There’s an old joke regarding different cultures’ interpretation as to when a fetus is considered alive.
The broadest definition of the beginning of life pinpoints the date at conception.
Others target a later date – namely, viability outside the womb.
But, the longest delay for the ‘beginning of life” is when the “person” graduates from medical school.
I hear two stories from doctors.
Some believe medicine is still a noble calling. A career in medicine delivers significant professional satisfaction. It pays well. And it comes with significant social stature.
Others believe medicine hit its peak years ago and today is a formula for frustration and professional burnout. And the pay and stature are pittances compared to what similarly situated smart people can earn in the marketplace.
These two narratives inform doctors in recommending what type of careers their children should pursue.
About half of us are still recommending a career in medicine for our kids.
The other half are arguing to steer clear.
There’s little doubt medicine has changed over the past two generations. And some specialties are experiencing higher burnout than others.
What is inarguable is that getting into medical school is hard; really hard.
According to the most recent data from U.S. News & World Report, the average acceptance rate for medical school hovers around 5.8 percent in the U.S. At the country’s 10 most competitive medical schools, meanwhile, this number drops to 2.6 percent.
Which begs the question: What is the admittance rate at the hardest school to get into? A staggering 1.8 percent: Just 86 of 4,802 applicants got in at 2016-2017.
Even schools with comparatively “high” acceptance rates reported staggeringly low numbers. Specifically, just 14 percent of applicants were admitted to the medical school with the most favorable acceptance rates.
Of course, prospective students submit applications to more than one program. And that improves the odds of getting into at least one school.
Now let’s look at the mathematics behind applying to medical schools. Let’s assume a particular applicant applies to 15 medical schools and has an 8% acceptance chance at all of them (8% is pretty reasonable for a qualified student). Given those variables, the student has a 71% (1-.92^15) chance, at getting into at least one medical school. If that same applicant applied to 20 medical schools, the chance would jump to 81%. Furthermore, if the applicant applied to 25 schools, the chance would rise to 88%.
Still, unless the applicant is reasonably qualified, he/she will not get past the gate.
So, insiders are not as enthusiastic in recommending medical school as we have been in the past. Nonetheless, more and more people are working hard to become insiders.
What do you think?
ABOUT THE AUTHOR
Jeffrey Segal, MD, JD
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
If you have a medico-legal question, write to Medical Justice at infonews@medicaljustice-staging.shfpvdx8-liquidwebsites.com.
Whenever invited to present at a Career Day, I tell students that if they want to go into health care, they should become PA’s. No 4 years wasted in medical school with medical school debt; earn 80% of MD; 40 hr work week with union protection; no malpractice headaches nor risk of bankruptcy; no 4 – 9 years wasted in residency. Becoming an MD is a lose/lose proposition.
I stopped excepting career day invitations more than 10 years ago, once things turned really sour for me. I agree 100% with advising those who are committed to health care that they are better off becoming physician assistants or nurse practitioners. At the rate things are going, the autonomy that extenders are granted will only increase as the autonomy that physicians used to enjoy will continue to disintegrate. Medical schools continue to deceive applicants by convincing them that there is a “doctor shortage” in this country. What does exist, is a maldistribution of physicians. There will not be a doctor shortage because number one, medical needs are increasingly being met by extenders, and secondly, physician needs will be met increasingly by foreign-trained physicians who care less than we do about the increasing abuse to which we have been exposed over the past 2 decades. Those individuals who remain enthusiastic about entering the medical field today are simply ignorant. I hear all the time from colleagues who interview prospective students how idealistic they are, yet have absolutely no clue about the treacherous path they wish to pursue. I consider myself very lucky to have been able to exit clinical practice, and reinvent myself.
Agreed – we will see just how much of a shortage there is if/when health care goes back to capitation (new name = bundled payment). The new incentive will be to do as little as possible
The wealthy will have access to private doctors and hospitals (unless illegal Canada style) and being a private doctor could be enjoyable and reasonably lucrative
If Medicare and inscos allowed balance billing we would see just what kind of free market there is with a theoretical price floor and preservation of access. No more paying the same to bad surgeon as good one.
Another scenario will utilize AI, extenders and FMG / non US trained surgeons who would gladly hack away for 25 cents on the dollar
My wife and I each accumulated over $200k in student loans to become physicians. We ran our own practice for six years, and saw the reimbursements decrease, and at the same time the requirements to get paid by insurance increase.
We specialized in a procedure that functions as a prosthetic cornea, giving patients that were once legally blind, vision to drive once again, yet each year the insurance cut our rates,
When we sold our practice this year, the reimbursements from most insurance companies didn’t even allow us to break even for this life changing procedure.
We have started our own business outside of healthcare and love life once again!
I wouldn’t recommend any job in healthcare to anyone if health insurance companies are directly involved in the determination of his or her pay.
You were able to sell your practice? I’m amazed!
A very unique situation indeed, as so few physicians today have the freedom to maintain their own practice. Congratulations.
I retired 5 years ago from a 43 year career as an Oral & Maxillofacial Surgeon. I had a very happy, rewarding career which included private group practice, private single doctor practice and academics both full and part-time. I was somewhat disappointed that my sons were not interested in going into medicine or dentistry, especially Oral & Maxillofacial Surgery. They thought I spent too many hours working. Now they put in as many or more hours than I did.
I found that during my last years of practice, insurance companies were having an increasing influence on the practice. But I was able to make a better than average income and still enjoy what I was doing. The surgeon who bought the practice has been very successful as well and was easily able to handle the debt of her schooling and the purchase while earning a good living.
I guess a lot has to do with the specialty you choose. I think that I wouldn’t discourage my grandchildren from choosing a career in medicine or dentistry.
