The reasons our future doctors are choosing medicine have changed

Why would anyone want to become a doctor?  Seriously.  Think about it, because this is a very important question for the future of healthcare in our country.

The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising.  Doctors must see many more patients in a day to maintain their salary, all while dealing with more paperwork in their limited time.  The hours are often long and the training is challenging.  Students must attend four years of medical school after college plus an extra three to seven years of residency depending on their chosen specialty.  So, why on earth would the best and the brightest young minds want to pursue a career in medicine, especially when they’ll be expected to pay in upwards of $200,000 for their education?

As a second year medical student I’m proud to report that the reasons our future doctors are choosing medicine have changed.  The decision is no longer made because of prestige or money, as it commonly was in the past.  Some of our nation’s best students are choosing medicine primarily because they care about others.   I’m not saying that older physicians don’t care about others, but they entered medicine under much different circumstances than what we face today.  Ask any pre-med student who’s shadowed a doctor and the majority will tell you that they were encouraged to choose a different career path.  There are plenty of kind and compassionate doctors out there, but there are also many who went into medicine for the money and recognition.  Personally, I was told that I should become a plumber, “because it pays better and medicine isn’t what it used to be.”

Yet, according to the American Association of Medical Colleges, the number of applicants to medical school has been steadily increasing for the past ten years, and students are choosing medicine despite all the challenges.  They see the challenges that our healthcare system faces and they’re excited to start working on solutions.  As of 2010, there were over 47,000 medical student members of the American Medical Association (AMA), showing their interest in shaping the future of healthcare policy.

So what does all this mean for the future of healthcare?  Overall, we’re going to see more and more doctors who are compassionate and who chose medicine for the right reasons.  These doctors will understand the challenges that are facing them and they will be prepared to fight for the interests of their patients, whether their opponent is an insurance company or a congressman.  That is why I’m optimistic about the future of healthcare.

The author is an anonymous pre-medical student.

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  • John Key

    I think your premise may be correct but I think your reasoning is wrong.  I think we go into medicine because we like practicing medicine.  It’s challenging, it’s personally rewarding and fulfilling.  When I entered medical school 40 years ago we were all conditioned to tell the admissions committees “I like to help people.”  I don’t think any of us really did.  We liked the science, we liked the challenge, and yes, the potential for financial reward was great–though that last one hasn’t worked out so well.  We all–all of us pre-meds–aspired to make a lot of money but I don’t think we would have chosen the upward road to medical practice solely for that reason–it’s too hard.  Why not just go into finance, law, or some other lucrative field?

    Yes, now I am one of those old docs who tell young students today, “don’t go into medicine”. and I feel that I have not really enjoyed my career.  But on the other hand, I am not sure I would have enjoyed another field with any greater enthusiasm, and medicine has been interesting if at times a bumpy ride.

    I am proud that for many young men and women today, their goal remains “to be a doctor.”

    • http://twitter.com/Sophia_Wong Sophia

      I agree with John. While money may be one issue (and it would be for most people) I think a lot of docs entered medicine because it would be a challenge. I mean, to get into med school you probably have to enjoy (and thrive in) challenging situations. Having said that I also see where you’re coming from Jeffrey – it’s possible that people from younger generations have different motivations though I’d like to think that the older doctors had similarly altruistic intentions.

  • http://pulse.yahoo.com/_TJL24CFV4HSOGSKSJSLRBUUTYQ brian

    every generation has tried to make this argument. easy to do when your a student…. I did it too.  
    we love our job, we love what we do, BUT it is STILL a JOB.

    to presume that prior generations of physicians are some how less noble because incomes were better is just faulty. 

    • Jeffrey_Many

      I feared that people would latch onto the income issue when I wrote this post.  The real point I was trying to make is that there are tons of new issues facing physicians that didn’t exist in the past and students are still choosing medicine despite them.  Income is definitely one of those issues, but it’s certainly not the sole reason someone chooses medicine vs. another career.  I have tons of respect for prior generations and I was in no way trying to imply that they are less noble.  Instead, I was trying to show why I’m optimistic about healthcare’s future – because the new generation sees the challenges and is willing to take them on.

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        Actions speak louder than words. They claim altruism, then they go straight into high-paying specialties, avoiding primary care like the plague.

