Be a nurse or P.A. instead of a doctor: the underrated perils of medical school

http://jseliger.wordpress.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/

by jseliger • 13 years ago

42 56 13 years ago

jseliger.wordpress.com

iends3• 13 years ago

Don't be a nurse, be a dentist. 4 years of schooling beyond BS, no residency, $146,920 per year median (BLS, 2010). In several states "dental culture" is to only work 4 days a week.

In cities around the size of Raleigh, NC a practice with one experienced dentist can generate 800k-1.2m in revenue and end up with a 250k-300k take home. Of course it takes a few years to build up the patient base. Starting salaries for dentist in Raleigh working for a larger practice is 150k-170k. (Source: My wife is a fourth year dental student).

mathgladiator• 13 years ago

What is the barrier to entry? i.e. What makes this hard? Is it just "being the bad guy"?

edit: not to sound like a jerk, but I'm curious

tsotha11• 13 years ago

Four years of extra school is a pretty big barrier.

rdouble3• 13 years ago

There isn't much barrier to entry besides the extra school. It's just that nobody really wants to be a dentist.

eitally3• 13 years ago

The biggest barrier is probably not an obvious: if you're not good with people, you'll probably fail (unless you become attached to a hospital). If you can't actually see yourself as a medical practitioner, working in a high touch environment, you shouldn't do it.

iends3• 13 years ago

Getting into dental school is exactly like getting into medical school in the USA. It's very competitive, especially at the top schools. Everybody is type A personality, great grades, hobbies, research, leadership, community service, etc.

Before being accepted (and before we were married), many people/admissions officers/etc made a huge deal that my wife would have to sacrifice our relationship to get through school. We even had a Dean of a dental school pull me to the side while touring with my wife and tell me that we would not make it if she was accepted. This was largely overhyped and I'd say the stress in our marriage has only increased 5%-10%.

Dental school itself is also a lot like medical school. Every dental school I know is roughly 8am-5pm with the first two years spent mainly in classes, and the last two years spent in a mix of classes and student clinic. You take many similar classes as you would in medical school, for example, gross anatomy (i.e. real dead bodies) of the entire body before spending a few extra weeks on the neck up.

One thing to be a dentist is that you have to be good with your hands as every dentist has to give injections, fill cavities, etc,

Socially, I think dentists have a perception problem. Many people think dentists are trying to cheat people out of their money (similar perception to chiropractors) and being a dentist is certainly less prestigious than being an MD.

mililani2• 13 years ago

But you'll be looking and working in people's mouths all day. I say, don't do anything you're not passionate about. People end up in these fields for the wrong reasons, i.e., money, and end up becoming miserable people.

thaumasiotes• 13 years ago

But you'll be looking and working in people's mouths all day. I say, don't do anything you're not passionate about.

This is really another argument _for_ becoming a dentist instead of some other specialty. The mouth is one of the nicest, least disgusting bits of anatomy you might aspire to work with as a medical professional (after optometrists, I guess). People go into medicine for all kinds of reasons -- money, prestige, religion, a desire to feel helpful -- but not because they're easily grossed out.

eitally3• 13 years ago

The practice we go to (in Cary) has had three owners in the last 10 years. The first owner, who opened it, is a fantastic dentist & has become a personal friend, and she sold it when she had her first baby. The second owner ran it into the ground, went bankrupt and one of the hygienists was arrested for drug abuse (selling scrips using the dentist's prescription pads). The third/current owner runs a regional "chain" of dental/orthodontic practices and is a much better businessman. I'm 100% sure they bring home >$1m income per year.

iends3• 13 years ago

Some of the dentist who own multiple practices pay themselves almost a million a year in salary in our area. It's not bad work if you're interested giving up patient time to work on the business side. In our state, only dentist can own dental offices, so it keeps 3rd party corporations from forming.

GuiA2• 13 years ago

French person here, a lot of my French friends from high school went into med school. Free universities, no debts, heavy unionization, you can easily move to nursing/pharmacology if you fail med school... free education solves many social problems.

tsotha11• 13 years ago

It's not really free, though. It's just paid by someone else.

tobylane2• 13 years ago

The US is switching over to 'not' paying for healthcare, at the point of sale at least. The next thing to be changed like that would probably be education.

GuiA2• 13 years ago

It's free for the students; that's one of the points of the article, that financial debt can be an obstacle to personal liberties.

derleth2• 13 years ago

Their healthcare overall costs less than US health care, though.

