As I help my blog through its identity crisis, I’d like to apologize to the followers who couldn’t care less about this physician income series. It is written primarily for premeds, particularly those using and contributing to studentdoctor.net, where the question of physician income, as well as “should I do medicine for the money” comes up all the time. I felt compelled to write this series for two reasons, one being to offer a dose of reality to premeds drooling over some magical $200K pot of gold at the end of the medical education rainbow, because, as you’ll see in this post, money isn’t an efficient currency with which to purchase happiness. The second reason is to show any non-physician readers that not all doctors are “in it for the money.” As someone who started down this track later in life, I was forced to think about income primarily to answer the questions “will I be able to provide for my family as a resident?” and “will I be able to manage the debt that I incur?” Not to mention the opportunity cost of leaving behind a career first to go back to college and take the prerequisites for medical school, then apply to medical school (one year process), and finally move on to medical school itself, effectively turning my back on 7 years of salary. In my circumstances that meant trading about $350,000 worth of income for ~$200,000 worth student debt. For a “nontraditional” (read: “old”) applicant to medical school, “should I do medicine for the money?” is a laughable question; reflecting on physician income is simply pragmatism, a necessary evil.
Anyway, onward to the conclusion of this series. Can money buy happiness?
I just asked google for the third time this week. It took that many running starts to get through the top hits because, well, they sucked. The articles were too long, boringly written, and extrapolated the meager results of a couple of studies into overreaching, overblown conclusions.
I see this abuse of research everywhere (forgive the digression). In education, the idea of “learning styles” (visual learning, auditory learning, kinesthetic learning), is still fairly pervasive, even though there is no significant empirical evidence that catering to one sensory input actually improves learning. I don’t actually care that people, including the majority of educators in American public schools, believe in learning styles without having any tangible evidence for their beliefs. What irks me is how people exaggerate the importance of a lack of evidence. Some psychologists did a review of the existing research on learning styles and found that no experiment in the existing fund of knowledge had been designed in a way that it could actually provide evidence for the popular model of “learning styles.” Based on that literature review, people have started completely rejecting the theory.
I’m not saying I support or reject the notion of learning styles. Maybe I’ll rant about that in a different post. What I’m saying is, this group of psychologists didn’t even conduct an experiment. They didn’t prove or fail to prove anything. They just did a literature review and said, to date, no one had supported “learning styles” with adequate research. And then people latched on to their article, sensationalized it, and started trashing the entire idea of “learning styles” as if there were suddenly a glut of new research that concretely and permanently disproved any “learning styles” theory. People just don’t understand research and it’s limitations. Digression over, perfect segue.
Plenty of different studies have examined people’s responses to money, and the results of these studies are almost always discussed by the media under the theme “can money buy happiness?” One study showed people pictures of money before giving them a piece of chocolate. Compared to the control group, which consisted of people who were not shown pictures of money, the people who did see the images consumed their chocolate more quickly.
The people who conducted the study admitted that this could mean anything. The money-viewers might have thought about all of the germs and nastiness on dollar bills, which could have prompted them to eat more quickly. The germs serve as another possible explanation for the research finding, and if the findings of your research have multiple possible causes like that, your study has “confounding variables.” If you have any confounding variables you cannot make a causal inference. You cannot say one thing causes another; in this case you can’t even say “pictures of money cause people to eat more quickly.” Although that is the phenomenon that was observed, there were confounding variables. “Fear of germs causes people to eat more quickly” is just as plausible an explanation. The experiment would need to be designed in a way that eliminated confounding variables if you wanted to directly link money, and not germs, to the people’s behavior.
In spite of that, the media grabs hold of studies like this and blows them way out of proportion. Not only do they report that money was the cause of the quickened eating, confounding variables be damned, they take it a step further and say that money takes away people’s ability to savor things. Talk about a flying leap. And don’t even get me started on how the media latched onto the studies that purported “anything over $75,000 per year doesn’t increase happiness,” or the dismal lives people have led after winning the lottery.
Can money buy happiness? Maybe. Maybe not. It depends on you more than it depends on the results of any study. Chances are, if you’re a happy, well-adjusted person you’ll be happy with or without a lot of money and other factors should dictate your career decisions. Conversely, if you’re generally unhappy, hard to satisfy, and prone to whining, no doctor’s salary is going to make that go away.
