Why I Can't Encourage Others To Pursue A Career In Medicine

A warning for prospective or current physicians-in-training

Although part of me wants to leave the writing of this type of post to someone else, or just allow it to not be written altogether, there is a larger part of me that wants to make sure that everyone who is thinking of pursuing a career in medicine has access to the experiences of many different people to help them to make an informed decision.  So, here we go! 

I entered medical school in 2003, graduated in 2007, and completed a pediatric residency in 2010.  At this point, I have been practicing medicine for 5 1/2 years.  The feelings of doubt about my career choice started soon after residency, and have only grown since then.  At this point, I do not encourage anyone contemplating a career in medicine to pursue this option, and I am seriously considering getting out of clinical medicine myself.  My goal in writing this is to tell you why, and to give you more information that will hopefully help you make the right decision for you.  

I am not alone in my feelings.  I hope you will not write me off as one disenchanted doctor, thinking that I am in the minority.  I do not believe I am, as you will see.  I am sure there will be others who will disagree with my stance and who will be eager to offer anecdotal encouraging, happy opinions about being a physician.  I hope you will continue to read, ask questions, and talk to many people to get an accurate picture of what being in medicine is like today, and what it may be like by the time you are actually practicing.  

I made the mistakes that I hope to help you avoid.  I did not ask many physicians about their career and life satisfaction, and I ignored the physician who tried to persuade me to not pursue medicine. My uncle, a psychiatrist, quietly suggested that I look into a different career path as I was applying to medical school--I quickly brushed him off and disregarded his advice, thinking that his negative opinions were only due to some personal struggles he had had during his training.  Now, looking back, I wish I had listened to him.

In a poll conducted in 2012, 9/10 doctors indicated they were unwilling to recommend health care as a profession to family or friends (http://tinyurl.com/z6zt7uy).  Consider some of the comments: "I am a third generation physician and have actively discouraged my son from pursuing and career in medicine" and "I would not recommend becoming an MD to anyone."  Interestingly, in the summary of the study, the only positive comments about being an MD came from surgeons (http://tinyurl.com/zct95kg -- see page 13.)

 

Medicine in the United States has become a depressing business.  Insurance companies often dictate or limit the meds I can prescribe and the tests I can order.  Our current system incentivizes volume and encourages doctors to see as many patients as possible.  This leaves me and many of my physician colleagues feeling like we do not have time to create meaningful relationships with patients or provide a thorough evaluation of a patient's complaint, especially in one visit.  As the list of required checklists to meet quality measures during a patient visit grows, my ability to provide a personalized, tailored interaction with the patient shrinks.  You may have heard of reimbursement moving in a different direction, perhaps towards being dictated by patient satisfaction or improved outcomes.  I am not optimistic that this will provide the improvement in care delivery that physicians are striving to meet.  Patient satisfaction is definitely not always a good measure of the quality of the service provided (think of the chronic pain patient who just wants their opioid prescription), and improved outcomes ultimately must rely on the patient's actions--a physician may provide outstanding care, but if a person with diabetes refuses to lose weight or take their insulin, their free will allows them to do so and ultimately the physician cannot force compliance or a positive outcome.

The time I spend working looks much different than I thought it would when I applied to medical school.  I assumed that I would spend most of my day talking with and examining patients.  At this point, I spend almost as much time on administrative duties (charting, reviewing diagnostic studies, making phone calls, filling out forms, researching medical topics) as I do on patient care.  My "total working hours" are almost double what my office hours are.  Being a salaried employee, my seemingly reasonable pay becomes much less reasonable when I actually factor in the number of hours that I actually work, not just the number of hours I see patients.  I have a friend in residency who was recently reprimanded by his program directors for not finishing all his charting in what they thought was a "timely manner"....he told them that once he went home to be with his wife and children, he was not going to spend time charting.  This response left his superiors questioning his "dedication to his profession."  Only in this (and perhaps a few select other) profession would his dedication be questioned--he, who has committed to years of school and training, has committed tens or hundreds of thousands of dollars, and works 80+ hour weeks.

It is wonderful, but also difficult, to be a physician in the internet age.  Information is at our fingertips, but it is also at the fingertips of our patients.  I continue to notice a decline in the respect given to our profession by the general population, as they assume that they can go to Google themselves and determine their illness and the best treatment.  Misleading and downright false information about medical care is now accessible with the click of a mouse, and for some reason, a blog post online is sometimes much more trustworthy than my professional recommendation.  In the past, I have often enjoyed the reaction I get (especially from others in the LDS church) when they find out I'm an M.D.  It has, in the past, made me feel proud and important; now, I find that admiration from others means relatively little to me because I feel that my own patients see me as somewhat unnecessary.

