Tuesday, November 10, 2015

Should I go to med school?

A young man writes

I am thinking about pursuing medicine as a career. However, it is not something that I am entirely sure of because of the changing healthcare landscape.

Suppose I enter medical school at age 26. Four years later I have my MD. Five or six years later I will be done with a surgery residency and two years after that with my fellowship. I will 37-38 years of age with kids, a wife, and most likely a home. My kids will be around 9-11 years of age. In addition, I will be near $250K in debt from medical school because of interest accumulated throughout my residency and fellowship. This is of course not including retirement, car, house, investment, and kids’ college savings.

My friends tell me not to think about it, but if I don’t, I can end up in a position that I don’t want to be in. Even if I pay off my debt at age 50, I still have all those other things to address. And even if I do, when will I enjoy my money? What is perhaps most important though, is the time component. I am essentially giving up my entire life to a profession that will not allow me to transfer laterally to other professions if I choose to. I can be pursuing my other interests in the time that I would be becoming a surgeon such as business or engineering.

Lastly, I grew up in poverty and have no financial assets. It will take me years to accumulate wealth. And once I do (at around age 60), that wealth will be passed down to my children.

Did I miss something? What are your thoughts? 


While rereading and editing your email, I realized you did miss something. What's missing is enthusiasm for becoming a doctor. You listed several reasons not to go to med school, but nothing about why you want to do it. If you don’t truly love the idea, you will be very unhappy.

I think you need to reassess your future.

For those who want more information, I have written a couple of posts about questions related to this one [links here and here.] The comments on the more recent post are worth reading..

16 comments:

Anonymous said...

While considering finanaces is important is any major life decision, Skeptical Scalpel pointed out you seem to lack passion for medicine. This alone should dissuade you. How I do I know you don't have a passion for it? You never state why you want to go into medicine. At the end of the 3rd paragraph, you bemoan the lack of being able to transfer skills to other professions and time for other interests.

Medicine is a hard road, no matter the age. It must be a passion. The road doesn't get less hard after medical school or residency.

artiger said...

While I don't agree that medicine, especially surgery, necessarily has to be a "passion", it does have to be something that you'll like doing. At least a little bit. Otherwise, I agree, don't do it (based on what the young man wrote above).

I can already hear the "follow your dreams" crowd about to chime in, but if I read correctly, the young man has two very young children presently. I think there is a certain amount of responsibility to the family to provide, one that overrides the desire to follow dreams. And since it doesn't appear to be a dream in the first place, there are certainly faster and easier ways to provide.

Lots of people have the ability and intelligence to get through med school and residency; what counts is the patience and tolerance to put up with everything that goes along with it.

Anonymous said...

When the passion for medicine is not there, its about $$$. Don't do it. You won't be happy and it will show in your work and to your patients.

Skeptical Scalpel said...

Thanks for the comments. I don't think he has children right now. He is speculating that he will have pre-adolesents by the time he is 37 or 38.

I agree it shouldn't be about the money. Who knows how much money any doctor will be making in 15 or 20 years? It might be far less than what we see now.

Anonymous said...

I tell my residents and medical students that a career in medicine is like a chronic disease: It is not just a job or profession, but it is part of you and your close loved ones 24/7/365. If you don't love it enough to be able to tolerate that, then you will be miserable when doing it, and miserable doctors make bad doctors. While I think following your dreams is great, following your instinct is critical.

Skeptical Scalpel said...

Anon, great comment. I never thought of it that way, but it's a good analogy. Like a disease, it even goes on vacation with you. You are never totally free of it. I've been retired for 3 years and I still dream about being on call.

natselrox said...

On the plus side, you will get to help a bunch of different people in distress, you get to operate on one of the complex things in the universe, the human body and so on. I'm not trying to say that money is not an important factor but there is so much more to medicine than just that. If you love the profession, you will enjoy your student and residency years as much.

Skeptical Scalpel said...

Nat, you are correct. Our young man didn't mention any of the things you did.

artiger said...

Scalpel, I apparently did misread earlier about the author already having small children, but it appears that he plans on having them right in the middle of school and residency.

I don't think it's a sin to desire a profession that is lucrative, but I agree that it shouldn't be the sole motivating factor.

Anonymous said...

Skep, re the November 12, 2015 at 7:15 AM comment, its called PTSD. Call isn't a memory that's a nightmare. Its over dude. :)

Skeptical Scalpel said...

Thanks. People ask me if I miss working. Not so much.

Anonymous said...

Anonymous Europe: Guys, I just want to tell you a story I read recently in the local medical council's monthly magazine. A room full of students in Germany was asked how many wanted to have a private life: everyone raised their hands. Then they were asked who wants to be a professor: one hand went into the air....
This is a complex issue. Is it worth doing what we do? Laugh at me or not I heard the best answer from Scrubs Season 9 from the young surgeon kid: Why do I do surgery? Because it rocks hellyeah!

Skeptical Scalpel said...

I guess that's as good a reason as any. I hope it keeps rocking when you're 55 years old.

Chris said...

I agree with artiger above that the concept of Medicine as a passion/calling is oversold. Obviously if medicine is truly the one thing in life you're passionate about, you should pursue it.

On the other hand, I think there are many physicians, including many good ones, who became physicians because it's interesting and challenging, because it's what their parents did (guilty), and, yes, because it's a prestigious and generally appreciated role in a community. Well, it was at one point, anyway. It is well-paid, but not to a degree that is inconsistent with the finances, emotions, and time invested in the training and certification required for entry, nor with the degree of risk and workload entailed by the job itself.

I often think that the best way to respond to these "should I go to med school" questions is to say "no, probably not." If a potential applicant is dissuaded by one person's casual opinion, they probably don't have the dedication, work ethic, and just-plain-stubbornness to enjoy the experience of going through pre-med, med school, residency, fellowship, and THEN 7-15 years later, starting their actual job. In my opinion, resistance to adversity is a key component of a successful physician's personality, so we might as well screen for that at the "should I go to med school" stage.

Chris said...

One other thought occurs: one of the most commonly cited reasons for seeking a career in medicine is a desire to "help people".

For me this always brings to mind an anecdote from South African/MSF trauma surgeon Jonathan Kaplan's book "The Dressing Station". He recounts a flight home from a war zone where he was working for MSF; next to him on the plane was a water engineer who had implemented a water sanitation facility in a huge refugee camp. Kaplan realized that the water engineer in that single act had probably saved many multiples more lives than Kaplan would in his entire career.

So a desire to "help people" does not entail a career in medicine; in fact medicine is not likely the most efficient route if that's the goal. Bill Gates did something entirely different with his life, yet has saved many more lives than all of us docs reading this blog put together and multiplied by 10000. Always worth pointing out to young people in search of a purpose in their life.

Skeptical Scalpel said...

Chris, great comments. Thanks. I read Kaplan's book. It is something every surgeon should read.

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