I told both my children that I would break both of their legs if they went into medicine. Fortunately neither of them was interested in medicine, and neither had the aptitude or interest or grades to go into medicine. Unfortunately unless one is in a concierge medicine practice or something similar, medicine is just not worth the hassle and headache in most cases. If one is going to go into medicine, one must be prepared to be told what to do by administrators.
When my kids were growing up I was an emergency doc in the regional trauma center, and took my turn as managing partner of my group, and later as hospital credentials chief. None of my kids showed one minute’s interest in medicine as a career. I guess the gauntlet that is Emergency Medicine didn’t look too appetizing.
It’s no longer a lucrative profession for anyone other than those who are born into independently wealthy families who can afford to chase a “dream” profession (if you want to look at only the positives without the risks). There is plenty of money to be made in medicine, but not as a doctor. There are many other areas where you can have a rewarding and balanced career. None of our three kids is considering anything close to being a physician, having watched what our family has had to endure.
No, I tell my daughtes not to become doctors, physician or dentist, not that they’re interested anyway. I explain to them, and any other young person considering becoming a doctor, they will going to be facing the prospect of being an employee of a corporation…just another cog in the wheel, but with all the potential liability and debt. And while we hear about great shortages to those considered “underserved” , what we truly face is a shortage free healthcare, as the population is getting more and more accustomed to not being responsible for participating in the cost of their care.
Another radioactive issue with respect to admissions is that classes are 50% women and full of “diversity hires” which significantly degrades the quality and quantity of MD workforce all for political reasons
Plenty of well qualified people who would be highly productive and effective are shunted aside
Becoming a physician is a “calling”. Either you’ve got it or you don’t. Even with the emasculation of physicians, and the growing restraints and governmental control, I would support any of my kids who wish to become members of the tribe. At least I’ve got a skill to teach, and I’m more than content with my job. Thank you.
We are mad as hell and not going to do this anymore!
Let the bureaucrats cover the ER.
Interesting numbers in your article. I would like to point out that he probability of getting into each school is not independent of the other. What I mean is that if you get into one school, you’re likely to get into others also. Thus you must have the qualifications for acceptance and applying to more schools does not increase your odds of acceptance if you’re not qualified. In your hypothetical example, you increased the application from 15 to 20 schools and increased the acceptance rate. Statistically this is not possible because the odds of getting into one school are not independent of the odds of getting into another school due to qualification requirements. Overall good article. I just wanted to point out the statistical fact about dependent probabilities.
Guys, your whining is embarrassing! I am sixty years old, and I have been in medicine for about two thirds of my life: first as a paramedic, now as a private Ob-Gyn. I thank god every day for having the privilege to dedicate my professional life to those who need it.
I work mainly with recipients of public assistance (MedicAid etc.) Reimbursement may be lower than in the past, but my kids still do not go hungry. We all have a roof over our heads – and even a couple of used SUV, all paid for. Granted, an insurance company CEO makes much more money than I do. But his or her only joy in life is probably counting that money. Totally meaningless.
My joy is sending the new moms home. I have very high risk patients, and together we go through grueling pregnancies. After the pregnancy reaches a successful end, I have the privilege of sending them on their way with their new, usually healthy baby. I humbly acknowledge that many other physicians or mid-levels could have achieved the same results, but that acknowledgement does not lessen my joy.
I have practiced in the same town (Fresno) for a quarter of a century. I have seen the babies I delivered brought in by their moms when they freak out about their first period. Then they come on their own because they started a relationship and are worried about STD’s and contraception. Finally, they return when it is their turn to have a baby. There is no insurance CEO salary that provides anywhere near the satisfaction as being able to become a partner is health with those women and families for decades.
My younger daughter is now in pre-med. Like me, she realized that medicine is by far the best profession. She studies and works through long days and night, missing much of the partying that other kids her age enjoy, all with the hope that one day she would be able to dedicate her life to serve others. MCAT and applications – next year…
So all of my whining colleagues: you want to make more money? You will not be able to take it with you where you are going to at the end. You think you work too hard? You will get plenty of rest when it is all over. For now, remember what made you choose a medical career in the first place, and remember how much effort you put into getting to where you are today. You got into it because you wanted to do good. Now you can. Do good for others – it will to good for you. Enjoy your chosen profession. It is the best one!
With all due respect, I do not believe that anyone in this chat went to medical school doubting that they would be able to feed their family and have a roof over their heads. People who never went to college are able to feed their families and obtain adequate shelter. This is about reaping rewards for our efforts. The current ROE for becoming a physician is plummeting. If the same ROI existed for other careers, most of the population would choose to go on welfare.
October 20, 2018
MedicalJustice.com
Re a recent article ( 10/18-2018?) –“Do you want your kid to be a doctor” by Jeffrey Segal, MD, JD:
I am not sure of what ‘reasonably qualified’ means for aspirants to medical school—reasonably qualified for medical research or to be a practicing physician?
My understanding is that medical schools’ primary interest since the Flexner Report of 1920 has been in medical research. That report based on Abraham Flexner’ studies on the deficiencies of medical education at the time—no full time teachers, poor laboratory facilities, little basic science instruction, and poorly prepared students—sparked a revolution in medical education.
But Flexner (who was not a physician) later on thought that the system had over-emphasized the scientific and underemphasized the practical aspects of medical practice.
One of his contemporaries, Sir William Osler, a recognized physician and author of a medical textbook and one of the founders of Johns Hopkins, believed that medical research should be conducted in ‘institutes’ and medical practice taught in hospitals by community physicians.
It’s interesting to speculate what our health system would look like today if Osler’s ideas and not Flexner’s had been the blueprint.
Almost certainly, the implications of reasonably qualified’ would mean something different than whatever it means today.
Edward Volpintesta MD