
Why you should not go to medical school - known
http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-should-not-go-to-medical-school-a-gleefully-biased-rant/
======
arn
So, surprisingly, this rant is more or less accurate, imo. (I went to med
school, residency, fellowship)

I mean some things stronger than others, but it hits on the major negatives as
you go through training. I know a lot of these rants tend to romanticize how
hard people's own professions are in a "no one else has it this hard" type
stance. We see similar "how hard it is to be a programmer" type rants as well.
But, I'll pull out the one aspect that I've always felt I lost.

"3) You will spend the best years of your life as a sleep-deprived, underpaid
slave."

I do feel like I missed being young (20s) and just having a regular job,
enjoying life with my friends. 4 years of medical school, and 3 years of
residency pretty much wipe out age 22-29. So I do regret that.

~~~
roentgen
I had a different experience. Medical school was easy, I was single and went
out drinking / partying two or three nights a week. Not to be crass, but I did
well with the ladies. Luckily I can get by on four hours of sleep or less. So,
I don't feel like I missed out on much of the early twenties experience. Most
of my non-medical friends had jobs and I didn't, but that was the only real
difference.

Things got a little more serious my intern year, but I still managed to go out
twice a week, and the nurses were much more responsive to my advances now that
I was doctor.

At the start of my residency I got serious with a girl from my medical school.
Her training was in Psychiatry and I was in Radiology. We worked a minimum of
80 hours a week, but we always had time for each other. We got married during
third year.

Now I'm a partner in a successful practice, and she's taking a few years off
to raise the kids. I make over 800k a year, and take 14 weeks of vacation. I
don't deal with patients. I have the ultimate job security. And, I am a
tremendous resource for my family. I'm sure you know how easy it is to get
screwed by the medical system. That won't happen to me or mine.

I'm not a risk taker, so what else could I be doing with the security and
benefits of my current job? Lawyer, maybe.

~~~
patrickgzill
Thank you for your honesty.

May I ask, what exactly do you do that you feel justifies your 800k per year?
It seems to me that your career is ripe for disruption.

~~~
sp332
Generally, rare goods - and skills - are valuable. So going to school for a
long time to learn an unusual skill well means that your services are more
valuable.

Also, providing a large amount of value in a small amount of time (like
accurately interpreting the results of a scan) leads to providing huge amounts
of value over the course of a year. Part of the explanation is the sheer
volume of individuals he can give a reasonable amount of value to.

~~~
startupcomment
Wouldn't radiological and physician services, in general, be less "rare" if
medical schools started to train more physicians (admit more students)? I have
read studies that suggest that in certain markets and certain practice
specialties we are and will face shortages of physicians in part because
medical schools are training too few physicians. When I ask academic
physicians they seem to think admitting more students would erode the quality
of students. In other words, scarcity is a public good in this case as it
helps to ensure that the "most talented" will ultimately become practitioners.
I don't know how this view squares with the large number of foreign-trained
residents in some residency programs.

~~~
nostromo
The Planet Money podcast covered this topic once. In proper markets,
increasing the supply of a good or service decreases its cost. However, in the
US, the more doctors we train, the more we spend on healthcare.

A reason this is the case is because the average healthcare consumer is
totally removed from the cost of healthcare and the doctor has a perverse
incentive to make work for him or herself and other specialists.

------
codexon
The reason why it is so hard to become a doctor is because the AMA restricts
the number of applicants and schools that can create doctors so wages can
remain artificially high.

[http://www.forbes.com/2009/08/25/american-medical-
associatio...](http://www.forbes.com/2009/08/25/american-medical-association-
opinions-columnists-shikha-dalmia_print.html)

[http://gregmankiw.blogspot.com/2009/06/physicians-incomes-
an...](http://gregmankiw.blogspot.com/2009/06/physicians-incomes-and-
healthcare-costs.html)

~~~
michaelochurch
That post should go straight to the top.