Money is rarely a primary motivator anyway. People usually pursue money as a means to some other end. Motivation is a complex psychological phenomenon. Suffice it to say, secondary motivators don’t have much leverage to improve happiness. Life outlook, personality, and attitude are much stronger correlates to happiness. Some people need nothing to be happy. Others aren’t satisfied with anything.
It helps to have your basic needs met, no doubt. It helps to have a little extra. But there are a lot of different ways to get there; medicine is just one option. If you feel like money is one of your primary motives, you’d be a fool not to consider other career options.
That’s it, no more about money for a while.
It depends whom you ask. It also depends on choice of specialty, practice modality (private practice vs. academic vs. other options and combinations), and whether you practice in a rural or an urban area. We’ll start with some data from an MGMA survey…I would link it but the link I had a year ago is now expired. The sample size was over 60,000 but I don’t remember anything else about the survey. This bit just compares median incomes for each specialty in “academic” practices vs. “other” practices.
All Primary Care:————$158,218———$191,401
Infectious Disease———–$159,502——-not reported
Maternal/Fetal Medicine—–$296,933——-not reported
Neonatal Medicine————-$208,762——-not reported
Pathology: Anatomic———–$214,557——-not reported
All Nonphysician Providers————————-$94,441
Physician’s Assistant (Surgical)—————–$101,000
Physician’s Assistant (Primary Care)————$89,021
All of the pretty graphs below are from a physician income survey done by Medscape. You can still go directly to their site to check out the methodology, etc. All of this should serve to get the point across that physicians have a tremendous range of incomes, and that there is still overlap between physician income brackets and other health professions.
I had heard that physicians in smaller towns earn more. The explanation I got from a family medicine resident was that, at least for salaried physicians, the pay had to be better in more rural areas as an incentive to go somewhere you wouldn’t want to live elsewhere. Regardless of the reason:
Regrading hours worked per week, and breakdown between patient care and other activities:
There’s a lot more info in the study about other compensation factors. You’ll need a Medscape account to view it, and if you don’t already have one I highly suggest you check it out ASAP. It is a great resource.
You want to choose medicine for the money. And you want my permission. Well, go ahead.
There are 2 problems I’ve recognized every single time this question comes up.
- The person who asks it (assuming they’re asking in earnest and not just trying to get a rise out of someone) doesn’t know they’re not supposed to ask it. In other words, they’re kind of dumb.
- The (dumb) person doesn’t listen to the responses. They’ve already decided that it’s ok to become a doctor for the money, and they were simply asking as a courtesy, without the slightest intention of considering other peoples’ thoughts on the issue.
Well, in my new-found blogging spirit of “who the hell cares if people are listening to me?” I’m going to address the issue anyway, once and for all. It’s going to take a while, so I’ll do it in a series titled “Medicine for Money.” That way my non-existent readers don’t get too bored.
Because this is such a frequently asked question, I have plenty of fodder for discussion. I’d like to start by ridiculing some of the fruitless analyses other people have done on this. Don’t worry, they won’t be offended. They’ll be glad that I’ve linked people to their crappy content.
Here’s one: http://benbrownmd.wordpress.com/
And here’s the other: http://www.er-doctor.com/doctor_income.html
While I admire the effort (and I don’t begin to disagree with the point they’re attempting to make), the numbers aren’t that hard and fast. There are zillions of different possible scenarios with different debt figures, different choices of medical specialty, different investment outcomes, and myriad other things that would affect the final figures for net worth or how many years it takes for a physician to catch up to a UPS driver. It’s easy to ignore these spreadsheets because they are so hypothetical; I could spend the rest of my life creating equally plausible, yet contradictory spreadsheets where the physician comes out vastly ahead and maybe even becomes POTUS. I might pay attention if they posted 30 years of tax returns for a real UPS driver and a real physician, but the fake projections are sadly unconvincing.
This series will not rely on math to prove any points. It will not rely on hypothetical or anecdotal “evidence.” It will not make appeals to your emotions. It will just explore the reality of choosing a career in medicine for the money, and the implications of making such a choice in the high school and college years.
I hope you enjoy, and comment along the way.
Why you should avoid critical comments as an interviewee:
Interviewing at a state school:
Interviewer: “So, how did you enjoy going to ______ state school for undergrad?”
