Wonderful article, VP! My youngest son wants to go into medicine. I told him, “If you can look past bad Google reviews, social media rants, politics, the iron-fist control Big government/insurance/pharma has on our field, being chronically undervalued (and underpaid), being surrounded by endless need, being suffocated by suffering, being lied to…if you can look past all that and say, “Damn, today was a good day. Look how I connected with this person and blessed him/her through my work”, then medicine is for you.
A few years ago, I was so done with medicine (family practice) I was going to quit and go into botany or horticulture or something that I would actually enjoy again. Found a job in direct primary care and it is much better— more like the medicine I remember when I started back in the 90s, when you had time with people, were not the cog cranking out RVUs etc. etc.. My kids all wish I could have switched sooner! They saw my stress levels go up along with the charting at home etc in FFS medicine. One kid trying for dental school, works as a dental tech so he sees the reality, still wants it. Another tried nursing, worked as CNA, decided “nope!”
My goal is no long term basement dwellers and fulfilled useful humans.
Neither of my daughters followed me into medicine. When people ask me if they should consider it as a career, I tell them that if there is any other career on earth, that would make them happy, they should do that. If medicine is absolutely the only career they can possibly imagine themselves in, only then should they pursue it.
"If medicine is absolutely the only career they can possibly imagine themselves in, only then should they pursue it"
Wow, that's what an acting coach told me when I was 12 . . . "If acting is the only career you can imagine yourself doing, then pursue it; otherwise don't" . . . I decided not to pursue professional acting as a career."
My husband and I are both physicians and we have 3 college-age children. I did not discourage our kids whenever they might have expressed interest in considering the medical profession. I did not really encourage it much either - I figured they'd choose something that interested them.
None of the three have decided to go into medicine. I think that one of the main issues was their birds-eye view of lifetime careers in medicine. The unrelenting long hours, late nights in getting done with work, working on charts from home - it just didn't appeal to them. Our son, in particular, has said he does not want to work as hard well into his 60s. All 3 of our kids are hard workers. They are each putting in the time needed for difficult majors in college (CS, engineering, graphic design). I expect them to put in long hours during the early parts of their careers. It just seemed to them that having some option for things to ease up a bit when they hit their 50s would be something to shoot for.
I've enjoyed everyday of my life at work - I love the constant thinking and problem-solving that medicine entails; talking to people/patients; helping people. But - it has taken much of my life-blood in time and energy. Not for everyone for sure.
I totally agree with your statements. I am a nearly retired PA in orthopaedic surgery. I was a prior OR tech and didn’t really know what I wanted to do and I sort of ‘Forrest Gump’d” my way into the PA profession. This did fill some of those questions I had about the human body/experience and being able to make an impact on my patient’s lives. I’m grateful for a wonderful career from Air Force to private practice to VA. So my oldest kid is a cop in Albuquerque (incredibly proud!), daughter finishing up dual majors in Business and Dance (equally proud), and youngest started a zoology program. I never pressured them into medicine (maybe they saw the downside—being on call, missed birthdays, late dinners, etc.). To young students I try to put it as you did sir, although not nearly as well stated.
I agree with "it depends". You covered the pros and cons very well. The only thing I would add is "Is being your own boss a significant factor in the decision?" If so, I would recommend against.
Ha ha. In the old days most physicians WERE THEIR OWN BOSSES. When was that? Around President Kennedy's assassination? I watched Kennedy's funeral with my physician father on his private medical office's building's basement TV. He joined a "hospital group" sometime after that.
Perhaps you misinterpreted my comment. It wasn't meant to be humorous or sardonic. Being my own boss was one of the factors that led me into medical practice and I answered to no one but my patients (the actual bosses) from the day I went into practice in July 1978 until the final stage of my retirement in 2020. The steady corporatization and bureaucratization that took over the field has made it extremely difficult to do that now.
