Some Friendly Advice:
Do NOT Become a Doctor!
"Some crawl up through a thousand indignities to reach the crowning dignity, only to realize that the object of their toil was their epitaph."
Becoming a physician is not worth it. The opportunity cost is too high and when all factors are taken into consideration - personal, family, economic, endless exams of questionable value, and the diminishing freedom to practice medicine in an ethical and humane way - becoming a doctor is simply no longer worth the declining personal and financial rewards.
Young people thinking about entering medicine because they have no idea what else to do other than “go to med school” have an inkling that something is wrong. Physicians are retiring in droves.1 Health care reimbursements are on the decline.2 New doctors console themselves by saying that if they wanted to make money they would have gone to business school. Visiting your own doctor is a headache filled with long wait times, senseless paperwork, and unsatisfying encounters, leaving you thinking you should have just consulted WedMD.
These are all vague, wooly reasons why becoming a doctor or entering medicine is probably no longer a smart thing to do. Well, what about concrete reasons? Let’s consider some.
Today’s physicians practice under the weight of endless regulations and mandatory rules, pointless online courses, mandates of continuing dubious medical education, lengthy and arbitrary certifications, increasing licensing fees, piling coding and billing regulations, hours of data entry, the threat of lawsuits, and an endless and shifting mass of insurance documentation and life sucking paperwork. To bond with and care for human beings in need is a tertiary goal after financial and regulatory considerations. The cost to oneself and one’s life and personal wellbeing, not to mention one’s finances is no longer worth participation in a system that is so fundamentally flawed.3
Healthcare being one of the few growth fields in the American economic landscape means more and more entities are feeding at this $3+ trillion4 trough, increasing the bureaucratic burden, taxpayer expense, and misery for practitioners and patients alike. We have amongst the worst health outcomes in the industrial world and spend the most per capita on healthcare.5 6 The medical system is in shambles and practicing as a physician means nothing more than spending the best years of your life becoming a cog in this broken and damaging machine.
Medicine is money in the United States. The worst motivations of the hedge fund managers on Wall Street are now completely aligned with the vulture CEOs and hospital administrators perched in their cushy hospital corner offices, smiling in expensive suits and speaking in caring voices and reassuring tones as they feed on the carrion of the system that they have created. These same people who don’t know how to change a band aid tell doctors and nurses how to manage their time, patient loads, and tell them what they can and cannot do.
Doctors and nurses in the hamster wheel of medicine are ordered to run faster, work harder, document more, see more patients in less time, be more efficient, withhold treatment, maximize their billing, accept lower pay and fewer benefits, and do it with a smile plastered on their faces. This is the relentless mantra and more practitioners (and patients) are getting fed up.7
This is the real face of modern medicine in the United States. Lay people have no idea about any of this. Neither does the prospective medical student or resident. Nor are any outsiders supposed to know any of this.
Let us take a quick stroll through the process of becoming a doctor in American. You may be able to relate to this process or you may have had a completely different experience. But here is how it works for many:
Hapless souls entering the medical profession are supposed to focus their time and attention on doing well in classes. They must focus on getting a great GPA and getting published. Buff up their CVs. Work on personal statements that somehow expresses why they want to become doctors without sounding cliché. They are supposed to want to volunteer in a hospital to get some useless experience. Score well on their MCATs. Their focus is to just get into a medical school. Just get in. This is something they will tell themselves and will be told endlessly. Just get in and it will all be ok.
After a tremendous amount of hard work, sacrifice, and likely at great financial cost, the supplicant might get the coveted acceptance letter. There is a tremendous sense of pride and relief. And he thinks he’s set for life. Not so fast!
After working very hard in college for that GPA and acing the MCAT, this is only the beginning. In medical school they will spend two years sitting in a classroom, or in some cases rarely going to class but reading notes or watching lectures online.
Online learning is passed off as “innovative.” It is inexpensive for the institutions and supposedly convenient for the students. Who wants a doctor treating you who has an online MD? In addition to your online courses the prospective doctor will take tests. Lots of them. He or she will spend two years doing this. Two trips around the sun looking at computer screens, studying for tests, and taking exams. They will take an exam on average every six weeks. These are called block exams. They are very stressful and unrelenting. And they matter. Having flashbacks yet?
If he does well enough and pass enough tests he will start rotations on the hospital wards. This is where he will learn that he really don’t know anything. And this is when he will start seeing what residents are actually doing. He will have his first contact with patients. At this stage the young medical student is typically very idealistic but often becomes sorely disappointed and shocked with what they experience. Everything is rushed. The caring, emotional moments they wanted to share with patients are few and far between. And there are more exams. More exams after every six or eight week rotation. They are called SHELF exams and they matter.
This is also when the young student learn to kiss ass like his life depends on it. Because it does. Suck up to the residents. To the attendings. Are you attractive? Flirtatious? A sports fan? Have something in common with the chief resident? Use it. To the hilt. People who are often assholes must be flattered and praised and spoken to with respect. They will be writing letters of recommendation and can make or break your chances of getting into a good residency. Smile, take the abuse, and say please and thank you.