Medical training was, honestly, the most humiliating experience of my life.  And keep in mind, I trained in pediatrics, what I consider to be the "nice" specialty with the "nice" people.  Sure, I had good days, and loved many of my classmates, and had a few outstanding attendings and role models...but all medical training has elements of unhealthy competition, a "weeding out" of the "weak," and a preference to single out and attempt to embarrass individuals.  I would encourage anyone considering medicine to follow Pamela Wible MD on Facebook and read what she posts.  She has a keen understanding of the abuse physicians and physicians in training go through and she's not afraid to talk about it (and yes, it is abuse, no matter how much we would like minimize it and explain it away because it is the "culture" of medicine).  Dr. Wible takes on difficult topics, including speaking out about some of the hundreds of physician suicides that occur each year.  She coaches physicians on how to build their ideal medical practice--I would encourage you to read what some of the physicians who take her course say about their medical career and medicine before working with her.  It's overall very dismal.  (See http://tinyurl.com/gs9abhz.  I would love to take her course but unfortunately I don't have an extra $3000 laying around to do so.)

Realize that medicine has the highest suicide rate of any profession.  Doctors are some of the most dissatisfied people when it comes to their chosen profession.  Of course most of us aren't contemplating suicide, but estimates are that 300-400 physicians commit suicide every year.  Think of what that means--if that many are willing to commit suicide, how many more are depressed or unhappy?  A medical student recently wrote me that she hadn't met many physicians who would admit to being dissatisfied. My response was, "Why do you think that is?  I think it's because it's embarrassing.  It's embarrassing to admit that something that you spend 7-10 years training for, and a ton of money for, is ultimately not something that makes you happy, is not something you want.  No one wants to admit a mistake like that." Looking back, the physicians that I shadowed as an undergraduate did not seem happy.  I didn't not think to ask them about it, but I should have.  I wish I had asked them, "Are you happy?  Are you glad you went to medical school and became a physician?  Would you do it again?"  and most importantly, I would ask them, "Would you encourage your son or daughter to go into medicine?"  I'm pretty confident in what they would say to that one.  The survey I mentioned at the beginning already tells us the answer.  

I was talking to another colleague the other day about the difficulties of the career, and he said something that I have since thought about many times, which I find quite telling: "Doctors help their friends not to become doctors."  That's right, I thought.  I want to be a friend to others and help them not to become a doctor.  Sad, but true.  

I have, in this post, specifically kept my audience general because I don't recommend that anyone--men or women--go into medicine.  The added difficulties of being a wife and mother (especially a wife and mother active in the LDS church) in medicine is for another post.  Briefly, my satisfaction and my perceived ability to achieve an appropriate work/life balance significantly declined after the birth of my second child.  Mommd.com is full of women looking to leave clinical medicine after they have discovered that the balance is very difficult to achieve.  Working part time has also been more costly monetarily that I realized it would be.  At this time I pay my own malpractice insurance, licensure fees, professional dues, and CME costs because I don't work enough hours for my employer to cover them.  This is a problem that I have run into as a part time physician.  Of course this may not apply to all part time physician jobs, but I never expected being a physician to cost me thousands of dollars out of pocket a year.  Finally, if I do decide to leave clinical medicine, my insurance company will immediately require me to pay $14,000 in tail insurance to cover possible future claims.  This is a relatively low cost of tail insurance since I only work part time (apparently this cost can be much higher), but at this point, I can't afford to leave clinical medicine even if I absolutely was sure I wanted to.  

Here are a few articles that you can look into for more information.  They are not necessarily the best articles on this topic, but only the ones that I have come across in the past couple years, and helped me feel that I was not alone in my dissatisfaction as a physician. I got many of the statistics that I quoted above from these articles.  They also give more titles, including books written by physicians, pertaining to this subject that you can look into if you are interested:

 

How Being A Doctor Became the Most Miserable Profession http://tinyurl.com/pumm46f

Doctors Tell All--And It's Bad http://tinyurl.com/kgkvma3

American Physicians are Killing Themselves and No One is talking About It http://tinyurl.com/nqg48zn

Please feel free to contact me if you have further questions.  I would be happy to talk with anyone who is looking for further insight.  

--Whitney W. Pack, MD, FAAP