Agreed! I also am a firm believer that if there is anything else on the face of the planet that you could be happy doing that isn’t medicine, do that! If there’s not, if this is it, then it will be worth it. But then and only then. I heard it a handful of times myself as a pre-med, and that was the advice given to my mom by doctors when she would talk about her daughter that wants to be a doctor. It was true then and it’s true now. It is the thing for me. But I have a certain amount of fear and trepidation for my 6 year old daughter who is already saying, “I want to be a doctor like you, Mama.”
I have spent 40+ years in ID - according to polls, very low on the income scale, very high on the satisfaction scale. I spent $800/year on med school, courtesy of the State of New York, it would be insane to go now for anything except the highest income specialties. I agree that Ortho or Derm are still a good bet for paying off loans. The problem is, as internal medicine and family medicine crumble (just look around), the whole system is going to crash and be reorganized, so not sure even Derm will be safe in the long run. Not to mention that med school itself is in crisis - how many times do I have to hear that a “B” or “high pass” in Medicine means “no Dermatology for you”?
I have read of surveys wherein >50% of current med students do not plan to see patients, ever. Taking the wrong people and teaching them the wrong stuff.
How many Michael Crichtons are there really, though?
This is one of my favorite pieces that you have written. You nailed it . As a mom of 3 kids who chose other professions, I totally understand why. They grew up sharing me with many others but they also know the pride I feel and in turn so do they. I worry about the future of medicine and we all need to do more to encourage the right people to come join us. We are standing on the shoulders of giants and we need people to stand on ours !
Beautiful as is expected from Dr. Prasad. But the journey might not justify the end. They really do a number on your prime energy and creative years. A humanistic career predicated about knowing saponification more than Shakespeare.
So would add a caveat - if you could get rid of premed requirements (4-semesters of chemistry!!) and streamline them and then make medical school 3-yrs; and make the testing reward reason more than rote memorization; and stop fee for service and the lavish salaries of surgical sub-specialists and let mid-levels practice truly under physicians - then it’s such an easier decision. It’s literally a career of swimming upstream to do the right thing. And the system rewards doing more than doing right.
Peel away that and it’s a beautiful and good way to spend your working hours.
I think it’s difficult to have the maturity to make a decision about going into medicine and doing it for “the right reasons”, especially at age 18 when one is entering college. Are there very mature individuals that come into the field for the “right reasons” and can do so at a young age? Absolutely, but they are few and far in between. I definitely notice it more however in the older individuals but again they are a small minority.
I think probably a good chunk (I’m guessing 80-90%) of matriculating medical students did 4-5 years of undergrad +/- 1-2 years of a post bacc or Masters degree or research year etc to get into medical school and most probably did it for a safe ROI. Be honest, most people are not smart enough or have enough life experience to really know what career suits them best and have the foresight to know they will excel at it in the future. Also, those who get to pursue those careers and can thrive within it, well that’s usually a luxury of the rich and well off and well connected. And very few regular people have the aptitude, discipline and luck to really find their passion/calling and make an extremely successful career out of it. Thus, we gravitate towards jobs with income potential and stability and probably convince ourselves of the passion that goes with it over time.
So back to the question, would I advise my son or daughter to go to medical school? If they didn’t know what they wanted to do and I saw them as a decent human being that likely wouldn’t take advantage of the system for financial gain - then yes because I don’t see many other professions out there (even with all the bias and interference from drug/med device companies) that can afford you an above average lifestyle, endless opportunity for education and the occasional, extreme gratitude of a patient.
I am a very curious person that likes to challenge the status quo, and fortunately medicine allows me to do that with my more open-minded colleagues. Does it bother me that most people in the profession are not like that? Of course, but that’s why it feels extra special when you meet someone that can share this discourse with you. Yes, medicine can corrupt you but more often than not, it does keep you humble.
Are there a disproportionate amount of middle eastern and south Asian and east Asian students that go into it for less than ideal reasons and are just doing it for some combination of financial aspiration and just because that’s what all their friends are doing?? Yeah, totally. Should we convince them to abandon medicine so they can go into I-banking, VC, PE or some high paid tech job so we can make room for the “passionate”, older more mature people who are going to probably burn out emotionally and physically like everyone else and just turn towards some cushy lifestyle specialty if they have the chance like everyone else??
