Once upon a time going into medicine was one of the most sought after career paths, and for good reason. High income, lots of autonomy, little accountability, and plenty of respect were a lot to add to the opportunity to help people. Sure the long hours could be a downer and the job could be stressful, but that was about it.
Things changed with the advent of managed care. Income got a little harder to come by, autonomy took a big hit. More recently with the quality and patient safety movement accountability has risen and respect isn’t automatic. Physicians are even expected to be team players. As the field has evolved into big systems it’s now harder for a doc to maintain a viable private practice, and you see very few opening up. Some specialists still find a way to make a ton of money but in primary care it can be pretty ugly. In wealthy, high cost of living places like San Francisco primary care physician incomes don’t automatically land one in the upper middle class.
Meanwhile, other ways for high-achievers to make a lot of money without a lot of accountability have emerged, with financial services serving as Exhibit A.
No wonder many docs say they’d do something different if they had a chance to start over.
And yet the number of medical school applicants is rising. Maybe it’s because applicants are uninformed about what awaits them, and in a few years they’ll be filled with regret just like their elders. On the other hand, the prospect of a steady, decently paid job with a chance to help people probably looks pretty good compared to some other choices that are available, such as going to law school and then ending up in a menial role.
It’s too bad that medical school is so expensive. High medical school debt is bound to deter students from becoming lower-paid but essential primary care physicians.
Maybe in another generation or so we’ll evolve to a single payer system and government sponsored medical schools. Seems far-fetched now, but I think that’s where we are heading in the long run.May 4, 2012