
Second-Chance Med School - dataminer
http://www.nytimes.com/2014/08/03/education/edlife/second-chance-med-school.html
======
bkeroack
Here's a big, dark secret: being a physician isn't really that hard. Sure,
there's a lot to learn. Yes there are some physical techniques that must be
mastered (lots if you want to become a surgeon). But the raw intellect
required is not especially high--anybody above the 66th percentile would
likely do just fine.

A long time ago I was in pre-med. Similar to the article, I got a 35 on my
MCAT. I know a lot of physicians. They're all very smart (because you have to
be to get into medical school). The vast majority of them are bored with
medicine. They do anything they can other than see patients. Some invest in
real estate, some manage other physicians in a group practice--there's one guy
who built a small datacenter and runs a business selling electronic medical
records systems as a service to other medical practices!

The point is--the practice of medicine kind of sucks. It's mostly the same
things over and over, with a lot of paperwork thrown in. Med school lures in
the young with the prestige attached to the magic letters "M.D." and because
med school is an ultra-exclusive club for smart people. The sick joke is that
after all the work and sacrifice and expense the job usually isn't worth it.
If you want to be a doctor, imagine yourself working in subsaharan Africa
helping the neediest, poorest people imaginable. If it doesn't sound like
something you'd want to do, you don't like medicine enough for the career path
to be worthwhile to you.

~~~
tomwalker
Very good post and I agree. The job is stressful, the individual liability is
extremely high and the sacrifice is not worth it for many. Often family
expectations are involved.

~~~
cpwright
One of the things that struck me about the article was how many of these
people wanted to take over a practice from a parent.

------
zxcvvcxz
Two fundamental arguments are being made in this thread: 1) some organization
is responsible for limiting MDs and this is a bad thing, and 2) MDs need to be
limited because there are not enough residency spots, hence students shouldn't
be allowed to start on a path leading to 4 years of study and massive debt but
not enough jobs.

I'd like to attack the counterpoint in #2, as I don't believe it to be in the
spirit of free market economics. The argument basically presumes that if
someone attains their medical education, they will have no career prospects
_except in those careers that already exist._ Anyone with even a slight
entrepreneurial bend must realize the ridiculousness of this. Ditto for anyone
who understands the concept "creative destruction".

Imagine for a second a parallel universe without an artificial cap on medical
students, where MD numbers overflow such that a bunch of MDs don't get
residency positions. Is it impossible to imagine new institutions, businesses
and services forming as a result? Another question then is how much innovation
could we be missing out on?

There are some instances where artificial caps are a good idea. I don't
believe education is one of them.

------
angersock
A really interesting bit is this photograph:

[http://static01.nyt.com/images/2014/08/03/education/edlife/0...](http://static01.nyt.com/images/2014/08/03/education/edlife/03CARIB-
BILL/CARIB-BILL-superJumbo.jpg)

Note that the currencies are local, and costs are listed up front.

~~~
Grazester
The currency use is the Eastern Caribbean Dollar(XCD) or called the ec dollar.
1USD = ~2.71 XCD

As for the safety concerns about Grenada. Its one of the fastest Caribbean
islands. You should be pre-cautious since as a foreigner you may be more of a
target but you wouldn't find yourself walking down a dodgy street at night in
your home country then why do it here in Grenada?

~~~
vermontdevil
> fastest Caribbean islands

Didn't know these islands can run. :)

I presume you mean fastest growing.

But like you said, if you are careful you'll be fine and that applies pretty
much everywhere even North Korea.

~~~
chris11
I'm assuming he meant safest.

~~~
Grazester
ahahaha safest and fastest(we are the current 400 metre Olympic gold medalist)

Yeah but I meant safest :)

------
lnanek2
I never really understood why the US has quotas intentionally preventing
students who are skilled enough from getting education here.

~~~
hackuser
As I understand it, there's a quota of med school spots, and it doesn't
increase with the population. Perhaps it's a way of keeping doctor's incomes
high (by reducing competition) and maintaining exclusive status?

~~~
pokpokpok
exclusive status and 80hr work weeks

~~~
copperx
I wonder if any doctor would be willing to get half their $250k for half the
work hours.

