't see patients and will lose money. That's not good business. I have head of precisely one doc to do this, and he worked by himself out of a small office and was very old-school. And, again, the experiences I describe are in several areas of the country.</p>

<p>That is not to say that there are not some issues. In fact, I specifically noted some issues I have heard. However, these are not even daily occurrences. I sincerely doubt there are reams of physicians regretting their career choice because of an issue that affects a small minority of their decisions. Frustrating when it happens, yes. But honestly, as Opie said before - what job doesn't have something like this? As a teacher, I was annoyed with parents, and they were far more frequently an issue than insurance is for doctors. One sis works in an office, another is a journalist. My dad is a research scientist. All have their own recurring issues with their jobs.</p>

<p>Again, as I have already said, insurance issues are more frequent for managed care and less for hospitalists.</p>

143

<p>"And yes, the docs do not generally deal with insurance issues unless there is a major problem. They have staff."</p>

<p>If there is serial resistance from insurers, we stop even trying to get our staff to arrange therapies or investigations. Today I saw a woman with a suspicious region of microcalcification in her breast. Ideally, she needs a radiologically guided stereotactic biopsy. Instead, I arranged a FNAB, a investigation that is suboptimal in this situation, that is easier to get approved by the insurer. Things like this happen several times a day, every day.</p>

<p>Why would I waste my staff's time by having them ring insurance case managers about modalities that are probably going to be rejected ? My staffs time is finite and valuable. </p>

<p>I am afraid that you really have no idea as to how things function in real life medicine. Knowing a few residents and junior trainees does not give you any insight into the realities of medical practice.</p>

144

<p>Desp, you are missing the point. The issue isn't whether "dealing with managed care is a ..... minute-to-minute thing". The issue is whether the hour per day or two hours some days or four hours some week is more than a minor irritant... for many specialities it is the CRITICAL issue which impedes quality patient care, precludes some procedures or treatment protocols, hinders a physicians ability to care for the entire patient vs. managing a single body part or disease.</p>

<p>10 years ago in my neck of the woods many OB/GYNS gave up performing abortions.... it became too dangerous, and although many of them were committed to safe, medically supervised terminations (vs. the alternatives) they felt that they couldn't risk the health and safety of their staffs and other patients. Now they're all giving up obstetrics; what's next-- Pap smears??? How do you practice quality medicine with outsiders telling you what to do and how to prescribe and when to intervene?</p>

<p>You are dreaming if you think that it's only staff that has to get involved in these issues- a receptionist can't prescribe (at least in my state); a receptionist can't refer to a specialist; a receptionist can't authorize a hospitalization or surgical procedure. The billers don't get to decide who gets an active course of antibiotics to treat an infection vs. palliative care- only the physician can, and when these decisions get second guessed and challenged on a daily basis it is often enough to drive that physician out of practice.</p>

<p>We don't have Hospitalists here yet; neither of my parents were lucky enough to die in hospitals which did. They had harried residents with overwhelming patient loads, and wonderful specialists who did the best they could under trying circumstances and HMO's trying to curtail the amount of care on an hourly basis.</p>

145

<p>While I still want to emphasize that I can't imagine doing anything else (except retiring), and I'm a Child Psychiatrist (5 or 6 years resident+fellowship btw, and NOTHING like MY real life), I think it's worth mentioning that having to staff just to deal with managed care is in itself a big deal. In my practice, it comes up several times a day, and mostly in terms of whom I will not see and what I will not do. This is largely determined by my office manager who takes the first call and asks about which insurance they have. I take the second call to see if I can help the patient within the limits of their insurance or cash. I left my HMO position because the only way to make it work seemed to be to churn prescriptions all day long. Nice benefits though.</p>

146

<p>Interesting thread to say the least. My D is in her 6th semester of pre-med studies, majoring in integrative physiology with a psych minor. And she’s into it up to her elbows, taking a full load on top of a Kaplan MCAT class (2x week, 3 hrs each) in prep for the test the end of May.</p>

<p>This high-achieving track was her decision, though. We have explained to her the financial ramifications, that it’s doubtful that she will be even close to wealthy until she’s well into her thirties, if then. She knows the hurdles in combining the practice of medicine and raising a family concurrently. And she still wants to do it.</p>

<p>I think any student who has a passion for a chosen field thinks of opportunities rather than consequences. And at least in pre-med, in advising her I have the luxury, if she gets somewhat burned out, of telling her there certainly is a Plan B and Plan C if A doesn’t look that good anymore, or the road looks too long.</p>

<p>The process is a long & arduous road, but there appears to be so much learning as opposed to constant regurgitation of facts, that wife & I are proud supporters of her dream.</p>