I asked one of our medical residents if she had always wanted to be a trauma surgeon. She said her dream had been to become a veterinarian, but she could only get into medical school. She settled for a different species.
As a recently retired DVM, I hope you daughter doesn't find the Vet Med system broken by the time she graduates.
Corporations are attracted to acquiring veterinary practices because it's a lucrative investment that can help them diversify and make a profit. Some private equity-backed chains buy community-based practices without rebranding them, which can make it difficult for clients to know that the ownership has changed
Over the past decade, vet med has increasingly been aping human med. As of 2023, approximately 75% of specialty and emergency clinics and 25% of all first-opinion clinics in the US are owned by corporate consolidators, estimates suggest that consolidators control around 50% of all US veterinary hospital revenue and it is estimated that 50% of US DVMs work for corporate practices. As a result, many DVMs find that they have to adhere closely to dictated corporate policy which encourages sales of unnecessary tests and products to maximizes profit.
Thankfully about 50% of practices are still corporate owned. But many pet owners, who treat they pets like children (or better in some cases), demand more sophisticated tests and treatments. Subsequently, it is becoming increasingly difficult for privately owned practices to compete with the deep pocketed corp practices.
My biggest gripe with this.. is that they are going to literally squeeze out as much as possible from people that truthfully don’t know how little evidence there is in veterinary medicine. I have a lot of respect for vets, I really do and I own a dog and 2 cats. My wife however trusts them wholeheartedly when I know they’re charging her for useless stuff all the time. Most stuff they do is just borrowed from human medicine and I feel they usually opt for the more expensive and invasive treatments because well.. they can and people will pay for it. Bring in private equity.. pshh.. it’s gonna be 10x worse.
Rani: what is your basis for saying that "...they're charging her for useless stuff all the time."? That doesn't sound very respectful.
Whether it is human med or vet med, in the end an educated client is in the best position to make wise decisions based on their risk tolerance. But in both fields is increasingly challenging to find accurate info -- both for the practitioner & the client. Especially since advertising is allowed and promoters for "natural" treatments have zero burden of proof of efficacy. (Thanks FDA!).
Don’t mean any disrespect and I’m sure not everyone does this. But what’s the point of q6 month wellness checks, the probiotics they try to sell her, annual boosters, unnecessary Dx testing like you mentioned, overuse of antibiotics.. I mean it’s not just veterinary medicine.. it’s in human medicine too. Heck, don’t even get me started on the lack of evidence that goes into dentistry.
I frame it this way, "I have great respect for the medical professionals that deliver the services, but great DISRESPECT for the system. In fact I think the Pareto principle applies here that 20% of the systems's services are valuable and substantive, but 80% are bullshit.
I also disrespect high-level medical administrators like Fauci and Walensky.
Should veterinarians pursue their field for any reason but the “love of animals”? Most vets I see and know are obviously trying to milk you every chance they get. So this whole facade of there being an honorable profession out there.. honestly I’m having a harder time believing it everyday.. maybe if you’re a clergyman/woman but yeah I’m running out of examples already
Underlying everything you've written is the sense that you know what Medicine is -- or should be -- and the kind of person who will maintain that vision, nourish and enhance it. For myself, I am not sure what Medicine is (your wealth of reflections are very helpful, however) and less sure of where it should go as a discipline or how it should get there. I smiled/grimaced to see that the first reason you mentioned for NOT pursuing a life in medicine is wanting make a health care app. Of course I'm not sure what you are envisioning as an app (likely something trivial and flashy), but I see technology (sensor-based, high-rate sampling) as the best path to gathering the very large amount of data we need to continuously improve and better inform decision-making. It's hard to believe that this is not an important part of the future of care.
Wonderful article, VP! My youngest son wants to go into medicine. I told him, “If you can look past bad Google reviews, social media rants, politics, the iron-fist control Big government/insurance/pharma has on our field, being chronically undervalued (and underpaid), being surrounded by endless need, being suffocated by suffering, being lied to…if you can look past all that and say, “Damn, today was a good day. Look how I connected with this person and blessed him/her through my work”, then medicine is for you.
