Applicants Down 12% Nationally

[psyspy]

Remote work was an anomaly honestly. Most big tech companies are now calling everyone back to office. Also, most FAANG employees were/are in NYC, SF, etc. Most weren't savvy or able to set up shop in Thailand (which btw is a different time zone from american work hours) for several months because of the pandemic.

Also the bullishness of tech in the past 5-7y was also an anomaly. This "retire by 40" mindset assumes no bear market where lots of layoffs happen (layoffs even happen in bull markets).

All that said, the tech bros are likely the main ones propping up the out-of-this-world housing market right now because of their bullish market and high salaries.

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[psyspy]

I see people switching into medicine for similar reasons sometimes, and I applaud your decision to dive in and make a positive (if 7+ year delayed) impact in your community.

As the poster above alluded to, keep in mind that the primary complaint from many if not most physicians as we head increasingly towards our wonderful dystopian venture capital investment driven healthcare world, is that physicians become more like cogs in a machine. The system is the impediment to providing good care in many physicians' eyes- e.g., insurance won't approve y or z until x has been done (which also devalues all of your knowledge because it's just an algorithm that you have to follow every time- you're just the gatekeeper). You see administrators making 6 figures working short hours due to your work- and they tell you what to do and how to work, all without any actual knowledge of medicine. You experience unprecedented encroachment into previously physician-only roles by non-physicians and witness legitimate harm to people as a result. You experience increasingly insane levels of competition from very bright colleagues for desirable specialties that often minimize (but usually not eliminate) what I just listed above. I have classmates that are incredibly hard working, bright, and people I would want treating my family... find that they did not match into desired fields. That's a bit of a bump in a road in your late 20s.

All of this to say, make sure you pursue medicine with open eyes and with an open mind for what you end up doing. I would strongly recommend considering fields that have an option of practicing on your own, with the possibility of escaping large health systems if you become disillusioned by them. Residencies like IM, FM, psych, ophtho, derm, PMR, and fellowships like pain or palliative can probably get you there most of the time. They all have unique challenges (I hear derm is experiencing expansion and other problems) but are more protected from midlevels and hospitals employing and squeezing you like EM, anesthesia, peds, or perhaps general surgery to a lesser extent. People typically recommend other surgical subspecialties too, but one needs to keep in mind those are usually extremely competitive and many years of long hours.

That all address the business side of medicine, which I don't think premeds and med students think enough about. The humanistic opportunities we have, though, are incredible. For that I would not trade this career for anything else.

Derm is quietly getting wrecked by PE. Multiple pgy4 grads saying they're generally getting only $350k offers (if anyone says "that's high enough bro" I'll ignore you). Not very promising for having had to constantly be in the top 1% of top percentile learners in the world

 

[psyspy]

Lastly not sure about the OP given this:

Medical school applicants and enrollments hit record highs; underrepresented minorities lead the surge

The 2021 first-year class is larger, more diverse than any before. Did the pandemic, social justice, or remote interviews boost motivation of aspiring doctors?

www.aamc.org

 

[Redpancreas]

Derm is quietly getting wrecked by PE. Multiple pgy4 grads saying they're generally getting only $350k offers (if anyone says "that's high enough bro" I'll ignore you). Not very promising for having had to constantly be in the top 1% of top percentile learners in the world

1.) There will be a response to PE. I think fields liable to PE hits are those that have limited supply to stay competitive (i.e. Derm, GI) as opposed to fields with an oversupply issue (Rad Onc, Emergency). We should all do what we like. The fields getting hit hard in the next 5 years are likely to bounce back strong in the next 15.
2.) You aren't getting paid in derm for being the top of your class. That's just the artificial barrier we put on derm. You are being paid to diagnose skin conditions and prescribe *mostly* steroid variants from 9-5.
3. If someone who enjoys staying up to date on skin, etc. and enjoys every case they see, they're likely going catch the zebras and save lives. If someone worked hard and studied their ass off so they could generate high income and live lavishly for a relatively low stress lifestyle/setting, they may be someone who prescribes steroids to the wrong patient when their mind is elsewhere in 20-30 years.

 

[psyspy]

1.) There will be a response to PE. Fields liable to PE hits are those that have limited supply to stay competitive (i.e. Derm, GI). The fields may get hit hard in the next 5 years, but bounce back in the next 15. We should all do what we like.
2.) You aren't getting paid in derm for being the top of your class. That's just the artificial barrier we put on derm. You are being paid to diagnose skin conditions and prescribe steroids from 9-5.

1. 15 years is too long a time for anyone currently in undergrad, med school, or residency to be concerned with. My point is derm is yet another field that has bit the dust for a while (EM, rad onc). The boom/busts back then didn't involve as much midlevel encroachment + PE.

edit: Most people nowadays don't see their specialty as a calling. Plenty of people go through every rotation unenthused with any specialty.

2. It's still a reality for people who are applying, in spite of its unimportance.

 

[Redpancreas]

1. 15 years is too long a time for anyone currently in undergrad, med school, or residency to be concerned with. My point is derm is yet another field that has bit the dust for a while (EM, rad onc). The boom/busts back then didn't involve as much midlevel encroachment + PE.

edit: Most people nowadays don't see their specialty as a calling. Plenty of people go through every rotation unenthused with any specialty.

2. It's still a reality for people who are applying, in spite of its unimportance.

I think this is partly because we (myself included) are failing medical students and not teaching them the mechanisms behind things so they underestimate the fun involved in medicine.

