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Medical Student Interview

Article #46   June 2013

"Medical student perceptions of medical
practice that reveal what the new
generation of doctors think"

Anyone who believes that the new generation of medical students and new doctors aren't as committed to a career in the practice of medicine as us older wrinkled doctors were, has to be insane.

In fact, these new doctors are facing more obstacles, barriers, and obligations that far surpass those older doctors faced even 30 or 40 years ago. You might look at their situation like Friedland described, "The situation is hopeless, but it's not serious."

When you then add to that these mentally unsanitary factors and sissy issues that make a medical student consider self-immolation, it's no wonder recruiting medical students has become a permanent job position. Think about these as paving the cow-path to continuous desperation...

  • Average medical educational debt accumulated by
    graduation time... $160,000

  • Impossibility of learning medicine factors that double
    in number each year

  • Face inevitable governmental control of healthcare
    as well as doctor fees

  • Forced to tolerate practice in states with no medical
    malpractice caps


  • Increased control of medical practice and eventual
    destruction of private medical practice


  • Persistent reduction in physician incomes whether
    employed or not 

  • Running a private medical practice business with no appropriate business education to insure it is
    profitable and not fail

These are just a few things to think about... and then wonder where the passion to become a physician comes from, in light of their future in medicine. How is it possible to find any college student tough enough to run the gauntlet?

What I'm doing to discover why students are willing
to volunteer for a life of secular priesthood...
medical practice.

Today, I'm including an interview with a medical student that I consider has an elite and unusual, but passionate, view of reality you need to think about. His name is not important, nor is his medical school. What he says is!

Q. #1---You must have had a very good reason for giving up your financial career and going into medicine. Please tell me why you would ever do such a thing. With all the issues students face in medicine, how do they, and you, rationalize going into medicine today?

Before I got into medicine, I was an accountant. By my second year, I was extremely bored with work and needed to do something else. I could not see myself doing accounting for the rest of my life. So I decided to become a doctor.

That decision was made without having all the information. I assumed that being a doctor will guarantee me a life-long, high-paying job. And as a bonus, I will get to help people (whatever that means). Tuition would be a moot point because I can eventually pay it off with a doctor's salary.

But once I got into medical school, I began to do more research about being a doctor that practices medicine. I learned the following:

1) If you want to be board-certified, you will be taking tests for the rest of your life. (I hate taking tests.)

2) The third-party payer (either government or
insurance companies) will place an artificially low price
on your services.

3) Everyone thinks doctors are moneybags. Therefore, expect to spend a lot to practice medicine (from going
to medical school to taking certification exams to
paying for malpractice insurance). 

Q. #2---Have you already discovered your medical skills and talents, and decided on which specialty you intend to train in relative to your interests and skills? This question is about whether students make those decisions at the last minute of medical school, or if professors are helpful in pointing you in the best direction.

I decided on my specialty before entering medical school. My goal was to be the most help to as many people as possible. And I wanted to practice on my own as fast as possible. Therefore, I chose family medicine. 

The most help in medical school for choosing a specialty is third year when you are rotating with different doctors. You will get to see what each specialty is like. But take what you experience with a grain of salt. Your rotation experience will depend a lot on the doctors who are teaching you. If you got a crappy preceptor, your experience will be crappy. 

Q. #3---What are your expectations for yourself in medical practice eventually? Do you have in mind a clear view of what you intend to do, the path you have already planned out, or are you letting circumstances direct you where you will end up in your career? In my time in med school, most students kept waiting for some opportunity, or sudden challenge, or events to unfold to show them what they should do in medicine.

I have a clear idea of my future medical practice. I have already determined what city I want to practice. I research about asset protection laws, demographics, median family income, and lifestyle of the city.

I am constantly planning what services I offer and how I will differentiate my practice from other medical practices. I researched the fees that other cash-based practices charge so I can pick and choose the best ones to implement to my practice.

President Bush allegedly said, "If you don't set your own agenda, others will set it for you." Although many people made fun of him for being dumb, he is still one of the most wealthiest and powerful people in the country. (Read Confessions of an Economic Hit Man to find out what I mean.)