I agree. I couldn’t have said it any better. I was at a party with several doctors my age (73); all said they would do it again.
This is a wonderful answer and I could not agree more.
A few years ago, I was so done with medicine (family practice) I was going to quit and go into botany or horticulture or something that I would actually enjoy again. Found a job in direct primary care and it is much better— more like the medicine I remember when I started back in the 90s, when you had time with people, were not the cog cranking out RVUs etc. etc.. My kids all wish I could have switched sooner! They saw my stress levels go up along with the charting at home etc in FFS medicine. One kid trying for dental school, works as a dental tech so he sees the reality, still wants it. Another tried nursing, worked as CNA, decided “nope!”
My goal is no long term basement dwellers and fulfilled useful humans.
Neither of my daughters followed me into medicine. When people ask me if they should consider it as a career, I tell them that if there is any other career on earth, that would make them happy, they should do that. If medicine is absolutely the only career they can possibly imagine themselves in, only then should they pursue it.
"If medicine is absolutely the only career they can possibly imagine themselves in, only then should they pursue it"
Wow, that's what an acting coach told me when I was 12 . . . "If acting is the only career you can imagine yourself doing, then pursue it; otherwise don't" . . . I decided not to pursue professional acting as a career."
My husband and I are both physicians and we have 3 college-age children. I did not discourage our kids whenever they might have expressed interest in considering the medical profession. I did not really encourage it much either - I figured they'd choose something that interested them.
None of the three have decided to go into medicine. I think that one of the main issues was their birds-eye view of lifetime careers in medicine. The unrelenting long hours, late nights in getting done with work, working on charts from home - it just didn't appeal to them. Our son, in particular, has said he does not want to work as hard well into his 60s. All 3 of our kids are hard workers. They are each putting in the time needed for difficult majors in college (CS, engineering, graphic design). I expect them to put in long hours during the early parts of their careers. It just seemed to them that having some option for things to ease up a bit when they hit their 50s would be something to shoot for.
I've enjoyed everyday of my life at work - I love the constant thinking and problem-solving that medicine entails; talking to people/patients; helping people. But - it has taken much of my life-blood in time and energy. Not for everyone for sure.
I totally agree with your statements. I am a nearly retired PA in orthopaedic surgery. I was a prior OR tech and didn’t really know what I wanted to do and I sort of ‘Forrest Gump’d” my way into the PA profession. This did fill some of those questions I had about the human body/experience and being able to make an impact on my patient’s lives. I’m grateful for a wonderful career from Air Force to private practice to VA. So my oldest kid is a cop in Albuquerque (incredibly proud!), daughter finishing up dual majors in Business and Dance (equally proud), and youngest started a zoology program. I never pressured them into medicine (maybe they saw the downside—being on call, missed birthdays, late dinners, etc.). To young students I try to put it as you did sir, although not nearly as well stated.
I agree with "it depends". You covered the pros and cons very well. The only thing I would add is "Is being your own boss a significant factor in the decision?" If so, I would recommend against.
Ha ha. In the old days most physicians WERE THEIR OWN BOSSES. When was that? Around President Kennedy's assassination? I watched Kennedy's funeral with my physician father on his private medical office's building's basement TV. He joined a "hospital group" sometime after that.
Perhaps you misinterpreted my comment. It wasn't meant to be humorous or sardonic. Being my own boss was one of the factors that led me into medical practice and I answered to no one but my patients (the actual bosses) from the day I went into practice in July 1978 until the final stage of my retirement in 2020. The steady corporatization and bureaucratization that took over the field has made it extremely difficult to do that now.
Agreed! I also am a firm believer that if there is anything else on the face of the planet that you could be happy doing that isn’t medicine, do that! If there’s not, if this is it, then it will be worth it. But then and only then. I heard it a handful of times myself as a pre-med, and that was the advice given to my mom by doctors when she would talk about her daughter that wants to be a doctor. It was true then and it’s true now. It is the thing for me. But I have a certain amount of fear and trepidation for my 6 year old daughter who is already saying, “I want to be a doctor like you, Mama.”