        • NewMexicoRam

          Yes, until I see many more students going into primary care, I really won’t believe the altruism I read about.  I heard the same thing from my fellow 1st year med students, and by the time our senior year started, I heard a lot of talk about which specialties paid more.

          • http://www.tryingtobeamedicalstudent.blogspot.com/ TTBAMS

            Apologies for the double reply!

      • http://www.facebook.com/brianpcurry Brian Curry

         Jeffrey, of course you were trying to imply they were less noble, or at the very least, you succeeded admirably in doing so unintentionally.

        The decision is no longer made because of prestige or money, as it commonly was in the past.

  • http://twitter.com/iPodiatrist Dr. Alec Hochstein

    Truth is no matter what field you choose to persue, you will never be truly happy in it if monetary return is your only motivation. I love my practice and I love what I do, and yes I love that I am able to take care of my family in very nice fashion. I do not believe that doctors on a whole are steering students away from practicing medicine, it is still a rewarding life, yes it is challenging and students are often misleaded into believing that once you earn the degree the rest is easy (simply not the case) anything worthwhile requires work, and comes with trials and tribulations. 

    The frustrating thing with medicine these days is that we are being forced to practice in a manner that none of us want to ……we WANT TO take care of people, we DO NOT want to buried in hours of paper work and  forms, and be subject a host of other constraints that have come of late….this is not good for patients, doctors and the future of medicine. 

    Having said that ….. I would not discourage anyone from this life, including my own children, do what you love…the rest will take care of itself

  • http://www.facebook.com/people/Juan-Bosch/100000158668560 Juan Bosch

    After 40 years in Medicine, I can tell you that I have enjoyed every minute of it. The hard intership and residency are probably the greatest memories of my life, the growing responsabilities and the pleasure of helping others have made the 40 years fly. I am strugling with retirement because I still love what I do. Money, yes is important but is nothing compare to the excitment and fun of Medicine. When I look back the effort was well rewarded.Those who seek money in Medicine never find enough!!

  • http://www.thehappymd.com/ Dike Drummond MD

    I have asked hundreds of doctors out in practice … “Why did you choose medicine as a career … what was the thought process you went through?” There is a striking pattern in their responses.

    Less than 5% have felt it was a deep seated calling
    The remainder describe as either …
    - a natural next step on graduating college (it just happened and I am not sure how)
    - something that their family expected (everyone is a doctor or lawyer)
    - a respected career where they could make a solid living – which is very different than “Prestige and Money”
    - or a general attraction to helping others

    And almost all of them say …  “THIS is not what I thought it would be like”. Being in practice at the end of the long tunnel of training (7 years minimum to your board certification) is not what they envisioned. There are parts of the day that are rewarding and a LOT of hassle and drudgery in between.

    If what you suggest is true … that today’s doctors in training are in it for deeper, more purposeful and conscious reasons … eyes wide open … that is great. Keep that connection. Don’t abandon your outside interests. Take really good care of your needs so you can be there for your patients. Support each other through the personal challenges and tragedies that will punctuate your training. Soak up the things that are most rewarding about your days and do your best with the rest of “the system”. Love your family like crazy and spend as much time with them as you can along the way. And I wish you the best of luck,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • Jimmy_Peanut

    I found that for my med-school class, a lot changed during clerkships in 3rd and 4th year. Many of those who had the same altruistic values as you mention and who came into med-school intending on going into primary were the people who ended up matching into derm and optho.

  • amytownsendmd

    As a student, you have the luxury of viewing medicine from this noble point of view.  I was the same way just a few short years ago.  I was not really concernend with making lots of money.  However, I have been in practice for five years now and my views have changed dramatically.  Medicine is a business, whether we like it or not.  When you come out of medical school owing 150K or more, you have to bring in a fair amount of money just  to survive and keep the doors open.  To make ends meet, I have to see many more patients in a day than I would like to.  Which means I can not spend the kind of quality time with my patients that I would like.  And this affects the quality of care that I can give.  This is the disappointing thing about medicine and the thing that students are not yet aware of.  I once had this same view of medicine and feel I went into medicine for all the right reasons.  However, it is all the obsticles to providing quality care that makes me second guess my decision to go into medicine.  I hope Jeffery is able to hold on to these ideals as long as possible.  I miss the days of being blissfully nieve.