This is also why residents have to suffer ridiculous hours. With the severe
limitations on the number of people who can become doctors, the profession is
characterized by an extreme workload.

It's seriously wrong. I, for one, would not want to be operated on by a
surgeon who'd been working for 21 hours straight. Commercial pilots are
limited to 40 flight hours per month, and what they do is a lot less complex
than what doctors have to do.

~~~
pavel_lishin
So, effectively pilots are only working 1/4th of the time that I work? Or is
there non-flight-time work that eats up 120 more hours a month?

~~~
michaelochurch
There's a fair amount of non-flight work. It'd say that it averages 120 hours
of work time total per month. Less than we work, but with worse hours.

If you fly international with the majors, you're in good shape. Those guys
make $200k easily, but those jobs are essentially inaccessible because the
people who get them never retire. The rest make very little, and work a lot
harder.

~~~
pavel_lishin
What sort of non-flight work do they do? I'm honestly curious, and I don't
know any professional pilots. I imagine there's paperwork to fill out before
and after every flight, and maybe mandatory training...

~~~
mahyarm
Walking around airports, going through customs, switching planes, waiting for
matinee, paperwork, hotels, etc.

------
BenoitEssiambre
I'm married to a resident and this article is a very accurate portrayal of a
resident's life. Her work schedule is insane. It's not just the amount of
hours but the fact that these hours are packed and spent with difficult people
and life or death situations. After a day of work she often mentions she
didn't have time to eat or pee during the day. She has had some call shifts
that lasted 40h strait (more than 3 days) where she got only 3 to 4 hours
sleep breaks per night plus a few eating breaks here and there because it was
busy the whole time. That meant no time for a shower in those three days, only
superficial cleanups and quick change of scrubs when things got too
bloody/amniotic.

~~~
jseliger
I'm dating a resident.

Also, anyone thinking about medicine should realize how little autonomy they
have. When my girlfriend explained how residency works, I was shocked: it
sounded like a circumstance ripe for an anti-trust lawsuit. Turns out it was
the subject of a lawsuit: [http://www.nytimes.com/2004/08/14/us/antitrust-
lawsuit-over-...](http://www.nytimes.com/2004/08/14/us/antitrust-lawsuit-over-
medical-residency-system-is-dismissed.html) , but one that Congress and
President Bush granted an anti-trust exemption. So residents can't even
negotiate outside the match. The legal barriers to medicine help explain why
it's so miserable.

------
adrianwaj
Great article and on point.

A former flatmate of mine committed suicide about 1.5 years after I left the
flat, which I did due to his erratic and hostile behavior toward me, which I
think was due to a number of factors, but mainly his stress from an intense
hospital residency while he also did further study simultaneously.

There's an article mentioning him here:
<http://vitualis.files.wordpress.com/2006/09/action_vow.pdf>

The danger zone for med students is when they sacrifice themselves and
tolerate all the reasons that the Harvard article states why not to go to med
school, because of the idealistic notion that:

"You have only ever envisioned yourself as a doctor and can only derive
professional fulfillment in life by taking care of sick people."

As such, these smart and ambitious med students shoot for the moon, and due to
the reasons in the article, realize that they won't make the moon (ie earn
that fellowship, obtain that degree, receive that certification, get that
promotion) and then they feel that their life is a failure, or won't have any
further meaning the way they wanted it to, and then they kill themselves,
because they have no exit strategy (or plan B) and are ill themselves.

There's nothing noble about the suicide of med students and interns, but I've
seen how it happens right up close. I have further thoughts on the matter but
that's the core of my experience regarding the negatives of this career path.

------
Confusion
There is not a doubt in my mind that this schedule ensures that they learn
less and perform their jobs in much worse ways than compared to when they
would be able to get more sleep and less stress. There's zounds of experiments
that back me up on this.

As far people saying it's cheap labor: when residents make mistakes and the
hospital gets sued, the labor suddenly isn't so cheap anymore. Again, there is
not a doubt in my mind that this practice leads to a lot of damage and death,
with the associated financial fallout.

That hospital management doesn't try to change this shows how blind they are
to the consequences of entrenched practices. I wonder whether the health care
market could be disrupted merely by creating hospitals that actually try to
get their employees to perform optimally.

------
boas
I personally have been very happy with my decision to go into medicine
(specifically, interventional radiology). I have a few comments about this
discussion:

1\. The average radiologist gets paid about $40 (after expenses) to read a CT
scan. So you have to read a LOT of scans to make as much as roentgen. Many
scans contain hundreds of images, and the diagnosis can depend on just a few
pixels. Partly based on the radiologist's diagnosis, the patient may need to
go to surgery (at least $25,000) or need another round of chemotherapy
($50,000), etc. When viewed in this context, I think $40 is a great value for
getting an expert opinion. (As a side note, there is a lot of regional
variation in salaries. They are probably lowest in New York City. Contrast
that to law or finance, where the highest salaries are probably in New York
City. I think the difference is due to the fact that medicine (even radiology)
is practiced locally, and thus depends on local supply and demand, and does
not have the kind of network effects that you see in law or finance.)

2\. In terms of disruptive technologies in radiology, I don't think that
computers will be able to replace radiologists any time soon, but there are
lots of ways that computers could help radiologists be more productive or
accurate. Much of the advances in consumer technology from the past decade are
not yet available in radiology. Images are usually transferred to another
hospital by mailing a CD. Reports are transferred using a fax machine. We're
lucky if we can get 10 frames per second when scrolling through a large study.
Computer systems are not linked -- ie, we have to type the patient's name into
both the radiology system and the medical records system. For various reasons,
many of these problems will have to be solved by big companies and not
startups. But there are other opportunities for startups. If you're
interested, check out my startup <http://www.revisionrads.com>.

------
jobu
Some of the comments on that page are even better than the main article/rant:

 _"Last note, what bullshit is it that your plumber can charge whatever he
wants to unclog your drain, but if I replace both knees the insurance
companies automatically take 50% off the second. What am I, fucking Payless?"_