I have spent 40+ years in ID - according to polls, very low on the income scale, very high on the satisfaction scale. I spent $800/year on med school, courtesy of the State of New York, it would be insane to go now for anything except the highest income specialties. I agree that Ortho or Derm are still a good bet for paying off loans. The problem is, as internal medicine and family medicine crumble (just look around), the whole system is going to crash and be reorganized, so not sure even Derm will be safe in the long run. Not to mention that med school itself is in crisis - how many times do I have to hear that a “B” or “high pass” in Medicine means “no Dermatology for you”?
I have read of surveys wherein >50% of current med students do not plan to see patients, ever. Taking the wrong people and teaching them the wrong stuff.
How many Michael Crichtons are there really, though?
This is one of my favorite pieces that you have written. You nailed it . As a mom of 3 kids who chose other professions, I totally understand why. They grew up sharing me with many others but they also know the pride I feel and in turn so do they. I worry about the future of medicine and we all need to do more to encourage the right people to come join us. We are standing on the shoulders of giants and we need people to stand on ours !
Beautiful as is expected from Dr. Prasad. But the journey might not justify the end. They really do a number on your prime energy and creative years. A humanistic career predicated about knowing saponification more than Shakespeare.
So would add a caveat - if you could get rid of premed requirements (4-semesters of chemistry!!) and streamline them and then make medical school 3-yrs; and make the testing reward reason more than rote memorization; and stop fee for service and the lavish salaries of surgical sub-specialists and let mid-levels practice truly under physicians - then it’s such an easier decision. It’s literally a career of swimming upstream to do the right thing. And the system rewards doing more than doing right.
Peel away that and it’s a beautiful and good way to spend your working hours.
Communication, compassion, curiosity, self-sacrifice, and intelligence are a winning combination for physician happiness and fulfillment.
I think it’s difficult to have the maturity to make a decision about going into medicine and doing it for “the right reasons”, especially at age 18 when one is entering college. Are there very mature individuals that come into the field for the “right reasons” and can do so at a young age? Absolutely, but they are few and far in between. I definitely notice it more however in the older individuals but again they are a small minority.
I think probably a good chunk (I’m guessing 80-90%) of matriculating medical students did 4-5 years of undergrad +/- 1-2 years of a post bacc or Masters degree or research year etc to get into medical school and most probably did it for a safe ROI. Be honest, most people are not smart enough or have enough life experience to really know what career suits them best and have the foresight to know they will excel at it in the future. Also, those who get to pursue those careers and can thrive within it, well that’s usually a luxury of the rich and well off and well connected. And very few regular people have the aptitude, discipline and luck to really find their passion/calling and make an extremely successful career out of it. Thus, we gravitate towards jobs with income potential and stability and probably convince ourselves of the passion that goes with it over time.
So back to the question, would I advise my son or daughter to go to medical school? If they didn’t know what they wanted to do and I saw them as a decent human being that likely wouldn’t take advantage of the system for financial gain - then yes because I don’t see many other professions out there (even with all the bias and interference from drug/med device companies) that can afford you an above average lifestyle, endless opportunity for education and the occasional, extreme gratitude of a patient.
I am a very curious person that likes to challenge the status quo, and fortunately medicine allows me to do that with my more open-minded colleagues. Does it bother me that most people in the profession are not like that? Of course, but that’s why it feels extra special when you meet someone that can share this discourse with you. Yes, medicine can corrupt you but more often than not, it does keep you humble.
Are there a disproportionate amount of middle eastern and south Asian and east Asian students that go into it for less than ideal reasons and are just doing it for some combination of financial aspiration and just because that’s what all their friends are doing?? Yeah, totally. Should we convince them to abandon medicine so they can go into I-banking, VC, PE or some high paid tech job so we can make room for the “passionate”, older more mature people who are going to probably burn out emotionally and physically like everyone else and just turn towards some cushy lifestyle specialty if they have the chance like everyone else??