Between the third and fourth year of medical school or at the start of residency, many medical students get married. Some may marry out of fear of being alone while they go through the upcoming grueling training process, or maybe they will do it so their spouse can financially support them during training. A few people even do it because of love. Congratulations. Depending on your specialty, it probably won’t last.8
Now after four tough years in college choking down Biochemistry and three or four years of medical school she is pretty invested in this medical Ponzi scheme. During this time she will come to internalize as Gospel a very harmful and self-destructive philosophy that those around her have come to accept as self-evident. This philosophy will remain with her for the rest of her career and possibly the rest of her life.
The philosophy is this: the indefinite deferral of gratification and marginalization of the present. The word indefinite is key. Not temporary. Not even long term. But indefinite. Because once the prospective doctor has attained a milestone through deferral of gratification, the next one awaits his arrival years down the road, and on and on. One is taught to think, I just have to get into a good residency. Then everything will be ok. Get used to this concept. It will be better and ok after I do x. I just have to suck it up and take this shit (whatever that is in the moment) for the next x number of years and then it will be great. It’s “all retch and no vomit,” as Alan Watts would say. It’s insanity and it’s very damaging to medical practitioners.
Eventually, one thinks that they will be a respected doctor and do good works and get compensated well for their services after an ever increasing number of tasks, hurdles, or certifications. Then it’s going to be great…but one just has to get through this. Tolerate today. Sacrifice today. Live for a tomorrow that may never come. Then it will all be better.
Prospective doctors hold onto this vain hope with gritted teeth as they wade their way through USMLE step one, step two, and step three. All of these exams are expensive and important and will to a large extent determine if the student can go into their field of choice. Can they become an orthopedic surgeon in a big city or will they be “stuck” being an underpaid doctor in a rural shithole? These exams will influence their options greatly and they will spend some of the best years of their youth studying for them in isolation in front of unblinking computer screens.
After, many doctors will get a divorce. In fact, some residencies boast about their high divorce rates because it serves as a measure of the rigorous training.9 Divorce happens either because a spouse can’t put up any more with crazy hours, mood swings, and bad attitude, or because the young doctor gets into a great specialty and dumps their spouse for a newer, shinier, younger model because they think they’re going to be making a ton of money (their new spouse believes this too). Congratulations on the divorce. Maybe the second marriage will take.
We have just touched on the process of becoming a physician. If this doesn’t give you pause or the shudders, read on. When people start to understand what it means to practice as a physician they will run from the profession like their hair is on fire, that is, if they have any sense.
People who go into medicine are idealistic and stubborn and often don’t listen to the opinions of people who discourage them. They believe that their experience will be somehow different and superior to the lessor idiots that went before them. They think that those who complain are merely grumbling or lack compassion or went into medicine for the wrong reasons or just don’t know how to really work hard.
The purpose of this series of articles will be to describe, without deference to political correctness, the process of becoming and working as a physician in the United States. It will force the thinking premedical student or aspiring doctor to face the unpleasant facts that one does not usually learn about until they are well down their career path where cruel surprises and malevolent thieves await them. The hope is that they will be dissuaded from an unfulfilling profession before wasting years of their lives and potentially hundreds of thousands of dollars.
The articles can also serve to inform an uninitiated lay public to the ugly realities of Medicine in America. The realities behind the shiny, high tech, Madison Avenue, public relations veneer.
In the authors’ opinion the only way to save this profession is to let it implode and start from scratch - a real crisis in medicine where the system collapses and is completely restructured from the ground up by the people who live and breathe in the clinical realm - doctors and nurses. Special interests, insurance companies, MBAs, or our useless government will not come to the rescue. They have and will only continue to make things worse.
Until that time, the current system will limp along with worse care and outcomes for patients at higher costs for all of us. There will be worse working conditions for doctors and nurses and larger profits for hospitals, drug companies, and insurance companies, the entities hard at work destroying a once noble and fulfilling profession that actually served sick human beings. Hospital administrators and CEOs will continue to parade around hospitals with their coffee mugs, go to “important meetings,” and set up toadying subcommittees. They’ll continue cutting jobs and pay while collecting fat paychecks all the while making the system more dysfunctional.
Our hope is that these articles will also compel a philosophical inquiry. A look inward of the type that our culture does not reward or encourage. Who are you and what do you want to do with your life? And why? Are your motivations monetary? Are they noble? What kind of person do you want to be? Do you simply have no idea what you want to do in life? Do you crave the respect or approval of others? These are very deep questions. I would encourage an honest and lengthy meditation on these matters before even considering taking such a potentially life ruining step as a career in medicine. Many respected physicians have never reflected deeply about themselves until late in their careers and the twilight of their lives. A tragedy in itself.
Many people who are outraged by these articles will certainly have good criticisms and we welcome them. Likely the ones who most vociferously attack the points that we raise will, we think, have the most invested in the current stinking system. Likely they are people who don’t daily have to perform the tasks assigned doctors and nurses. Unless they get their hands dirty in the nitty gritty of patient care, to us, their opinions mean little.