Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

What do you want from a career in medicine?

I am often asked why I decided to pursue a career in medicine; starting at a later age and with many demands both mentally and physically. Quite simply, I knew that I would enjoy those mental and physical demands because I love working with my patients to identify and help solve their health problems. When a patient walks into your clinic, office or you encounter them in the hospital, the most amazing relationship develops that you will ever experience. A person walks into your life and puts their health and trust into your hands. This trust means that you give your best knowledge in terms of figuring out their needs and meeting them.

Too many people will confuse what they see on the telly (House, Dr. Kildare, Gray’s Anatomy,Ben Casey, Scrubs, ER) with what is the actual reality of being a physician. There is little “glamor” in this job but there is loads of personal satisfaction in winning those hundreds of little “victories” that you will win over the course of a day. There is also the knowledge that if the health care system continues along the road that it has taken, you are going to make less money for every day that you work in the practice of medicine. The question that you need to ask is “am I willing to work this hard for this career?” If you can answer this in the affirmative no matter what the future holds, then likely you will have a satisfying career in medicine.

In no other career are you asked to be out of the work force for essentially 8 years just to be able to enter a job where you will be making less than minimum wage with an average educational debt of more than $150K. In no other career is your income totally dependent on the policies and regulations of private industry, government regulatory agencies, Congress and state governments. You have no control over what reimbursement will be for your services (those reimbursements have been cut every year in the name of holding down costs) while your costs of maintaining your practice have continued to increase dramatically.

Primary care (Internal Medicine, Family Medicine, Pediatrics and OB-GYN) have seen their ranks shrink in popularity among graduates of American medical schools for a number of reasons not the least of which is the extremely high costs of medical education, rising interest rates on loans and decreased pay. Those people who are yet to enter medical school and those who are yet to graduate face even more challenges in terms of just being able to make a living (purchase a house, pay off educational loans, open a practice). If you are not yet in medicine/medical school, you are likely (unless you enter the armed forces) not going to be able to afford to enter primary care because of past educational expenses. Along with that, add the fact that if you are not a very strong performer in medical school, you won’t be eligible for residency in one of the “money” specialties and thus, you will be scrambling to make a living even if you are able to get into medical school.

The American Medical Association has been extremely slow to organize and speak for the needs of the young physician. Most of the people (and I am thankful for their efforts) that are able to lobby, have been established physicians in specialties such as opthalmology who can afford to take a day away from practice because their loans are paid off and their homes are purchased and their children have their college education paid for. They have little in common with the newly minted physician who has a young family, a 10-year-old car from residency and a $2,000 a month loan payment in addition to rent (mortgage if they are lucky)and office overhead expenses.  I remember my cousin, who is a neurosurgeon state back in the early 1990s that she had to make a minimum of $10,000 per week in order to keep her office door open.  I am sure that number has increased (increased malpractice costs and office costs) while her payments have been decreasing. In the face of this, why would anyone want to enter this career? How would anyone afford to enter this career?

The answer to these questions are not easy but they are expensive both in time and energy. The truth of the matter is that you had better know as much about the day-to-day practice of medicine before you enter your pre-med curriculum because by the time you have finished your first two years of medical school, you have racked up too much debt to be able to do anything else. Little is taught about practice management/investment/finance either in medical school or residency. Medical school  prepares you for residency and residency prepares you for practice.

Some people want residency programs to include more about practice management, marketing and finance but along came the 80-hour work week restrictions and thus, most residency programs are still scrambling to make sure that they can include all of the experiences that residents need to learn just to practice let alone add to what they need. The business of medicine is very complicated and growing more complicated daily with policy changes at both the federal and state level. It takes many hours to keep up and keep yourself informed.

This gets back to what do you want from a career in medicine? Financial/job security isn’t out there anymore. Definitely respect and admiration are not out there anymore. Hard work, long hours of study and personal and financial sacrifice ARE definitely out there and ahead. I caution anyone to look long and hard at this career because it’s not easy and there is no relief on the horizon.  Be very, very sure that you have a realistic idea of what day-to-day life is like for physicians who are coming out today and not what you see on the telly. None of those shows are remotely close.


3 February, 2008 - Posted by | academics, graduation, medicine


  1. Good post, except I believe its a little more negative than realistic. Regarding declining pay; Some procedures may decline in pay over the years, but overall, medical work is protected by very high barriers to entry and protection in comparison to other professions. The legal barriers protecting the medical field make variant procedure income a mute concern. A surgeon may make 430,000 a year instead of 440,000. Such suffering.

