I'm just about to finish my in internal medicine residency this summer and based on my experiences (my program is based in a academic community hospital) the past three years I laugh at how stressed I was as an undergraduate about my GPA, MCAT score, research so that I could get into medical school because the way I see it there really are no good reasons to be a physician if you are a bright individual who wants to be successful for the following reasons:
1) Compensation: People say the 10 years of delayed gratification will be worth it afterwards but is it really? Even for someone with no loans to me physicians currently are grossly underpaid (250-350k) for the amount of effort they put into studying and training especially when PA's and NP's are making six figures for a few years of school with no calls/patient responsibility.
2) Autonomy: One could still try to keep their independence by remaining in private practice if they want to deal with the overhead but economically these days it makes no sense (lot of work for little reward). Therefore the only solution is to work for the hospital (hospitalist, specialists in groups that are being bought out by the hospital) which means being told what to do by administrators who have no clinical background (not just MBA's but nurse coordinators as well).
3) Ambition: The job dissatisfaction that comes with losing autonomy is largely a result of our own failures. Even in the old days there has never been a strong voice to advocate for physicians and this has only worsened as everyone has started to look out for themselves. Consequently there is no leverage for us to fight back as an administrator can replace us easily with someone else (look at the rapid job turnover at hospitals especially among hospitalists) who is naive/not willing to make any noise for fear of their own job security. Administrators understand the disaster that would happen if physicians joined forces (threatened to quit unless changes were made) but they ysknow this won't happen because the older generation of physician are close to retirement and my generation either doesn't see the big picture or they just don't care (happy to do shift work, easy hours, paycheck).
4) Professional Development: Sure- as a physician you have a job for life that pays you a good salary (very few professions can say that) but that's the ceiling. No room to move up the ladder and more importantly it does not matter how good you are (no financial reward for being a better physician either clinically or with patients). There is no incentive to do a proper thorough job if your co worker writes one sentence notes, spends two minutes with their patients, and leaves the hospital hours before you do but makes the same.
5) Respect: It used to mean something being a physician- patients/nurses/administrators would treat doctors with the respect that they deserved. I'm not asking for people to bow down to us but at the same time I feel there has been a concerted effort to group us a "health care provider" at the same level as others. Patients have designated parking spots close to the hospital as a sign of loyalty. Physician lounges have minimal spreads. No pharmaceutical dinners. All of these are small things on their own but at the same time given the stress and difficulty of our job warrants some reward/recognition.
6) Technology: The main advantage we had was our medical knowledge gained from classes in medical school and reading books like Harrison's during residency. Technology (web md, up to date) has made things easier but at a major cost- we have become lazy (inherently know less than older generations) which has opened the door for us being replaced- I see primary care doctors being extinct in the future as NP's will follow a protocol to triage outpatients and even in sicker patients not requiring surgery can be managed largely with a computer algorithm that takes a history and makes a diagnosis/treatment plan.
All of this makes me sad about the future but it's not late for us to put up a fight if we have the courage to go for it.
1) Compensation: People say the 10 years of delayed gratification will be worth it afterwards but is it really? Even for someone with no loans to me physicians currently are grossly underpaid (250-350k) for the amount of effort they put into studying and training especially when PA's and NP's are making six figures for a few years of school with no calls/patient responsibility.
2) Autonomy: One could still try to keep their independence by remaining in private practice if they want to deal with the overhead but economically these days it makes no sense (lot of work for little reward). Therefore the only solution is to work for the hospital (hospitalist, specialists in groups that are being bought out by the hospital) which means being told what to do by administrators who have no clinical background (not just MBA's but nurse coordinators as well).
3) Ambition: The job dissatisfaction that comes with losing autonomy is largely a result of our own failures. Even in the old days there has never been a strong voice to advocate for physicians and this has only worsened as everyone has started to look out for themselves. Consequently there is no leverage for us to fight back as an administrator can replace us easily with someone else (look at the rapid job turnover at hospitals especially among hospitalists) who is naive/not willing to make any noise for fear of their own job security. Administrators understand the disaster that would happen if physicians joined forces (threatened to quit unless changes were made) but they ysknow this won't happen because the older generation of physician are close to retirement and my generation either doesn't see the big picture or they just don't care (happy to do shift work, easy hours, paycheck).
4) Professional Development: Sure- as a physician you have a job for life that pays you a good salary (very few professions can say that) but that's the ceiling. No room to move up the ladder and more importantly it does not matter how good you are (no financial reward for being a better physician either clinically or with patients). There is no incentive to do a proper thorough job if your co worker writes one sentence notes, spends two minutes with their patients, and leaves the hospital hours before you do but makes the same.
5) Respect: It used to mean something being a physician- patients/nurses/administrators would treat doctors with the respect that they deserved. I'm not asking for people to bow down to us but at the same time I feel there has been a concerted effort to group us a "health care provider" at the same level as others. Patients have designated parking spots close to the hospital as a sign of loyalty. Physician lounges have minimal spreads. No pharmaceutical dinners. All of these are small things on their own but at the same time given the stress and difficulty of our job warrants some reward/recognition.
6) Technology: The main advantage we had was our medical knowledge gained from classes in medical school and reading books like Harrison's during residency. Technology (web md, up to date) has made things easier but at a major cost- we have become lazy (inherently know less than older generations) which has opened the door for us being replaced- I see primary care doctors being extinct in the future as NP's will follow a protocol to triage outpatients and even in sicker patients not requiring surgery can be managed largely with a computer algorithm that takes a history and makes a diagnosis/treatment plan.
All of this makes me sad about the future but it's not late for us to put up a fight if we have the courage to go for it.
