Tuesday, August 18, 2009

Why Medicine?

So I'm going to get right to the point. Randy asked a few days ago (and I'm paraphrasing): "Why do people (and you) choose to go to med school?" So out of everything out there, why medicine?

I'm actually surprised I had not explained or elaborated on this before. Maybe I have in some post and forgot about it (and if so, I'm not going to dig through my 260+ posts to find it). I'll first enumerate some of the reasons that people go into medicine before I speak for myself.

Warning: This is a rather long post.
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Money, power, prestige, fame, the title, wanting to do good, desire to serve the community, desire to heal/cure/save lives, a calling - these are the main reasons that I believe people choose to pursue medicine. I will first and foremost speak of my peers at my med school. Most of the people I've met in the last 2 weeks sincerely want to be good physicians and "do good." Everyone has his/her own opinions and leanings towards this specialty or that based on life experiences to date. We all entered med school knowing full well the "sacrifices" we would be required to make, to have the next decade (or even longer) of our lives "locked down." We all entered med school knowing full well the $160K+ debt we are incurring (not including interest). We all entered med school knowing full well we would be sacrificing sleep, food, and sometimes sanity. But we all chose to do it because that is where we see ourselves, that is where we feel our career niche lies.

But as a result I have sensed, however, a feeling of entitlement to satisfactory rewards when we're "done" and out of med school and residency. It is the feeling that, because we're sacrificing perhaps the second best years of our young lives (the first best years being the 3-5 years of undergrad), because we're incurring astronomical debts, because we're - almost literally and ironically - sacrificing our own health to learn how to heal others, we should be compensated. And it is for this reason that many of my peers dream of interesting specialties that they can flourish in and/or of specialties that have a more "cushy" lifestyle.

We know that fewer med students willingly choose to enter primary care and that primary care is approaching collapse in the US. Yet many of us still wish to avoid it if at all possible. Why? It is because we're wary of primary care - of the low reimbursements, of how you can spend 15-30 minutes with a patient and get paid less than an operation that takes 5-10 minutes, and of the sense of powerlessness in primary care (as you're always referring away patients to specialties). I don't know if I've said this before, but I heard on NPR about a month ago how many pediatricians back in my home state are leaving due to the high unemployment rate and the now heavy reliance on Medicare/Medicaid. It's scary to hear that pediatricians don't make enough to keep their practices open, that many who've practiced for years are now going bankrupt. Almost everyone I've talked to one-on-one - nurses, doctors, med students - warn us to avoid primary care like the plague because we will not be able to make enough money to pay for office rent, electricity, water, internet, heat, staff salaries, malpractice, loan repayments, etc.

And so, while many of us want to help the community and want to do the most good we can, we do not want to do it at our own expense. The culture of medicine is changing - med students today do not want to be on call all the time, med students today want to help others but also want to have a family and a life outside the hospital. I had linked to a blog article in my post here. As my friend, RZ-F (who's an M2 at Case Western), said: "I did not go into medicine to make a net income of $65K for a few years and have to pay the ridiculous loans. I did not go into medicine to not be able to truly help patients and having to refer them away. I did not go into medicine and 'sacrifice' a decade of my life for nothing." I found an interesting clip on NPR (here) that mirrors the sentiment med students have towards primary care; please listen to it as it really speaks the truth.
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Now, as for me. I had wanted to go into pediatrics for a very long time (sorry, I won't be doing prostate exams, lol). A good part of me still does. But I've heard strong admonitions from the doctor I shadowed (an internist/endocrinologist, I'll call him Dr. L) against going into pediatrics and psychiatry. And every med student I've talked to kind of backs away from me slightly when I express my interest in pediatrics (they actually look at me as if I'm slightly crazy, no joke). One guy said, "Man, you must have a very good soul to go into pediatrics. AND you must be very tolerant, especially of parents." Of any of the primary care fields, pediatrics is the one to be most avoided. So then, why pediatrics?

I feel pediatrics is where I can do "the most good." And I LOVE kids, I think they're the best. I tend to connect with kids very well and I think they should be given more credit. I believe that children require a strong health advocate and also that they're entitled to know what's going on with them. Children should, to a certain and varying degrees (depending on age and maturity and such), be aware and have a role in their own health care. Many times doctors tend to talk at or to the patient, and not with them. I feel my communication skills, that I've learned and refined a bit from teaching undergrads, allow me to explain a complex issue in a simple way without simplying the issue. It allows me to be more of a teacher with patients, rather than a patronizing lecturer. I think I can even handle the parents too (hopefully).

