9.21.2007

Medicine the man-whore

Like many young doctors, I get asked a couple of the same questions over and over and over again.

Would you do it again? Any advice to premeds? Would you encourage your children to become doctors? Or some other variation of "Are you happy doing what you do?"

The short answer is 'yes.' I love being a doctor. I love being called 'doctor.' I am proud to tell people I am a doctor. It makes me feel 'satisfied' to know my parents are proud of me...that I have accomplished (in their mind) the epitome of accomplishments. I love it when patients say "your mother (it's always only 'mother') must be so proud of you!!" Yes she is. It really feels good to hear your loved ones brag about you...simply being a doctor is a big deal to most people.

Becoming a doctor doesn't require one to be a genius. You just have to be focused...and do your homework. In high school - go to class and do your homework. In college - ace your exams and do your homework. Medical school certainly isn't about being 'smart' but rather 'organized' and methodical. Studying smart, concentrating on only the most relevant, high yield material. Doing research, and kissing lots of ass. If you study hard, do research, and get good letters of rec, you'll likely get into the field of your choice (especially if you're willing to move anywhere in the country). Once there...you work your ass off. All of this doesn't require you to be smart, per se, just dedicated, passionate, organized, persistent, etc.

I recommend a student go straight thru the process, and not take breaks. If you finish up residency at 26, you still feel like your young adulthood is yours to experience. As a resident, you can have a life (depending on the specialty, of course). You can still go out with friends, date, and hang out. I even endured 2 pregnancies as a resident (afterall, when are you supposed to have those babies?). Residency isn't about studying and learning....it's about working. If you work, you'll finish. You can always study for a test (boards) later. I found residency less stressful than medical school because...in my mind, I'd 'made it' already. I was a doctor. Simply being a medical student makes you....nothing. No pass = No MD. The fact that I'd accomplished a major achievement by simply graduating from medical school, relieved lots of stress for me.

If you go straight thru, you may graduate residency at 29 years old. That's still plenty young. The sacrifices are much less. Afterall, you don't feel as though you've sacrificed 'your entire young adulthood' to medicine if by 30, you're making 6 figures...like many of your professional friends. (Granted they may not have the debt you have).

If you put off medical school, and do a long residency, by the time you're finished...you may feel you've given too much of yourself, of your life. If you decide to put off relationships, marriage, having kids...you may find yourself in a situation where you *can't* have kids, or the family you always dreamed of. You may miss end of life activities with grandparents/parents. You may miss other significant life events of other family members/friends. And, you'll gradually lose your close friends as they have families, and hang out with other people in similar social situations. You may realize that you're the oldest guy/girl at the club. And, it may become increasingly difficult to find a suitable match as a life partner. Young adulthood is the time to lay the foundation, both professionally, and personally, for the rest of your life. If you are a medical student/resident thru this process, you may find yourself, your life, unbalanced. As you pursue this (arguably) awesome career, you lose the opportunity to experience these other aspects...that are much more important in the grand scheme of things.

Being happy in medicine happens as a result of going into it with accurate information, eyes wide open. Forget about the fuzzy 'feel good' I wanna help people bullshit. Forget about the 'privilege' or 'calling' that some try to say is medicine. Realize it is just a job. It is just one aspect of your being. It, in itself, will not make you happy. Realize that patients are no substitute for family. If you can see yourself doing something else, and being happy doing it...you should strongly consider that option. Medicine is like a sexy man-whore. Attractive, alluring, exciting, and seems to have 'everything you'll ever need'. But, the reality is, he will betray you. He will beat you. He will not keep his word. He will not appreciate your greatness. He is selfish. And basically, not what he appeared to be. Likewise, medicine will not be what you thought it'd be. The patients will sue you. The 'purse-holders' will not appreciate you or value your work. You will see plumbers make more per hour than you do. Medicine will not provide the life you thought it would...and you'll feel betrayed.

You'll be happier if you realize that medicine isn't 'everything.' You will not make even the modest money you thought you'd make. Realize that student loans *are* a big deal, and will not be easy to pay off "on a doctor's salary." Realize that you don't have control, and are at the mercy of the powers that be...and the pig-headiness of some arrogant peers who see no value in unionization and advocating for 'physician rights'. Do not put off things in life that you really want to do, like get married, or have children. Develop outside interests, and don't let medicine become your identity - do this and you'll have a strong defense against burn-out and disenchantment (this is why it's so important for residency to be humane. Medicine isn't what it once was. There is no pot-o-gold at the end of the rainbow if you suck it up and sacrifice your young adulthood like back in the day when docs were respected, and paid handsomely for their services.) If you view medicine as a stable job that pays a decent wage....you'll be happier. Do not try to make the man-whore a loving husband. See him as he is, and either accept it, or move on.

Also important is, finding a specialty that fits your personality. If you want to be an involved parent, surgery isn't for you. If you want to have a comfortable lifestyle, you might wanna rethink primary care. If you like to interact with people, radiology/pathology may not bring you satisfaction.

Don't overwork yourself. Even if you enjoy speeding around the ED running codes and trauma, do it too much/often, and at the expense of personal health, relationships, or other recreational activities....I promise it will cease to be fun quite quickly. The check is nice...but your life is suffering. In the end, many docs decide it isn't worth it....

...all because they haven't achieved balance.

So, in review - to increase the likelihood that you'll be happy in medicine:

-get the training over with while you're young; don't take breaks (or alternatively, wait until you're a bit older)

-keep it in perspective. You are not a saint because you are a doctor (don't be arrogant and think more highly of yourself than you should). It is not a calling. See it as a stable, respectable, secure, job. Your work is valuable, but not more valuable than yourself, or your family.