 

[psyspy]

I think this is partly because we (myself included) are failing medical students and not teaching them the mechanisms behind things so they underestimate the fun involved in medicine.

Agreed. Clerkships are generally now "do whatever it takes to not get bad grades" instead of "learn as much as you can from the attendings/residents without concern for unreasonable grading". Students who get the latter for any rotation should consider themselves lucky.

 

[jhmmd]

Lastly not sure about the OP given this:

Medical school applicants and enrollments hit record highs; underrepresented minorities lead the surge

The 2021 first-year class is larger, more diverse than any before. Did the pandemic, social justice, or remote interviews boost motivation of aspiring doctors?

www.aamc.org

There was a thread about this last year
Can't find the link but I'm sure it exists somewhere.

 

[psyspy]

It's because midlevel problems are gaining more traction. Doesn't affect people who are already set on med, but will have a greater and greater effect on people who are still deciding on a career path.

When I applied to med school, I knew PAs and NPs existed but I thought they knew their place and everyone knew who the real doctor was. As it becomes more and more apparent that this isn't the case, med school apps are gonna drop.

I actually think it's probably gonna take a pretty precipitous fall within the next 5 yrs.

If people in med school are hardly paying attention to midlevels (trust me most current EM applicants are in complete denial) I highly doubt naive premeds with boomer parents likely clueless about midlevels are paying attention to them.

Also the wording of OP is incorrect. As you’ll see in a previous post, 2021-22 had a record number apps, just like last year had. I guess this means gen Z is “willfully drinking the kool aid” rather than “wising up”

 

[jhmmd]

If people in med school are hardly paying attention to midlevels (trust me most current EM applicants are in complete denial) I highly doubt naive premeds with boomer parents likely clueless about midlevels are paying attention to them.

Also the wording of OP is incorrect. As you’ll see in a previous post, 2021-22 had a record number apps, just like last year had. I guess this means gen Z is “willfully drinking the kool aid” rather than “wising up”

What are they gonna do after generation Z? Generation A?

 

[bGMx]

What are they gonna do after generation Z? Generation A?

I believe it will be generation Z+, and they will settle the Canadian frontier as Quebec separates and the US absorbs Alberta, Saskatchewan and the Yukon. There will be a golden age.

 

[GoSpursGo]

In 2021, we had 17,881 applications. We were up 24% and applications were up nationally 18%. In this current cycle, we have 15,993 applicants, so we’re down 11%, nationally they’re down 12%.

Georgetown University School of Medicine: Secondary Application Essay Tips [2022 - 2023] & Podcast Interview

Applying to Georgetown University School of Medicine? Follow these guidelines to create secondary essays that show your fit for the program and get you accepted!

blog.accepted.com

Bad statistics. You need to include the rest of that paragraph. Can't say I'm surprised since dropping tantalizing quotes/articles with the purpose of stirring up controversy is sort of the OP's thing, but I'm surprised nobody pointed this out yet:

In 2021, we had 17,881 applications. We were up 24% and applications were up nationally 18%. In this current cycle, we have 15,993 applicants, so we’re down 11%, nationally they’re down 12%. Comparing that to the pre-pandemic to 2019 to 2020, we had 14,464 applications. We’re actually, this current cycle, if you leave at the 2021 cycle, we’re up about 10.5%. Usually, that up or down is about 2-3%, so it’s very interesting to see.

Overall, apps are still trending up over time. The story is more that there was a crazy spike in 2021 and we are seeing regression to the mean this year, not that there is a precipitous drop in applications.

 

[sloop]

edit: Most people nowadays don't see their specialty as a calling. Plenty of people go through every rotation unenthused with any specialty.

I don’t think this is necessarily true. I think this entirely depends on the circles you run around in.

You have highlighted that one problem with med school is that people are committing to a grueling and expensive education without any guarantees about what their job will actually look like. As a result, most people go to med school because they want to be a doctor (which is actually better than a lot of other paths like law school where a lot of people just go because they don’t actually know what they want to do, but I digress). The problem is that “I want to be a doctor” is actually kind of a meaningless statement when you actually examine it. The life of a nephrologist is nothing like the job of a psychiatrist. It’s very easy to vaguely want to be some sort of doctor, but find out that you hate the actual job involved in most areas of medicine.

I also think that if you’re looking at a lot of the competitive specialties, you’re going to find people who were motivated by things other than work. You mentioned derm. I’m sure there are people out there who are fascinated by skin. That said, I don’t think there are enough of those people to make derm as competitive as it is. So obviously a lot of dermatologists wouldn’t describe their work as a calling.

In my field of psychiatry, however, I think that most of my colleagues would describe it as a calling in some sense. They might not use those words or such strong language, but they would generally say that they’re doing it because they love the work. I went to an excellent residency and am in an excellent fellowship, so the people I’m around did well enough that they could have done any, or almost any, field they wanted but chose psych. The lifestyle in psych is great, but it’s also not something people tend to choose if they don’t love the work.

I still think that a lot of people see their work as a calling to some degree.

 

[99cutter]

I am a software engineer. I am applying to medical school this cycle or next. I am 29, an Asian male, and in an SMP right now. I am enjoying it so far.

My reasons:
Startup grind is tough.

