Advice for Those Who Wish To Become Physicians
When I was in undergraduate school, I wanted to be an oceanographer. I was fortunate enough to be accepted to three top ranked programs. Unfortunately, they were all private schools, and even with partial financial aid, my newly arrived immigrant parents couldn’t pay the difference. Like many others, I applied to banks for private loans. As I had no collateral to offer, and there was no guarantee of a job at the end of my degree, I was turned down for the loan. One bank officer, seeing my science heavy transcript, suggested that if I chose to apply to medical school instead, they would be happy to give me the financial aid I sought. Lacking other better options at the time, I followed his advice, was accepted, and have remained grateful since to have the opportunity to provide care for people in need. My new career choice occurred a little more than fifty years ago, and medicine has changed considerably since then. Yet, if you were to ask me today, “would you do it again?” the answer would be a resounding yes.
There are not a lot of opportunities in life that offer the chance to help someone other than yourself, that remain constantly challenging and evolving, that come with economic and relative job security, and that offer an extremely wide variety of options in an ever expanding science. Medicine has allowed me to meet and get to know people with remarkable stories of life that have been more fascinating than many novels, and inspiring in ways I never expected. Despite all the roadblocks being erected between physicians and their patients, these opportunities continue to exist today, and remain, at least for me, the greatest reward of my profession.
Despite the negative changes driven by the corporate and governmental takeover of health care, more students than ever are applying to medical school, and even more are needed. The biggest challenge for those desiring to be in this field is getting accepted. The best advice I can offer is to do your best to get into the best college/university that you can, then work as hard as you can to get the best grades possible. Sadly, even when you achieve this goal, there is still not an absolute guarantee that you will be accepted. If this is something you truly desire, don’t give up if you’re turned down. Take an extra year in a master’s program and/or research, and reapply again. I know a number of highly qualified applicants initially turned down who were accepted the following year. Know also that there are some significant differences between schools offering an MD as opposed to a DO degree. The later, also known as osteopathic schools, are all private institutions, typically with equally or more expensive tuitions, whose graduates are also called doctors, and who today can be licensed in all US States. Aside from a greater selectivity in the admission process amongst entering applicants, the first two years of school are similar in both types of institutions. DO schools typically are not actively involved in basic science research, so if you are considering an academic career, these are definitely not the schools for you. The biggest difference occurs in the last two years, the so-called clinical years. DO schools typically do not have a university hospital (where students train with full time clinical staff who in turn, teach, provide direct patient care, as well as conduct research.) affiliated with them. Rather, students in DO programs have to find community preceptors to obtain the required clinical training. These are usually individuals in private practice, who without direct compensation (or oversight) from the school are willing to have student follow them around for a month. While some of the physicians who provide these services are competent and are good teachers, others look upon students as a cheap source of labor, and haven’t always kept up with the advances in their own fields. Students at DO schools also have to travel at their own expense, not infrequently out of state, to find required clerkships. Having served as faculty in both an MD and DO school, I have certainly had DO students who have turned out to be excellent doctors, in some ways, better than their MD counterparts. The uniformity of learning experience, however, leaves many DO students at a disadvantage, which becomes apparent to them when they discover their inability to be accepted into more competitive medical specialty training programs such as ophthalmology or orthopedics.
If you are still reading this piece, what follows are some life choices I would advocate for those going to medical school. To say that med school is strenuous is not an exaggeration. It’s hard enough to do by yourself, but even more challenging if you are a newlywed. By the time I graduated, half my class was married. When I went back for my 25th class reunion, only four of those couples were still together. It can be done, but…
As I said, school is not only difficult, but at times, traumatic. Death, dying, abandonment, failure are tough topics that many of us had never faced before. The advice here is, don’t try to do it alone. Whether it’s a friend, family member, a faculty mentor, you minister, talk to someone – don’t keep your feelings bottled up inside. Depression, anxiety, suicide are real issues in school magnified by the pressures of what you see and do. I almost quit medical school after my first year, and it was only through the intervention of an understanding faculty mentor that I made it through.
As students going through our clinical rotations, we often change our minds in which field we wish to practice our art. Our choices are not infrequently influenced by a charismatic practitioner we are exposed to, leading us to think, “This is what I want to do for the rest of my life!” Before you make a final decision, learn us much as you can about the field of your interest by not only talking to a number of different doctors who are doing what you desire for yourself, but ideally, spending some time with them to see how their career choices have impacted their lives. Emergency medicine is a popular specialty for both sexes these days, as it allows you to work fixed hours, limit your schedule during the childbearing years, and offering relative geographic portability in the case of two career couples. The down side comes when you get into your fifties and sixties, and your body has difficulty dealing with the shift hours and time changes the specialty requires. And if family life and being involved with your children is your first priority, you might want to rethink interventional cardiology as your medical specialty.
Of those physicians currently in practice, 52% are now employees. While many new graduates find this not only acceptable but even desirable, as they don’t have to learn and deal with the challenges of running a medical practice, it also places them in a role where the hours they work, the time when they take a vacation, and the number of patients they have to see in a day is decided for them. It’s difficult to establish rapport with a person when you are limited to a 7-10 minute window for each visit. It is also hard to show compassion to someone who needs a lot more of your time when your assistant is mandated to turn over the room every 10 minutes. The only way you have any control over your own life is to be your own boss. Think about that when you chose the model in which you practice.
While most doctors are still well compensated for their time compared to other fields, that amount is decreasing each year. In 2022, Medicare is cutting what they pay us by 6%, with commercial payers happily matching those reductions. You can expect this trend to continue for a long time. At the same time, many new graduates are carrying student loans in excess of $300,000. Sadly, this results in people making career choices based on how much they can make, rather than on what they actually would like to do. Part of the problem is that with the deferred gratification medical school requires, too many new graduates lock themselves into expensive lifestyles by purchasing expensive houses and cars and taking luxury vacations. They feel they are “owed” this for putting all the years and effort into their training. The sad result of adding to their financial commitments is the marked narrowing of choices with respect to the way they practice. Knowing that as soon as their financial production falls of they can lose it all, they find themselves on rapidly accelerating treadmill of work. They can’t afford to slow down, to “smell the roses”, to live their lives as their own conscience and the needs of their family might require. If you keep your expenditures significantly below your income, you can weather downturns without anxiety, and make important life choices without money being the key decider.
We need more good physicians, ones whose bottom line will be the welfare of their patients, not their own. I sincerely hope you will be one of them.
Medico Musings 