  • janiceamancuso

    Jeffrey, yours is the most hopeful essay I have read in a long time. I hope you are right about today’s future doctors choosing the profession of medicine “for the right reasons.”

    janice
    http://www.OslerSymposia.org

  • http://profile.yahoo.com/BRDB4JQJCWCARQUXHEBJBSGNSE arnold

    As you trek forward, just remember this phrase, “We have met the enemy and they is us.” Compassion in medical school does not translate to passion in the “REAL WORLD.”

    Bonne chance.

  • CougDog

    If you consider the basic concepts taught in your economics class, you would also recognize that while the market is depressed at present, the current low wages of physicians are not sustainable. I have read several articles about physicians working shorter hours in exchange for less pay and a better family life. Certainly, we are still burdened by the immoral and exponentially increasing debt load placed on students to obtain this degree. However, I believe (especially if Obamacare is upheld by the Supreme Court) that doctors will continue cutting insurance plans, such as Medicaid, that don’t pay enough. If anything this country is headed for higher doctor salaries once again.

  • CeeCee500

    I would LOVE to be a doctor. However, even though I wouldn’t be in it for a large amount of money (just a decent living and helping people), the debt load is forcing me not to live my dream. 

  • Author Intersect

    The argument espoused in “Are We Recruiting Better Doctors Today” is essentially: to recruit more caring doctors we should pay them less. I have seen this blog post tweeted and retweeted, and I’m afraid that its conclusion is being accepted by some in the community. I would argue that to recruit more caring doctors, we should in fact pay them more.
    Basic economic research demonstrates that individuals are more motivated by financial incentives when they have less of it. Reviewing the basic backward bending labor curve is a simple illustration. Below a certain income level, individuals are motivated to increase the proportion of their time committed to work. However, as income increases, the marginal utility of increased labor is substantially diminished and these individuals opt for less work — The same curve can be applied to a physician’s responsiveness to financial incentives.
    Presumably we want our physicians to be less motivated by money, and according to the labor curve model, that goal can be best accomplished by reducing the marginal utility of more capital. These physicians act in the best interest of their patients, work because they love what they do, and are the types of doctors our parents speak so fondly.
    I come from a large family of doctors; I’m the third generation. I would argue, in comparison to the medical student’s opinion that all doctors > 35 are in it for the money and don’t care about patients, rather those individuals were not bound by the extreme financial constraints of many entering the industry today and therefore were more free thinkers because of it.

  • http://www.tryingtobeamedicalstudent.blogspot.com/ TTBAMS

    I really like this idea that medicine is going to become
    more compassionate. I think in the UK we’re not going to see this just yet: you
    cited the cost of training as one of the reasons why only the most dedicated do
    medicine – I’m a final year student and my university fees for my medical
    training have cost me less that £5,000 (I’m guessing $8-9,000). The fees went
    up the year after I started, so my colleagues are paying three times what I
    paid, but even so, it’s miniscule compared to your figures. As of next year,
    the fees here will be £45,000, hugely more than I paid, so it will be
    interesting to see if that makes a difference to whether compassion is the main
    driving force of new medical students in the next few years.

    Another reason why things may be different in the UK is that we can start
    medical school at the age of 18 (or even 17 in rare cases). I applied to study
    medicine when I was 17, and my priorities then certainly weren’t what they are
    now at 25. Compassion is still a great driving force, but I wonder if now my
    mind would be more open to seeking other ways of utilising my compassion,
    rather than just plumping for medicine because it’s the most obvious.

    You say there’s less prestige now; I agree, but it’s still definitely present.
    I wonder if younger applicants are more affected by the prestige. I was greatly
    encouraged to persue medicine at university because of the prestige, and I
    enjoyed that encouragement.

    Whatever the differences, I have great hope that that your idea of more students
    choosing medicine for the right reasons proves to be correct.

    TTBAMS.

    Trying to be a medical student
    http://www.tryingtobeamedicalstudent.blogspot.com

  • http://twitter.com/GTWMA1 GTWMA1

    In a world which is going to require doctors to apply evidence based medicine, I’d like to know what evidence exists to support your claim? I see nothing in this article that demonstrates that today’s students are more compassionate and less focused on income than yesterday’s students. It certainly could be true, but the hallmark of your future in medicine is going to be whether or not you and your peers will relentlessly seek and apply the best care and refrain from doing things just because they can be done, rather than use the muddled logic and evidence you show in this article.