That said, I know I cannot survive without incredible luck by being "just" a pediatrician. There are two specialties/sub-specialties that I'm considering: endocrinology or medical genetics. I shy away from most specialties because I don't like to delve too deep into one or a couple things, my interests are a bit ADHD for that, and I know right now I want nothing to do with surgery (the less cutting the better). General pediatrics is great because it spans the whole gamut of issues for individuals from 0 to 21 years old. Endocrinology is great because rather than focusing on one organ, it focuses on dozens scattered throughout the body. Medical genetics is great because genetics is emerging as being ever more important in medicine, and genes affect almost everything (and it'd be nice to "ride this wave" as it were). With pediatric endocrinology, I'd likely focus on obesity and diabetes, a growing epidemic in the US. With pediatrics and medical genetics, my primary patients would still remain children, but I could also see adults with genetics-related concerns (though I'd likely focus on prenatal and pediatric genetics, if possible).

So have I now mirrored my peers above? Have I sought a well-compensating specialty after doing residency in primary care? Actually no, lol. Pediatric endocrinologists don't make that much more than general pediatricians, and medical genetics actually makes somewhat less than general pediatricians (FUCK!!). I guess, if my current interests hold, I'm doomed to being a poor ass doctor. I can live with that, as long as no one sues me or yells at me . . . I didn't go into medicine for the money, or the power, or the prestige. I went into medicine believing I could truly help people and make them feel better, and maybe even save a life now and then. But man, that $160K+ debt is looking daunting about now . . . T.T

It's going to be a tough life, but maybe less so if I manage to achieve my even more ambitious goal. More than being "just" a pediatric endocrinologist or a general pediatrician with a focus in medical genetics, I want to go into academic medicine. While I have little interest in pursuing research as a primary focus, I wish to go into academic medicine (almost solely) for the opportunity to teach students, whether they are undergrads, grad students, or med students. I truly do love to teach and prior to last year, I wouldn't even have known. If I'm lucky I might get tenure, lol.

Suffice to say, I don't know if all will go as planned. I don't know if I'll break down and change my mind (and pursue a "cushier" specialty), or where life will take me in the coming decades of my rising career. But hopefully I'll have the resolve, the will, and the luck to make it out and still be me, still maintain my idealism, have a family, and have a life outside the examination room. Here's hoping.

Oh, and Dr. L told me an amusing joke. "The internist knows everything but does nothing. The surgeon knows nothing but does everything. The pathologist knows everything and does everything, but it's too late. The patient's already dead." I guess it might only be interesting to those in medicine . . . If you're curious as to what it all means, ask me about it.

---TANGENT---
Oh, I just read up on a new blog called Daze Gone Bi by Dave83201. If you haven't had the chance to go over and read, please do so and you can let him know I referred you. ;-)
---END TANGENT---

18 comments:

Anonymous said...

As an M2, I think you did a great job of writing this out clear and concisely.

I've been interested in endocrinology since senior year of high school. I'm still as interested, if not more. Definitely looking into specializing in it after I graduate.

-b

Jason Carwin said...

That was a very interesting point, and it was great to hear about this from your point of view and from the "med student community" at large.

Steevo said...

I have an older couple/friends with kids who r now my age. They tell of the incredible pediatrician they had who worked for Kaiser. He loved it cuz he had decent hours, decent income w/o malpractice worries, etc.

In five years we can hope medicine will be better. One of the Scandinavian countries has lots of doctors; about as many as engineers.

Getting into med school is about as hard as getting into any top notch uni grad program. I think they have decent medical costs and lower infant mortality rate than the USA.

Hummmm...

steevo
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James said...

Of course, with the increase in diabetic patients, who knows, you might have that many more patients. More patients = better business, no? (and yes, I realize that's a cold way of looking at it...but it doesn't change the facts)

Dave83201 said...

Great post! and I've got a big dump-truck full of thank yous I'm gonna dump on your font lawn for your kind plug regarding my blog. I can hardly believe people really would want to read it.

To be honest, as far as blogging, I feel a little overwhelmed. I'm uncertain about manors and protocol dealing with readers and fellow bloggers. I'm even now unsure about if I have a proper layout. Advice would be welcome.

Also, You asked a few questions in the comment section of my posting of Sunday, Aug 9. I hope you go back and read my response.

Thanks!

Randy said...

Hmmm... I guess I prejudged doctors. However, what happens when the sparkles in the med students eyes dim, and they take that disillusion as motivation for only money...

But you answered that before....

Anywayz, a doctor is an honorable profession, and good luck man, I hope you follow through.

Aek said...