-know the drawbacks, and balance those with the benefits of becoming a doctor today.

-the money *does* matter (both the student loans, and the eventual salary).

-don't sacrifice having children, visiting aging parents, or other significant life events in lieu of becoming a doctor. It will not be worth that sacrifice.

-Choose your specialty with care. Chose based on your personality...not based on what is most prestigious, what other people want you to do. Your specialty will determine your potential work environments, your pay, your lifestyle, and the number of years you spend 'training.'

-Finally, don't work too many hours. If you do, you'll be more tired, less healthy, and more likely to experience dissatisfaction and fatigue.

43 comments:

Toni Brayer MD said...

Very thoughtful and well written. There are many variations of how, why, when that also bring satisfaction and fulfillment, but overall you have pegged it.

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enrico said...

Oops, I hit 'publish' instead of 'preview' again to edit... I meant to simply add that humor aside, this was a brilliant post. Part of me feels, as student in his mid-30s, that I'm beyond stupid for doing this, but I do have the satisfaction of having experienced and accomplished many things that most of my classmates will have to wait for longer, if ever, to achieve. All the previous life experience helps tremendously in my training; I just wish there was more life (read: earning years) when the training gets done.

Zagreus Ammon said...

I love it! Like with many things in life, a proper perspective and a clear vision is critical to navigating a medical career.

Personally, I like the notion that "medicine is not a calling, medicine is not a business. It is both!"

Chloe said...

Medicine is not what is used to be. My 89 yr old former pediatrician aunt loves to go on about how residents have become soft now. In her day, she would work mad hours. Yet in her day, she was well-revered and enjoyed the luxury of fee-for-service payment. She did not have loans.

Now, I go to parties and literally get attacked when I say what I do for a living. Doctors are not well-revered by the public, and sometimes, I don't even revere myself. In addition, I have loans and they are not going to go away.

I think your blog entry hits home. I would also refer you to another article on similar themes:

http://www.medscape.com/viewarticle/561725

Best of luck. Hope you find the balance you are looking for.

The Lone Coyote said...

This is a fantastic post. You give one of the most clear, insightful, and humorous pieces of advice for those contemplating medicine that I have seen. I am going to link to this post on my "advice for premeds" area of my blog. Keep up the good work.

MY OWN WOMAN said...

Great Post. I'm sending it to my daughter. She's newly out of residency and into the "big practice."

One of the things she has done right is choose her specialty. She's Family Medicine through and through.

Prudence said...

That was insightful. I might share that with some of my friends.

Up to now, I'm still thinking about what specialty I want to have. Actually, it's only after medical school that I realized that it is important to carefully pick what specialty to have. No, I don't have a specialty right now. But it just dawned on me that it's the job that I might be doing for the rest of my life (or most of my productive life) so I better make the best choice. For me, I think surgery is already out for me. Primary care is good and maybe a specialty in endocrinology.

DC Med Student said...

Excellent post! Well thought out and insightful. Thank you.

Anonymous said...

Sorry to disagree but I found my experience in another field before medicine to be very helpful in medical school. I (and others like me) had life experience, history of responsibility, and a point of view that the younguns straight through couldn't understand. It made the first two years hilarious at times when the straight through types would get worked over things that those of use with experience knew were not important. Additionally, I found the older students (in general) did a beter job of relating to patients.

ER doctor said...

anon,

you're absolutely right. having a life before medical school will, no doubt, make you a better student/doctor. i'm much better after getting married, and having children. life, and the experiences it brings, is a wonderful gift.

keeping in mind, different pathways are right for different people...i recommend for the average person contemplating medicine, the path is better endured if one starts sooner than later, and doesn't dally around much. i'm not talking a year off to do research, switching your major or changing residencies. i'm not talking about taking a year off to become a better adjusted parent, or participate in the care of elderly parents, nurture a marriage, etc.

and, i do mention (albeit in passing) that waiting until you've accomplished some other goals is alternatively a great plan too. but, as you mentioned, most people who 'delay' don't fall into that category either...

...most medical students are some variation of gunners...or slackers turned gunners later in life after dilly dallying around for a few years. that's fine, it just makes it more difficult to stay optimistic about medicine if you've given it your entire life...and in doing so sacrifice these other life experiences that are actually very important to most people (whether they realize it or not at age 25 when they start this process). afterall, the process of becoming a practicing physician doesn't lend its self well to achieving balance (yet!). and if not something one strives for...it will not just happen 'by accident.'

thanks for highlighting a pov that i really glossed over....
...i agree with you.

Anonymous said...

It seems to prove the old saying that Medicine is a selfish mistress

Anonymous said...

Excellent article

Chuck McKay said...

This is solid advice for anyone entering any career. Thank you.

Anonymous said...

I hope everybody want this but everybody has their own opinon. So I can't say about it. Off-course this is a good information for young and informative also.

Meds4All said...

I hope everybody want this but everybody has their own opinon. So I can't say about it. Off-course this is a good information for young and informative also.

Gristlee said...

its very good thoughts and well written...what i am thinking is, always go with good and registered doctors...and if you are going to take prescription drugs like viagra, cialis or levitra ect.. then you must carefull beofre taking drugs from pharmacy...must consult with doctors before taking any kind of medication..

M said...

This was a kick in the head for me and I've only been at Med school for two months. Good christ, I'm going to stop reading blogs.

I'm a first year. I'm allowed to be enchanted and delusional.

*denial, denial, denial*

gerald said...

that was a great article.very well written.it just brings out what's in side my mind.being 38 years and st ill single and currently doing my re sidency in emergency medicine.i'm really thinki
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