Seeking Information About Being a Doctor

In My Humble Opinion
1

My daughter is suddenly thinking about becoming a doctor and is looking for information to make sure there are jobs she would enjoy.

Some background:
She likes science and problem solving
She likes working with people
She doesn’t want to be a specialist, thinks that might be too limiting
Also doesn’t think she wants to be a family doctor due to seeing too many people for too short a duration

Questions:

  1. Is the impression of a general practitioner seeing lots of people for short durations and not having good problems to solve, is that generally correct?
  2. Are there types of doctors that seem to have a happy medium between a specialist and a gp?
  3. Are the doctors in a hospital typically different from a gp in the types of cases they have?
  4. What types of doctors don’t have time for a family and which types do have time for a family?
  5. Are there non-doctor positions that might be good to look into, that have similar science/problem solving/patient interaction? Do nurses get to do these types of things much or are they just following orders?
2

I am a doctor. The best way for her to understand the profession better is to start calling doctors and hospitals to ask about shadowing or volunteering.
It is essentially required for US medical schools to have some hands on patient care experience to show you really understand what being a doctor is like and are really serious about it.

Being a doctor is unavoidably a very time consuming profession. In some specialties the attendings (docs who have graduated residency) can work part time, but it’s a long road to get to that point. Medical school and residency are very time consuming and that’s 7 years of your life at minimum (4 years of med school + 3 or more years of residency depending on what you go into). It’s not the kind of job where you can just clock out and say “See ya” if there is some kind of patient issue going on. When you’re the doctor, the buck stops with you.
For that reason, being a doctor MAY not be the best choice for someone whose highest priority is free time and spending time with their family, though a lot of people do manage to juggle med school/residency with a spouse and kids. I think most would say that it can be hard at times, but it can be done.

A similar job to investigate would be a Physician Assistant. The schooling is shorter and they tend to have less time consuming work schedules. Again, the best way to learn what it’s like would be to see if you can find one that would let her shadow them.

A good resource to check out would be http://www.studentdoctor.net - a very helpful site for pre-meds.

3

The vast majority of jobs in nursing involve just that, problem solving and patient interaction. That being said, doctoring and nursing are two very different animals, and much depends on which model she finds a good fit for her. I echo lavenderviolet’s advice, she should do volunteering/shadowing with various health professionals, and see which one appeals to her most.

4

Another MD checking in.

Is your daughter in high school or college? While it is very important to not hate science, there are often misconceptions that one has to be a biology major in order to attend medical school. There is usually a general set of pre-requisites in order to apply to medical school (generally 1 year of biology, 1 year of general chemistry, 1 year of organic chemistry, 1 year of physics, and generally an English class and a semester of math) but otherwise one can major in any area. I was a biology and English major – I did the biology major because I loved the field; however, over the long term, I think the English major may have been just as good of a preparation in terms of critical thinking and writing for medicine. In my medical school class, there were plenty of biology or chemistry majors but there were also engineers, former lawyers, and a variety of different majors in the humanities or social sciences.

Regarding specialties, there were a few people in my class who came in saying they knew they would go into pediatrics or surgery, etc., but the majority either did not know or ended up doing something very different from what they thought they wanted to do before entering medical school.

The majority of US medical schools have students spend the majority of the first two years in classes such as gross anatomy, microbiology, biochemistry, and pathology.

The third and fourth years are the clinical years. There is some variation from school to school but the majority of schools will have all students rotate through a core group of rotations (internal medicine, pediatrics, ob-gyn, surgery, psychiatry, etc.). The amount of time spent on each rotation may vary from school to school; for example, at my school, we spent three months each in surgery and internal medicine while the remainder of our rotations (pediatrics, family medicine, psychiatry, ob-gyn). During the fourth year at the school I attended, there were a couple of required rotations, a few selectives (i.e., had to take 3 out of a list of about 12 different rotations), and the remainder were electives.

I was one of the students who came in “knowing” what specialty I wanted to do and actually ended up doing it. However during the third year, I went through considering several different areas because I enjoyed the different rotations so much.

Another thing to consider is that within a particular specialty there is going to be a whole lot of different options for practice (100% inpatient vs. 100% outpatient vs. mix ; academic medicine vs. private practice, etc.) even if one does not further subspecialize (i.e., complete a fellowship in a particular area of the primary specialty such as cardiology).

