A Med School Memoir

From wikipedia:

Opportunity cost is the cost (sacrifice) incurred by choosing one option over an alternative one that may be equally desired. Thus, opportunity cost is the cost of pursuing one choice instead of another. Every action has an opportunity cost.

I’ve read tons of blog posts and message board debates about whether or not going to med school is worth it. In a world where diminishing respect and declining salaries for physicians appear likely to continue into the foreseeable future, a new generation of nervous pre-meds, disillusioned med students, and jaded residents all seem to be asking themselves the same question at one time or another: is going into medicine worth the time, effort, and financial burden? Here’s just one example of the type of thread I’m talking about. If that’s not enough for you, you can click on over to the forums at the Student Doctor Network and do a search for “opportunity cost;” you’ll find plenty of discussion from people of varied backgrounds debating this question.

These debates seem to take the same form time and time again. Someone will point out that once student loans are paid for and you factor in all the time spent earning nothing in medical school, followed by a relatively modest salary throughout residency, the plain fact of the matter is that medicine is not the highest paying job out there. And–GASP!–other jobs can actually pay better–get this–while requiring far less education and training. It has even been suggested that a UPS man has a lifetime earning potential which is comparable to that of a doctor, if you get creative with the numbers.

Is this actually shocking to anyone? Does anyone know of a family practitioner with a garage full of gold-plated Land Rovers and a swimming pool filled with Cristal? While medicine is higher-paying than many professions, it is by no means a gateway to extreme wealth, largely due to the fact that training for a career in medicine is both long and costly.

From witnessing, and occasionally participating in these debates, I have noticed that there are two general schools of thought on the subject. On one side, there are the big-hearted optimists who insist that they are only going into medicine to help people, and therefore they would be happy to do the job for a teacher’s salary, as long as it still meant they could help make a difference in the lives of others. That’s a great sentiment, but I have doubts as to how long this outlook can be maintained in the face of the realities of medical education and practice. As a result, this side of the debate is often accused of being naive–after you perform enough pelvic exams of HIV/HepC+ patients, the argument often goes, and you’ll change your tune.

On the other side of the debate are the selfish pessimists who see the writing on the wall and know that they’ll never make as much money as their college buddies who went into investment banking if they match into a family practice residency. These are the ones who, while still taking Gen. Chem in undergrad, are already gunning for residencies in dermatology or plastic surgery because they can’t possibly imagine a future in which they would be forced to scrape by on less than $250,000 per year. Considering that the median household income in the USA is around $48,000–less than half of what even the lowest-paying specialties earn on average–this side of the debate is often called out for being greedy and for “going into medicine for the wrong reasons.”

Well, I think both sides have good points, but overall, I think the whole debate has been framed wrong. The debate can’t be solved by consensus or by universal prescriptions. I have seen message board arguments devolve into accounting lessons where people argue over the minutest details related to the financial costs of medical school; from this, people hope to prove, conclusively, that medical school isn’t “worth it.” I don’t think it’s possible to make blanket statements that can apply to the entire spectrum of pre-meds, as too many intangible and unquantifiable elements are excluded from these calculations. Rather, the answer is specific to each individual. Everyone has different expectations for medical school and their careers, and while one person might not consider the time and sacrifice that is required of medical school to be worth the ultimate rewards, you can bet your ass that there is another person who would stab their grandmother in the eye for the opportunity to become a physician.

The biggest problem with these opportunity cost debates is that they’re generally framed as economic decisions, but I don’t feel that money should be the primary motivation for entering the field. But not for the same reasons you’ve hear 1,000,000 naive pre-meds preach about. I would never insist that all doctors be motivated purely by compassion, because, frankly, a lot of what doctors do is difficult, and anyone who puts themselves through the rigorous ordeal of becoming a physician deserves to get paid well for it. I think it’s perfectly acceptable to expect decent compensation upon completion of your residency–but I don’t think that the desire for said compensation alone is reason enough to go after it. Said differently, it’s okay to want to make money as a physician, but wanting that money isn’t sufficient reason to become a physician. A bit of a Catch-22, I know. But hear me out.

Face it, you don’t start making the “big bucks” until many, many years after you begin your training, and the distant prospect of money on the horizon will not likely be sufficient to motivate you through close to a decade of extreme studying and never-ending work.

Look at it this way: after college, you’re still at least four years away from any salary at all, whereas your friend who got an IT job is already making $40-50,000 per year, which he uses to buy a new super-sized plasma screen TV. Meanwhile, you’re nuking ramen night after night as you cram for Biochem or Pathophysiology exams while hoping/praying that someday this will all pay off. At graduation you tell your friend about how you matched into a really good IM residency where you’ll probably pull down about $35,000 per year. He congratulates you right before speeding off in his new Lexus. Three years of residency later, you decide you’re a glutton for punishment, and decide to go for that cardiology fellowship. You call up your old college buddy to tell him the news, and he congratulates you right before telling you about the pool he’s putting in.

Simply put, you won’t make a significant salary until at least seven years after college. And then, if you’re like most students, you’re burdened with so much debt that it severely diminishes any income you actually see for the next several years. While you’re going through all this, money will not be sufficient motivation to keep you going. If you go into medicine solely for the dollar signs flashing their golden light at the end of that long tunnel, you will be frustrated and disappointed, and you will likely end up regretting your decision.

As a physician, you’ll never make enough money to get that diamond-encrusted yacht. If you still want to become a doctor after hearing that bad news, you need to honestly assess the reality of the current situation; it is well known that physician reimbursement has been declining in the last decade (or two), and there is nothing to indicate that this trend will reverse any time soon. If you plan on going into a field like Family Practice or Pediatrics, you’d be well advised to have a pretty thorough plan that outlines how you will manage your debt in the face of diminishing earning potential. Acknowledging early on that your debt will play a significant role in your lifestyle for the next decade (or more) is certainly a wise move for any medical student, but it is especially true for students who plan on going into the lower-paying fields. Furthermore, I disagree strongly with those who suggest that one’s specialty should be chosen principally by the income it can generate. The bottom line is that medicine, while rewarding, will also be a job–so, if you really, really like family practice, but are perhaps tempted to match into radiology for financial reasons, even though you’re not too fond of scanning films, keep in mind that no salary, no matter how big, can justify the decision to spend the rest of your life in a job that you hate.

It all boils down to the fact that there are hidden costs to medical school that a lot of people don’t think about. Many people see the six figure salaries that come with an MD, and assume that the big bucks are only a few years of school away. The truth is that the vast majority of doctors don’t earn much money fresh out of medical school, and many still find themselves burdened with heavy amounts of debt after residency.

As a pre-med, you should be absolutely certain that medical school is worth your time and effort before deciding to go down that road. If you can imagine yourself doing anything besides medicine, you would be wise to examine it and compare your options. Personally, I wanted to be a doctor from a very early age, but as I grew older, I started to become more aware of the vast effort required of medical training. At that point, I started to explore other careers. At one point or another, I considered being a musician, a writer, a chemist, a chef, a teacher, a small business owner, plus about a dozen other things. Eventually I realized that while I am interested in all those things, medicine was still my true calling. While these career explorations took a couple years, I’m extremely thankful that I allowed myself the opportunity to explore a little bit. Now I feel absolutely ready to begin medical school without wondering “what if?” about other career options.

Tags:   Musings · opportunity cost1 Comment