~~~
Cass
In countries where it's more socially accepted for doctors to work part time,
and where half a doctor's salary is a livable wage (i.e. you don't have to pay
off half a million dollars of student loans), a ton of doctors do, especially
women who want to stay home with their kids. Hell, here in Germany I know a
lot of residents who are happy to take half their €48.000 for half the work
hours. (I don't envy American doctor working hours, but I sure do envy their
salary.)

~~~
chimeracoder
> (I don't envy American doctor working hours, but I sure do envy their
> salary.)

Once you factor in the levels of debt they have at that point, you may not be
so envious: [http://www.cbsnews.com/news/1-million-mistake-becoming-a-
doc...](http://www.cbsnews.com/news/1-million-mistake-becoming-a-doctor/)

I can't remember where I saw the statistic, but the number of years it takes
for a physician to have a positive net worth after leaving medical school has
been increasing dramatically. (This is because debt from medical school and
undergraduate have increased nominally, while the expected income of a
physician has dropped dramatically[0])

[0] Again, the magnitude of this effect varies by state, but it's a nationwide
trend.

~~~
pcrh
Relative to the income received after qualifying, the debt incurred during
training is not so burdensome. That article you linked to cites the average
debt of newly qualified doctors as being ~$166,000, and their income averages
$270,000 pa., so about 5 months of wages.

~~~
chimeracoder
> Relative to the income received after qualifying, the debt incurred during
> training is not so burdensome. That article you linked to cites the average
> debt of newly qualified doctors as being ~$166,000, and their income
> averages $270,000 pa., so about 5 months of wages.

$166,000 is the average amount of debt upon _graduation_ [0] from medical
school. You spend several years training gruelling hours for a pittance as an
intern/resident/fellow (3 minimum, but after that you're only qualified for
the lowest-paying fields - the highest-paying ones require as much as ten
years of training).

Even someone who just completed their residency is highly unlikely to make
$270,000 (or anything close to that). It takes a long time to work your way up
to those sums.

A doctor who has paid off his/her debt by the age of 40 is the exception, not
the norm[1][2]. It's not unreasonable for a person considering medical school
to have to plan on taking about _30 years_ to pay it off[3].

I don't know about you, but I'd consider that burdensome.

[0]
[http://sls.downstate.edu/financial_aid/AverageDebtofMedicalS...](http://sls.downstate.edu/financial_aid/AverageDebtofMedicalSchoolGraduates.html)

[1] And this is assuming that they got a free ride for their undergraduate
degree and didn't have to pay tuition or take out any loans there.

[2] [http://forums.studentdoctor.net/threads/how-long-does-it-
tak...](http://forums.studentdoctor.net/threads/how-long-does-it-take-to-pay-
it-all-back.853448/)

[3]
[https://pay.reddit.com/r/personalfinance/comments/17iuse/how...](https://pay.reddit.com/r/personalfinance/comments/17iuse/how_long_is_it_typically_taking_medical_students/)

~~~
pcrh
That is how investment works. You invest money in order to gain a highly
lucrative career.

Your first link does not show numbers much different from the previous article
linked.

Your second link bemoans that a $100K income (which is below the median for
qualified physicians) "goes pretty quick" \-- try telling that to the average
American worker.

The reddit link doesn't contain anything substantive.

You state that the pay during residencies and fellowships is really low, but
in fact it is higher that the median US wage.

