Doctor, maybe?
March 5, 2010 5:33 PM   Subscribe

I'm potentially interested in becoming a primary care (family) physician. My career so far has had nothing to do with medicine. I need to figure out if this interest is legitimate or just a phase. Can you help me find resources I can use to decide if this is something I really want to pursue, or just a fantasy?

This question is not "How do I become a family physician?" I am well acquainted with a number of folks I've seen go through the post bacc and med school application process, so I know the answer to that question.

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Potentially necessary background:

I'm in my mid twenties. Throughout high school and college, I was always pegged as the person who was good at the humanities. I did well in science and math, too, but no one ever seemed to notice, and it seemed natural, once I got to college, to declare a major in the humanities. Since college, all my jobs have been in the arts. I'm building a pretty strong career for myself in my particular field, though it's still early days (while I work on my own projects, I also spend a lot of time working on my boss's projects). I like my job (like it a lot, actually). I am paid very little, which can sometimes be a strain.

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In the past few years, as I have watched a roommate and several college friends apply to and begin medical school, and as I have developed a close relationship with a family practice physician who has encouraged my interest in medicine, I've been thinking more and more about possibly going into family practice medicine myself. I am particularly fascinated by the question of how primary care can be changed to be more efficient, more effective, and more satisfying, for both doctor and patient.

Initially, these were just idle thoughts, but recently, while talking with the physician I know about my very, very long work hours (I have the kind of job that you have to take home with you), she said to me, "If you're working that much, you might as well go to medical school." Her comment surprised me, and I asked if she was joking, or if she actually thought I should. She said she thought I'd make a great doctor, and that I should give it serious thought, but I should only do it if I "have to."

So now I need to figure out if I have to. I don't know any family practice physicians other than the one I've mentioned; I also don't know of any books about family practice (all the books about being a doctor that I'm familiar with are by surgeons or researchers). I also don't know if my ideas about what's interesting are actually interesting, or if they'd be dealt with within the first few weeks of medical school and then, well, I'd be stuck.

So, mefites, can you point me to resources I can use to learn more about the profession of family medicine, and to help me determine whether or not I actually want to do it? What questions should I be asking? Who should I be talking to?

Anon because people I currently work with know I'm on mefi.

If I've been too vague, or if you've got any other questions: dr.maybe.q.perhaps@gmail.com
posted by anonymous to Work & Money (22 answers total) 11 users marked this as a favorite
 
Have you thought about becoming a physician's assistant, or something similar to that, instead? You'd spend significantly less time time in school and be actually doing the things you want to do- seeing patients and providing primary care- much sooner. Alternatively, you could go back to school and do something related to health care management, or just find a job in that field. That would be another way to work towards making health care "more efficient, more effective, and more satisfying, for both doctor and patient" without going back to school for years.

Basically, you seem to see becoming a doctor as the natural progression of your interest in primary care. That isn't necessarily true. If you absolutely want to be a doctor and can't imagine doing anything else, go for it. But if you think you could be satisfied working towards the same goals from a different angle, it might be worth considering other paths.
posted by MadamM at 5:51 PM on March 5, 2010


An excellent first step would be to arrange a series of information interviews. Step one is figuring out who to contact. When I did a mid-career change, I got a list of practitioners in the field from the local professional society. I started with the A's, left a message on the voice mail explaining what I wanted and (for my field) got about 30% call back rate. If people called back, I scheduled a 20-30 minute phone interview at their convenience. I made a list of the questions that I most wanted to know and when from there. After about a dozen calls, I found that the answers were consistent enough that I felt I had a good sense of what I had wanted to know.

If you can find a personal connection (mutual friend, alumni of your alma mater, linked-in) that you can reference, you are more likely to get a call back. The secret to this type of networking to just tell everyone that you know that you are looking for some family physicians to talk to about the profession. Most people will get engaged in the question of who you might contact - you would be surprised at what turns up when you just pose the question to the universe.

You might want to offer them the option of you buying them a cup of coffee or meal, meeting at their office or phone interview. You get more out meeting in person, but I found people didn't want to spend that much time on me - YMMV, especially if you have a personal reference.

If you want a copy of the questions that I asked, send an email via my metafilter account.

