David Crippen:
Yesterday the rotating PharmD student in the Department marched into my office and announced that she had decided she wanted to chuck pill rolling and go to medical school. She then asked my advice on whether or not this was a good idea?
I greeted this revelation with some consternation. Knowing what you know now, if you had it to do over, would you still go to medical school?
Bob Hallett:
ABSOLUTELY YES!
Despite all the bullshit we have to put up with, the paperwork, the new breed of middlemen who suck money out of the healthcare industry, to tell patients which doctor they can see, and to tell doctors how many days they can keep a patient in the hospital, or what tests they can order, and despite the often negative feedback from the government, or from the press, and despite the intrusions into our profession by some very small lawyers - despite all of this and more, the answer must be YES!
We all have a lot of pressure on us, both pprofessionally and personally. It is part of life. For myself, when I am alone with one patient, doing a complex procedure in the cath lab, or wading through a ton of information and lab results and X-ray reports, nothing else matters. I can devote all my energy to doing something I believe I do well, stimulate my own brain, and often make a difference in someone else's life. No one can ever take that away from me. This is still the finest profession anyone could ever wish to be a part of, and no outside force can ever take that away from any of us.
Craig S. Conoscenti:
My response would be that I would do it all over again in a flash. No one ever said it would be easy. Being 40 now, I went into medicine knowing that the monetary reward would clearly be less than physicians in practice before me. And in fact it definitely is and I didn't go into medicine because of the money. But lets face it in spite of what we say I don't see too many docs on the bread lines or living in city housing. I too was in a different field. I was a respiratory therapist and made the decision.
I also knew that the beaurocratic problems would worsen and not get any better. Yes, none of us thought that managed care would become what it is but we knew economics would be the main focus of the future.
Everyone has problems in their job. The accountant, the dentist, the school teacher, the garbage man, the housekeeper people in your hospital. If anyone tells you they have no problems and love their job they likely would buy the Brooklyn Bridge too. There is no better feeling than knowing you have worked your hardest to save a life and see that person walk out of your institution. For all the ones that can't walk out that one feels good and gives you a sense of accomplishment. The decision to do it over would not be hard one for me.
Vlad Kvetan:
Yes. M.D. is still the most flexible degree in the world that allows you to be a clinician, writer,administrator,scientist....You carry it all in your head and it is fully portable without equipment requirement.Most people still respect it and take it seriously. With the evolving reverse brain drain in US medicine,it is transportable worldwide. Eventhough US medicine is perceived as collapsing job market due to physicians abandoning administration 30 years ago and getting into bussiness which now rules medicine by business rules,it is not relevant.Just do it.
Malcolm, Fisher:
Like a shot. Since I was first seconded to an ITU in 1974 because we had a patient with tetanus, I have never wanted to do anything else and it has given me the opportunities to meet some great people, see some great places, and catch some humungous fish. I might have liked to have finished my career before the advent of generic managers, or stayed on my original plastic surgery path and had a Ferrari and a weekender and I haven't encouraged my kids that way. I think it was better to do medicine when you didn't have to be as clever as you do now.
Rainer Schaefer:
Yes. It is more frustrating to be a doctor now, but I love the medicine part of the job. I am not as thrilled with the HMO, PPO, IPA, etc part of the job. The very best part of the job is that you get a "ringside seat" on life. You get a great chance to learn about the really important parts of life. I think one of the major reasons we are here is to live and learn, and medicine allows us to do that efficiently. We also get to do some good. Event though medicine business can be frustrating, the human, and science part of it is great. Well, I thought it over and over again.
In our profession, it's not so easy to be satisfied with what you do. We often can't save lives although we desperately try to. And we can't compensate for this by thinking of the huge amount of bucks piling up at the end of the month ;-) ... In very desperate moments (these come more often at the moment, for I'm in the middle of my midlife-crisis...)I think of quitting the job, and living as an artist or something the like.