~~~
_delirium
That's not a great analogy. The insurance companies have _negotiated_ a fixed
rate with the hospital, and so if you work for the hospital, of course you
must honor it. Same as if you were a plumber working for a large plumbing
corporation, which had a contract with its clients. In that case, if you
unclogged the drains at BigCorp, you would not be able to charge whatever you
want, but only the rate BigCorp had negotiated with your employer.

------
carbocation
So I owe HN a blog post. Here is something of a stopgap.

I am (still) a medical student at Johns Hopkins, and I love the place very
much. I have for the past 6+ years.

After my third year, essentially on a whim (my sponsor, I think, knows this) I
pursued a research fellowship in cardiovascular genetics. I loved it a lot,
and stayed on a second year (spontaneously; thank you, Stanley and Lola J.
Sarnoff).

After my fifth year in medical school, my second year of CV genetics up at MGH
and the Broad Institute, I got the opportunity to pursue the startup dream for
a year. I'm midway through and absolutely loving it.

But yet, I miss medicine. And I think that the grass is always greener, so I
think I will miss whatever I'm not doing. Next year, in medical school for the
first time in three years, I will miss research. Or I will miss the startup
life. Something. I know it, because right now, I miss the hospital.

I miss working 80 hours a week while paying $50,000 a year for the privilege.
I miss having a best answer (and if you think there are better answers in
software than there are in medicine, please email me so I can hire you).

But I know that soon, I will miss the freedom of working at a startup. There
is no right answer for everyone. And for many of us who were drawn to
medicine, I think there can be no possible right answer, ever.

------
mrrres
Married to a final year surgery resident and unfortunately this article rings
very true. I'm not sure if the profession changed at some point, but if we
were advising my kid now on future professions, doctor would not be on that
list. I remember the idealism that my wife went into the profession with and
that is completely gone now. I find that very sad.

