Yeah ...
I don't disagree. You're right. For 5-7-10 years from now, the future doesn't look good for entering students. It's not that I'm biased about the present. The present is what it is.
They completely bungled it with their predictions, first saying we had too few and then realizing we had too many. And this happens with a lot of fields - the predictions are wrong and things end up either worse or better than expected. I don't many other specialties very well, but I would say from my perspective - medical oncology was in no way considered the field that it was when I was even an intern, but now it is very exciting, very lucrative, and still on the ascent. That was in a very short period of time. I wish I could be a medical oncologist - no joke. I'm jealous of their field. I think there are certain optho specialties, gastroenterologists, dermatologists and pain management folks that make far more than I ever though was possible when I was graduating medical school. Things changed really quickly. And who knows what will happen to them. Even 5 years ago, yes, we heard footsteps (especially on SDN), but it really didn't seem dire, until it became so.
My thinking is that for the remainder of my career, I should make just about what I make now, or a little bit less, but it won't be horrendous. Maybe that's false optimism, or blind faith, maybe it's laughable, maybe it's stupidity - I don't know. I know that the last few years things have been relatively stable in our neck of the woods, and there is some good growth. Volumes are higher, it takes more work to earn the same amount, but a lot of practices are well situated to do things similarly. I can practice in a way that is medically and ethically sound, have a good QOL with a 35-37-ish hour work week, with another 2-3 hours after hours total per week. I make enough money. I can't really afford a Lamborghini or Berkin Bag or a beach house or a mountain home. That's okay. When I graduated, I thought I would earn a lot more money, like 50% more than I'm making (that's what everyone said the average was at the time). Is it fair? I don't know. It can be really annoying to think about.
I'm angry at the ASTRO leadership. At the ABR. At the "fake news" and the lies and the doublespeak and the gaslighting. You'll note that I've been angriest at those people like Ralphie (a person I looked up to), Ken Oliver, that young person that says "so what" to the end of private practice. This is our leadership and they sold us down the river for a couple of retweets and so their cancer centers can extract more money through rent (not in a real estate sense, but the economic definition of unearned income) from the system and from us, without providing any real tangible benefits except hospital and academic administrators becoming more powerful and wealthier than they deserve.
But, can't really live in that anger. I don't have that many years to go, I'll save well. I'll eat a lot of lamb biryani, maybe veg if I get high cholesterol. I'll watch my kids grow up and hopefully I'll have my health and mind during my mid 50s and beyond to enjoy time with my family and friends.
If you are risk averse, do not choose this field. There is a less than 10% chance it remains as good as it has. And, that's not true of all of medicine. Heck, most of medicine is on the up.
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