I tried, but my eldest daughter preferred to study vet-medicine; maybe my rants about the broken system here were to often ;)
(alothough I love the job)
I asked one of our medical residents if she had always wanted to be a trauma surgeon. She said her dream had been to become a veterinarian, but she could only get into medical school. She settled for a different species.
As a recently retired DVM, I hope you daughter doesn't find the Vet Med system broken by the time she graduates.
Corporations are attracted to acquiring veterinary practices because it's a lucrative investment that can help them diversify and make a profit. Some private equity-backed chains buy community-based practices without rebranding them, which can make it difficult for clients to know that the ownership has changed
Over the past decade, vet med has increasingly been aping human med. As of 2023, approximately 75% of specialty and emergency clinics and 25% of all first-opinion clinics in the US are owned by corporate consolidators, estimates suggest that consolidators control around 50% of all US veterinary hospital revenue and it is estimated that 50% of US DVMs work for corporate practices. As a result, many DVMs find that they have to adhere closely to dictated corporate policy which encourages sales of unnecessary tests and products to maximizes profit.
Thankfully about 50% of practices are still corporate owned. But many pet owners, who treat they pets like children (or better in some cases), demand more sophisticated tests and treatments. Subsequently, it is becoming increasingly difficult for privately owned practices to compete with the deep pocketed corp practices.
I wish your daughter well.
My biggest gripe with this.. is that they are going to literally squeeze out as much as possible from people that truthfully don’t know how little evidence there is in veterinary medicine. I have a lot of respect for vets, I really do and I own a dog and 2 cats. My wife however trusts them wholeheartedly when I know they’re charging her for useless stuff all the time. Most stuff they do is just borrowed from human medicine and I feel they usually opt for the more expensive and invasive treatments because well.. they can and people will pay for it. Bring in private equity.. pshh.. it’s gonna be 10x worse.
Rani: what is your basis for saying that "...they're charging her for useless stuff all the time."? That doesn't sound very respectful.
Whether it is human med or vet med, in the end an educated client is in the best position to make wise decisions based on their risk tolerance. But in both fields is increasingly challenging to find accurate info -- both for the practitioner & the client. Especially since advertising is allowed and promoters for "natural" treatments have zero burden of proof of efficacy. (Thanks FDA!).
Don’t mean any disrespect and I’m sure not everyone does this. But what’s the point of q6 month wellness checks, the probiotics they try to sell her, annual boosters, unnecessary Dx testing like you mentioned, overuse of antibiotics.. I mean it’s not just veterinary medicine.. it’s in human medicine too. Heck, don’t even get me started on the lack of evidence that goes into dentistry.
I frame it this way, "I have great respect for the medical professionals that deliver the services, but great DISRESPECT for the system. In fact I think the Pareto principle applies here that 20% of the systems's services are valuable and substantive, but 80% are bullshit.
I also disrespect high-level medical administrators like Fauci and Walensky.
Should veterinarians pursue their field for any reason but the “love of animals”? Most vets I see and know are obviously trying to milk you every chance they get. So this whole facade of there being an honorable profession out there.. honestly I’m having a harder time believing it everyday.. maybe if you’re a clergyman/woman but yeah I’m running out of examples already
I don’t think she has seen all to deep insights in the real-life job yet (just hope she doesn’t get cynical as many do in the course of time)
Underlying everything you've written is the sense that you know what Medicine is -- or should be -- and the kind of person who will maintain that vision, nourish and enhance it. For myself, I am not sure what Medicine is (your wealth of reflections are very helpful, however) and less sure of where it should go as a discipline or how it should get there. I smiled/grimaced to see that the first reason you mentioned for NOT pursuing a life in medicine is wanting make a health care app. Of course I'm not sure what you are envisioning as an app (likely something trivial and flashy), but I see technology (sensor-based, high-rate sampling) as the best path to gathering the very large amount of data we need to continuously improve and better inform decision-making. It's hard to believe that this is not an important part of the future of care.