Monday, February 24, 2014

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.

11 comments:

  1. Is $120,000 *really* the estimated starting salary for a family physician? Sorry, I couldn't get past that question!

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  2. Thank you so much for writing this post! It significantly helped to lower my med student anxiety about juggling future debt, paycheck, and family.

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  3. Still, I think it's not something you should do just for the money. There are other ways for smart talented people to get 120K salaries that don't involve that amount of debt (or blood).

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  4. More balanced perspectives like yours should be available, most of the time the younger generation on the totem pole is given this scary perspective about all aspects of the future.
    Student loans, intern year, fellow ship etc.
    Thank you for not scaring someone away.

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  5. I feel like so many of my classmates are worried about going into primary care for the main reason of "they don't make anything." It's hard to hear that- but honestly I think the main problem is how expensive medical school is in the first place. They would not be so turned off by primary care if they didn't have 300k in debt before starting residency.

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  6. Thanks for this perspective. I am 9 years out of residency and have paid off my student loans already. I'm in family medicine and my husband is a professional as well (though I do make more than he does). We have a fairly nice house and are actually looking at a different one that is bigger and better suited to our family. I have partners whose wives stay home and they are still able to send their children to private school. Plus, I'm part of a physician owned group and could make more if I was part of a big system. It's not about the money, but we still live comfortably. Students should pick a specialty based on their interests not on the paycheck, but that's hard to realize.

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  7. The top 1% earns >350K per year. 120K would plant a person in the top 15% or so. 120K is not bad, it's just not the top 1%.

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  8. OMDG thanks soo much for that information.

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  9. The problem is that for people who can successfully get into medical school, get through residency, etc., the other career options are also likely to be careers that make 100-200K annually, if not more, not 40-50K annually. And frequently those careers have a lot less debt, and earlier earning potential instead of not starting until sometime in the 30s. Compared to the general public, sure we're doing great. Compared to my Ivy League classmates? Fine, but not near the top by any stretch.

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  10. Mommabee -- I was really surprised to learn this myself a few years back. It's crazy to think that one out of every 100 families in this country has that kind of income, but I guess it explains why I see so many Lexus SUVs around.

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  11. Thanks for posting about the cost. I like to check numbers first before jump into another profession. That girl was very (damn) smart to check the cost first & see if it would be worth it. I already have a "basically" worthless Bachelor Degree that I wasted $55,000 on when I was young & dumb ;) The most I can make is $33,000 a year & I STILL qualify for welfare. And right above the limit if my husband is working. I am the money maker in the family. Thankfully I don't have really young children, one going into High School & the other in Elementary. One of my really good friends is a OB/GYN and she is 33 :/ I should have not wasted my time or $! Props to you for being a single mom in med school! That takes fierce determination & dedication to making your life better!

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