“I can see the interest in being a physician, as there are many different types, but I cannot understand wanting to be a dentist, although they make very good money. Human mouths are really nasty!”
Delivering healthcare is not for the squeamish. You have to tackle the medical problems wherever they arise whether it’s “nasty” or not. Dentists don’t have it so bad. Gastroenterologists (who are MDs) spend much of their careers working on the human digestive system from opposite end from the dentists.
I worded my statement badly. I meant too many specialists as compared to primary care physicians, rather than too many specialists overall. Just another reason not to shut down schools producing DOs.
One other factor for the higher ratio of specialists to primary care physicians beyond pay rates and med school debt is perceived prestige among many who are MDs.
Basically, while being an MD is already considered an elite profession which signifies to many laypersons one is not only keenly intelligent even among above-average academic achievers/professionals, but also with a high work eithic…being a specialist…especially in areas like cardiology means one is considered the elite within the elite. Especially by one’s fellow MDs.
The dynamic isn’t too different from how my former Naval aviator cousin described how among Navy pilots, those who were chosen from Naval Aviation flight school to fly fighters(especially the F-14 Tomcat back then) usually had to be and were considered a cut above the rest of the already elite Naval aviation community. While graduating from Naval flight training in any platform is already a major achievement considering the exceedingly high selectivity rate AND high washout rate (Over 60% isn’t unheard of), those selected to join fighter/attack squadrons tend to be considered a cut above the rest…and the F-14 pilots a cut above them*.
I agree dentistry isn’t bad and I specially suggested it to my children but overwhelmingly most high achieving students simply don’t want to be limited to the mouth. As for the GI guys many people have misconceptions about what they do. For the most part it is not remotely nasty. The patients have bowel preps and are fully cleaned out and then the patient is totally prepped by the GI nurses and techs. The gastroenterologist is mostly using a high end scope or other device at a significant distance from the mouth, any or other body part.
Wouldn’t primary care physicians need to greatest breadth of knowledge and problem solving skills, since they could encounter patients walking in (or bring brought in) with just about anything? In contrast, a specialist, while s/he may need to do something technically demanding, can concentrate on a specific subclass of medical problems instead of having to deal with everything possible.
MODERATOR’S NOTE:
12 posts deleted. Please keep to topic. Nowhere did the OP ask for educational background needed for firefighters, not pay scales of police vs. fire.
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young doctor with 300-500k in debt simply can not choose a profession where the income is 150-175k.
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This is true. When straddled with a bunch of med school debt, there is a pressure to seek a better-paying specialty. And, those who go to private med schools without any aid, can be looking at $350k of debt upon graduation…all of it unsub. Many residents can’t afford to make payments yet, so their loans are on hold for another 3-5+ years accumulating MORE interest. Resident salaries are modest, and can evaporate when the hospital is in a pricey area and rent/utilities are eating up 50+% of their gross pay.
Maybe the fed gov’t needs to offer an incentive…those who choose a lower-paying primary care specialty will have their loans changed to sub…and any accumulated interest is cancelled.
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Wouldn’t primary care physicians need to greatest breadth of knowledge and problem solving skills, since they could encounter patients walking in (or bring brought in) with just about anything? In contrast, a specialist, while s/he may need to do something technically demanding, can concentrate on a specific subclass of medical problems instead of having to deal with everything possible.
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Lol…they all need to know a lot.
What specialties all make up primary care? Family practice, peds, Obgyn, general internal med, gerontologist, what else?
There are specialties, “advanced specialties,” urology, ophthalmology, dermatology, diagnostic radiology, radiation oncology, physical medicine and rehabilitation, neurology, psychiatry and anesthesiology, that require a prelim/trans year of training before they being their specialty training. I thought that was because it was believed that those specialties need to know more, have a greater breadth, but maybe I’m wrong.
Usually, internal, family, and pediatrics are shown when you go to a large medical group’s web site to look up “primary care physicians” to see as a new patient. Though some women use obgyns as their primaries, and some older people try to find gerontologists as their primaries.
I was recently told a story by someone who has two different medical conditions X and Y. He was proactive and got the specialist treating X and the specialist treating Y together so that they could know about the the concurrent conditions before recommending any treatments. But the specialist treating X prescribed a drug for X that aggravated Y anyway.
It may be a cautionary tale if you have more than one medical condition. If a specialist prescribes or recommends a treatment for one condition, you may want to confirm that it is ok with all other specialists for your other conditions and your primary care physician before beginning that treatment.
My H’s PCP has done a fantastic job of managing my husband’s care while trying to control the egos of the various specialists: cardiac surgeon, cardiologist, lung spec., gastroenterologist, urologist. Last evening, the surgeon rudely ignored the PCP while H was trying to introduce them. The surgeon might be brilliant but he definitely has not been looking at the big picture and the PCP has had to change several orders that are conflicting. I am happy that we will continue the relationship with the PCP and hopefully will not have to see the surgeon after the followup visit. The cardiologist seems much better at “playing with others”. He and the PCP seem to work well together.
Unfortunately, the logical factors you’ve cited aren’t considered.
What’s considered is the level of difficulty in gaining an internship/residency leading to a particular subfield of medical practice and the salary commanded.
Comparatively speaking, getting an internship/residency leading to a specialty such as cardiology or surgery is much more competitive and difficulty compared with getting one for primary care. And correspondingly, the salaries commanded by the former are much more than the latter.
When I was hanging out with a group of friends which included many MDs…the ones with specialties such as cardiology or surgery were regarded with awe by fellow MDs within the group. The Primary care physicians…crickets.
I’m afraid that cobrat has it the wrong way around. The higher remuneration is one of the factors that make medical speciality residencies more competitive, not the other way around . Other factors include the limited number of residency slots and the burden of student debt. The salary discrepancies reflect the relative values assigned by market forces, in which insurance companies play a major role. Most physicians would agree, some begrudgingly, that some specialty services are overvalued while primary care is undervalued.
As a pediatrician on a medical school faculty, I can assure you that much more goes into the choices made by individual students. Most of them haven’t made up their minds until the third year of clinical rotations when they usually discover the particular area of medicine that that they feel most comfortable in or fall in love with.
I’m not sure what he means by ‘crickets’, even though I seem to be one, but I can assure you that primary care physicians do not regard their specialist colleagues with awe but rather with respect when they have earned it.