    Comment by John | 24 July, 2014 | Reply

    • To John:
      I don’t think you actually work in surgery or in medicine. There are NO legal protections and plenty of declining reimbursements for services across the board. There are no “barriers” to entry and definitely no “protection”.

      Comment by drnjbmd | 24 July, 2014 | Reply

  2. Hi there,

    Great post! You hit the nail on the head! I’m a Canadian student studying medicine in Europe (hence, an IMG) and before I made this big leap to study medicine, my father posed a similar senario for self-reflection – Down the road, medicine might change as a career and you may not get the same benefits doctor are getting now, considering this you have to be VERY sure that this is the path you want to follow, otherwise it won’t be fair to your patients in the future.

    Its very informative to read your blog. Thank you for being so open about your experiences.


    Comment by G | 11 April, 2008 | Reply

  3. Reading all your posts (esp mastery of biology, academic excellence etc)have given me a lot of inspiration to do my best in my academics. Could you please write a post about how you went about making notes, and also what methods did you use to understand the concepts & integrate it. You also mentioned in your earlier posts about always having the big pic, could you pls elaborate on how you went about it.( I find this part tough)It would be very helpful to learn what methods you used to read your texts & then how you reviewed material. How did you manage to put in such good effort consistently through med school?

    Comment by lia | 18 February, 2008 | Reply

  4. Could you possibly consider writing an essay on your approach to studying for exams and boards? How you organize your approach, strategies you utilize during the exam, etc.

    There seems to be a hole in my test taking skills. Often I miss questions that I knew the answer, or am often by confused by questions that have more then one right answer – but, you have to choose the “best” answer. Thanks!

    Comment by Dan | 17 February, 2008 | Reply

  5. Evidence Based Medicine is taught in most medical schools in the United States. We didn’t have a textbook for this course but you might try doing a Google search to see if any are out there.

    Comment by drnjbmd | 15 February, 2008 | Reply

  6. Thanks for the reply, this is the first time i have come across ” evidence based practice” did a little bit of reading on the net about what it is. Any suggestions on how i might find out more about this & apply it to my studies now? Do you know of any books that teach this or any courses given on this in the US? thankyou

    Comment by carol | 15 February, 2008 | Reply

  7. To Carol,
    Look back thorough some of my past posts. I have posted quite a few on my study methods.

    I will be the first person to tell you that I am no “master” of every area of medicine. I did learn my medical school coursework. After that, it was easy to “review” what I had “learned” in the first place.

    Medicine is about constant review and research (Evidence Based Practice). My school placed heavy emphasis on learning to practice Evidence Based Medicine and it stuck.

    Check out some older posts and see if they answer your questions.

    Comment by drnjbmd | 14 February, 2008 | Reply

  8. have just recently stumbled upon youre blog & really loved it. i hope you continue posting articles.
    Im an IMG student & while going through youre blog, it was very clear that you have a mastery of every area of medicine.

    Right now, i feel like i just know medicine vaguely, even though i just recently completed med school. I dont have a firm grasp over any of my subjects. How do you develop mastery over your subjects. what is the method you adopted to study medicine? I feel despair most of the time seeing the volume of work that needs to be covered.

    Comment by carol | 13 February, 2008 | Reply

  9. It certainly makes sense to do what works for your situation. In today’s health care environment, you have to do what you believe is best for you and your career. I would certainly say that anyone contemplating medicine or being a Physician Assistant should thoroughly evaluate all aspects of these great fields and make the best decision.

    My guess is that you are going to love your career as a Physician Assistant because it’s a great career. It shares much in common with medicine and is quite rewarding. It’s a great opportunity to touch the lives of your patients without loads of political overtones and long-term financial sacrifice. Good luck to you!

    Comment by drnjbmd | 4 February, 2008 | Reply

  10. These struggles about being a doctor is inevitably what led me to become a Physician Assistant. While I start PA school in June, the obstacles that lie ahead now and in the future are too surmountable for a student my age. I was certainly pulled taut on the decision, but feel that becoming a PA was in my best interest to practice medicine without the overbearing personal and financial sacrifices.

    Comment by Dub | 3 February, 2008 | Reply

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