Final thought, don't go into this because you want to change medicine. You should feel confident that you will be satisfied practicing medicine in (one of) the mainstream ways - changes are a bonus. (This is something you can be asking about in your interviews - what are the different practice models, the feasibilities and pros and cons of independent practice, small group, large group, underserved etc.)
posted by metahawk at 5:54 PM on March 5, 2010 [4 favorites]


The obvious question would be whether you've taken the required science and math courses in college. If not you'll have to take those courses before you can apply to medical school.
posted by dfriedman at 5:56 PM on March 5, 2010


The best resource is the one you already have. You should ask your family doctor friend if they might consider letting you shadow or volunteer in their clinic. Also ask if they have any colleagues that would be willing to do the same so you get a broader picture. You need a better understanding of what being a doctor is all about, and really the best way to figure that out is to see it in action.
posted by drpynchon at 6:27 PM on March 5, 2010


Volunteer in an oncology ward or an ER. Geriatrics or a burn ward. A wound clinic. Better yet, a free clinic. See exactly how bad it can really get, and feel what it's like to be abused by doctors and insurance companies. Get used to it.

MCATs:
Pick up an old science textbook. Do you know what a buffer solution is? How about what the electron configuration of Fe(II)? If you don't know, do you want to know and have a deep desire to find out why exactly it is what it is?

How good are you at physics? Molecular biology? Can you tell me how DNA is replicated? How about the difference between Meiosis (I) and Meiosis (II)?

Pick up an MCAT book, thumb through it and say, am I willing to learn everything in this book? Sample question: The rate of an Sn2 reaction can be increased by all of the following except by: a. increasing the concentration of the electrophile. b. increasing the concentration of the nucleophile. c. stabilizing the carbocation intermediate. d. reducing the steric hindrance around the electrophilic carbon.

Medical school:

What do you mean by you did well in your science and math classes. Did you get A's in high school and college? Are you willing to work hard enough to get perfect A's in a postbac program?

How about biology, have you taken any lab classes? Would you like to? Not just dissecting an earthworm, I mean like a cat or a shark, and memorize every single muscle, where it originates and inserts, its function?

How about bones, do you know what the olecranon process is? Go here: http://homes.bio.psu.edu/people/faculty/strauss/anatomy/skel/skeletal.htm. Do you want to memorize every single number of every single image?

Residency:
Read House of God by Samuel Shem. Practice taking your engine apart after two days without sleep. Put it back together and drive it.

Money: MCAT class is about ~$2000. MCAT itself is $200. Primary applications typically take anywhere from 1-3k. secondaries are ~$300 per school. Then you have to fly to the school and stay in a hotel for interviews on your own dime. Loans typically average $100-250k. As a resident (where you live in the hospital and are on call for 2 nights in a row+) you'll make $40k for two years.

And know that, even if you love doing every single thing, that there's a >95% chance that you're not going to get into medical school. You've got to EXCEL at these things, be in the top 5% of the entire population. And even then you're probably not get into medical school.

I want to emphasize, though, that medical school and medicine is far far beyond "work that you take home with you." The med students that I know and the surgeons that I work with, this IS their life. As a family practice doctor, you're responsible for the well being of your patients. Are you willing to be on call EVERY NIGHT for the next 40 years? No vacations for more than a weekend? Wake up calls at 3 in the morning because of a nosebleed? That's the bare minimum, and then we can talk about how you want to change the practice of medicine.

You're not going to get paid very much either. For the next decade you'll be in debt and then, if Medicare doesn't implode, you'll have to hire a staff and deal with insurance companies, which is probably as close to hell as you can possibly get.

This is totally just to scare you, but not really.
posted by wayofthedodo at 6:33 PM on March 5, 2010 [2 favorites]


My father started as an Army Corpsman, transitioned to Nursing, then to Physician's Assistant, then to Doctor. I wonder if there would be an interim step as another kind of health professional. Nursing I think would be a natural first step for you. It gives you exposure to working the kinds of science you would get in medical school, exposure taking care of patients, and set you up with better paying work that you can do any kind of hours you want: hospitals don't sleep.

Now, there are scenarios whereby you can get people to pay for your med school in exchange for agreeing to work for them for some period of time. Underserved areas, military, there are many options here.

The anonymity is kind of a bummer for feedback. I'd love to hear the questioners thinking process as he or she makes this decision.
posted by artlung at 6:35 PM on March 5, 2010


Oh, and +1 for House of God. I'll add Year Long Night.
posted by artlung at 6:38 PM on March 5, 2010


And know that, even if you love doing every single thing, that there's a >95% chance that you're not going to get into medical school. You've got to EXCEL at these things, be in the top 5% of the entire population. And even then you're probably not get into medical school.

