Sunday, October 13, 2013

Young Idealistic Medical Students

A new survey has just been published in Academic Medicine that drew my attention due to its provocative title. It is called, "Primary Care, the ROAD Less Traveled: What First-Year Medical Students Want In A Specialty." Since the paper deliberately used ROAD in its name, it felt like a personal attack on the field of medicine that I love best. I had to investigate this travesty further.

The researchers asked over one thousand first year medical students what they considered to be important factors in the medical specialties they might choose when they graduate medical school. Naturally they asked about the importance of lifestyle. They delineated lifestyle into five different subcategories. The medical students felt that "Enjoying the type of work I am doing" was the most important criteria for a good lifestyle, with 61% of the votes. "Having control of work schedule" received 15% of the votes for a good lifestyle. "Having enough time off work" got 14% and "Enjoying the work environment" got 9%. Rounding out the bottom of the list for a good lifestyle was "Financial compensation" which received a measly 1% of the votes.

Oh you poor, poor, naive med students. Perhaps it's not fair to do a survey like this on first year students since you are still so young and enthusiastic. Many of you are simply regurgitating what you wrote in your med school applications. Sure you want to enjoy the type of work you're doing. But how much enjoyment will you get when you are seeing forty patients a day in your office and working at least 60 hours per week, much of it uncompensated like calling in prescriptions, answering phone calls, and fighting insurance companies. That is what's in store for students who go down the ROAD less traveled, straight into primary care hell.

As for having control of your work schedule and getting time off from work, well good luck with that. Unless you sign up as one of those part time doctors that pisses off everybody else in your group who has to accommodate your precious schedule over their own, you are unlikely to have much of your schedule under your control. This lack of ability to control one's own destiny inevitably leads to loss of enjoyment of the work environment which you can ready about on any primary care doctor's blog.

That financial compensation is listed last in importance to a good lifestyle shows that these students haven't yet confronted the terror of paying back hundreds of thousands of dollars in student loans. Believe me, when the first four criteria eventually fail, especially in PC fields, financial compensation will quickly bubble to the top.

It is ironic in their discussion that the authors claim, "Although time for family and balance between work and personal life were important to all first-year medical students, these specialty characteristics were significantly more important to PC-first students." It is precisely for these reasons that most doctors choose to get out of primary care. Even residents who match into a primary care field eventually realize the heartaches ahead and scamper away into a subspecialty just so they can attain that elusive work/life balance. They can see the handwriting on the wall with the healthcare industry cutting reimbursements while expecting greater productivity (more work for less pay). Something's got to give and it's usually primary care.

Perhaps these students will wise up in the next four years of their studies. In the next phase of their work, the researchers plan on asking these same students again as they graduate from medical school how their responses and actions differ from their initial survey. It will be interesting to see how much cynicism has been pounded into their overstuffed brains by then.


  1. Excellent ZMD! I'm a med student. The only reason I would do primary care (internal medicine) first is to get into a subspecialty (cardiology, gastroenterology). But that's an insane 3 years to get into what you really want to do. I wish they had a match directly into subspecialties.

    The only primary care worth going into is emergency medicine since it's a short residency and pays relatively well. I know people make upwards of $400K and more (in the South). However I hear there's a high burnout in the ED. And who wants to deal with all that social crap and GOMERs! I have heard of several emergency physicians switching into anesthesiology, but only one (so far) anesthesiology resident switching into emergency but she was very bubbly and social and seemed to have a hard time being in one place for a long time.

  2. Excellent post Z. And don't you love the social engineers who suggest we open a few dozen more medical schools for PC's only, or pay off PC pledges' loans, or some other half-baked measure, when the problem, and the answer, are staring everyone in the face: PC is a sh$%^4y job... and if only you make it better maybe more people will end up doing it. This means fewer patients with better reimbursement. And not by playing the zero-sum game of taking money from specialists either. So let's wait for that to happen.