Seeing major acquisitions and people's life change before your eyes does happen. It is not common. It takes some of the following (but not all): good pedigree, amazing self-confidence, an affinity for risk, connections, youth/time on your side (older founders are looked down upon). You need, most importantly...a product-market fit for whatever business you're launching. Very talented/smart engineers have shuttered down their companies and gone back to regular jobs after being jaded or not having the exit they wanted. Others do get that one acquisition and become set for the rest of their lives. This is not really a gamble, but the odds are against your favor, but fortune favors the bold.

From the point above, I have zero entrepreneurial skills. I went to a horrible state school, I have no connections. But more than that, I don't have the tenacity to develop those connections, and I cannot relate to the spark entrepreneurs have. So my option is basically climbing the tech ladder - which is still absolutely great. If you are a motivated person inspired by entrepreneurship, this is the field for you. Even before/after medical school. You can always change some existing market. Just look at ZocDoc as an example of an MD innovating in tech. Even MacRumors, an apple blog, is founded by a physician.

Ageism
You need to be set by 50. I don't care what anyone else says. Ageism is real. That doesn't mean you can't stop working, just that it becomes harder to keep up and make the same amount of money, comfortably, when everyone is younger than you and you're an at-will employee. The average software engineer age is like early thirties (which will go up over time - this field is exploding). Fortunately for the 22-25 year old getting started, they should have more than enough time in tech to make 3-4million+, assuming they don't do any startup stuff, if they stick to big companies throughout that time, and can then live off the dividends as they get older.

I was behind on retirement because I worked at startups for 3-4 years instead, and then 1 year of big tech, instead of just working at big tech right away and stacking that money. Even if I went back to big-tech and make 200-300k in the next year or so (and 400k+ in 2 or 3 years), I'd still be kind of behind for when the ageism years creep up. Tech stocks will continue to make gains in the coming decades and amplify your return from RSUs/stock packages given in the form of equity when you work.

Timing
My decision to begin transitioning into medicine was pre-COVID. I did not want to live in the city forever. COVID unexpectedly changed everything. If I was in the position of making this decision after COVID already happened and all these jobs stayed remote, I probably would have stayed in tech.

Non-money reasons
I love the impact physicians have. I was inspired by physicians in my own city and the kind of work they've done. I may be stupid but I want to work with people, and have an impact in my local community, away from the big city and tech bros. I don't want to be behind in sprint-cycles/development timelines behind my computer forever. I like the feeling of security and being more than employee #<insert number>. I was beginning to hate coding because it was mired in bureaucracy and I was just another robot. The challenges left me uninspired. After being an early employee and excited to work on cool things, after 4-5 years of this it just became a job devoid of meaning (to me at least). Nobody truly cares about what you do, as long as you can bring results. As such, this work is transactional.

I understand medical school is a huge opportunity cost. But I've learned to look at all of these costs as a part of a process. An extra million or two at a decade of age or younger is great, but I found the destination is just as important as how you get there (stupid cliche I know).

I know I rambled a lot but there's my reasoning when you inject a personal view into tech vs medicine. There is nothing wrong with either. If you're 21 and want to make the most out of your 20s, tech is there. You can do all the things you want and make a ton of money and within 4 years you will make well over 300k a year and can retire by the time you're 40-45.

In my gap year I will be returning to tech.

THESE THE RED OCTOBERS

 

[nimbus]

I believe it will be generation Z+, and they will settle the Canadian frontier as Quebec separates and the US absorbs Alberta, Saskatchewan and the Yukon. There will be a golden age.

And with climate change, Canada should become increasingly habitable.

 

[nimbus]

Derm is quietly getting wrecked by PE. Multiple pgy4 grads saying they're generally getting only $350k offers (if anyone says "that's high enough bro" I'll ignore you). Not very promising for having had to constantly be in the top 1% of top percentile learners in the world

The interesting thing about PE is that they respond to market conditions. Because there is a shortage of available anesthesiologists due to an ever increasing demand for services, PE owned national anesthesia groups like NAPA and USAP are offering $500k to new hires, even in large metropolitan areas. They still can’t get enough warm bodies and I wouldn’t work for them because I prefer to decide my own fate.

 

[psyspy]

Bad statistics. You need to include the rest of that paragraph. Can't say I'm surprised since dropping tantalizing quotes/articles with the purpose of stirring up controversy is sort of the OP's thing, but I'm surprised nobody pointed this out yet:



Overall, apps are still trending up over time. The story is more that there was a crazy spike in 2021 and we are seeing regression to the mean this year, not that there is a precipitous drop in applications.

Regression to the mean? The post I posted shows a higher linear rate of change starting in 2020. There were more apps this past cycle than even the 2020-21 one (yes OP is incorrect)

 

[GoSpursGo]

Regression to the mean? The post I posted shows a higher linear rate of change starting in 2020. There were more apps this past cycle than even the 2020-21 one (yes OP is incorrect)

Regression to the mean in this case means “still rising, just not at the crazy rate of rise from last year.” Maybe not precise language, but bottom line you and I agree.

 

[Dr. Doctor MD]

I also think that if you’re looking at a lot of the competitive specialties, you’re going to find people who were motivated by things other than work. You mentioned derm. I’m sure there are people out there who are fascinated by skin. That said, I don’t think there are enough of those people to make derm as competitive as it is. So obviously a lot of dermatologists wouldn’t describe their work as a calling.

In my field of psychiatry, however, I think that most of my colleagues would describe it as a calling in some sense. They might not use those words or such strong language, but they would generally say that they’re doing it because they love the work.