I don't believe this is true in the US. Do you have a cite to this?
posted by anniecat at 6:58 PM on March 5, 2010


You sound like a good candidate for med school and although I loved reading House of God, the current thinking regarding resident work hours is quite different from what wayofthedodo describes. If you are that interested in medicine, go for it. But be aware that you may well find yourself interested in something other than primary care by the end of your 4 years; at your age and given the variety of things you will see in med school, there is really no telling how things will shape up. I know my career in medicine has taken a number of unexpected turns (and may well take more), but it has still been good.
posted by TedW at 6:58 PM on March 5, 2010 [2 favorites]


wayofthedodo sure knows how to give a pep talk... Wow. Fortunately for you, much of what was said was untrue or at least entirely dated. House of God is a great read and still of value, but modern medical education is a shadow of the dramatized and fictionalized world of an intern at a Beth Isreal over 30 years ago. By the time you make it to internship you will most likely be forced to stop working after a 14 hour shift as opposed to multiple nights on call.

Seriously. Decide if you'd actually like being a doctor before you worry about the sacrifices you may need to make to become one. It sounds like you're at a stage where you need to learn more about the job, not be berated about the organic chemistry minutiae that can always be learned.
posted by drpynchon at 7:07 PM on March 5, 2010 [4 favorites]


From personal experience, I work with a lot of doctors and their work seemed so interesting so I went back to college and loaded up on all of the chemistry and biology classes that I didn't need for my humanities major figuring I would go on to medical school. Long story short, I was so stressed out by one SEMESTER of chemistry that I figured that if I took six more years of it I would be the one needing a doctor (like psych ward with rubber room kind of doctor). Alas I stayed in my prior field and continue to write about medical and health topics without the $200k loans hanging over my head or the panic attacks brought on by Chem 101.
posted by MsKim at 7:07 PM on March 5, 2010


I don't believe this is true in the US. Do you have a cite to this?

In 2007-2008, 42% of applicants successfully secured a position in the U.S. according to the AAMC [pdf].
posted by drpynchon at 7:18 PM on March 5, 2010 [1 favorite]


Just be advised that many medical schools will look askance at someone applying as a second career. My med school (U of MA) tends to be one of the few to admit older students, but those that have gotten in here have extremely distinguished backgrounds in medicine-related industries, and STILL had to be better then us young'uns to get into the same caliber institutions.

I'm not saying that you wouldn't be a great doctor (many of the older students in my class seem much better prepared to be physicians then those straight out of college), and lord knows that the world needs more primary care docs, but you will have to work much harder then your younger, less mature colleagues to get the same recognition. Just be prepared do see discrimination in this area.
posted by genmonster at 7:24 PM on March 5, 2010


Thanks drpynchon. I knew wayofthedodo was off base.
posted by anniecat at 7:40 PM on March 5, 2010


My Dad is a family doctor. He's a really amazing guy- a doctor who models his practice on service to the community (both in rural Washington, and mission work around the world). For him, service to the community was a big part of why he went to medical school. He has been in practice since 1980, and has seen in his career the slow eroding of family medicine as a respectable specialty.

When I was a kid and wanted to be a family doctor, he said, "If that's what you'd like to do, it is a wonderful and rewarding career."

When I was a teenager and wanted to be a family doctor, he said, "I'll support you no matter what, medicine can be a wonderful way to be of service."

In my 20s when I've considered being a doctor, he tells me "I get paid less and less every year. My practice will likely have to merge with a larger practice to survive. I cannot practice the kind of medicine I went to medical school to practice. I will always be a doctor, but it is not the life I would dream of for you."

He still does it the way he always has- visits some patients at home who need it, spends the time with other patients that they need in order for him to listen to his patients and really elucidate what is going on in their lives, but he is under increasing pressure to spend less time with each patient. His practice (which he owns with several other doctors) has been pressuring him for years to keep his time with patients to <1>
He is one of the few family doctors in his area to still do labor and delivery- the malpractice insurance, in addition to the fees charged by the local hospitals, are prohibitive for everyone else. But my Dad says that for him, being able to deliver his patient's babies (when they want him to) is incredibly rewarding, far beyond any financial gain, or loss. In the last few years, he has had a couple of the kids he delivered come back to him to have him deliver their kids, which he really gets a kick out of. He has patients that have been with him for 29 years, and those relationships mean the world to him.

He has a day a week off (in addition to weekends) but is on call 1-2 weekends a month, and usually 2 big holidays a year (this year it was Xmas and New Years) which involves at least a couple of small emergencies. Two nights a week, he gets home between 10 and 11 p.m. The way he manages to squeak extra time with his patients into his day is by doing his charting in shorthand, and transcribing it in longhand after the last patient of the day goes hom.