------
djacobs
Well said.

After four years of gearing up to go to medical school, I dropped that goal
and went into software engineering. I wrote about this choice pretty
extensively, as it was not an excruciating decision [0]. In spite of how much
I really wanted med school, I also wanted a life. I tried to maintain a life
while applying to med school, full of all the hobbies that make my life fun,
but balancing those two wasn't actually possible. So I chose to reclaim my
life.

Reading this piece is refreshing--I haven't seen enough people talk about the
trade-offs of a physician. A lot of people in software think "I would have a
meaningful life if I were in medicine"--and they probably have the smarts to
be in medicine--but I think we should combat the idea that moving in that
direction makes for a life that's any more fulfilling than engineering.

[0]: [http://wit.io/posts/pivot-my-journey-from-medicine-into-
tech...](http://wit.io/posts/pivot-my-journey-from-medicine-into-technology)

------
ofca
They should be treated as Flight controllors. My friend is one and ,it being a
high-risk job like being a doctor, they have 8hr workdays with 2 hours of
working and 2 hours of resting, and their salaries are sky-high. So sad all
those smart,kind and hard-working people are being so used.

(plus, so glad I didn't end up in med school, I almost did :)

~~~
mattm
Do you know how they settled on the 2 hours on/2 hours off deal? I'm
interested in alternative working hours to improve productivity and would be
interested in knowing more about their schedules.

------
kingkawn
I started the med school track late in life (27 when I started taking premed
classes), and while I haven't finished, I have to say that all of the
complaining I hear from fellow students and doctors is ridiculous. All careers
take up lots of your life. All careers end up dominating your social circles.
All careers leave you feeling underpaid, including the people I know in
finance who makes tons of money and work 12 hours a day 7 days a week minimum.
Life is hard. I'm glad I took a lot of my 20's to experience that in other
ways, so now that I've come to the medicine path, it really feels great. I
agree that the decision to do this is not one that an 18 year old starting
undergrad should make. But nonetheless, medicine is no worse than anything
else.

~~~
DTrejo
Did you read the article?

~~~
kingkawn
No of course not I'm studying to be a doctor.

~~~
fadzlan
Kinda explains.

------
jevinskie
Was it always this bad? Was the process of becoming a doctor more sane in the
past?

------
MrVitaliy
What would be the picture of perfect 22-29 span? Being born with a silver
spoon in a mouth? Partying every day?

I'm a CS grad student, married to med student. While our schedules are
different, there isn't much difference in time. I'm mostly occupied with
reading papers, grading papers, doing homework, grading homework and generally
providing very cheap labor in a form of research assistantship and teaching
assistantship to university.

To me, the experience of every point the author mentions is the sole reason
for existence between 20-30 years of age.

------
daylast
The most telling part of this article is point #8 (which basically says you
will end up blaming and then eventually disliking the patients for your sad
lot as a modern day doctor). What I find amusing here (and so comically
characteristic of a Doctor's absurd notion of self-importance) is that the
author so completely lacks the capacity for self-introspection that he doesn't
even realize the truth of who is to blame.

To all the doctors out there that feel the same way as this author does I have
one message for you. The only person to fucking blame is YOU!!!

Guess what? You're the one who made the decision to go into medicine and so
you're the person at fault for the sad state of affairs in the modern medical
profession. It's your fault for failing to do your due diligence on the
demands and rewards of the profession. Why didn't you do your due diligence?
You probably had some romantic notion of what it would be like as a Doc. Or
possibly you went into medicine to make your parents happy? Or you thought it
was a respected profession, or you simply wanted to help folks in need because
it's an altruistic pursuit.

Well, sorry buddy, but all those things aren't an excuse for not doing your
due diligence. It get's worse though...