Based on the bolded portions of your quote, clearly you're not in tune with some of the more recent psych applicants from the last 3-5 years. Psych has become the go to specialty for a good amount of people who hate everything, don't want to do medicine, and realized they want to be able to coast in residency and be able to work 3 days a week and still make great pay.

Everything you posted about dermatology applies to psych applicants to a far greater degree. What do you think has lead to the explosion in psych applicants in the past 5 years? Are people just suddenly developing a passion for mental health? I don't think so... I think the cat is out of the bag and medical students have realized that psych is a very short residency, with exceptional hours during and after training, a booming job market, and ridiculously high salaries and jobs available in the right markets. There's a reason it went from the least competitive, most IMG friendly, to moderately competitive in such a short period of time, and it's not because of a passion for mental health.

As far as dermatology goes, the dispassionate student doesn't just incidentally crush all of their classes, rotations, step exams, and publish 10+ papers and just accidentally apply dermatology as a fourth year... On the other hand I know plenty of lower achieving students, slackers, people who were pressured by parents, and those who regretted ever going into medicine and who applied into psychiatry as an escape plan, and most of them matched.

I want to clarify before I get called out and this gets misinterpreted: I'm not being disrespectful towards psych, and most people who go into it probably absolutely love it, but from personal experience, a non insignificant portion is doing it purely from a lifestyle/dislike everything/regret medical school, especially compared to 5 years ago. Honestly it takes a really special person to want to do psychiatry and truly enjoy it, and we need more people who are actually passionate about it. It's sad to see some of the people that have been flocking to psych recently. And to be fair, you're right that there probably are some high achieving superstars, who hate everything, and go into dermatology for the lifestyle, but that just isn't the norm, and you'd be far more likely to find these people in psychiatry than dermatology.

Thought experiment: if you were and average student stuck 3 years into medical school and realized you hated everything, what would you apply for, and what options would you realistically be competitive for?

 

[psyspy]

Clearly you're not in tune with some of the more recent psych applicants from the last 3-5 years. Psych has become the go to specialty for a good amount of people who hate everything, don't want to do medicine, and realized they want to be able to coast in residency and be able to work 3 days a week and still make great pay.

Everything you posted about dermatology applies to psych applicants to a far greater degree. What do you think has lead to the explosion in psych applicants in the past 5 years? Are people just suddenly developing a passion for mental health? I don't think so... I think the cat is out of the bag and medical students have realized that psych is a very short residency, with exceptional hours during and after training, a booming job market, and ridiculously high salaries and jobs available in the right markets. There's a reason it went from the least competitive, most IMG friendly, to moderately competitive in such a short period of time, and it's not because of a passion for mental health.

As far as dermatology goes, the dispassionate student doesn't just incidentally crush all of their classes, rotations, step exams, and publish 10+ papers and just accidentally apply dermatology as a fourth year... On the other hand I know plenty of lower achieving students, slackers, people who were pressured by parents, and those who regretted ever going into medicine and who applied into psychiatry as an escape plan, and most of them matched.

I want to clarify before I get called out and this gets misinterpreted: I'm not being disrespectful towards psych, and most people who go into it probably absolutely love it, but from personal experience, a non insignificant portion is doing it purely from a lifestyle/dislike everything/regret medical school, than was the case was 5 years ago. Honestly it takes a really special person to want to do psychiatry and truly enjoy it, and we need more people who are actually passionate about it. It's sad to see some of the people that have been flocking to psych recently. And to be fair, you're right that there probably are some high achieving superstars, who hate everything, and go into dermatology for the lifestyle, but that just isn't the norm, and you'd be far more likely to find these people in psychiatry than dermatology.

Thought experiment: if you were and average student stuck 3 years into medical school and realized you hated everything, what would you apply for, and what options would you realistically be competitive for?

Doubtful. Anesthesia and rads are much more likely to steal them (at least now). Both generally have markedly higher salaries and booming job markets (in spite of psych’s), and most people can’t handle complex psych patients on a regular basis. Gas/rads is almost certainly a path of lesser resistance for those kind of jaded high achievers rather than psych

Even this past cycle psych competition seemed to cool down compared to the other

If you’re talking about average/below average kids who are doing psych just for the lifestyle, sure, you may have a point. But PDs have said if psychs can’t or won’t do complex cases, they’re gonna struggle for cases against midlevels several years from now

 

[Dr. Doctor MD]

Doubtful. Anesthesia and rads are much more likely to steal them (at least now). Both generally have markedly higher salaries and booming job markets (in spite of psych’s), and most people can’t handle complex psych patients on a regular basis. Gas/rads is almost certainly a path of lesser resistance for those kind of jaded high achievers rather than psych

Even this past cycle psych competition seemed to cool down compared to the other

If you’re talking about average/below average kids who are doing psych just for the lifestyle, sure, you may have a point. But PDs have said if psychs can’t or won’t do complex cases, they’re gonna struggle for cases against midlevels several years from now

I think you're right that anesthesia and rads also get their fair share of disinterested applicants, but anesthesia is still a pretty rigourous residency with an intern year and includes nights/weekends/call even once you finish, and that can be a big deterrent. Rads is also 6 years (with essentially mandatory fellowship included in that) which is really long, and has huge amount of reading and studying and minutia to memorize (similar to derm) so it's not really an easy path either.

