Goals when starting medicine and how some have been disillusioned

When I went into medicine, I had clear goals in mind. Helping people. A stable income to provide for a family. I grew up under the spotlight of my father, who is a neonatologist, and lived in awe of his work. I remember being in restaurants with my dad – people would come up to him reverently and sing his praises (to his obvious embarrassment).

Talk about their son or daughter that he had taken care of, and fill him in on how they were doing now. Once, in a small town in college, I was filling out a check at a convenient store. The clerk recognized my last name as the same one as the doctor that saved their premature baby. “Your dad is amazing. It must have been wonderful growing up with a father like that – one who hung the moon.”

So although my path was a little wayward, I found myself starting medical school at 23 years old – not too bad after taking three years post college doing B.A. level psychiatric jobs and taking pre-med requisites. I thought I might be a psychiatrist, but quickly changed my mind because I worried about the burnout I might experience taking on the burden of other’s emotional and mental issues. Then I decided to be an ophthalmologist, but changed my mind at the last minute – fall of senior year.

This is why. I was on a month away rotation in a different state, and worked closely with an ophthalmologist at the general clinic. She was elegant, razor-sharp, and efficient. I watched her manage the clinics with grace and ease – quickly entering and exiting each room, performing eye exams, dictating notes for the chart. She took me out to lunch. Here is what she said.

“Don’t do it. Did you see how many patients I plowed through? It’s like that every day – you have to see more and more. Some days I squeeze in 60 or 70. It didn’t used to be this way. Did you see me get to talk to a single patient?”

I didn’t.

“The techs do all the talking. I don’t get to know them at all. I’m like a machine, getting briefed by the techs and looking at their eyes. It’s all I get to do. Then I tell the techs what to write in the chart, and have to rush to the next room. Job satisfaction is nil.”

My best friend in medical school ended up going into ophthalmology – I’m going to take my kids to visit her this weekend. She works in a small town, and seems to have good patient interactions, but her job is not without its challenges. Overall, she seems happy.

I am reminded of another experience my third year when I was considering orthopedic surgery. I had the grades, and the strength to manipulate the hardware. I was surrounded by encouraging attendings, but they and the residents were all male. I asked if anyone knew any female orthopedic surgeons I could talk to. One of the attendings gave me the name of a woman that rotated once a month from a practice in a smaller town. I called her. She was in her early 50′s. Here is what she said:

“I made great sacrifices, for my family, in order to do what I did in my career. If I had to choose all over again, I would choose differently.”

The one girl I knew who went into orthopedics, she was a year above me – bailed for radiology as soon as she started a family.

I encountered a lot of frustration on the pediatric wards when I rotated. The pediatric residents, especially those in the SICU, liked to stay up late talking about how hard they worked and how little money they would get in return, when all was said and done. Massive debts, burnout, and destined for salaries that barely scraped the bottom of the physician barrel. Many residents in the primary care fields appear to share this sentiment.

I was watching a film recently called The Vanishing Oath. What I saw was this. An ER doc who sacrificed for many years to study – missing important life events of family and friends along the way – and is now overworked and bogged down in bureaucracy. He feels he has no time to spend with his patients from all the charting and hospital hoops he encounters. A few years out of med school, having barely made a dent in all of his debt, he is ready to get out – or at least take a big sabbatical. I need to give it another shot so I can do a proper review, but the little I saw inspired this post.

I work in the field of pathology. I do have a little patient interaction, but most of my work does not involve patients. I love my job – wouldn’t trade it for the world. I have become somewhat disillusioned by how much of a money game it is between hospitals and doctors. I spent a day in a special session of legislature last year, watching a battle, and that was an eye-opener. I am also disillusioned by the lack of teamwork involved. Dr. Gawande said it better than I can in a med school graduation speech at Yale called The Velluvial Matrix that I read earlier this week. It’s not that we don’t try to work as a team, the system is just set up against us. And it really is our job to figure out how to fix that.

Sometimes when I get really angry and jaded I try to remember that little girl that sat in awe of her dad, through all those chance encounters with the parents of the many babies he helped that would not otherwise have lived. Now I’m doing my own part – although somewhat more behind the scenes. I love calling doctors and telling them the results of their procedures so they can move on to treat the patient.

Recently, I got to help an enigma of a young girl being treated for a brain tumor with fever and neutropenia. The pulmonologist was so happy when I called to tell her there was pneumocystis all over the GMS (fungal) stain. Something to treat. A cardiothoracic surgeon called me three times, hanging on my assessment of a CT-guided lung biopsy. When I finally called him late in the day to tell him that yes, me and my partner agreed we could name that cancer on three cells so he did not need to proceed to mediastinoscopy – he was overjoyed. One less procedure, and one more step toward treatment. Every day I get to supply a big piece of the puzzle that can help the clinicians move on. That is extremely satisfying.

So my question is – what were your goals when you started medicine? And how have you been disillusioned along the way? What keeps you going?

Gizabeth Shyder is a pathologist who blogs at Mothers in Medicine.

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  • http://www.drveronica.com Dr. Veronica

    I loved my patients. I hated the business of medicine with dealing with not getting paid by insurance companies, long hours and the ever present threat of lawsuits. When I think about leaving my first son at six weeks post-partum to go into internship working 80-100 hour weeks and then going into preterm labor with my second son while on call at the hospital during one of those 100 hour weeks, I feel angry. I left that son 13 days post partum to begin my residency after the concern that I put my own child at risk because I felt the urge to try to save the world.

