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
graduation time... $160,000
Impossibility of learning
medicine factors that double
number each year
Face inevitable governmental
control of healthcare
as doctor fees
Forced to tolerate practice in
states with no medical
Increased control of medical
practice and eventual
Persistent reduction in physician
employed or not
Running a private medical
practice business with no appropriate
education to insure
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
What I'm doing to
discover why students are willing
to volunteer for a life of secular
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
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.
I got into medical school, I began to do more research about being a
doctor that practices medicine. I learned the following:
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
paying for malpractice insurance).
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.
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
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.
#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 intention is to be your own boss, make your own rules, and set
your own pay, start being a boss now rather
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
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
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
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
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
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.
traditional medical practices will have harder and harder time to
survive, due to these main reasons...
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
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.
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.