If you're a burnt out med student and want the path of least resistance, psych is your definitely your best bet to be able to work 40-60 hours during residency and then 30-40 hours per week as an attending with no call, nights, or weekends, for ~300K+. For the truly burnt out, apathetic student, psych provides the best escape by far out of any field, and I think that's unfortunate since the vast majority of current US MD/DO psychiatrists out in practice probably picked the field because they were passionate about it, and I think these new classes are becoming more of a mixture of the passionate and the apathetic.

 

[sloop]

Based on the bolded portions of your quote, clearly you're not in tune with some of the more recent psych applicants from the last 3-5 years. Psych has become the go to specialty for a good amount of people who hate everything, don't want to do medicine, and realized they want to be able to coast in residency and be able to work 3 days a week and still make great pay.

Everything you posted about dermatology applies to psych applicants to a far greater degree. What do you think has lead to the explosion in psych applicants in the past 5 years? Are people just suddenly developing a passion for mental health? I don't think so... I think the cat is out of the bag and medical students have realized that psych is a very short residency, with exceptional hours during and after training, a booming job market, and ridiculously high salaries and jobs available in the right markets. There's a reason it went from the least competitive, most IMG friendly, to moderately competitive in such a short period of time, and it's not because of a passion for mental health.

As far as dermatology goes, the dispassionate student doesn't just incidentally crush all of their classes, rotations, step exams, and publish 10+ papers and just accidentally apply dermatology as a fourth year... On the other hand I know plenty of lower achieving students, slackers, people who were pressured by parents, and those who regretted ever going into medicine and who applied into psychiatry as an escape plan, and most of them matched.

I want to clarify before I get called out and this gets misinterpreted: I'm not being disrespectful towards psych, and most people who go into it probably absolutely love it, but from personal experience, a non insignificant portion is doing it purely from a lifestyle/dislike everything/regret medical school, especially compared to 5 years ago. Honestly it takes a really special person to want to do psychiatry and truly enjoy it, and we need more people who are actually passionate about it. It's sad to see some of the people that have been flocking to psych recently. And to be fair, you're right that there probably are some high achieving superstars, who hate everything, and go into dermatology for the lifestyle, but that just isn't the norm, and you'd be far more likely to find these people in psychiatry than dermatology.

Thought experiment: if you were and average student stuck 3 years into medical school and realized you hated everything, what would you apply for, and what options would you realistically be competitive for?

If I hated everything, including psych, I definitely wouldn’t do psych.

If you hate psych, you’re going to really hate it when your day to day life involves anxious people constantly claiming that every medicine gives them intolerable side effects, including 20 mg of Prozac and 25 mg of lamictal, psychotic people trying to assault you, homeless people malingering in the ED when you’re like 10 patients deep in overflow on the medical side, autistic patients trying to bite everyone, etc. Then factor in the times that you’re a resident stuck in the hospital waiting to go to court for your patient on the involuntary docket. And leading eating disorders group where half of the patients hate you because you increased the calories of their diet or had to put them on observation because they were spitting their food into the trash. The list goes on and on. Psych patients will make you want to pull your hair out like no others, especially if you don’t actually like working with them to begin with.

Also, psych has an average residency length of four years. The hours may be cush during some residencies, but that’s not universal. My schedule sucked until like halfway through third year and I was doing regular weekend/night shifts in the ED all the way through my last month of residency.

 

[psyspy]

I think you're right that anesthesia and rads also get their fair share of disinterested applicants, but anesthesia is still a pretty rigourous residency with an intern year and includes nights/weekends/call even once you finish, and that can be a big deterrent. Rads is also 6 years (with essentially mandatory fellowship included in that) which is really long, and has huge amount of reading and studying and minutia to memorize (similar to derm) so it's not really an easy path either.

If you're a burnt out med student and want the path of least resistance, psych is your definitely your best bet to be able to work 40-60 hours during residency and then 30-40 hours per week as an attending with no call, nights, or weekends, for ~300K+. For the truly burnt out, apathetic student, psych provides the best escape by far out of any field, and I think that's unfortunate since the vast majority of current US MD/DO psychiatrists out in practice probably picked the field because they were passionate about it, and I think these new classes are becoming more of a mixture of the passionate and the apathetic.

If they’re truly burnt out and apathetic lots of them will likely burn out in psych given the inevitable types of patients that will frustrate them. It’s a lower burnout specialty sure but the burnout isn’t zero.

 

[Dr. Doctor MD]

If I hated everything, including psych, I definitely wouldn’t do psych.

If you hate psych, you’re going to really hate it when your day to day life involves anxious people constantly claiming that every medicine gives them intolerable side effects, including 20 mg of Prozac and 25 mg of lamictal, psychotic people trying to assault you, homeless people malingering in the ED when you’re like 10 patients deep in overflow on the medical side, autistic patients trying to bite everyone, etc. Then factor in the times that you’re a resident stuck in the hospital waiting to go to court for your patient on the involuntary docket. And leading eating disorders group where half of the patients hate you because you increased the calories of their diet or had to put them on observation because they were spitting their food into the trash. The list goes on and on. Psych patients will make you want to pull your hair out like no others, especially if you don’t actually like working with them to begin with.

Also, psych has an average residency length of four years. The hours may be cush during some residencies, but that’s not universal. My schedule sucked until like halfway through third year and I was doing regular weekend/night shifts in the ED all the way through my last month of residency.

Believe me, you don't have to highlight how challenging caring for the actual whole spectrum of psychiatry patients can be. Those are all things you'll need to deal with to an extent in residency, but nothing is stopping an attending psychiatrist from renting a one office room, hanging a shingle and charging $200-300 (and sometimes more) per hour to treat depression/anxiety/ADHD and do medication refills for low acuity visits - anywhere from 20 to 40 hours per week, with no nights, weekends, or call.