So, not free, but it does, in fact, cost less.

rrreese• 13 years ago

Why abuse the language? Almost every thing that is free is paid by some one else. Free means free to the person receiving the good/service. I appreciate English may not be your first language, but if you want to point out the costs, there are better ways then redefining the word free.

robmil• 13 years ago

Such as doctors who are further on in their careers — it's actually rather a nice system, where those who have been lucky enough to be successful can help out those who need it, and all benefit.

gte910h• 13 years ago

The word free means nothing if you insist on this definition.

rdouble3• 13 years ago

One unmentioned upside to being a doctor is you make a good salary anywhere in the country. A GP can make $180K in a town where an engineer would be lucky to make $40K, if any engineering jobs existed at all. PAs are mostly in the same boat but top out around $90K. Nurses are usually in demand in most places but the pay can be lousy. Every other well paying job is very location dependent.

rdouble3• 13 years ago

Also, one thing I forgot to add, is that PA school is very expensive.

For example, at the University of North Dakota, the PA school tuition is $34,287 per year, with no discount to in-state residents. In contrast, the medical school tuition is $24,998 per year for out of state students, and $12,815 for in-state students.

atourgates• 13 years ago

There are some good points in this article that most anyone thinking about entering a medical profession should consider. But there's quite a bit of anecdote and cherry picking of facts as well.

Here are a few counterpoints worth considering.

* The example used by the article for salaries is for primary care doctors, one of the lowest paid (and by any account underpaid) specialties. According to the Medscape physician compensation report [1], the highest paid specialties brought in between $350K and $400K 2012. I don't think there's many PAs or nurses making that.

* Yes, medical school and residency are hard. My wife regularly put in 90+ hours during a couple years of her education as a physician. But I'm certain there are plenty of developers on HN that put in 90+ hours during certain phases of their careers. Working very hard for a couple years won't ruin your life. By the time they're practicing - 52% of physicians see patients for 40 or less hours per week.

* The article says that, "nurses start making money when they’re 22, not 29", glossing over the fact that physician residents and interns do in fact get paid. Not a ton of money, but usually around $50K/yr. So really, doctors start making about the same amount as nurses by the time they're 25, and substantially more just a few years later. And yes, medical school loans are expensive, but nursing school is far from free.

* The success rate for physicians who start their own practice is very high. I've been shocked at the amount of unsecured credit that banks are willing to extend to my wife to start a practice. It's like we've stepped into a time-warp back to 2006.

* If you're interested in living someplace rural, you can, without any negative financial repercussions. In fact, you'll probably make quite a bit more money practicing medicine in a rural area than an urban one. There aren't many careers where that's true.

* If they had to do it all over again, 51% of physicians would start again in medicine (again, the Medscape compensation survey). I don't how how that compares to other careers, but it sounds fairly reasonable to me

Being a doctor certainly isn't easy, but there are some definite benefits. One of the biggest is that it's one of the few careers left where you're pretty much guaranteed to be well-compensated so long as you do well in school.

There are certainly pitfalls, and I wouldn't advocate it to anyone who's doing it solely for financial reasons. But, if you have a passion for medicine, there are still plenty of rewards to be had by being a physician.

[1] http://www.medscape.com/features/slideshow/compensation/2013...

Gatsky2• 13 years ago

Just about the workload, I think that working hard in medicine is quite different to working hard in most other situations. Certainly doing long shifts in a major hospital often invovles:

1. An entirely unpredictable work load, with no mechanism to compensate for excessive demand. 2. Dealing with problems for which you have not been properly trained. 3. Dealing with other doctors that are also extremely busy and stressed, and therefore limited in how much they can help you. 4. Having to work while physically and emotionally exhausted or actually genuinely sick, with no recourse to get help. 5. Having to do all this while studying or taking exams. 6. Not being paid fully for the hours you work. 7. Sometimes being sworn at, racially vilified, spat at, threatened or attacked. Depending on which job you do, this could come from your colleagues, nursing staff, admin or the patients.

I think that certain other professions such as the police or military personnel encounter similar situations, but I would hazard that they are better trained, better supported and rostered better than doctors ever are. So although many other people might work 90+ weeks, I doubt it is under these conditions. Because that would be a dumb thing to do right? And only doctors with their misguided sense of duty and high pain tolerance are willing to front up again and again. Nurses can suffer the same problems, but in general they are much better at protecting themselves.

lostlogin• 13 years ago

Just to add to what you're saying, I know of specialist who make vastly more than 400k per year. 6 total hip joint replacements in a normal day netting 6k each approximately as an operating fee makes a fair salary. And this is unusual.

cafard• 13 years ago

You say "By the time they're practicing - 52% of physicians see patients for 40 or less hours per week." How much of their time is given to office or practice administration, and what percentage of physicians are wholly out of practice, and running hospitals, doing research, etc?

mililani2• 13 years ago

First, I know the medical field quite well, as I'm working in it, and I can emphatically say that nursing is quite saturated now. It has always gone through boom and busts, and currently, it's going through a bust. Just read the All Nurses forums to see all these threads about new grads being unemployed and unable to find jobs for a year or more. It's definitely tough out there and will only get tougher since SO much nursing programs have become accredited in the past decade.