But, thinking real, I would try to become a doctor again (in my next life). Except one thing: never would enter the anesthesia-biz again. I'm so tired of calls, night-shifts, flying around with my rescue-helicopter in the dawn and fighting to get the victims into the desired hospital. How nice would it be to become a specialist let's say in ENT or ophthalmology and settle in my own private practice, making a lot of money and living in peace.... But where's all the fun and excitement in this scenario? So, I'll really continue doing what I'm doing today - and I think I would really do it again, if I had the choice another time!
Todd Dorman:
Not only would I do it again, I would do precisely the same things in much the sam way!!!! I loved my Internal Medicine residency, my anesthesia residency and my Critical Care Fellowship. Having decided to make a career out of Critical Care Medicine, going back and doing a second residency and then a fellowship were the "BEST" moves I could have made! I LOVE problem solving!!!!!!! Is that not at the core of being a doctor. I'm lucky. Whether clinical, administrative, investigational, business, or with personnel, the challenge is stimulating.
I would tell this individual the following.
1) Yes, I would do it again!
2) It is an enormous amount of hard work, time, and emotional energy.
3) Many who choose the same path will choose it for the wrong reasons, be careful, do not be swayed by those who grouch about the changing face of medicine, yes it is but another problem (challenge) to face head on and solve.
4) Medicine is an education for a lifetime! If you choose this path, learn, from the beginning, the ability to self-educate. Become comfortable with one's knowledge and inquisitive about new horizons.
5) Most of all enjoy what one does, enjoy life!!
Louis Brusco:
Looking back, would I do it again AT THE TIME THAT I DID IT? Absolutely. However, I would not do it now. Here is why.
When I went to Med School, tuition was only $800 more per year than undergraduate tuition. Loans were available even if your family made more than minimum wage. Job prospects on the horizon were bright. Postgraduate training had not changed much, so that you could use past experiences to guide your choice in a place to do your residency. You could also be assured that your career choice, when made, would have roughly the same job prospects, etc., when you finished as when you made the choice.
Contrast that to now. The tuition at the med school I attended is over $25,000 per year, and four year costs are close to $140,000! At this time, I would not be able to get any loans, and my parents would have to hock their house to send me to school. Job prospect are not bright. Residency programs are in a sever state of flux, and a program or set of rotations you may go to a program for might not be there tomorrow. My residents getting out of anesthesia now have far, far different job prospects now than when they made the choice to go into anesthesia.
Most important, if I had gone to med school five year later and were just going into practice now, I would be facing a future with a much lower paying job, not being able to live where I am now, not having the things that I have now. All in all, I probably would have gone to work with my father in the family real estate business.
Ernest Benjamin:
I could not agree more with you. I think that the changes occurring now and in the near future in the way medicine is practiced will weed out of the field all those that, as you said, got into it for the "wrong reasons". The way I look at it, medicine has never been so beautiful, so challenging, and so gratifying. Twenty, 50, or 100 years from now, medicine will be just gorgeous! But it will be quite different, obviously, and practiced differently, the same way that we practice differently from our colleagues of 50 years ago.
Mark L. Wulkan:
In a second! I love my job. I couldn't think of anything else as stimulating and rewarding as medicine. When I was in college I made a concious decision to enter the medical field, rather that persuing a career in computers. I doubt I would be Bill Gates, but I'm sure my financial rewards would have been much greater than they are now (as I get ready to enter my 8th year of post-graduate training.) My experiences as a doctor have taught me what is important in life. Besides, how else could I be an intensivist, Pediatric Surgeon, and computer geek!
Lori Schoonover (PharmD):
I completely agree with your comments regarding that utter sense of "This is my calling". As an assistant professor in a college of pharmacy, I am often asked the very question you were asked. I too considered the medical profession when I was at a similar point in my training.
One of the difficulties of being a pharmacist is that the ultimate responsibility of the patient lies in the physician's hands (or so it is often debated in this group). I believe that it is true and teach my students the same to be true. I think that many students of pharmacy get frustrated with not feeling like they are contributing to patient care. They see their counterparts in the College of Medicine and decide that they should change careers.
I guess this is just a long way of saying that I see this commonly and your advice is right on track ! (in my opinion). Regardless of one's profession, especially in medicine, one really should be somewhat consumed with the desire to do whatever is chosen because we spend so much of our lives doing it. I did the right thing staying in pharmacy. It was my calling and I would do it again.