Some specialties may offer more flexibility than others in term of life-work balance. I think I currently have the perfect job in my subspecialty (although a lot of my colleagues HATE my subspecialty) – good reimbursement, some academics, and generally good life-work balance. However, my non-physician friends would likely consider my work schedule to be “too much” when it comes to call duties. There is also a bit of an emotional burden and learning how to prevent burnout is critical.

Anyway, sorry for the long rambling post.

5

I am not so sure a PA would be the way to go either. In my area, PAs take most of the call, they are the ones that go in for consults only calling the MD if it isn’t routine. The do the majority of the dictation and summarize the records after review for the MD. In other words, the docs are home with their family while the PAs and NPs are doing the grunt work.

6

I guess. It’s more about managing routines than true problem solving. The problem solving that exists is very rarely “What condition could explain this set of symptoms?” and more “How can I convince this patient to quit smoking?” True House-style medical mysteries come along, and that’s cool, but it’s a pretty small part of the job.

It depends on what you consider the pros and cons to be. There are plenty of specialties that still see a wide range of patient types and conditions, and others that are really specific. There are some that are far more time consuming than a typical PCP would be and some that aren’t.

If you mean a GP that is entirely office-based, then yes. A GP who sees both office and hospital patients will see the same sorts of problems that a pure hospitalist sees, just fewer of them.

PCPs are increasingly dividing themselves into hospitalists and outpatient docs, and I think it’s a good thing. It’s really hard to be good at both ends of it anymore, and it’s become increasingly difficult to take good care of hospital patients if you’re only there for a few hours before your clinic day starts. In ten years the “traditional” model will be extremely rare; it already is in some places.

Any of them have time, if they really want to. Some specialties are more family-friendly than others, like family medicine and psychiatry, and academic settings are generally better than private practices. Lots of people have kids during their residency; I think it’s insane, myself, but they do it.

Good nurses do just as much science and problem solving and FAR more patient interaction than doctors do.

7

Thanks for the replies.

Regarding shadowing:
Yes, she wants to do this, this thread was just kind of a starting point.

Her age:
Senior in high school
I’ll have read this tonight and see if she has any follow up questions.

8

My father’s a GP in a small town in rural western Wisconsin. Whenever aspiring high schoolers come to him for advice on becoming a doctor, he basically has this to say (so I’ll pass it on):

Take chemistry. Take as much chemistry as you can. Then take more.

He’s one of the old traditional GPs **DoctorJ **spoke about. His family time was limited: he worked many holidays, was on call many weeknights and weekends (and often was called into the hospital when he was), and generally did miss out on a lot of things. He’d attend our functions when he could, but often was called out or simply couldn’t come in the first place. This didn’t bother me so much, but it’s a pretty large bone of contention for my older brother.

I can’t speak to whether newer doctors have more family time - I think this will largely vary according to the doctor, rather than what specialty he or she has.

9

FWIW I tend to experience it otherwise. Specialists seem to have much more of managing routines; generalists never know what is behind door numer 3. Back pain. Could it be another influenza myositis, or is this the one you need to dig deeper on because this one is a spinal epidural abscess? Managing uncertainty, knowing not what could explain this set of symptoms, but when the pattern mismatch detector is ringing enough to think that maybe the usual is not the case this time, and alternatively (and more importantly) when testing is more likely to do harm than good because the uncertainty is small enough, is the every visit problem solving. Along with following guidelines and being a very good salesperson on managing behavior changes.

The solo and small group practice is struggling though. To survive you need to be able to work as part of large teams, both of other docs and of other healthcare providers.

Within that context the physician does have more autonomy than do many other members of the team. And is compensated better. But with a sizable investment of time and debt to get there. Some do make the argument that putting that money (not just tuition, room and board, but deferred income potential as well) elsewhere for those years, and investing that time in furthering your career as a different sort of healthcare provider or different path entirely, may be a rational decision for a bright person. Me, I couldn’t see myself doing anything else.

My advice. Follow a passion whatever it is and also take the classes she needs to apply to med school. Chemistry, math, dance, art, literature … become accomplished in something she loves during college.