At the macro level it's a self-reinforcing cycle. The lack of due diligence
happens so frequently and by so many aspiring docs, it has repercussions on
the profession as a whole. At the aggregate level, it causes wages to fall and
working conditions to get worse for docs and interns (since the demand for
medical school entrance remains strong regardless of conditions or wages).

You think just because you got good grades and got into med school that makes
you smart? Ummm...no. And that is why Doctors get paid less than - and have
more difficult working conditions than - Investment bankers. The type of
person who goes into I-banking is smart enough and introspective enough to do
their due diligence. The type of person who goes into medicine isn't.

------
shabble
As a complete aside, the _Piecework_ article by Atul Gawande linked from the
story has now been archived, and they broke the original URL.

Working version at <http://www.newyorker.com/archive/2005/04/04/050404fa_fact>

------
skrebbel
wait, so, in the US a programmer earns double what a doctor earns?

~~~
learc83
No, not at all the average doctor's salary is more than twice the average
programmers salary.

~~~
skrebbel
The article lists $45,000 per year for doctors. Programmer polls on HN showed
that $100,000 is little.

What am I missing? :-)

~~~
tsotha
$45/year for residents. At that point you're still basically an apprentice
doctor.

~~~
skrebbel
Right. Turns out I completely misunderstood every sentence that contains
"resident" in that article, then :-)

Thanks for pointing it all out. Does make his argument about the bad money
bogus though. Nearly every other job is worse money than being a doctor (which
is why he compared to investment bankers and the likes)

~~~
mootothemax
_Does make his argument about the bad money bogus though. Nearly every other
job is worse money than being a doctor_

If you worked those other jobs for 80 hours a week, I think you'd start
catching up pretty quickly ;-)

~~~
hugh3
Yeah, but in medicine, by the time you're making the big money you're working
much less. Or on whatever schedule you like.

At the age of 29: $45,000 for eighty hours a week.

At the age of 49: $600,000 for forty hours a week.

------
logjam
I practice, but most of this article rings true for me as well, and I think
most of my colleagues would consider me pretty idealistic.

Residency training is mostly cheap labor for hospitals. Working 36 hours
straight every third or fourth night (common when I was a resident) saves
teaching hospitals from hiring night floats or other coverage. Trying to make
any kind of important decision for another human's medical care after you've
been up for 24 hours is like trying to do so after several shots of alcohol.
Such a schedule does not teach efficiently, endangers patients, and stresses
the mental and physical health of physicians. There have been new work rules
supposedly limiting residents to 80 hour work weeks, but they are routinely
ignored.

Physicians spend most of their time trying to bring order to chaos. Regardless
of a physician's specialty, I daresay each was shocked to learn how much time
he/she spends basically just trying to simply coax new behaviors in patients -
as such, performing at some level as psychiatrists (who I respect greatly -
tough work). That's the challenge; everything else is pretty much plumbing.
Either you find that work interesting (and it can be) or you soon get pretty
burned out dealing with humans as they are, and they are obviously at their
(usually temporary) worst much of the time when they need medical care.

My own colleagues are the best people I know - I still see the driving
compassion there on a daily basis, and I think that's true for the great
majority of docs. On the other hand, I've met a few physicians who would be
happiest in concentration camps performing medical experiments on the inmates.

~~~
mahyarm
It's ironic that it doesn't have to be this way at all. It's counter
productive other than it makes someone richer. Doctors want to keep their high
prices with artificial barriers such as these and the glamor keeps the supply
relatively high.