Jeremy Blanchard:
I have been reading with interest the replies to your initial message. I am not nearly as seasoned as many of the physicians who replied to your e-mail. I am an internist in the army, 2 years out of my residency; this July I will start my critical care fellowship. But since setting out on my quest to be a doc, I have known it is the only job/life for me. I met with my mentor and his wife prior to beginning medical school to try to understand what it was like to be a physician, and whether the journey and trials were worth it. Because I went to medical school on an army scholarship, and I do not have the financial concerns of many of the young docs in my position, may make me more optomistic, but I am as enthusiastic as ever. I love my patients, I love the responsibility, the call for integrity our profession puts forth. Knowing that when a patient lives that I may have played a part, and when a patient dies that I have the opportunity to help the family survive this overwelming experience is life fueling for me.
There is a book, now out of print, called "So You Want to Be a Physician" by Naomi Bluestone, that was helpful to me. The other book which my wife and I read together was "Married to Their Careers", I can't remember the author, but it was excellent as well.
When I meet with young people considering medical school, I tell them there are 6 attributes that make a good doctor: 1)a basic fund of knowledge, 2)certain learned technical skills, 3)honesty, 4)good communication skills, 5)objective compassion, and 6)knowledge of one's limitations. But to be a happy doctor you must want it with your heart. I have never been the smartest, nor the most technically skilled, but I enjoy my life, because I am pursuing the call of my heart. I hope this was helpful, I am usually just a computer lurker(?). Good Luck to the person you are advising.
Dick Burrows:
Thinking about it I find myself pulling together a lot of confused thoughts and memories. There have been great times when the ego jumps to the diagnosis you made when everybody else was scratching his head - then everybody has that. There were the times when you busted your arse all day & night to get a patient through and thanks weren't necessary - just the knowledge of having done a good job.
There were the unpleasant times when, with a goodly dose of Hepatitis B (before vaccination was available) presumably contracted in the line of duty, I didn't care if I made the next day or not because i felt so bloody shit - never mind wonder if I'd be able to put another whiskey down me throat.
Then there are the bean counters who seem, almost deliberately) to do their best to make my life miserable in oh so many ways. They shafted my staff so that 10 patients became 5 and then 3. But then there are the victories there too when we took the bean counters to law and won a battle against them to pay the registrars overtime. That was a victory I will long savour.
Overall, on the balance, for me the victories beat the defeats. I still tried to talk my son out of doing medicine however. I think medicine is becoming an exercise in the technical with patients referred to as clients as if they were purchasing insurance. With doctors relegated (and relegating themselves) to the level of purveyors of vendibles. With medicine becoming a commodity to be purchased on the basis of a suspect 'evidence base' as opposed to the 'experienced thoughtful doctor' (who does not have to be clever!)
Phil Maiorano:
Absolutely - but I would do it very differently...
Though I agree with the spirit of what those "who would" are saying, I do sense that there is often very little respect for physicians these days based on some of what I've seen. It has come to a point, in some areas, where clinical excellence is a secondary consideration to "political correctness". With an increasing number of physicians working for larger corporations or hospitals, I hear growing numbers stories of our colleagues being treated more like commodities than individuals. It seems there are many non-physicians who seek to craft a system giving them control over clinical details and the capacity to eliminate our "license of artistry", or what we refer to as clinical judgement. We have already seen elements of this occur with "restricted formularies" and the like. but I digress...
The "magic" of being a physician, for me revolves partially about the challenges that we all know about, thus do not require detailing - anyone who is involved passionately in clinical work is completely familiar with the unique aspects of the challenges physicians face in and betond their training. I would not have been happy nor would I have rested if I were not to complete my training. I still can't picture doing anything else (though at times I fantasize about being a tester for "Godiva" or something that doesn't involve sleeplessness)
The "bigger picture" however - and I know many may think this is a bit "out there" - is to be a part of the "mystic coven of medical practitioners". In a sense we all share the "force" in practicing a craft in which the basic philosophies of operation have not changed for thousands of years (in some senses) despite increasing pressures from outside forces. Medicine is a noble profession and it is an honor to be counted among those who have earned the right, through compassion and caring for the ill, to be called "Doctor". Among physicians words such as "ethics" and "Integrity" still have great meaning (yeah yeah, everything has exceptions).