There's literally no other field in medicine that can match that lifestyle besides psychiatry. Psychiatry offers one of the best careers, with the least call/nights/weekends, great pay, a booming job market, and is attainable for pretty much any MD student. It's a great gig, and that is going to unfortunately attract some people who are using it as an escape from the grind of most fields of medicine.

The only reason, I'm calling you out on this is because in your original post I quoted you acted like derm is filled with apathetic residents who don't actually like the skin, while completely ignoring the same thing that's actually happening in your own field, and declared that everyone in psychiatry is in it for the passion, which is clearly not the case for everyone. If you've ever interacted with derm residents, you'll realize quickly that you need to love the field to do well in it. Good luck handling the constant studying/reading in residency and seeing 40-50 patients a day along with the callbacks and notes, if you don't love what you do.

Some of the best and kindest people from my school have gone into psychiatry, and on the flip side some of the absolute worst (who I would never let treat a family member) have too and they have been quite honest about their intentions. I'm glad that you're at a strong program with people who love psychiatry, but there are a lot of spots in the country and not everyone who fills them is going to have the same passions and aspirations as you.

 

[sloop]

Believe me, you don't have to highlight how challenging caring for the actual whole spectrum of psychiatry patients can be. Those are all things you'll need to deal with to an extent in residency, but nothing is stopping an attending psychiatrist from renting a one office room, hanging a shingle and charging $200-300 (and sometimes more) per hour to treat depression/anxiety/ADHD and do medication refills for low acuity visits - anywhere from 20 to 40 hours per week, with no nights, weekends, or call.

There's literally no other field in medicine that can match that lifestyle besides psychiatry. Psychiatry offers one of the best careers, with the least call/nights/weekends, great pay, a booming job market, and is attainable for pretty much any MD student. It's a great gig, and that is going to unfortunately attract some people who are using it as an escape from the grind of most fields of medicine.

The only reason, I'm calling you out on this is because in your original post I quoted you acted like derm is filled with apathetic residents who don't actually like the skin, while completely ignoring the same thing that's actually happening in your own field, and declared that everyone in psychiatry is in it for the passion, which is clearly not the case for everyone. If you've ever interacted with derm residents, you'll realize quickly that you need to love the field to do well in it. Good luck handling the constant studying/reading in residency and seeing 40-50 patients a day along with the callbacks and notes, if you don't love what you do.

Some of the best and kindest people from my school have gone into psychiatry, and on the flip side some of the absolute worst (who I would never let treat a family member) have too and they have been quite honest about their intentions. I'm glad that you're at a strong program with people who love psychiatry, but there are a lot of spots in the country and not everyone who fills them is going to have the same passions and aspirations as you.

I’m sure that there are some people who go into psychiatry purely because of the lifestyle. I still think that’s a terrible idea, but whatever.

Still, skin is a pretty niche interest. I went to med school too, and I knew a bunch of people who went into derm. Some of them were close friends. I don’t know that any of them really expressed particular excitement about skin pathology. Again, I am sure that there are some people who are really interested in it but I honestly don’t think it’s a common interest. I also think that many people probably cultivate an interest in it throughout training, but that’s not exactly the same thing. The demand for derm spots is astronomical and I don’t think that demand is even close to accounted for by genuine intrinsic interest in the subject.

More than half of the people who went into psych in my med school class knew they wanted to be psychiatrists on day 1 of med school. They also regularly talked about how fascinating they found psychopathology. Psychiatry is a topic that is intrinsically interesting to even many lay people. I guarantee that if you surveyed a thousand random people about whether they found psychopathology and skin pathology interesting, the amount of interest in psychopathology is far greater than that of skin pathology.

None of this is a slight on derm or the people who legitimately love that work. It’s just that derm is one of the most competitive fields when it deals with a subject in which interest is relatively uncommon. Psych is a moderately competitive field which deals with a subject in which interest is relatively common. That seems to imply that the number of people going into derm for reasons other than interest in the subject is greater than the number of people going into psych for the same reasons.

Also, by the way, it can be totally fine to go into a field for lifestyle reasons. Again, I had friends who went into derm for these reasons. I just think it’s weird to claim that this happens more (or as much) in psych as it does in derm, because that seems clearly false.

 

[Dr. Doctor MD]

I’m sure that there are some people who go into psychiatry purely because of the lifestyle. I still think that’s a terrible idea, but whatever.

Still, skin is a pretty niche interest. I went to med school too, and I knew a bunch of people who went into derm. Some of them were close friends. I don’t know that any of them really expressed particular excitement about skin pathology. Again, I am sure that there are some people who are really interested in it but I honestly don’t think it’s a common interest. I also think that many people probably cultivate an interest in it throughout training, but that’s not exactly the same thing. The demand for derm spots is astronomical and I don’t think that demand is even close to accounted for by genuine intrinsic interest in the subject.

More than half of the people who went into psych in my med school class knew they wanted to be psychiatrists on day 1 of med school. They also regularly talked about how fascinating they found psychopathology. Psychiatry is a topic that is intrinsically interesting to even many lay people. I guarantee that if you surveyed a thousand random people about whether they found psychopathology and skin pathology interesting, the amount of interest in psychopathology is far greater than that of skin pathology.