Applicant: “Blah, blah blah, I loved it, it think public education is important. I think I received just as good an education as people who go to Harvard or Yale. I think those schools are over rated for undergraduate education…(going on about grade inflation)”
Applicant: “So where did you do you undergraduate education?”
Applicant: “and where did you go to medical school?”
About that photo you included with your med school application:
First thing the interviewer says after an applicant walks through the door:
“WOW! You look so much FATTER in the picture you sent with your application!”
The other way that can go:
Interviewer: (gives me an incredulous look, then opens my file before looking back at me) “Wow, you certainly photograph well.”
How to be Awkward:
“This happened at my interview about a month ago. Kind of threw me off.
Applicant: (nothing just sat there)
Interviewer: Thanks for saying God Bless You. Didn’t you say that you were a caring person.
Applicant: Uh… Sorry, I forgot.
I’m having difficulty controlling THE VOLUME OF MY VOICE:
Interviewer: “So I see you have virtually no research experience.”
Applicant: (I don’t know how this happened, maybe I breathed funny or lost my train of thought, but I answered with a loud, long “NO” followed by a loud, short “MAM” *awkward*)
She made me feel better by mentioning she had no research experience before medicine either.
Be ready for anything:
“So at my 5th interview, I’m feeling real good… do the standard chatting up with the other interviewee’s, then have my first interview with a Ph.D and that goes super well cause we just end up talking about research….
then the day goes on and I meet my second interviewer
she appears to look like a nice old lady, i assume she is a retire M.D. doing this interviewing thing for fun. But no, let me just say to NEVER ASSUME what your interviewer is like based on appearance. She takes me behind the admissions office, in a little room and sits me down.
She starts out asking nice easy questions, “tell me about yourself, oh you like sports, what did you do studying abroad… blah blah blah..”
then she hits me with “Ok now that we have that over with…. we will start the REAL interview”
meanwhile i was just thinking, come on… how hard can this be, I am a pro at interviewing now…
she asks me “You are the governor of the state, and I want you to draw up a detailed plan for a health care system, please keep things realistic… start now”
so i said “well… i endorse the idea of a universal health care system…”
“NO! WHAT DOES THAT MEAN? BREAK IT DOWN FOR ME”
(a little shocked by her tone… and facial expressions…)
“ok, well I guess you would start with implementing a policy where everyone can get screened by health professionals..”
“NO THAT IS NOT RIGHT”
(sweat drips down armpit)
“well, I think it is necessary to emphasize preventative medicine in order to cut down on costs…
(interrupts) “NO THAT IS NOT RIGHT EITHER. I WANT YOU TO BREAK IT DOWNNNN FOR ME”
So basically it goes on like that for 40 minutes of her interrupting me and preaching the ideas of healthcare she has. I have to admit she was right about everything, but HOW WAS I SUPPOSED TO KNOW HOW TO CREATE A HEALTHCARE SYSTEM FOR AMERICA!??”
You must know basic geography for your interview:
Interviewer: “ so what do you like about our school?”
Applicant: “oh I loved everything… ann arbor seems like such a cool city, and…”
Interviewer: interrupts, “you’re not in ann arbor, you’re in pittsburgh.”
Applicant: “oh that’s what i meant…”
An applicant talking with an orthopedic surgeon about why he wants to be a doctor:
Interviewer: “Have you thought about what you’d like to specialize in?”
Applicant: “I work with [a doctor at the school I was interviewing at] and I really enjoy what we’re working on and can see myself in internal medicine/infectious diseases. I really enjoy diagnosis and talking to patients, I don’t really see myself focusing on procedures.”
Interviewer: “Procedures like hip replacements?”
Applicant: (mental facepalm) “… Procedures… like hip replacements.”
“My interviewer appeared to be really old. Like older than my grandpa old.
Interviewer: “So, what questions do you have for me?”
Applicant: asks good question about that school:
Applicant: “So what type of physician are you?”
Interviewer: “I’m an endocrinologist.”
Applicant: “and how long have been practicing?”
Interviewer: “Over 50 years.”
Applicant: “Wow. so…. when insulin was first introduced, how did that affect your practice?”
Interviewer: kind of laughs… “Well, insulin was introduced in 1922, so I wasn’t born yet. I’m not that old.”