~~~
fossuser
The long hours and over working is more a factor of a hospital trying to save
money than having anything to do with supposed 'price controls' being
purposefully set up by doctors. The price comes mostly as a factor of the
extremely expensive education (both in cost and time) that is necessary. If
you want talented people in any field, especially one with such a laboring
path of entry, you have to pay them well.

~~~
mahyarm
If the kids had choices, they would not choose hospitals where shifts are 40
hours long and only sleep of 6 hours out of those 40 every thing else being
equal. They don't, because of the power that the hospitals have over residents
in granting their licence and the cultural ubiquity in practice.

Similarly, there are very limited spaces to enter medical school and it's
extremely difficult to enter. How many new orthodontists are trained in a
year? Under a 100? In a country of 300 million people? On top of that, medical
school is very expensive. On top of that, you have to go to university for 3-4
years before you can even enter med school.

Imagine if engineering degrees were like that, because they could of been.
Similarly with accounting or finance. Maybe they're not because the math heavy
nature is enough of a barrier, even the simple math of accounting. American
medical schools (and doctor associations) could choose to structure their
curriculums to be similar to an engineering degree, admit high school students
and make the education be 5-6 years long, teach in the summer, whatever. I'm
fairly sure the UK does that, and I'm not sure if they haze their residents
too with 40 hour shifts. They can also release the spigot, hire more teachers
and teach more students to increase the supply of doctors. The increased
supply of doctors will lead in a decrease of overall doctor wages and decrease
health care costs. That along with an FDA drug approval process that doesn't
cost 200 million and more clearly defined and easy to avoid malpractice rules
(as in it's not easy to commit malpractice by mistake) would lead to huge
systemic decreases in US health care costs alone.

Don't tell me it's about wanting the best, because treating people with sleep
deprived residents is negligent. That is no where near the best care for any
sort of patient. The best will just walk away once they know that they can
make more money doing less work in i-banking, tech, petroleum, engineering, or
business in far nicer environments, and they do by droves.

~~~
arethuza
Medical degrees are first degrees in the UK:

[http://en.wikipedia.org/wiki/Medical_school_in_the_United_Ki...](http://en.wikipedia.org/wiki/Medical_school_in_the_United_Kingdom)

I believe traditionally junior doctors in the UK were also made to work
extremely long hours - there have been efforts to change this recently.

------
jsavimbi
> You should become a doc because you always wanted to work for Medecins Sans
> Frontières and your life will be half-lived without that.

Everything else was just whiny bullshit.

------
grey666
We all hate people. It's because people have no common sense anymore. People
don't respect the Earth anymore. It's all about greed... and greed is and has
always been the seed of all Evil. Combine greed with a constant influx of
media and interruption, you get zombies.

It's never going to change. We are left here on this lonely planet to our own
devices - we were warned about greed, but greed has in fact taken over.

The 90's saw the most productive and the most lucrative period in the history
of mankind. We take it for granted. The truth is - to live in the USA during
the 90's was the pinnacle of human civilization and it will never be that way
again. It was unsustainable.

We are in a death spiral, there will be casualties. Those that cannot adapt
will be sacrificed. Gasoline has been replaced by the Internet and global
marketing. Gasoline is obsolete.

Gasoline is obsolete. Because it's cheaper to hire foreign workers via the
Internet than it is to make cubicles in the USA.

------
chime
One could say the same for any given field from sports to programming to
business to pet-sitting. It's a hard knock life for us all. None of these
reasons should have stopped any decent doctor from taking the path. The single
reason would be: Don't go into medical school if you care more about money and
an easy-going life than the actual field and people involved. And the same
applies to every single field.

~~~
niels_olson
> One could say the same goes for any given field

Please name a sport, business, or other profession that involves staying up 40
hours straight unshowered, unfed, on a routine basis, for years, trying to not
die or get anyone killed.

I can think of only two: medicine and the military. I do both. They're roughly
equal. Given the choice between residency and deployment, I would need more
information.

edit: Actually, I'm facing that choice now: do I apply for residency or orders
which will probably involve going to Afghanistan. I'm leaning toward
Afghanistan.

~~~
bootload
_"... Please name a sport, business, or other profession that involves staying
up 40 hours straight unshowered, unfed, on a routine basis, for years, trying
to not die or get anyone killed. ..."_

<http://en.wikipedia.org/wiki/Infantry>

~~~
mpyne
So... the military, just as the commenter you replied to already noted?