None of this is a slight on derm or the people who legitimately love that work. It’s just that derm is one of the most competitive fields when it deals with a subject in which interest is relatively uncommon. Psych is a moderately competitive field which deals with a subject in which interest is relatively common. That seems to imply that the number of people going into derm for reasons other than interest in the subject is greater than the number of people going into psych for the same reasons.

Also, by the way, it can be totally fine to go into a field for lifestyle reasons. Again, I had friends who went into derm for these reasons. I just think it’s weird to claim that this happens more (or as much) in psych as it does in derm, because that seems clearly false.

I think I've made my case, and won't argue it further for why psych more than derm may attract non-passionate people, and it's fine to agree to disagree.

The final thing I will say is that I think you greatly underestimate the overall interest in dermatology and the skin by both the general public and medical students.

It's one of the most fascinating fields of medicine for the general public as almost everyone has dealt with skin issues of some sort throughout their life, and even among those who don't, there is a cult like following in regards to dermatology procedures and conditions. Just look at the the TV shows, social media influencers, Youtubers, bloggers, etc. For medical students, the field has huge variety in scope and practice opportunities (kids, adults, procedures, cosmetics, surgery, dermpath, med-derm, lasers), which make it incrediblely appealing to a lot of people. It's honestly one of the coolest and most versatile fields in medicine, and it's very easy to understand the insane amount of interest.

I think that if you polled the general public on dermatology, you'd find one of the highest levels of interest, and the same is true of first year medical students. I feel like most schools have 20+ people per class interested in dermatology from day one, but only a small handful end up matching ~5 or less usually, and it's not because people realize derm isn't interesting or fun, it's because its unobtainable for most medical students. Honestly I think the fascination with dermatology among the public and non-dermatologists is a bit overexaggerated and glorified, (it's a great field, but by no means perfect and has its own set of issues that are often overlooked) but its a positive perception that remains none-the-less.

You may not personally find dermatology interesting, nor do a number of medical students, and that's okay, but I can assure you there is no shortage of people in the general public or in medical school who are fascinated and interested in dermatology, lifestyle or not.

 

[Slack3r]

I guarantee that if you surveyed a thousand random people about whether they found psychopathology and skin pathology interesting, the amount of interest in psychopathology is far greater than that of skin pathology.

I think the multi billion dollar skincare industry would suggest otherwise.

 

[sloop]

I think the multi billion dollar skincare industry would suggest otherwise.

How exactly does that suggest otherwise? Is being interested in having nice skin the same thing as being interested in skin pathology and the treatment of skin?

 

[Goro]

As an economics major, I can assure you this is false. We are on our way to another recession, and stagflation has already started

Premeds don't know that

 

[GoSpursGo]

Maybe traditional premeds don’t. I’m a non-trad that spent some time in investment banking. I also correctly predicted this stagflation 2 years ago. I’m just applying basic economic principles, and most of this stuff is pretty intuitive when you’ve studied it for years. Now I don’t claim to know exactly WHEN it’s coming but I’m seeing all the warning signs

I mean... a recession is ALWAYS coming. It's just a matter of when

 

[GoSpursGo]

True I mean that is the business cycle of boom and bust, but recessions usually don’t happen 2 years apart (2020 covid shutdowns also caused a recession) so having a recession in the near future is anomalous and wholly caused by government mismanagement of the currency and our supply chain as well as the fact the labor market still hasn’t recovered from 2020. Oh and did I mention that housing prices and stocks are in a bubble right now too?

That is one interpretation. But ultimately not really relevant to the OP, which was based on a mischaracterization of the linked article anyways.

 

[bGMx]

Psych is interesting to people who don't find the rest of medicine nearly as interesting. Same as derm and surgery. So all the slackers are going places that aren't your field.

 

[nimbus]

Doubtful. Anesthesia and rads are much more likely to steal them (at least now). Both generally have markedly higher salaries and booming job markets (in spite of psych’s), and most people can’t handle complex psych patients on a regular basis. Gas/rads is almost certainly a path of lesser resistance for those kind of jaded high achievers rather than psych

Even this past cycle psych competition seemed to cool down compared to the other

If you’re talking about average/below average kids who are doing psych just for the lifestyle, sure, you may have a point. But PDs have said if psychs can’t or won’t do complex cases, they’re gonna struggle for cases against midlevels several years from now

Not anesthesia because you can’t do tele-anesthesia. Tele-psych and tele-rads FTW!!


Btw, I know a married couple, both psychiatrists, both 100% tele-psych, and their dogs get walked 3x/day.

 

[nimbus]

True I mean that is the business cycle of boom and bust, but recessions usually don’t happen 2 years apart (2020 covid shutdowns also caused a recession) so having a recession in the near future is anomalous and wholly caused by government mismanagement of the currency and our supply chain as well as the fact the labor market still hasn’t recovered from 2020. Oh and did I mention that housing prices and stocks are in a bubble right now too?

If 2020 was a recession, that’s news to me. Financially it was the best year of my life….due to said housing and stock bubble.

 

[psyspy]

It was and is a recession for the true middle class and below of America

Telerads also has lots of promise for those into radiology. Anesthesia isn’t remote, but salaries have disproportionately increased more than the other two

Also the us hasn’t gone two decades without a fairly major recession. We’re due for a major one within the next 5 years and probably sooner

 

[deleted314957]

It's because midlevel problems are gaining more traction. Doesn't affect people who are already set on med, but will have a greater and greater effect on people who are still deciding on a career path.