147

<p>Well, I suppose if y'all are determined to misinterpret my words...</p>

<p>I didn't say staff deal with difficult stuff. I specifically said docs do that. I also stated that in non-hospitalist practices, the insurance definitely takes up more time and is more frustrating. Family medicine and OB/GYN, inparticular, and subject to this. I also gave specific examples showing that I do understand there are critical health effects at times.</p>

<p>This is that same stuff you've all said. That's not the point. The point is that on a day-to-day basis, most physicians are happy with their career choice. Sometimes people who are very unhappy with their situation cannot see outside of it, assuming their angst is universal in concerns and degree. It's not. And, frankly, if anyone hates practicing medicine so much, get out! There are research jobs, etc. that are alternatives.</p>

<p>And, by the by, I don't "know a few residents and junior trainees." My husband is a resident. Our friends are both residents and attendings. While most are our age (mid-30s), several are older and far more experienced.</p>

<p>If you want to complain about the health care system, fine. I'm with you on that. The US health care system, in regards to managed care and access, sucks. BUT...I think to say "Don't get into medicine because the managed care makes it absolutely unbearable!"...well, it's a bit of hyperbole and melodrama. Everyone's jobs have characteristics that are difficult. And before you jump in that doctors are different because they deal with people's health, I'd point out that as a teacher I had to deal with multiple situations of abuse, neglect, and criminal sexual assault against students. Social workers have huge case loads that impede their efficacy. compared to those professor, doctors have better pay, benefits, and greater respect.</p>

<p>What I'm saying, in short, is don't generalize your experiences to everyone - it isn't the case. And don't spread your discontent by advising people not to pursue medicine. Stick to the facts.</p>

148

<p>
[quote]
And, frankly, if anyone hates practicing medicine so much, get out! There are research jobs, etc. that are alternatives.

[/quote]
</p>

<p>Sometimes, you are in too deep to get out, ie too late to change or too much debt. That goes for most professions. This thread is for future seniors who are thinking of getting in the profession.</p>

149

<p>Hmmm</p>

<p>I only read the first two pages, so take this with a grain of salt.</p>

<p>In the modern service economy, the lucrative professions are no longer physician, attorney (in general), and stock broker.</p>

<p>Anyone can DO. Most cannot sell/make deals. The only really lucrative professions that I observe are:</p>

<p>1) owner of a small or medium sized business
2) deal maker/sales person for a company.</p>

<p>So who is making the $$ in medicine now? Not the physicians (except for those performing elective procedures like plastic surgery), who are probably making less than 50% in adjusted dollars of what they made 25 years ago. The money now is made by the owners of the contracts, the dealmakers & attorneys. The HMO/Blue Cross Blue Shield, etc.</p>

<p>My advice for anyone who is concerned about making large amounts of money (I am not saying that is even the right objective) is to learn to make deals and sell services. A physician can perform that role. So can an attorney.</p>

<p>As to the OP's original question, it would be good to ask the son whether he would enjoy being a physician even if he made just twice the earnings of a school teacher. I suppose there are always those attracted to the profession because of prestige and challenge, and others for the "lifestyle" made possible by large earnings. As those large earnings are a thing of the past for 95% of physicians, it would be good to get to the heart of the motivation early on.</p>

150

<p>jnm123 wrote: "that it’s doubtful that she will be even close to wealthy until she’s well into her thirties,..."</p>

<p>Try late forties. By late thirties the student is reaching middle class and chipping away at $150,000 student loan. Driving a Honda Civic or Acord, no a pricey german car. Just starting to pay the mortgage on an average house in an average neighborhood.</p>

<p>The payoff (financially) in medicine is 45-70 (exactly when equally hard charging, equally over achieving Hollywood or Investment types are preparing to retire wealthy). As the 2nd poster detailed, there is a LOT of financial catching up to do from 35-45 for a young physician.</p>

151

<p>
[quote]
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.

[/quote]
</p>

<p>Well, this casually left off perhaps the biggest difference of all, namely pay and working hours/life. Many nurses will make more than residents (especially on a per hour basis). In some markets, residents may make only about 40k or so. Sure lots of people make a lot less than that, but considering the level of education, hours worked (numbers approaching 80 per week not uncommon), and 200k+ of debt... it's not a nice situation anyway you slice it.</p>

<p>One should never enter a career because of the money, but equally one should never enter a career without thinking about the money. Money and financial outlooks aren't the only thing that's important, but it is still very important and dictates almost every aspect of ones life and lifestyle. </p>

<p>DespSeekPhd correctly points out that not everyone is miserable, but I also think it's highly misleading to suggest that most of the comments made on this thread are nonsense by simply brushing them off. There are all very real issues. Surveys showing almost half of current physicians saying they wouldn't do it all over again if they had the choice... that's no joke. It's also not just complaints about financial matters, or just complaints about HMOs, or just complaints about working conditions (many comments have only focused on one of those issues at once)... it's a combination of all those things and more. For those thinking about entering the field, which is what this discussion is about, these are facts that can't be ignored.</p>

