Doctors—the people behind the white coats, surgical masks, or at the other end of the endoscopes—are a strange breed of professionals. They study and sacrifice for years to practice the healing arts and sciences and most of them pay a heavy price in the process. That price is financial, psychological and physical, and is mitigated with the reasonably realistic promise of a high income at the end of the educational tunnel.
The typical mid-20th century view of a doctor was that of a white male, gentle and reassuring in nature and always quick to reassure and comfort the sick patient and his or her family. Think Marcus Welby, MD, if you are old enough to remember him. In the latter part of the last century, more women and minorities, thankfully, entered medicine to make the healing workforce more diverse. Today, more women and people of color practice medicine in the United States than at any other time since records on this were being kept. And with that change have come other evolutions in medical interactions and practice, related mostly to the way doctors communicate with you, record data about you and share information with each other. Some of this is really good, and some is not.
Consider this: You probably know much more about the person who cuts your hair than the person charged with watching out for your health. I’d bet that if I polled people on how long doctors train to become practicing generalists or specialists they would be way off in their estimation. Six years? Eight years? The truth, depending on specialty, is more like 12 to 15. Let’s see why this is so.
If we compare doctors to lawyers or accountants or other professionals, we see that doctors spend more time in school than anyone else, period, full stop. With a few exceptions, there’s four years of college…four years of medical or osteopathic school (that’s eight so far)…a year of internship (nine years)…and then a residency of anywhere from two to five five more years (11 to 14 years). There are even one- or two-year fellowships that can extend the educational process to the better part of a decade and a half. By the time many doctors get out of their training and actually see their own patients they can be in their late twenties to early thirties (I was an ancient 32 when I completed my anesthesiology program in 1989).
Contrast that with lawyers, who do four years of college and three years of law school—a piddling seven years to argue about everything under the sun. Or four or five years max for an accountant. And I have not even mentioned the standard examinations one must pass—tests in addition to all the ones taken as part of the coursework for college, medical school, internship and residency. Aside from the typical SAT or ACT test most every American student takes to enter college, the path in a physician’s career involves the MCAT (medical college admission test, taken during college), the three National Board of Medical Examiners exams (parts 1, 2 and 3 that lead up to licensure), and then the specialty board examinations. In my own case of the practice of anesthesiology, the board certification exam consisted of both written and oral examinations. You could not sit for the oral examination without first passing the written one. This is also the case in other specialties. And if that was not enough, there is movement to require recertification in some specialties every 10 years or so, the so-called MOCA (maintenance of certification) issue that has been raging in the courts. It’s no wonder people are rethinking whether they want to do the long med school haul these days.
And then there’s the debt. According to credible.com, eight out of 10 medical school graduates borrowed an average of $251,600 to earn their degrees (often at high interest rates) and 18% of the students had borrowed $300,000 or more. The same website estimated that the average time to repay medical school debt was 13 years. When you consider how old you are when you finish your training, a doctor might be close to or over 40 years of age when that debt is repaid.
If that’s not enough inducement to rethink medical school, consider the hours put in in training. Despite laws designed in the past few decades to limit interns’ and residents’ hours working, the Accreditation Council for Graduate Medical Education capped a work week for medical house officers (interns and residents) to 80 (!!) hours. This same organization set a limit to on-call frequency to no more than one every third night, a 30-hour maximum straight shift and a minimum of 10 hours off duty between shifts. Yes—that’s 30 hours working without sleep, rest, a change of clothes or a shower. “In my day”, as us old-timers like to say, it was much worse. There were no such limits imposed on on-call frequency, hours per week worked or rest between shifts. Even with the present system, life for a medical, surgical, obstetrical and other interns and residents can be exhausting and miserable.
And what can trainees in medicine expect as compensation for this 80-hour capped work week? According to Medscape’s Resident Salary and Debt Report 2019, the average pay rate for a medical resident was $61,200 dollars a year (mine was less than $15,000 in 1984), an increase of 3% from $59,300 in 2018. For an 80-hour workweek, admittedly an outlier, that comes to $14.71 an hour, less than my 19-year-old son is making working at Target after school. For a more realistic 60-hour-a-week pay rate, that comes to $19.61 per hour. What a pay hike that is.
There’s also the issue of continuing education. States, not the federal government, run the licensing boards for doctors. Therefore, each state sets a standard for how many hours of continuing medical education is required per year (or two years in some states) to maintain licensure. Certification exams, the exams that designate a practitioner as a diplomate of a certain specialty board, is another issue. It used to be that a doctor would take this exam once and be certified for life. Then there was a move by some boards to have the doctor recertify every 10 years or so, depending on the specialty board. That has been fought against many doctors in the courts as too onerous a standard to have to bear, and the doctors seem to have prevailed. This is an ongoing source of conflict and strife.
So, if you are considering a career in medicine, or just want to know what the person wearing the white coat went through to get there, consider what I have said. And appreciate it the next time you talk to your doctor.
For more with Dr. Sherer, click here for his podcast and video interviews, and here to buy his book, Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out