Anyway - it really sort of steams me up to hear about the necessity to cut health care costs as many CEO's of "businesses" involved in Health Care are seeing increasing salaries much like the situation in other aspects of the business world related to "corporate downsizing". At the same time the stories of compromising quality to save dollars continue to dribble by - though there have been encouraging developments in the area of perinatal length of stay (which are the most visible but similar circumstances exist in nearly every aspect of medicine) which will hopefully significantly contribute to the increased awareness on the part of the public that the quality of health care faces significant threats. This country has at times prided itself on having "the best healthcare system in the world" and if such is the case than perhaps radical "paradigm shifting" is not the answer. I don't pretend to know what the answers are, but I do feel that physicians should be given the time and the resources they need to care for their patients in the best possible way within reason. but I digress again...
I would do it differently by attending my state school instead of a "fine private univer$$ity" - I am now more completely convinced the quality of the education obtained is largely determined by the individual seeking to be educated (though "fancy" resources are nice they are far from essential). Though in contrast to the "mothers of invention" I didn't do it for the money, I didn't expect to have as much difficulty with my student loans when I began school, and these days the best advice I could give to anyone considering a medical education is do it as inexpensively as you can.
Sorry to ramble but I hardly ever burden you all with my $0.02 (usually it goes to the loans...), and it is a snowy Sunday here in the early springtime - guess I'll hafta put away those water skis...
Reply from David Crippen:
In my conversation with this person desiring to enter a career in medicine, I was interested in seeing what her reaction was to the standard 1996 objections; bureaucratic interference with clinical decision making, managed care boondoggles, cost cutting imbroglios, too many doctors, cutting back funding for medical education......during this litany, I watched her face looking for a reaction. If the decision to go to medical school was made like she might make plans for a weekend jaunt to the Jersey shore for a sojourn on the beach, her expression would dim quickly and she would develop an interest in the legal profession (such as it is). If she continued to do a passable Elizabeth Taylor lusting after a big diamond at Bergdorfs, or Mr. Spock in his rutting season...she might be in the right ball park.
I have always thought that the desire to be a doctor is nothing less than a simple passion of the soul. The peripheral circumstances surrounding it roll off the duck's back. It is a single minded, all consuming passion that devours all in it's way like a ball busting Sherman Tank. Those so possessed will willingly do incredibly stupid and unlikely things to obtain it. Study Physical Chemistry, for God's sake! They will endure physical and emotional hardships that are difficult for the uninitiated to comprehend. Surgery residencies, for God's sake!. There is no obstacle that cannot and will not be beaten out of the way. It's like Spock during his Vulcan mating ritual........eyes rolled back, emitting braying sounds.......single minded.......
Someone who was plying the songwriting/singing trade in Nashville (a tough row to hoe) once queried a famous and successful performer, I forget who, about their career choice. They asked if they should continue to pursue their current course in the face of seemingly impossible odds and daily disappointment. The singer replied: " If you have talent, you will be successful........eventually". The key word is eventually. I think there is a lot of truth in that. You have to pay your nickel and take your chances. There are too many doctors in the USA, without a doubt. There is a big push to make medicine as unappetizing as possible. The chances of making as comfortable a living as my generation and generations before me have is decreasing daily. But if you have talent and you are willing to stick out the tough times and endure, you have a safe bet in medicine.
It is difficult to conceive of a more unlikely candidate than me for a career in medicine. My tale is as weird as anything Ray Bradbury ever woke up screaming to. If any of you thinking about this decision have an interest, here is the en-tire massacree......, in four part harmony.
I was brought up in an upper middle class environment with a lot of love and very few problems. My dad (a physician) and I got along very well. I did fine in school until I hit the 7th grade (when you really had to start studying) and flunked everything. I was probably an attention-deficit type although no one ever heard of that then. I had a lot of nervous energy and was on the move all the time but not "hyperactive" in the sense of being a problem. No one knew how to make my schooling better. It was just all tossed out there and those who did well went on, those that didn't got left.