Qualifying as a physician in the US is one of the most secure ways to earn a
comfortable well above average income worldwide -- US physicians really have
nothing to complain about when it comes to finances.

~~~
chimeracoder
> Your first link does not show numbers much different from the previous
> article linked.

Correct. I cited that link because it more clearly shows that those numbers
refer to the debt upon graduation from medical school, not the date at which
the income numbers in the previous article become relevant (which comes
several years after the completion of residency).

I'm not sure why you selectively quote that one phrase from the second link
(which in context is _not_ saying that $100K isn't a lot; it's really just a
warning about how much worse it is to triple the principal on a debt with
compound interest), and yet ignore the clear evidence that it does, in fact,
take decades to pay off the debt (and even then, that's just to break even).
Even if you don't like those particular links, it's pretty easy to corroborate
that elsewhere.

Earning a "comfortable income" on paper is not very meaningful when you could
be well into your fifties and _still_ be behind where you would have been at
25 had you dropped out of college at 20 and gone to work for Wall Street or a
startup, or pretty much any other high paying job that someone of that caliber
would also be capable of. On top of that, as I already said, the income
statistics for private practice physicians don't factor in many of the costs
associated with maintaining a practice, so it's more like talking about the
revenue of a small business than the income of an individual.

Medicine isn't really that secure a job anymore, either, contrary to popular
belief. That's why so many practices have had to close in the last ten years,
and why physician salaries, for those not in private practice, have been on a
sharp decline.

It's really popular to hate on physicians for supposedly making a lot of money
for a supposedly cushy job. That may have been true once, but it's not really
true anymore, and it's becoming even less and less true very quickly.

~~~
pcrh
I am very familiar with the medical profession, I teach them and review their
grant and fellowship applications.

In no way conceivable is the debt incurred by medical students an irrational
one, unless they hate medicine and wish they had chosen a different career.

The only way on which the debt incurred becomes an _unusual_ burden is if they
don't subsequently obtain positions commensurate with their training.

Comparing the income of Wall Street traders to physicians is bogus, the skills
required are very different , and Wall Street is much more competitive and
cut-throat than the medical profession is.

"It's really popular to hate on physicians for supposedly making a lot of
money for a supposedly cushy job." Medicine is still a very well paid and
cushy job: try asking qualified lawyers doing document review for $20 an hour
with equivalent debt to newly trained physicians what they think of the
matter.

~~~
chimeracoder
> Comparing the income of Wall Street traders to physicians is bogus, the
> skills required are very different , and Wall Street is much more
> competitive and cut-throat than the medical profession is.

It's really not a bogus comparison. Comparing to the average wage of all
professions is meaningless, since a prospective doctor would be capable of
getting a top paying job if he decided not to go to medical school. The proper
comparison is between two jobs that a prospective doctor might choose.

More than half of all medical school applicants take a year or more off in
between college and medical school, and Wall Street and medical schools are
indirectly competing for a lot of the same talent - a person who decides
medical school is too heavy of a financial burden may very well choose to work
in finance instead. Students graduating from top-tier engineering schools, for
example, are prime candidates for both fields (and it is not uncommon for
someone with an engineering degree to work for a few years in finance before
deciding to go to medical school)

As I said before, it easily takes 30 years or more before medical school
starts to look like a good financial decision, and that's assuming you make it
that far without burning out and leaving the profession (as many do). That
time frame is increasing, not decreasing, which means medicine is becoming a
less attractive or sensible financial decision for the top-tier candidates,
who are theoretically the very people one would most want to be performing
one's open-heart surgery twenty years from now.

~~~
foobarqux
Specialist medicine beats finance in many ways, particularly lifestyle.
(Autonomy, work hours, vacation).

I don't believe the 30 year figure for specialists (Being a physician isn't
that great).