152

<p>DespSeekPhd, OK, now we know why you seem so clueless about how real life medical practice is conducted. Your husband is still in residency. Wish you told us earlier than to mislead us that he is about 6 years out of medical school and your 150+ friends are rarely impacted by managed care.</p>

<p>A lot of us speak from voice of experience either as medical providers or knowledgeable consumers. FWIW, I am also married to a doc, who's been out of medical school 30+ years. </p>

<p>We'll agree on one thing, despite all the difficulties doctors encounter in practice, they all love what they do......taking care of patients. And if you ask my H whether he would be a doctor again , it would be a resounding yes.</p>

153

<p>"My husband is a resident. Our friends are both residents and attendings. "</p>

<p>ie: Your "experience of medicine" is confined to trainees and newbies who are barely out of their med school diapers. No wonder you have no idea of what medicine is like.</p>

154

<p>rocketman - I don't feel I brushed off any concerns. I recognized that there were real and valid concerns, but that they don't make the job so unbearable that they should be telling people to run away from medicine. We're not talking about coal mining here.</p>

<p>cbreeze - I stated my husband is a resident in my first or second post. I can't be held responsible for your inability to read.</p>

<p>cbreeze and bearpooh - Y'all are very, very determined to redefine the group of doctors I have spoken to about this issue. What I always, always said was that they tend to be younger, but that several of them have been doctors for decades. Again, if you actually read the posts, I specifically explained the range of locations, specialties, and experience.</p>

<p>I'm not clueless, I am simply relating what I have been told. And yes, some of those people have been practicing as long (or longer) as your spouse, cbreeze. I also find it a little unsettling that you both have such a dismissive attitude towards younger doctors, as if they're idiots who simply don't know. In fact, what it sounds like is, "Those young people don't know nothin'. They'll learn, they'll learn..." However, these younger doctors, as well as the docs with a lot of years under their belt that treat these younger docs as peers, are all happy in their jobs. Perhaps you all need to learn something from them - how to be happy in your job.</p>

<p>Oh, well, there's always a group, and they always tend to be loudest. As a teacher, we all knew who they were. They'd sit around the teachers' lounge and complain ad nauseum, about everything and how terrible their jobs were. The rest of us recognized there were serious problems and occasionally discussed them, but we also managed to find good things in our jobs. And none of us would ever think of telling a young person, "You don't want to be a teacher, believe me!" I suspect this is the same thing.</p>

155

<p>
[quote]
We'll agree on one thing, despite all the difficulties doctors encounter in practice, they all love what they do......taking care of patients. And if you ask my H whether he would be a doctor again , it would be a resounding yes.

[/quote]
</p>

<p>I don't think this was the message that came across in the first few pages. Anyway, a lot of the older docs are probably spoiled from the good old days. As someone pointed out a few posts ago, this thread was started to give advice to high school seniors and college students thinking about medicine as a career. As such, the opinions and attitudes of younger doctors and residents are probably more applicable than that of a 70 year old Ob/Gyn.</p>

156

<p>
[quote]

cbreeze - I stated my husband is a resident in my first or second post. I can't be held responsible for your inability to read.

[/quote]

Whoa, be specific then, where in your first post #125 or your second post #133 did you state that your husband is a resident?

[quote]
My husband is a resident.

[/quote]

This came from your fifth post. So tell me do I have a reading problem or is it you ?</p>

157

<p>I agree with all the posters that say the practice of medicine sucks. It can only get worse. I personally want to encourage all of your children to read this well-reasoned respectful thread, especially if they were foolishly thinking of applying to med school or M.D./PhD programs and are sophomores (or anyone planning to graduate in 2010 and apply to med school in 2009). Statistics show that those students will be least likely to have happy, fulfilling careers as physicians or physician scientists. I think it would be a community service to link this thread to any site pre-med sophomores may visit. A tip of the hat to all who have shared.</p>

158

<p>I'll tell you what I will do, Cur...</p>

<p>I'll tell my D to steer as far away from the negativity in this thread as she can, including your line of bull. WHAT statistics show that medical students will be 'least likely to have happy, fulfilling careers as physician or physician scientists'?! Sounds like some skewed sour-grapes sociology class on steroids to me...</p>

<p>Certainly things can get worse before they get better. But they CAN get better.</p>

159

<p>Tee hee Curm. How is sophomore Mudgie doing on her pre-med path?</p>

160

<p>I think cur was trying to eliminate some competition for her daughter. I'm sure she'll do fine in the process regardless as she is very qualified.</p>