I graduated in the bottom one fourth of my high school class and the school counselor told my dad I was probably borderline retarded and the best thing for me was to get me in the Army so I would not be a burden on the family. I never made a grade higher than C minus. I had friends and an active social life although I was clearly never in the upper reaches of cliques. I did OK with girls and went steady with a very popular one, sharing her social connections. I was happy and my parents never expected much from me because I was obviously retarded.
This was in a small town in Northwest Wisconsin. I did take the SAT and did much higher than predicted from my grades. I think I got 900 total on the verbal and math. 530 in verbal and 301 or something in math. My math score was so low that it went off the bottom of the scale. I got two hundred points for just signing my name. Now it turns out that the University of Wisconsin system had to accept anyone with a SAT score higher than 900 regardless of their grades in HS but they only have to keep them one year. If they don't muster a C by the end of the year, they get the boot. So the UW had to take me on probation. Everyone was surprised when I announced I was going. No one got too excited about it. Well, to make a long story short, flunked out cleanly after one year with a GPA of 1.5 or so. This was in 1963 and I got a job as an orderly at the hospital where my dad worked. That was fun and I enjoyed it. I was there when Kennedy was killed. I wangled an acceptance back for the Spring Quarter on 1963 on probation again and I flunked out again. I hold the record for failing math three times in a row. Then failed the special remedial class for dummies. I have never passed a single math course in my adult life.
By this time my parents had moved to Georgia and they found a small college there that specialized in keeping rich Northern boys away from the burgeoning draft call. They were more than happy to accept me for the right price. I then proceeded to get tossed out of there on disciplinary probation because it was impossible to flunk out. I wrote an article in the School paper calling the president of the college variations of an Asshole. Yellow journalism started early for me and I still get in trouble for it. However, I correctly read the handwriting on the wall and was able to transfer to the University of Georgia just before I got bounced. I truly wish I had kept the letter the Dean wrote to my parents informing them the cops would be called if they ever saw me on the campus. Well, I then proceeded to skip the trees at the UGA as the draft really got intense. My draft board was made up of farmers who thumbed their nose at the Selective Service because they could not be drafted if they were sole owners. They got serious and came looking for bad grades. My GPA dropped down to 1.9 again and I found my self drafted in 1967.
I tried to enlist to avoid the infantry. I looked over the options and settled on Military Intelligence (the famous oxymoron). I began basic training at Ft. Benning, Ga and on the last day I was called into the COs office to be informed that MI had rejected me on the basis of an adverse background check. I could have retained an attorney and opted out but I figured out I had nothing going for me on the outside so I was able to make another selection. Field paramedic. I ended up in Vietnam as a field medic, 1968-early 70. I eventually got involved with Special Forces (the logical dumping ground for all college flunkouts in 1967), Long range Recon Patrols, Door gunning on Hueys, and other colorful activities, none of whihc impact on the present discussion. It was then that it began to dawn on me that it was about time to get serious about life.
I recall one vivid moment that I shall remember always. I was visiting a friend in the hospital (such as it was) and a physician came to the bedside of a nearby wounded Vietnamese soldier. The nurse called him over to the bedside to report some change in condition, they talked about it a while and ee decided to do a lumbar puncture. Some nondescript person came over to set up the equipment, the Doc wandered over to drink coffee and read the paper. After the setup was complete, the Doc wandered over stuck the needle in, tapped off some fluid, then wandered off leaving the entire cleanup and disposition to others. It was at that instant that I discovered that there were those who effected action in the world and those who cleaned up afterward. It was absolutely apocalyptic. At that instant I decided to be a doer and not a gatherer. And by the way, I now clean up my own messes.