As always going to a top school changes the calculus significantly compared to
everywhere else.

~~~
chimeracoder
> Specialist medicine beats finance in many ways, particularly lifestyle.
> (Autonomy, work hours, vacation).

If you're in private practice, _maybe_ , but that's really not the case
anymore. And in any case, private practices are a dying breed. If you're an
employed doctor, you have essentially zero autonomy with regards to your
practice, your work hours aren't that flexible (or forgiving), and you don't
get that much vacation time.

What you describe certainly did apply to doctors one or two generations ago,
and still applies to some of the outliers today, but it's not true for the
vast majority of doctors anymore, and the direction of the trend is very clear
and has been for many years.

> As always going to a top school changes the calculus significantly compared
> to everywhere else.

Not as much as the residency and/or fellowship does. The top schools charge
more, but _ceteris paribus_ , the residency is a better predictor of how much
money you can make. Both of those effects, however, are swamped by whether or
not a doctor actually lasts long enough after their fellowship to become one
of those incredibly lucky high-earners. As much as people might not want to
believe it, specialty medicine _is_ a very competitive and cut-throat world,
and there's a reason that so many would-be doctors burn out before ever seeing
the thick paychecks referenced in this thread.

> I don't believe the 30 year figure for specialists

It's true, though if you choose not to believe it, I'm not going to argue the
point further.

------
HorizonXP
I wanted to be a medical doctor. I volunteered at hospitals, local first aid
groups, I even took the prerequisites (anatomy, organic chemistry, etc.) while
I was in undergrad for electrical engineering. My pie-in-the-sky hope was to
combine my knowledge and skillset in electrical and software engineering, with
medical training to create new innovations in medical technology. I didn't
know exactly what I was going to do, but I knew the path I wanted to take.
Heck, it's even why I did a Master's in medical imaging (didn't write my
thesis though.)

I wrote my MCATs, got a 33S, which I was super proud of. Had a 3.5 GPA. Not
stellar, but I thought it was good considering my workload and degree choice.
I applied all over Ontario, in hopes of getting in. I never even managed to
get an interview. I guess I shouldn't have bothered to believe the medical
schools when they said they look at each applicant holistically. They just
care about the raw numbers. I mean, it explains why the entrance average at
some Ontario medical schools is higher than even Harvard.

I gave up. Sure, I looked at the Caribbean schools. Plenty of my friends in
the sciences went there. My sister is there now. I looked at going to the US.
I didn't want to do that. I wanted to study in my home country. I mean, I am
who I am because of the investment of my fellow Canadians in me through their
tax dollars. I wanted to try and start to pay that back, while also continuing
to reap those benefits.

I lost hope in my Master's degree. I didn't see the point anymore. I became
depressed. Things were going downhill. I left the program, and took a few
months to pull myself together. I sought out help. I tried to go back to my
Master's program, but it was all for naught; I couldn't get back into it.

I tried going back to what I loved: creating things. I fleshed out my mobile
payments startup idea, went through a whirlwind ChallengePost competition,
lost, but had a ton of fun. Then I taught myself to create Android apps, and
took on a contract for a friend in San Francisco. Proposed to my girlfriend in
Rome with the money from that contract. Took on another contract doing Android
development in Palo Alto. Decided to go full-time, moved to Palo Alto.
Facebook bought us, and I worked at Instagram for a while. I left to pursue my
own ideas back in Toronto, having tremendous amounts of fun and success doing
it. Got married. Have an amazing wife, an amazing place, and amazing family.

Like I mentioned, my sister went to a Caribbean school. She's in Chicago right
now doing rotations. She went straight out of high school, so she'll be a
doctor before she's 26.

The Caribbean schools can definitely give a second-chance to folks really keen
on becoming a doctor. If you're truly passionate about helping the sick and
injured, do it. I decided I ultimately wasn't passionate enough about it. I
found my passion in my old love of software. And I'm grateful that I did.

~~~
hkmurakami
That's an amazing story. Glad everything worked out for you in the end! Many
of my friends are in medicine, and some of them lament that if they could do
it all over again, they would pursue some form of engineering. It's hindsight
bias of course, but the grind is just so bad in the states and the debt can be
crippling. 4 years undergrad, 4 years med school, 3 years residency, possible
2-3 year fellowship.

That's a really really long time for a person to have to grind through the
competition, the residency politics, etc in order to be able to finally make
it to a place where they can actually practice medicine. Apparently 95% of
doctors wouldn't recommend someone to pursue medicine today. It's
disheartening.

------
lucidrains
If there are any software engineers around the bay area who is thinking of
going into medicine, please come talk to me first. Would be happy to share my
experiences as someone who left after getting the degree.

~~~
dataminer
mdcases.net looks like a very interesting idea and can become a very valuable
resource, are you pursuing it full time?

~~~
lucidrains
not really, after a couple successful demos to UMich (we knew the doctors that
wanted this software), they put us in their pipelines for procurement, and
that was 6 months ago! we periodically poll them to see where we are in the
bureaucracy, but they keep giving us vague answers. selling to hospitals suck
dude, that's what i've realized.

I am working on another medical idea at the moment, a crowdsourced medical
expert system. I hope to unveil it on HN by the end of the summer!