Secondly, being a nurse is a HARD job. It's a blue collar job, and it should be (probably was) on Mike Rowe's Dirty Jobs. It's back breaking labor, stressful, and debilitating. Most of my family work in health care, and so far, my cousin has three herniated discs from lifting obese patients over the years, my wife had several blood tests done from being exposed to Hep C patients, and I've known several nurses who have suffered extreme burn out.

Being a PA is marginally better, I suppose, but you're dealing with the same garbage.

There are some definite pros about becoming a nurse over a doctor for sure. But, if you plan on staying on working the floor, become a doctor if you're smart enough. It's still in nearly every regard better than being a nurse on the floor. However, if you have more ambition, you can try to move up the ladder in management and administration as a nurse.

Finally, there are lots of other oppty's for nursing besides beside nursing. If one gets burnt out on patient care, one could move into case management, school nursing, teaching, etc...

eitally3• 13 years ago

I second this. My wife is a biologist by training but went to nursing school (this was back in 2000) to ensure she'd always have a job, in any economy. She fell in with a nationally known urologist MD/PhD during the program and got an offer before graduation to start working in his clinic attached to the university. The pay was awful (~$35k/yr at that time) because of the glut of fresh nurses minted by the uni each year. The work wasn't bad in a clinic -- standard office hours and no obligation to pick up shifts at the hospital -- and it was a great opportunity to get involved in real research (she published in her first year there), but it was mostly repetitive and boring, and again, the pay stunk. When my company relocated me out of state, she switched over to drug safety & pharmacovigilance at a CRO, and then at a pharma. Most of the roles in those areas require a health care provider background (either RN/BSN or MD/RPh) and the stress & money are muuuuuuuuuuuuch better. I was a senior IT manager with a team of about 80 people in 10 countries and she was making more than I was (back in about 2009).

Nursing school is much easier than medical school, and there are still perks to having that professional credential, and, as she and her colleagues always joke, they can "always go back to the hospital if things get bad". That said, my next door neighbors are both consulting radiologists and work from home. I barely see them, but by all appearances they're making bank while exerting hardly any effort. My childhood friends who've become doctors are a pediatrician and an ER doc, respectively, and they work much harder but they love the career they've chosen. To each his own: in every field there are ample opportunities for the top performers.

Gatsky2• 13 years ago

It doesn't have to be this way. Why is it this way? There's a complicated answer and a simple answer. The simple answer is because human resources management for doctors is non-existent. It's an unknown, alien concept. Example - it required a major paradigm shift just to make a rule that doctors can't work for 36 hours in a row. So the question is, do you want to put up with all this because nobody can be bothered coming up with a decent way to manage a key part of the healthcare workforce? Or more correctly, because doctors can't get their shit together to demand decent working/training conditions?

Crake4• 13 years ago

In many ways, I feel like medical culture is very old-fashioned.

Truck drivers aren't allowed to drive if they haven't gotten any sleep, but your doctor in the ER making the decisions that will either keep you alive or let you die will almost always insist that 36 hour shifts are essential. There's a lot of ego involved, as can be seen in the way that that same physician will usually support limitations on truck drivers but will readily believe in their own inability to make mistakes--even in the face of scientific research showing otherwise.

idiot9003• 13 years ago

At my hospital, residents take 24-hour calls. The trouble with shorter calls (say, 12 hours) is increasing the number of transfers of care. With 25 patients on a service, spending even five minutes on each means each "shift change" would take two hours. So you spend closer to one minute on each, and at that point it's easy to miss important details. We are skeptical of the "scientific research" because we've all seen errors made because of poor signout that were not happening before work hours were so restricted.

For the record, attending ER shifts at my hospital are closer to 8 hours, and residents do 12 hours.

rdl• 13 years ago

I don't agree with this -- I've never been a doctor, but worked in a hospital for a few years with doctors.

The hand waving to say "you will be a primary care physician" is the worst part. Maybe you don't get our pick of specialty, but assuming you will be a pcp against your will seems silly, too, since you'd know going in roughly how good you are, and a lot of pcp are because they wanted to be.

It ignores one of the easiest/best ways to become a doctor -- the military. You give up a bit of your early career salary in exchange for a different/more interesting lifestyle for your early 30s. Still great pay.

If I were picking a career as a smart 18 year old, md/phd to go into research, or something amazing in clinical practice like a trauma surgeon or neuro radiologist, would be high on my list, independent of income issues.

wellboy2• 13 years ago

That is the most harmful advice you could ever give to someone.