    Disillusionment was the minor emotion. Clinical depression, PTSD and compassion fatigue were what I came away with.

    I left and now life is so beautiful. But I wonder who is going to stay given the quality of practice and personal life that physicians experience.

    There is no amount of money that would make me go back to clinical medicine.

    However, I am grateful for all the wonderful people I met both as patients and colleagues. These people did enrich my life in immeasurable ways. What a gift. And I want to thank all of my patients for selecting me as their physician and allowing me to participate in their care.

  • http://fertilityfile.com IVF-MD

    I’m curious about the people who left medicine for something “better”. Specifically, what are they doing now and what is better about those fields. Clinical medicine can still be a fantastic career choice and in my opinion, it doesn’t hinge solely on what specialty you choose, but on how you structure your specific practice within that specialty. It takes some trial and error and some reliance on creative brainstorming and some compromises, but when it all comes together, it’s hard to find another field which is consistently better. Just my opinion, or course. :)

  • jsmith

    The idea of medicine as a way to satisfy one’s psychological needs, as opposed to a way to make a living, is pretty much a thing of the past.
    What keeps me going is a wife and two kids to pay for. If I had enough money (and yes, that is subjective) I’d retire tomorrow.
    On the other hand, we in medicine are not the only ones with “suboptimal employment situations.” I have 2 in-laws with master’s degrees in engineering. Both were laid off this year. One has been out of work since February. Have you ever been on a factory floor, or ever worked at McDonalds ? I’m not saying that docs don’t have a hard row to hoe, but getting abused at work is more common than you might think.
    My advice: Save your pennies, pull the plug if you can’t take it any more. And realize most people are in an even leakier boat than yours.

  • http://www.weightlosscoachingmd.com Melanie Lane MD

    I chose a career in medicine because I wanted to help people live healthy lives and get well when they were sick. Unfortunately this was not my experience.

    I trained in family medicine and geriatrics because I so loved the relationships I could establish with my patients. I was employed in my first year post fellowship, where my employer’s geriatric practice was regularly financially supported by her husband’s GI practice. Sadly, you can’t afford to keep your doors open and provide the quality of care and detail these folks need. She eventually closed up and sought employment at a large multi specialty group.

    I went back to FP for a number of reasons, but the environment there felt completely disempowering. I felt like I was expected to fix the patients without them having to participate in their care, hand holding them through everything like children. I had my employers wanting me to see more patients to generate more revenue and the patients wanting at least six problems treated and all of their meds refilled, and all of their preventive care addressed. Of course this was to take place, start to finish, in 15 minutes. Then they’d be angry because I was late. In the midst of all of these demands, I would try to initiate discussions about healthy eating and the importance of exercise and stress reduction. If anything, my overweight patients just came in heavier each time. Many patients got very angry with me when I wouldn’t give antibiotics for a cold or prescribe diet pills, but they wanted to argue with me when I told them they needed medicine for their high blood pressure. This is not what I signed up for.

    I left medicine. I make WAY less money, but I am so much happier. I went to school to become certified as a life coach, and I am using those skills to help people lose weight. Now I am in the business of promoting wellness not treating sickness. I work with people who actively want to participate in generating and maintaining their health, which is very inspiring and extremely gratifying.

    I am also lucky to have a husband who is able to be financially supportive of me, for now. I suspect he’ll burn out in his neurology practice in another few years, and we’ll have to figure something else out. Hopefully by then, I will have found more fans of my multidisciplinary approach to weight loss and be earning a living to support both of us. Yes, I know. I’m a dreamer…

    • jsmith

      Melanie, I think whether you’re disappointed depends on your expectations going in.
      I chose a career in medicine not so much to help people live healthy lives, but to earn a good living and to try to help out as much as I could I expected to work hard, I expected that people would act like people (be noncompliant, etc), and I never expected to have my psychological needs met. I have my psychological needs met at home, not at work.
      I have been in the ballgame, including residency, for 25 years now. I must say that it has taken a toll, but I’m still showing up to work every day and am a pretty happy camper.
      The idea that medicine, or any job, is going to meet your psychological needs is dangerous. Jobs exist to meet others’ needs, not the needs of the workers (except economic, of course) . If you go in with that attitude, you’re less likely to flame out and, paradoxically, you’re more likely to help out others in the long run.

  • ErnieG

    I think jsmith is right. A job is not there to meet your psychological needs. While a job cannot make you happy, it can make you miserable. There is no doubt that medicine today is making life miserable for physicians, mostly because of loss of control coupled with increase pressure to “perform”. Doctors are uniquely trained to diagnose and treat diseases, and the combination of third party payers and legal liability are increasingly interfering with physicians abilities to deliver that care in the manor they see as best.

  • David Hager, M.D.

    I am most reluctant to recommend medicine as a career to my kids.

    Why subject them to such a hamster wheel life crowded by inexorably encroaching rules written by people who don’t see patients?

    Also, in private psychiatric practice I learned:
    1. If I don’t diagnose, I don’t get paid (even for initial evals, in some cases.) As far back as residency I was taught “benign diagnosis” to trigger remuneration.
    2. The less time I spend with a patient, the more money I make.
    3. If I don’t understand a Medicare rule, call multiple times and pick the least onerous answer.
    4. If I accept a hundred different insurance plans, I have at least a hundred different bosses.

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