paid a salary and being told to work harder to justify your salary, seems like a no-brainer to me. Running a medical practice is not rocket science, and there are always professionals out there to help you stumble your way through the business side of medicine. 4. You can do other things besides medicine with an MD. Most of us practicing physicians fail to realize that we do have other choices besides actually seeing patients and doing surgery. Teaching in a medical school or university is also possible. There are positions with state and federal governments that favor those applicants with a medical degree. Opportunities arise as a medical expert in the legal world. It may be easier to get financing to start a new business in some health care related venture if one has an MD. With some additional training in business and management, many non-practicing physicians find employment with HMOs, insurance companies and medical groups in various roles as a medical director. In short, it would not be a waste of time and money if someone graduated from medical school but decided not to practice medicine!
STOP
Top Reasons Not to Become a Physician
On the flip side, why is that so many physicians are not recommending medical school to their collegeaged kids? 1. It takes a long time to get through medical school and residency, and it is expensive. To get a job as a physician, it takes four years of undergraduate training, four years of medical school, and three to seven years of residency, depending on your specialty. About 50 percent of specialities decide to do a fellowship, which can last from one to five years. That is a lot of time spent before beginning a medical practice! The American Medical Student Association predicts that by 2020, the average debt for graduating medical students will be $300,000. The increased cost of medical education has significantly outpaced the increases in income for the average physician. These increases continue to shape specialty choices with higher indebted students usually choosing a more lucrative profession. Advice to our daughter: If you can finish residency with less than $150,000 in debt, choose whatever specialty you wish. If you owe $300,000, don’t choose family practice or pediatrics
and expect to pay off your student loans in less than ten years. 2. Doctors are increasingly viewed as “providers” and not “healers.” The delivery of health care in America has become a business, a big business. HMOs, insurance companies, and hospitals now call physicians “providers” and consider us “cost centers.” Quality is no longer considered the most important attribute by the largescale physician employers, but rather how many patients can one provider see in a single day. Hiring as few providers as absolutely necessary to get the work done seems to be the norm in large HMOs. Productivity standards can be harmful to the doctorpatient relationship if the “provider” has only minutes to discuss a patient’s medical condition. Physician “extenders” is a common term for physician assistance and nurses who are now charged with filling the gaps that exist in our current health care systems. Many patients now do not get the luxury of even seeing a physician during their doctor appointments. Expect these gaps to widen as the population ages and more people enter the system through the Affordable Care Act. 3. Most new doctors will be employees of large health care systems and not private practitioners. These health care systems have to function as businesses and, as such, need to operate with a profit margin. This means paying physicians as little as possible for the services they provide while persuading them to work harder. These health care systems shift costs by paying primary care physicians above-market rates and various surgical specialists below-market rates. Employee physicians can be fired for failing to follow a set practice pattern. Most new physicians seem to want both the security of practicing in a large group and the lifestyle of working “9 to 5,” leaving time for family and recreation. The ideal of being your own boss as a physician is an ideal that will likely be much harder to attain for the next generation of physicians. 4. New regulations are making medicine less efficient. The current amount of waste in hospital-based medical care is abominable. I estimate that nearly $500 of eye drops are wasted after each cataract surgery I do in the hospital-based ambulatory surgery center due to poorly written laws. Continued on page 17
JANUARY 2014 | SAN MATEO COUNTY PHYSICIAN 15