Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, August 20, 2009


Reams have been written on how medical students ought to select their field of medicine. There are even personality-type tests that ask questions about what kinds of situations you like, how you react to problems, and your working style that purport to predict for which specialty you are suited. (I came up as an oncologist or a nephrologist.)

Others have opined that once you crunch the lifetime salary numbers, and then compare those to the intangible lifestyle factors, avoiding Family Practice and other primary care specialties is a "no-brainer."

I beg to differ.

So much of life has involves things you can't count, add up or analyze on a spreadsheet. In terms of financial return, no one ought to be going into medicine when there are so many faster, more effective ways of simply amassing the benjamins. For all the hullaballoo about the sorry state of medical education today, there is still altruism aplenty to be found in the candidate pool. As tired and trite as it sounds, people really still go into medicine to help people.

I'm not saying that all doctors don't help people, but the opportunity afforded by family practice and other primary care disciplines to form long-term relationships with patients* makes our job qualitatively different from that of other medical specialties. Despite the fact that so few students are actually entering family practice, I cannot help but believe that many more of them would find it incredibly rewarding. It seems to me that too many of them are scared off by "rational" discussions from their peers and immediate superiors about the financial and alleged lifestyle drawbacks.

I also believe that there are plenty of specialists out there who aren't exactly unhappy with their career choices, but who may have the sense that they aren't as happy as they could have been if they had had the nerve to follow their dreams, shaking off the "logical" arguments of the naysayers they encountered earlier in their careers.

Not all decisions in life are strictly logical. People marry completely unsuitable partners for love all the time. Parents of children who dream of careers in the arts and professional sports often try to dissuade such "irrational" career choices, frequently producing unfulfilled adults who may never have made it big, but who wouldn't have to spend a lifetime wondering "what if?" if they had only been given the chance to try. The choice of primary care as a career isn't nearly as precarious a decision. Family practice may not pay as much as other medical specialties (and absolutely deserves to be paid more) but it's hardly the life of a starving artist. Those for whom this purest form of medicine is a true calling should not be afraid to follow their heart.

When it comes to choosing a career in primary care, I agree it's a no-brainer. Some decisions should be made with the heart instead of the brain.

* ER (ED, if you're WhiteCoat) frequent fliers notwithstanding.


At Thu Aug 20, 07:59:00 AM, Blogger drcharles said...

Great post.
Although the grind of the modern office can take away some of the allure of continuity, I agree that if you want to prioritize experiencing and practicing humanism in medicine, and to see the breadth of our very existence, primary care is worth it. You won't be rich, but you'll be comfortable, and we've all seen how evanescent gold can be... your story, and how you spend your precious time in life, is what should be most important in all decisions.

At Thu Aug 20, 11:39:00 AM, Blogger Doctor D said...

It's sad but altruism among medical students doesn't seem to be enough motivation to keep Primary Care clinics staffed in this country.

I think a lot has to do with medical school admissions. They exclude everyone but the whiz kids who ace every class. Sure they want to "help people" but they also know how to calculate the right answer. I don't know a single doc (of any specialty) who has ever used organic chemistry in practice, but we let the ability to do organic chem decide who gets into medical school.

You need to be intelligent to practice medicine, but it ain't rocket science. But because they aren't good at rocket science we exclude all the altruistic students who would make excellent primary care doctors.

At Thu Aug 20, 12:37:00 PM, Blogger Sara said...

One of the things that most impressed me along the decision-path was that every time I asked a family doc if they would do it again, they all absolutely said yes, were very happy. I did not see that in any other specialty, ever.

At Thu Aug 20, 05:40:00 PM, Blogger Dr. K said...

"... there is still altruism aplenty to be found in the candidate pool. As tired and trite as it sounds, people really still go into medicine to help people."

While it is true that some (as in one or two in thousands) people really still go into medicine to help people, I know from my many years of being involved in the admission and education of medical students that altruism is *far* from plenty in the candidate pool these days. /cynicism

At Thu Aug 20, 09:54:00 PM, Blogger Nurse K said...

It would seem just as a total outsider that with most groups (at least around here) using hospitalists that doing family practice wouldn't be so bad lifestyle-wise.

At Fri Aug 21, 09:16:00 AM, Anonymous Anonymous said...

do you really think it is the financial implications or the daily grind of insurance/work/etc paperwork/too many patients squeezed in that keeps the students away?

in contrast to your experience, most of the primary care docs i see seem more disheartened than the specialists. you might argue the specialists can couch their discontent while driving to work in their sports car, but honestly it is tough to know.

i still think most people at that age are still passionate about things and don't always spend a lot of time thinking about how much more money they might make in another field, or how their passion for the specialty might fade over time. if they did, even less might choose primary care.

At Thu Sep 10, 01:52:00 PM, Blogger Unknown said...

If a budding doc thinks she needs one of those personality tests to decide on a speciality, then she fails to appreciate one of the most important aspects of becoming a doctor: learning to use intuition, going with your gut. Taking things to heart, which is about the personal and social side of medicine, which so many students and practitioners put aside. Of course, it's easy, as a med student, to get lost in the multitude of considerations: finances, where you want to practice, prestige, etc. And med school debt is at an all-time high. Still, if you're going to go through 7-10 years of med school and training and not be happy with your career, it's a waste--financially, personally, and professionally. That's what I think (btw: leaning toward primary care). But we'll see in a few years....


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