So if you wait around until the very last moment before deciding on how you want to practice medicine, it is very, very likely you will go along with the flow and join a hospital or big practice. There is nothing wrong with that if you want to work for someone else. Others will set your agenda for you. You will see this many patients. You will work this many hours. You will accept only so much money for your services. You will not be in charge of
your destiny.

But if your intention is to be your own boss, make your own rules, and set your own pay, start being a boss now rather
than later.

Q. #4---What are your fears or worries about the future of healthcare and medical practice, if any? All sorts of changing good and bad information comes your way daily about medical practice... like ObamaCare, heavy educational debts to be paid back, malpractice increasing, how much money you will be able to make to meet your obligations to yourself and family, how you intend to earn that money in practice in view of increasing fee restrictions on doctors. Just some thoughts to churn around in
your head.

My main concern is if doctors are forced to take Medicare and Medicaid. In my practice, I will not take them. I would rather see Medicare and Medicaid patients for free. Too many doctors are losing money on those visits. If accepting Medicare and Medicaid is mandatory for all doctors, I would quit practicing medicine. 

My other concern is the huge educational debt. Some medical students will have more than $200,000 in medical school loans by the time they graduate. At the 6.8% interest rate or higher, these loans are more expensive than mortgages! Student loans are now the biggest debt the young people have, even more than credit card debt. America is living for the short-term by shackling the next generation into so much debt.

Doctors can take advantage of income-based repayment if they have a federal loan. It can help ease the debt burden a little. But I strongly feel that sometime in the future, there will civil unrest because so many people will have with unpaid student loans. The government will definitely have to do something about that. It may even make the loans dischargeable in bankruptcy. 

Other than that, I am not too concerned. With ObamaCare, many more people will be insured. That means the demands for primary care providers will go up. That means demand for my services for go up. People may be more willing to pay cash because there are not enough primary care doctors for everyone.

I really plan to practice medicine in my own way, with as little restrictions as possible. I will only comply with something if there is a law that mandates me to do a certain thing (i.e. have a medical license). Malpractice insurance, certifications, accepting insurance, etc. are all optional and will be subject to a thorough analysis, questioning if having them will make financial
sense or not. 

Q. #5---Do you see the future of private medical practice disappearing rapidly? Since surveys now show that at least 50% of medical students presently intend to join some type of medical management facility and remain an employee forever... meaning that they have to tolerate the restrictions of being an employed doctor, no means of increasing their income significantly in such an environment, all medical practice freedom lost making it nearly impossible to reach your personal dreams and goals you had at the start.

Smaller, traditional medical practices will have harder and harder time to survive, due to these main reasons... 

1. Medical practices are small businesses. Yet, most doctors do not have business skills. So what do you think happens when you get someone with no business skills running a business? Most likely than not, it will fail.  

2. Doctors are wimps. All they do is complain, but they don't take any action. Too many people want a piece of the doctor's pie, and the doctor doesn't even fight back. Reimbursements are decreasing. Doctors need to see more patients just to pull the same income as last year.

Malpractice premiums keep going up and up. Board certification changed from being life-long to lasting only several years, resulting in more money and more time to keep the few letters after your name. And doctors don't stand up for themselves and say, "No." Eventually, there won't be any piece of the pie left for the doctor.

There will be a few independent, financially-successful medical practices. They are ones run by business savvy doctors who follow their own rules. They see the struggles that they colleagues went through and were brave enough to do something different.


Note: Nothing has been edited out of the interview, or changed. This medical student (young doctor... a term used by most of my medical school instructors and professors to introduce a medical student to their patients. Something that I considered was a reflection of respect and documentation of my value to him or her.) is one of the few who reads, understands the broader picture concerning the practice of medicine, and is courageous enough to recognize the importance of a business knowledge in addition to medical knowledge.

Anyone who cares to comment is welcome to do so. 



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bright colored American flag Curtis Graham, M.D.
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