Thursday, September 1, 2016

It’s a Privilege, Not a Burden

Image Credit: Flickr
Author: Jacob Stelter, MS4
Loyola University Chicago
Stritch School of Medicine
Originally Published: Common Sense November/December 2014

After years of battling things like prematurely adopted EMRs, government bureaucrats, clueless hospital administrators, greedy insurance companies, malignant tort lawyers, CMG profiteers, and "emergency" patients who don't need to see any doctor at all — much less an emergency physician — it is easy to become jaded and lose sight of our real value. That's why I chose to publish this editorial from a medical student. I hope it reminds you of the true worth of what you do, and how important you are. Stay strong! — Andy Walker, MD FAAEM, Editor Common Sense

I recently read an article in the Chicago Tribune entitled, “Expert’s New Career Prescription: Forget About Becoming a Doctor.”[1] In it author Dawn Turner Trice interviews the executive director of the Chicago Area Health and Medical Careers Program, Regnal Jones, who advises students not to pursue a career as a physician. He cites the cost of tuition, the many years of training, the long hours, and more medical graduates than residency spots — among other things — as reasons not to become a physician. I respect his opinion and have no doubt that some of his points are legitimate, especially regarding the cost of tuition and the fact that there are insufficient residency spots for graduating medical students. However, I respectfully disagree with much of what he says. At the end of her article Trice says, “You've heard Jones' position. Now tell me what you think.” Well, I did just that — sending her an email rebutting most of Jones' arguments. Now I want to explain to you why Jones is largely wrong, and present some of the positive aspects of being a physician.

Before I entered medical school, I understood the path to becoming a physician and what the difficulties would be. I knew about the long hours, time away from family, and a seven-year-minimum investment from the start of medical school until the end of residency. I realized that when “MD” was placed after my name I would carry a debt of over $200,000 — with interest that would accumulate while I was making $50,000 a year as a resident. I knew that as the American population ages, doctors will be in higher demand but will be faced with many uncertainties as the Affordable Care Act becomes more established. I knew that it was becoming increasingly difficult for physicians to maintain their independent practices without relinquishing control and autonomy to hospital systems or other corporations. These are all points Jones makes, and I do not deny that each is a challenge. However, he fails to mention any of the rewards of medicine.

Let's start with finances, a minor but still relevant reward for practicing medicine. Though physician salaries remain uncertain, especially in light of health care overhaul, I don't know a single attending physician who makes so little money he is unable to own a home and a car, support a family, and pay back educational loans — simultaneously. While medicine may not be as lucrative as it once was, most physicians are able to live quite comfortably.

Second, physicians have a unique role in our society. As a student interested in emergency medicine, I have spent a lot of time in emergency departments. I am amazed at how trusting people are of physicians they have known only for moments. I have had many encounters with patients in which they revealed their entire history of drug use, smoking and drinking habits, sexual practices, and family medical history — despite the fact that we met just minutes before. People trust doctors, and that is something I and my colleagues take very seriously and find immensely gratifying.

Third, being able to intervene constructively in the lives of patients is priceless. A patient with congestive heart failure, who comes in barely able to breathe or walk, is indescribably grateful to his physician when he is able to walk out of the hospital breathing normally. A patient with a ruptured aortic aneurysm dies unless a physician immediately intervenes, often allowing that patient to leave the hospital a few days later with another chance to hug loved ones and enjoy life. It is these moments that make being a physician absolutely priceless. Moments like these send chills down my spine, as I see how physicians extend and improve the lives of so many people and earn for themselves a sense of satisfaction that no amount of money can buy.

Finally, physicians also have the opportunity to celebrate with families as we help bring new life into the world, and console families while we make patients comfortable as they exit this world. I would never trade such experiences, and they set our profession apart from all others.

Regnar Jones recommends becoming a physician assistant instead of a physician, saying, “Over the last decade, the number of physician assistants has more than doubled to about 93,000 today, according to the American Academy of Physician Assistants, which expects the number to continue to rise dramatically ... Many physician assistants already do what physicians do and, in some cases, do it better. Their patient outcomes can be better and they go to school for fewer years and don't do residencies or have the same debt. A lot of them don't even need to consult with anyone to manage care."

While PAs have definitely found their niche in the health care world, they neither are nor claim to be substitutes for physicians. Physician assistants increase access to primary care and basic urgent care for many people. However, the reason medical school and residency are so long is that it takes that long to master a medical specialty. I respect PAs and have worked with quite a few. I appreciate their role in the care of our ever-increasing number of patients, but they are not replacements for physicians. They do not “do what physicians do” — much less “do it better.” The same is true of nurse practitioners, even though — unlike PAs — some of them do claim to be substitutes for physicians.

In closing, at the end of my career I may not have a Maserati or Lamborghini in my garage. I may not own a seven-bedroom estate in a gated community or a massive condo on the Gold Coast in Chicago. However, I hope and believe that I will look back on my career with immense satisfaction and joy, knowing that through both amazing times and difficult times I was able to make a positive, sometimes life-saving impact on thousands of people. That assures me I have chosen the right career path, and I firmly believe that if you ask me thirty years from now, I will tell you that I would choose the same path again.


1. Trice DT. Expert's new career prescription: Forget about becoming a doctor. The Chicago Tribune September 25, 2013.

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