My Dad is more exhausted than I've seen him, in the last few years. He worries more, and I worry about him. The practice that he bought into thirty years ago is no longer is worth anything: when he retires, he will only be able to sell the building and the equipment. The practice, the business that has been around for more than half a century, is now worthless. If they are "bought out" by a larger practice, the terms will be how many of his staff are laid off. They will receive no compensation. His practice now has as many people handling insurance, medicare, and billing as they do people involved in medicine.

I hope he'll retire soon, but I don't think he will. He loves being a family doctor: it is the center of his life. So this is the advice I'd give you. Don't do it.

Don't get me wrong- I think being a family doctor is a heroic calling. But don't become a family doctor unless you can read this, and everything else, listen to everyone telling you how hard it will be and not care. This nation desperately needs family doctors right now, but sadly it is currently a grim situation for family doctors. Don't do it, unless you are so passionate about becoming a family doctor, that you would do it despite all the odds against you and your prospective profession.

(And if you are still interested, feel free to memail me if you'd like to talk to my Dad. He teaches part time at the UW medical school, too)
posted by RachelSmith at 8:08 PM on March 5, 2010 [4 favorites]


Sorry for the long response. My Dad just visited me, and it was hard to see how tired he is these days, so I'm pretty passionate about the tough conditions family doctors face these days.
posted by RachelSmith at 8:10 PM on March 5, 2010 [1 favorite]


Have you considered, with your humanities background and your interest in how primary care is administered, one of the public health degrees? An MPH focusing on health services might be just your thing.
posted by fairytale of los angeles at 8:18 PM on March 5, 2010


3rd year med student here, currently doing my family med rotation, and it's in my top 2 specialties I think I might match in. I was pretty much the opposite of you- good student all the way around, but best in the sciences, majored in Bio, did what Bio majors do and went to med school. Would I apply to med school again knowing what I know now? Tough call. wayofthedodo may exaggerate in some areas, but honestly, I agreed with a lot of that assessment. You think you are cash-strapped and fatigued now? Med school is no picnic- it is expensive beyond all belief, and 80 hours (average- sometimes you'll work 90) is still a lot, especially if 30 of them are consecutive, without sleep, on a nearly empty stomach, and requiring large amounts of mental focus.

Nothing is better than first-hand experience. I'm nthing the suggestions that you shadow. And then shadow some more. However, if you want some reading, the latest trend in family medicine is the "Patient-Centered Medical Home", to give you a google search term. I'm sure the AAFP website can give you plenty of propaganda on it if a google search doesn't tell you enough.

Questions I would ask: How do you deal with frustration when you're unable to deliver the best care to your uninsured/underinsured patients? Do you feel you have adequate time for patient education? As a corollary, how do you cope with patient non-compliance? (It can be very demoralizing to see somebody who's smoked for years and failed to take their B-blocker be hospitalized for multiple cardiac problems when you KNOW it could have been prevented). Do you feel you are adequately reimbursed for your time? Is your time in the office as rewarding as your time with your family and vice versa?

Honestly, it sounds like you like working with people, and you see some problems with the healthcare system. It doesn't sound like you have an interest in curing diseases, which is what you go to med school to learn about and most of the prep-work is aimed at. If you want to change how healthcare is delivered, get a masters in Public Health or lobby congress or get involved in some advocacy work for a local clinic.

Feel free to MeMail me with any more questions.
posted by alygator at 8:42 PM on March 5, 2010


As a counter-point to RachelSmith, the family physicians I know in Canada feel it is hard work, but fairly compensated. Her father's arguments are against the health care industry in the US (which in her description is pretty horrific). Unless you already plan to never leave the US you may want to investigate education and employment in a country with socialised medicine.
posted by saucysault at 9:31 PM on March 5, 2010


I was coming in here to echo fairytale's suggestion that you look into a public health degree. Your abilities in math and science will support you through the biostatistics and epidemiology classes, but your strong humanities background will help when you get to the health policy / community health education work (nearly all MPH programs have elements of all 4 of these sub-disciplines). The cost is much less, and it's actually a path where you might get *paid* to work on the changes that are drawing you towards the field. Feel free to memail me for further info about the application process.

If you're interested in learning more about public health, I strongly recommend contacting your local health department and asking if they would take you as a volunteer.
posted by pants at 5:02 AM on March 6, 2010


Shadow the doctor. That way you aren't making your decision based on a potentially inaccurate assumption about what being a doctor is.
posted by callmejay at 8:24 AM on March 6, 2010


Don't you still have to pass Organic Chemistry to get into Med School? Do that and see if you're still interested. :-)
posted by kjs3 at 1:21 PM on March 8, 2010


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