Want to become a doctor? 5 criteria you should consider.

While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.

But that is me, is it you?

A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going to live a sad and angry life. Happy doctors feel chosen to fulfill a purpose.

You are in this profession as a calling, not a business.

–William Osler

There are better ways to make money than medicine. Medical school and residency occupy at least 7 years during your 20s, while your friends are making money.

Becoming a physician does give one some immediate prestige, but prestige would mean nothing if the daily work was miserable. Prestige does not cure misery.

The first criteria for becoming a physician should be that you really want to help patients. How do you know? It helps if you have spent time with a physician. It helps if you have worked in health care. But ultimately it really is a personality consideration. Do you really want to help others?

The second criteria for becoming a physician is that you enjoy the mental processes involved in doctoring. As doctors we solve diagnostic puzzles, and use our knowledge to determine the best treatment options. Excellent physicians continuously expand their knowledge. We learn from our patients. We decipher their stories, examine them, and combine those activities with the tests we order. Then we persist in the thought process, following the patient to be certain that our assumptions are correct.

The third criteria is humility. We are never as good as we would like to be. We will make mistakes, hopefully not major ones. We must own those mistakes and correct them if at all possible. As new information becomes available – new symptoms, new physical findings, new test results – we must be willing and eager to adjust our approach to the patient.

The fourth criteria is our willingness to educate our patients. Being a patient is often very scary, especially in the hospital. We have a responsibility to help our patients through the medical maze and make certain that they understand (at their educational limits) what is happening and what we are doing.

The fifth criteria is accepting our limits. We cannot cure every disease. We cannot always save a life. But we can alway comfort. We can always strive to improve quality of life. We can always care, and let our patients know that we care. We can always comfort. And we understand that palliation is a success for the patient.

These are my beliefs as an internist. Other specialties would like have different criteria.

In April, I will attend my 40th medical school reunion. I remain thankful that I was able to tolerate the first 2 years of medical school and in my 3rd year found out who I was and who I would become. If you are a medical student or a pre-med student, I hope this helps.

My physicians complain about the bureaucratic hassles tainting medical practice in 2014. Danielle Ofri has a wonderful op-ed on this subject: “Adventures in ‘Prior Authorization’.”

But most physicians still love spending time with patients and helping them. Can you overlook the problems and still love doctoring? I hope that you can.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • guest

    “The second criteria for becoming a physician is that you enjoy the mental processes involved in doctoring. As doctors we solve diagnostic puzzles, and use our knowledge to determine the best treatment options. Excellent physicians continuously expand their knowledge. We learn from our patients. We decipher their stories, examine them, and combine those activities with the tests we order. Then we persist in the thought process, following the patient to be certain that our assumptions are correct.”

    I would have to say that if you really meet this criterion, there’s a reasonably good chance you will feel frustrated by practicing in today’s healthcare system, unless you go into direct primary care or concierge medicine. Judging from my experiences as a patient, and as a doctor, “efficiency” and affability are much more highly prized qualities than an interest in solving diagnostic puzzles.

    • guest

      I could not agree more. As a younger physician I think there are challenges we face that older docs do not experience. There must be a difference between our experience because most of my older colleagues are happier than my younger colleagues. Perhaps we are less efficient. Perhaps we take billing and coding rules too seriously. Maybe we are bullied more by administration. Maybe we do not see a way out any time soon with large debts and little other career options in which case it is more difficult to deal with lack of autonomy and large volume of patients. Does my generation just not want to work 12 hrs a day? I do not know, but almost everyone I know who is in their 30s and early 40s in medicine is complaining about their work, lack of autonomy, lack of good jobs in nice cities and declining pay.

      • guest

        I am actually an older physician (trained in the 80′s) and quite content with my job, but anxious every day because I have the sense that good jobs like mine are becoming vanishingly rare.

        I have to say that much of my empathy for today’s younger generation of physicians comes mostly from my experiences as a patient where I see that superficial, “efficient” evaluations are increasingly becoming the standard of care.

        I don’t think that your generation is any less efficient, hardworking or altruistic than the older generation. I do think that you are practicing a completely different profession, and in a completely different climate, than many of your older compatriots are.

        • guest

          The quality of care, patient interaction and patient record has declined. The quality of medical education has declined as well. We are in a different profession. We may appear efficient but we lack depth and quality in our interactions with patients and colleagues. On top of this, we feel guilt for not perhaps being even more efficient. It feels like working in a fast food restaurant. The worker is separated from the product, delivering low quality meal at a fast pace. For those of us who wanted to be chefs it is a different profession. Maybe this is at the root of the physician burnout epidemic.

  • John C. Key MD

    Good article as usual, Robert. I may not totally agree with your rank order of characteristics but on the whole you are spot on. Kevinmd nowdays is replete with articles about angry doctors, quitting doctors, suicidal doctors, dehumanized doctors, cynical doctors and a lot of that is certainly true.

    I think those of us who trained in the 60′s and 70′s were able to develop but manage a lot of cynicism and dehumanization and still emerge as pretty functional docs. My class of 225 had about 20 drop out, no suicides while in training, I’m only aware of one suicide in later decades (but there could have been more).

    I’m sorry there are those who become dysfunctional due to these stresses. I think I am as unhappy with medicine as a career as anyone out there, but I still soldier on, buoyed mostly I think by the intellectual challenge which abounds every day, and assisted by the dose of humility and acceptance of limitations. I always wanted the big money but it never came to me so I let that go.

    Why are so many younger physicians destroyed or maimed by these same stresses? I don’t know, I am certainly no iron man. I hope Dr Wible and others can help them.

    St. Paul the Apostle wrote that he had learned “to be content in every situation”. That is the key.

  • QQQ

    Good article!

  • buzzkillerjsmith

    The rules have changed. Diagnosis has gone the way of the Dodo in family med. The emphasis now is on administrative tasks and making sure the HgbA1c’s of your completely non-compliant pts are in range. Brainrot and typing are two bad tastes that taste even worse together.

    It’s the sea-anchor of having to spend time doing stuff that wastes our time and training and frustrates us that is the trouble here.

    I don’t think there is a solution here, at least not in PC. I say let the NPs and PAs have it–if they’ll take it.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    This may be a bit philosophical, but I doubt that the majority of 18 year old kids or even 22 year old persons have it all buttoned up before they choose medicine as a career. I think the environment in which you train and later on practice your craft is shaping who you will become and what your expectations will be, much more than the initial baggage you bring to your journey, and I think that the medical environment, and society in general, have dramatically changed in the last 40 years, and not in a manner conducive to better Oslerian doctoring.

  • guest

    I am 3 years in practice as a subspecialist. I made around 700k after tax since graduating HS. I worked 60 hrs/wk on average during this time, around 40k hrs. I paid 320,000 dollars for med school including interview fees, boards etc. Final calculation: I made $10.6/hr since. After 10 more years in practice I can hope to make $35/hr since finishing HS. If you go to primary care you actually never make more than average teacher salary. Medicine may in the long run give you middle class lifestyle, but consider the emotional and physical sacrifice. Decades drop out of your life. There are other ways to achieve middle class lifestyle for focused heard working smart individuals.

  • guest

    Most people do not really understand what they will end up doing as a physician and how much they will actually make. There is a disconnect between public opinion and reality. Most applicants are clueless. How many kids of doctors go into medicine? That would be a better indication of desirability of this career in my view.

    • rbthe4th2

      The last studies I saw said that 30+% of kids in medical school were from medical families.

  • stork

    Very well said. As an OB/GYN. a mix of surgery and primary care, I do not dispute your views, for what it’s worth.

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