Anonymous: Thanks! It's good to know that I'm not talking out of my ass or that my med school is somehow "atypical." Endocrinology really is quite fascinating, isn't it? :P

Jason: You're welcome. I feel that the doctors'/med students' points of views are rarely heard. I mean, no one ever pities doctors or even imagine that their lives aren't all riches and glamor.

Steevo: It's good that they found a pediatrician that they like. But everyone's different and every patient has a different "affinity" to a doctor.

James: Yeah, this is true . . . but it's kind of sad to think of it that way.

Dave83201: Nah, your blog's fine. Don't worry, first figure out WHY you blog. Do you blog for yourself? For others? For entertainment? There's no manners or protocols with readers and fellow bloggers. Read the blogs you like, follow them, and give them a shout-out. Leave comments on the blogs and posts you like or want to have a say. Don't sweat it.

And your layout's fine. It's YOUR layout, so you can have it set up and customized however you want. :)

Randy: Yeah, it's okay. Many people pre-judge doctors. The sparkles in the med student's eyes can dim surprisingly fast, I'll be honest. But we strive to prevent that from happening . . .

Anonymous said...

Three things: First, the joke begins with the internist and surgeon, and then the psychiatrist, who knows nothing and does nothing, followed by the pathologist...

Second, the average med student graduates with $160K in debt. That's a mortgage without a house. Not a small point to consider.

Third, endos are of three varieties: diabetes, thyroid, and everything else. The latter usually have a rough go of building a practice. Don't think of endo as getting involved with a variety of organs--your practice won't run that way.

Pilgrim said...

I only halfread yor blog so far, but your actual post tells me, you care for the soundness of human beings. I do it too, but before comes reseach. I studied and now come the doctorates in both my faculties. If I can make it,I´ll work most prbly. at the Institut Pasteur,, hoping to find a cure for Alzheimers. Whishful thinking you might say, but these are my life goals. Propz Pilgrim and good luck to you at your studies.

Aek said...

Anonymous 2: First thing, I didn't hear it with the psychiatrist but that makes sense. :P

Second thing, yeah . . . it's so scary to think about. T.T

Third thing, I suspected that was the case with endos. That's why I'm leaning more towards medical genetics, but who knows what the next 4 years will bring.

Pilgrim: Thanks. And good luck with your PhD! Good luck with finding the cure to Alzheimer's, that's a tall order there.

cvn70 said...

AEk

I read about the problems some doctors have had going bankrupt and the cost of malpractise is the reason. A friend in florida tells me he would or should be paying 85 for it where as i pay 1,500.00 for mine.

Also mmy siter was a childhood diabetic and she died early so i fully support that choice

and money i could make more too, i could work more hours, but why and wha for i want ot keep my life less complicated

The gene thing everything i red points out how important that is and i would look into it, i agree there is a lot of promise there

hey sorry for the lack of comments lately its good thing we chat so often :)

take care and be safe

bob

Mike said...

Interesting to hear your words. I don't think you shared this before. I was kind of wondering if it was peer pressure, family, or your choice. Glad to know it was yours!

Seth said...

That was an incredibly well-written post. I must say it's quite ... whats the word here ... powerful, to read someone's words who is so clearly able to grasp the future. You've got plans, and you will go far, no matter which direction.

Try not to drink too much unaffordable coffee along the way.

;-)

Dean Grey said...
This comment has been removed by the author.
Dean Grey said...

Aek!

My God, what a long post!

It sounds like you're not entirely sure what area to focus on. But aren't you allowed some flexibility in your studies or do you have to pick a specific field in medicine right off the bat?

Good luck to you on your path, however it transpires.

Hold onto the desire to help and cure and treat people that are suffering and you will do fine whichever direction you go in!

-Dean

Anonymous said...

judging from what you write, i think you went into med school with well-intentions. and frankly, i think that's all that SHOULD matter in such a line of work as helping and saving people. i'd like to believe that if you continue with your current beliefs, you'd be able to succeed.

having said that, i'd be interested to see how med school will affect you over the next few years. such a line, will likely change your perspective and (probably) general outlook on situation and life. it'd make for an interesting comparison; then and now

good luck again

KS :)

Anonymous said...

If you go into pediatrics, about half the reasoning you provide disappears. Medicine is about as homogeneous as engineering.

Aek said...

Dean: I don't have to choose what I'm going to do "for the rest of my life" until my 4th year, so I've still got time to explore.

Anonymous 4: Half of which reasons? I know that medicine is pretty damn homogeneous (which is kind of funny as people go into medicine for the independence), but hey, I'm being optimistic here. If even one or two of my primary reasons for going into peds succeeds, then I'll be content.

The sparkle in my eyes are of a different light, not the rosy vision of medicine. We'll see if/when that light dims and I succumb to the fold.