Applicant: “Oh my, I’m sorry… I thought…I just thought that…”
Interviewer: “It’s ok. Even my own children still think that I used to wear a leather helmet when I played football in college.”
Applicant: “Oh I’m so sorry, I didn’t mean..”
Interviewer: “Well you should probably get going now. I wish you luck”
Interviewer shakes my hand while simultaneously pushing me out the door.”
If your stats put you in the middle of the herd for med school applications, your statement takes on a new importance. It must differentiate you as a better-than-average applicant who has average numbers.
Fortunately, a lot of your fellow applicants will write terrible personal statements, making very common mistakes and relying on clichéd, overused advice. You do not need to write a fantastic statement; you just need to avoid writing a lousy one.
If a school receives 6000 applications, 5700 of the personal statements will be, in a word, heinous. You need to be part of the other group. Start with the following things in mind. After you finish, go through this list again as you edit to make sure you didn’t sneak something nauseating into your essay. You might even give this list to the people proof-reading your essay.
- Never forget what the essay is about. First and foremost, it must answer the question “Why do you want to be a doctor.” Spell it out. Don’t force your readers to guess and don’t leave room for them to misinterpret your motives. Make it absolutely clear. Once it is, then you can go into how you know you want to be a doctor and why you would be a good one.
- “Omit needless words.” -Strunk & White, Elements of Style. Be concise. Brief writing is powerful. It is clear. Wordy writing is cloudy, amateur, and boring.
- Do not start with a quote. This is lazy and overdone. You are not writing for your high school AP English exam – this is a statement about who you are and why you want to go into medicine. Admissions committees want to know about you, not Robert Frost, C.S. Lewis, Ralph Waldo Emerson, or Dr. Seuss. The only exception is if you have a hilarious patient quote, but even then don’t use it. As another blogger, Panda Bear, MD advises:
- “Avoid humor, by the way, unless you can pull it off which you can’t. You are not funny. You say some funny things occasionally, we all do, but that doesn’t make you a comedian.” This is perfect advice for your personal statement.
- Do not use the words “passion” or “fascinating.” In fact, for your reference, here is a list of the most overused words in all of the personal statements I’ve read:- Underserved
– Deep (deep interest, deep desire, deep need, deep understanding, deep fascination)
– Fascination, fascinating, fascinated (by the human body)
– Make a difference
– Persistence, Perseverance
– Cutting edge (research, technology)
– Scientific knowledge
– Saving lives; improving lives; quality of life
– My patients, my future patients
– Fueled, flamed, ignited, sparked, anything making fire a metaphor for you motivation or interest
- Do not talk about what qualities a good doctor should have, unless you have been asked to address this specifically in a secondary essay. You are not writing your personal statement to do the admissions committee a favor and educate them about health care. The personal statement is not a good platform to get philosophical about the practice of medicine.
- Do not use long or uncommon words. Even if you have a great vocabulary (not likely), give it a rest. Do not use a thesaurus. Use simple terms to avoid sounding pompous. Do not try to sound smart. If you are smart, it will show best in clear and concise writing.
- Do not use too many “ing” words. They sneak into your essay as present progressive verbs (i.e. “I was running…”[Forest Gump]) and as gerunds at the beginning of a clause or following a preposition (i.e “Learning is an art,” or “…the art of learning”). Use too many and your statement will flow like a kidney stone. Or, perhaps better said, using too many “ing” words ends up causing problems with the flowing of your writing.
- Avoid adverbs. You needn’t say “I ran quickly toward the door” because “ran” is already a quick action. You don’t need the adverb. Only use them if they actually modify, clarify, or enhance the verb or adjective with which they are paired. Adverbs make you sound verbose, which is uninteresting every single time. Instead use descriptive verbs and adjectives that require no modification.
- Do not talk about how many whales you have saved. Your service accomplishments should be listed in your application. Use your statement to answer “why medicine?” and to introduce things not covered elsewhere in your application. Don’t reiterate the litany that is your AMCAS application; instead, add depth to it.
Most people spend too much of the personal statement talking about things that appear elsewhere in the application. Readers do not like this, and it makes you seem either cocky, boring, or both. Talk about new things that will give the reader a sense of who you are. Remember, even on paper it is easy to tell when people are posing.