When I got back to the USA I settled back in Athens, Ga (Home of REM) and applied for admittance again to the UGA. They weren't too impressed with a total of four years of college and a 1.9 GPA but I managed to prevail on them as a veteran I deserved another shot. I got in again on probation. It was twice as tough because not only did I have to learn to study again but I had to learn all the things I missed in high school and college that I needed to build on. I enrolled in Pre-Med and this was greeted by a round of guffaws. The premed advisor refused to make an appointment to advise me. However, my Major Professor (who i still get a Christmas Card from every year) told me he would advise me and we would just make the best of it. For the next two years I maintained a 3.5 average and there were many days I saw the sun come up studying. I applied to Med school and received a form letter thanking me for taking the time to apply. I then started graduate school as an irregular, hoping to bolster with more newly good grades. But if you figure out the permutations, there is no way to bolster a 1.9 no matter how many 4.0s you get.
It was about this time that I got interested in electron microscopy and became a self taught expert. There was an old instrument in the Department of Microbiology that had been there for years and no one ever used because better instruments were available over the road. I dusted it off and learned how to use it. I then got a part time job making photos for publication for the profs. Then a fateful thing happened.
My prof came in one day followed by a lady who he introduced as Dr.
Normally they have a GPA cutoff screen for interviews. No grades...no interview. Period. There was never a chance that they would ever give me the time of day. Two weeks later, I received a letter from the Admissions office with a date for an interview. This was my one and only shot at it. My major professor sat me down and told me the rules. "You must go in there and blow your own horn..no one else will". "You must convince them of the passion that convinced me and Dr.
Two months later I got a letter advising me that my name had been added to the "alternate (waiting) list" for admission to MCG. If the class did not fill, they started filling from the list. They did not tell me my position on the list. The deadline was September 1. September 1 came and went. No word. I knew it was over. I had tried twice and failed both times, there was no reason to even try a third time. I came to the lab and bored my friends insensible with ventilation. They suffered me for a while then found excuses to leave. Next day I was moping around wondering how to accomplish painless suicide. It was about 11 in the morning. The phone rang out in the hall from my cubicle. The head of the Department happened to be walking by and answered it. "Crippen....your father is on the line". So I trudged out there, and as I did, I wondered why my dad would be calling me at the Department; I didn't even know he had the number. He was so excited he could hardly get the word out. "Pack your bags...you're in medical school....they want you down there in class this afternoon."
The MCG accepted 160 students and the class had been filled on Sept 1. They had taken an unknown number from the waiting list. On the first day of class, Sept 2, a girl who was on the waiting list for Emory Medical School in Atlanta got a call during the noon recess from classes with the news she had been accepted to Emory off the list. She ran to the admissions office, withdrew from MCG and drove to Atlanta to start classes there. MCG admissions went to the list for the next name and it was Crippen. I jumped in the car, drove to MCG, dashed by the bookstore for some paper and pens, found the class and began medical school in the middle of Freshman Anatomy.
Since then, my life has been enriched by unbelievable portions of dumb luck and being in the right place at the right time (with no other competition around). I often wonder where I might have ended up. I don't think I could have ever passed graduate school because, sooner or later, I would have had to pass a math course, and I have never passed one single math course in my adult life. I cannot add 3 + 3 three times and come up with the same answer. Interestingly, my son (age 9) in third grade is exhibiting some of the exact same traits I did. Back then no one cared. Those that got it received the attention, those that didn't were assumed to be either dumb or unmotivated. The one gift that I plan to give my kids is to reject that concept. We are working hard with the school to get him into programs and scenes that effectively address this before it passes the point of no return.
I wanted to be a doctor more than anything in the world. I
tore up the earth and I raised hell to get it. I saw the sun come up
studying stupid things I knew I would never see again. I read volumes of
Time magazine back issues to improve my score on the MCAT by acing the
current events section. I washed dishes, mowed lawns, ran a rip saw in a
lumber mill, worked highway construction, rode a beat up Honda to class
rain, shine, snow.....there was NOTHING I would have not done to get where
I am. That plus a little dumb luck and being in the right place at the
right time. Idiot bureaucrats, gatekeepers, managers, geeky, suit clad
administrators and the like all be damned. It doesn't matter...none of it
matters. It's the passion. It encompasses all.
That's what I'm looking for when someone tells me they want to be a doctor.