When I applied to med school, I knew PAs and NPs existed but I thought they knew their place and everyone knew who the real doctor was. As it becomes more and more apparent that this isn't the case, med school apps are gonna drop.

I actually think it's probably gonna take a pretty precipitous fall within the next 5 yrs.

“…knew their place…”? Feeling a little threatened? FYI, you are not a member of an exclusive Italian guild from the days of Cardinal Richelieu.

 

[deleted314957]

You really have to look at the economy of the top 1-5% wealthiest in the country. Med schools are (for now) competing for the top 1-5% most accomplished students, and those students are typically choosing between med, law, tech, or business, trying to cement their place in the upper middle class and satisfy cultural expectations.

Pre-COVID: Med school is the clearest path to the upper middle class. Income is the number one predictor of lifestyle. Doctors are respected and universally seen as well-paid professionals with satisfying work.

Mid-COVID: Invincible young people who don't feel COVID is a personal threat to them see doctors as heroes. Young people run to the profession with the same type of zeal as young men enlisting in the army in the 1940s.

"Post"-COVID: Doctors have been used and abused for two years in an extremely visible way. Meanwhile, 26 year old tech bros are working from home, buying investment properties, and driving Teslas. Management consultants got a pay bump and a break from the Mon-Thurs travel grind. Cravath scale compensation went up 20% since 2018. Maybe most importantly, people are acutely aware of how devastating not holding equity is in our current economy. As the housing market borders on the absurd, who in their right mind is going to take on a second mortgage and give up a decade of opportunity cost?

Between the threat of mid-levels, the long training pathway and growing debt burden, CMS refusing to acknowledge that inflation exists, and major talks of healthcare reform (that all focus on decreasing physician salaries), the one big "pro" of medicine (stable and reliable pay placing you in the upper middle class) is all but gone.

I genuinely believe that the only thing keeping med school even remotely competitive right now is many applicants' inability to see opportunity cost. The incomes still look nice, bolstered by older physicians who still own their practices, but most applicants don't understand that you need to chop those numbers in half when comparing to salaries in professions without the massive opportunity cost of medicine.

By the time we all retire, I believe American society is going to look on doctors the same way we look at professors, teachers, social workers, etc... We're becoming martyrs who work for "passion" and many younger people can see it. I work with them every day in the lab, tutoring, and TA'ing. The attitude towards medicine has changed dramatically.

Speaking from 45 yrs as an MD there is more than a grain of truth here.

 

[deleted314957]

You don't need to believe me. The data speaks for itself. (+Another one here).

The average is 110k in the US. And it gets much higher than that. So yes...most people make into the six figure range, and getting well (I define this as >200K total compensation) into the six figure range is a matter of 2-4 years of experience and working at an enterprise level company. (Google, Amazon, Microsoft, Twitter, etc.). This isn't anything new.

Walmart is now advertising starting pay of $110,000/yr for truckers.

 

[deleted314957]

I mean... a recession is ALWAYS coming. It's just a matter of when

Indeed. It’s called the “business cycle “. After 71 yrs it is a yawn.

 

[anesussy]

“…knew their place…”? Feeling a little threatened? FYI, you are not a member of an exclusive Italian guild from the days of Cardinal Richelieu.

The people who think that MDs are equivalent to medical auxillaries (PAs, NPs, CRNAs) are the ones you have to be the most afraid of imo because, often times, they're right in their case. They're completely out of touch, and it's not hard for the medical auxillaries to surpass the low, low bar they're setting.

 

[deleted314957]

The people who think that MDs are equivalent to medical auxillaries (PAs, NPs, CRNAs) are the ones you have to be the most afraid of imo because, often times, they're right in their case. They're completely out of touch, and it's not hard for the medical auxillaries to surpass the low, low bar they're setting.

I was happy to get all the help I could.

 

[anesussy]

I was happy to get all the help I could.

That goes without saying

 

[Lawpy]

What are they gonna do after generation Z? Generation A?

I believe it will be generation Z+, and they will settle the Canadian frontier as Quebec separates and the US absorbs Alberta, Saskatchewan and the Yukon. There will be a golden age.

Generation Alpha - Wikipedia

en.m.wikipedia.org

 

[jhmmd]

Generation Alpha - Wikipedia

en.m.wikipedia.org

But I mean like when they get past the last letter of the Greek alphabet are they just gonna start over? Or use a new language?

 

[Lawpy]

But I mean like when they get past the last letter of the Greek alphabet are they just gonna start over? Or use a new language?

New language likely

 

[Goro]

“…knew their place…”? Feeling a little threatened? FYI, you are not a member of an exclusive Italian guild from the days of Cardinal Richelieu.

Yeah, how dare those peasants try to rise above their station!

 

[anesussy]

Yeah, how dare those peasants try to rise above their station!

All I'm saying is every effective system needs a clear chain of command, and medical auxiliaries are trying their damnedest to break that chain of command down.

 

[voxveritatisetlucis]

It was a very short recession, with the economy quickly being propped up by printing/fr balance sheet expansion.

The fear is that in future recessions, rate won’t be able to be lowered. Unless of course you’re an MMT adherent and think that real rates can stay negative forever

 

[Lawpy]

As an economics major, I can assure you this is false. We are on our way to another recession, and stagflation has already started

Yes this is pretty clear and it’s strange anyone is questioning this

 

[Lawpy]

If 2020 was a recession, that’s news to me.

COVID-19 recession - Wikipedia

en.m.wikipedia.org