Who do a startup, if you can do a PhD, it's not that strenuous. Why do a PhD if you can just do a Masters, it's not that strenuous. Why go to university, if you can just go to a community college, it's not that strenuous. Why finish high school, if you can just do an honest labor job, it's not that strenuous.

See the false assumption here? 5 years from now, these people will regret that they didn't start 5 years ago. Hard work is builds you as a person, it makes life more interesting, it gives you purpose and after these 5 years, you can decide your own pace. You have the OPTION.

Not going for higher education, limits your options FOREVER. You can't change it anymore, it's final. If you're not looking for meaning in life, go for the lesser option, if you are looking for meaning, go for the highest option you can think of and then even one more. The funny thing is, once you're getting closer to your highest option, you discover that there is still more to discover and that it is beautiful.

For that reason, shoot for the stars, don't listen to nay sayers, make your life awesome you only have 1 and then it's over.

I'm still cringing, hope I could get my point across.

pessimizer2• 13 years ago

Not going for higher education, limits your options FOREVER. You can't change it anymore, it's final.

I didn't go to college until I was nearly 30. They still let you in.

wellboy2• 13 years ago

And that's the reason, why it is so harmful to not go for higher education. If there were only more people thinking that way, you might have heard of it and pursued it. Instead you had to throw your whole life around again at 30, where you could have been much further already.

But awesome that you took the step.

drchiu• 13 years ago

Disclosure - I'm an actual medical doctor.

* I agree with the overall theme of the article. That is, a lot of people go into medicine thinking that they will be "rich". And when they come out at the other end of the tunnel, they realize that the promises of job security and a comfortable lifestyle aren't really true.

Many of my classmates from medical school went into all of this with the false impression that they will make a lot of money. This misperception is because they see physicians from decades ago do really well, living in nice houses in expensive neighbourhoods, driving nice cars, etc. But unfortunately that is because 20-30 years ago, doctors' salaries were much higher relative to inflation. If a doctor made 200k in the 80's, the purchasing power "back then" was enormous. Not so today.

* The article does miss the point, as atourgates mentioned in the comments, that being a doctor is "one of the few careers left where you're pretty much guaranteed to be well-compensated so long as you do well in school."

I know a few guys who -- through brute effort -- bills upwards of 500-800k per year. Now this is gross billing, not net take home pay, but that is impressive nonetheless. It is, without a doubt, very hard work. You would have to work pretty much 6 to 7 days a week, and really convince yourself that you like money to make it all worthwhile.

* The last thing that the article barely touches upon which is important is how tough the job can be when dealing with (some) patients. Nowadays, the job is 90% customer service, and 10% medicine. Maybe less medicine -- certainly some days feel like that.

All this comes with the job's territory, but day-in and day-out of this can cause a lot of psychological stress/burden/fatigue for the physician himself.

This kind of job is not for everyone. Quite literally you have patients upset at you because they think the medication you prescribed for them doesn't work, and in the end it turns out they were not adherent on the medication (ie. they didn't use the medication or they didn't use it properly). It always reminds me how close a certain scene from House MD (http://www.youtube.com/watch?v=dMAS2S51bM8) approximates real life.

* Would I want my kids to go into this kind of a job? Only if they realize what it involves. I really do think some of the happiest jobs out there are ones where you get to be creative solving different problems every day.

Although I'm happy I'm making an impact on other people's lives, it involves very little creativity. A long time ago a specialist told me that "medicine makes you dumb." Medicine today is algorithmic: if this, then check this, then do that.

I don't think there is a simple answer whether medicine is "worth it." It is different for everybody, and it really boils down to what your personality is.

idiot9003• 13 years ago

I'm currently a resident (not in primary care), so I'm biased. But:

* Nursing sucks. It's terrible work. On top of that, you have to deal with jerk doctors and jerk patients. Not a single one of my many doctor friends would ever have considered nursing over med school. (Side note: if you meet a good nurse, thank them! Truly good nurses are rare.)

* PAs generally do not know all that much about medicine. With very few exceptions, it was frankly terrifying signing out my service to them every night, and never fun cleaning up their messes in the morning. But with resident work hour rules, there is no alternative.

* The bottom tier of medical students/residents aren't very good either. Pay doctors less and the smart ones will realize that maybe there is some other way to achieve life satisfaction, because money won't be a differentiator any more. Care will get worse but the general public won't notice or care. They will keep getting fat, diabetic, and ever sicker, insist on keeping their essentially vegetative elderly relatives alive at all costs, and then complain that healthcare is expensive.

Be a nurse or P.A. instead of a doctor: the underrated perils of medical school

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