Are the rewards of medicine itself enough to entice the best students to become doctors?
Edwin Leap reminds us that at one time, the rewards of medicine outweighed the financial benefits associated with the profession. Medical students and young doctors today may not be as altruistic, and indeed, seem to place greater priority on lifestyle. This is especially true in the current era of restricted work-hours and mandated nap times, compounded by the demand for specialties with manageable hours.
Without “a sense of temporal and eternal purpose,” Dr. Leap writes that doctors today “will have to be rewarded financially in order to stay in a long, arduous educational system, in order to work all hours, in order to expose themselves to risks physical, emotional and legal and in order to come back day after day to a job that is sometimes amazing but often quite tedious and frequently quite maddening.”
Dr. Leap urges caution about unilaterally demonizing profit in medicine and the salaries of physicians: “You’ll also need money to get physicians and mid-level providers to continue seeing all of the nonsense we see . . . [and] if we decide that profit is inherently bad, we’re going to have a tough time getting things like new medicines from companies, new procedures from surgeons and open office slots from any doctor on earth.”
Well said.
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{ 5 comments }
Although I agree with the premise that students are motivated largely by lifestyle and may not be as altruistic, I would argue that lowering salaries may not have detrimental effects Leap purports. As a Ph.D. student studying to be a medical sociologist, my fellow peers and I will attend, on average 23-25 years of school, in long and arduous (albeit different) graduate programs. Even though we are not compensated with six-figure salaries in our late-20s and early-30s, we are often driven by the beneficial lifestyle professors enjoy. Bottom line, although our professions have much different histories, students are still motivated by the lifestyle and engaging intellectual work.
The difference is what you are saying is lifestyle. The VERY best medicine lifestyle is dermatology. Yet, they still on average work 50 hours/week and when they are working they are going 100 mph. They typical see 40-50 pts a day which adds up to a lot of paperwork, work, and yes even stress.
If you are honest with yourself, you will realize that professors have a lifestyle that is unrivaled by any medical specialty.
Anon 2:29
Don’t you think its possible that the Derm mds work hard to maximize their income while they can? The earlier you can retire, the better your lifestyle!
I wouldn’t have. The process is far too long–thirteen years in my case–and far too expensive to tolerate a lower level of reimbursement.
Med students are motivated by things that interest them and that suit their particular personalities, life goals and needs. They are de-motivated by the appearances of practice areas that are not interesting, frustrate their life goals and fail to meet their needs. Practice fields that demand lots of personal sacrifice, pay relatively poorly, command little respect from patients or other doctors are going to be difficult to sell to anyone.
Derm pays well because it is possible to tailor a practice to your preferences (e.g., Mohs, oncology-only, etc) can be efficiently practiced in the office as opposed to a hospital, which is inefficient, allows selectiveness in participating with third-party payers, and generally enjoys respect from patients, if not from other doctors.
Lifestyle is not well-defined: sometimes it means short hours, sometimes it means flexible scheduling (women with children wanting part-time work) sometimes it means regular hours without call duties. Lots of fields offer some of these, EM, rads, derm, Rad. oncology, pathology, psych, ophtho.
I didn’t get into this for the money; in fact, I always dreamed of working with the homeless or other disadvantaged people in a novel, out of the box way. Now as I stare down my nearly $200K in loans, my lack of savings, IRA contributions, or real estate (or even a car that’s less than 10 years old), it seems like a far off dream that I don’t know will ever be realized. The debt and the lack of building any kind of safety net for myself as I enter my thirties makes me wonder why I chose this path.
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