10

There is no question that it’s better now than it was for docs of your dad’s generation. Clinic doctors work pretty much bankers’ hours, and hospitalists tend to work well-defined shirts (often long ones for several days in a row with long stretches off in between). Even most of the docs I know who do it all have very flexible call schedules that allow them to live relatively normal lives. This is true for most of the specialists I know as well.

It’s still possible to work 100-hour weeks and be on call all the time, if you want to, and some docs do. But it’s absolutely not required, nor is it the default situation anymore.

Older male doctors like to rant about this new state of affairs, attributing it to the increased presence of women in medicine. I agree that’s probably why things have changed–I just don’t see it as a problem.

11

Has she thought about clinical psychology? We have far more patient interaction than MDs. I see my clients for 50 minutes, usually weekly, often for months. I get to see real change. I love my work, and it is a great, flexible lifestyle. If I want time off, I cut back my available appointments. It is easy to do part-time, if that becomes what she wants.

12

…Must…resist…

[Nerd] First, steal a TARDIS…[/nerd]

…You may now continue with your adult conversation.

13

Came for the Doctor Who joke … left happy.

14

As a scientist who has worked with a handful of medical students and early career MDs in the lab, I second this. Science and medicine are very different animals. Physicians are not scientists and vice versa, and the skill sets involved in both are not particularly overlapping. I like having them around, and the energy they bring for short stints in the lab is nice, but few decide to stay with science after dipping their toe in the water.

(And on the other side, I would make an awful physician!)

15

Hi this is RaftPeople’s daughter,

thanks for the responses guys! but now i have some more questions.

  1. a lot of you seem to discuss the difference between science and medicine. I’m in love with biology. i love learning about different interactions within body systems and all the complex aspects of life. i was under the impression that medicine was a lot of applying knowledge of biology and anatomy along with chemistry. is that not the case? how would you say medicine differs from this?

  2. what are some examples of jobs done by doctors and jobs done by nurses? my moms a nurse and it sounds like she does a decent amount of critical thinking but also is often just following doctors orders or asking doctors permission to do things. so it sounded more like nurses were the doctors minions… how is it actually?

  3. so most people DONT go into med school knowing exactly what kind of medicine they want to go into? they figure out while there?

thanks again guys! and I am getting in contact with some of my moms coworkers to try to shadow them =)

16

I’ll add my $.02 as a PCP in solo practice. There are so many options within medicine. You absolutely do not have to make a choice of specialty until at least the third year of medical school. I like to tell my students that the choice is mostly a matter of rhythm and pace. Since I’m an Internist, not a Family Practitioner, I don’t see patients at a rapid clip. Even in primary care, you can have a lot of choice in what you do. An FP may see a patient with anemia and send them to a hematologist for a diagnosis; I prefer to make the diagnosis myself and only refer them on if they need specialty care or procedures.

If you watch medical shows on television you get a skewed vision of medical life. The majority of physicians on television seem to only work in the hospital and never see office patients. While there are hospitalists who only take care of hospital patients, and many PCPs don’t do hospital rounds, most specialty physicians still see patients both in the office and at the hospital.

There are a lot of specialties that offer excellent pay and hours; some with set shifts (like ER, Radiology, Anesthesiology) and some with few emergencies (like Dermatology).

Regarding the difference between being a doctor and a scientist, I always felt it was crazy that you were essentially required to do bench research to get into some specialties. Being in a lab and taking care of patients are like night and day.

My advice, besides shadowing a doctor, is to get as varied an education in college as you can. Take the premed requirements but then take what interests you. I majored in Chemistry, but mostly because once I finished the pre-med requirements I only needed 4 courses for the major which left me time to take a lot of English and History classes. If you get a broad education you will always have more options.

The thing about being a doctor as opposed to a lot of other jobs is that it is never routine. You never know exactly what you will see next. If you are somebody who likes things planned and sticks to a strict schedule, you might not like it. You can’t decide you need to leave early one day and then just take off at four if a patient happens to develop chest pain. The other best description I ever read is that as a doctor you are actually not your own boss. You are working for each and every one of your patients. This is a service industry and if patients aren’t happy they will leave. Sometimes making a patient happy is at odds with the best medical care for them. You do need to like dealing with people, even people who are sick, cranky and scared.

I can’t detail for you just what a doctor does since there are so many different options.
A Radiologist might spend all day reading x-rays while a surgeon might have a couple of operations in the morning and then see office patients who are either pre- or post- op in the afternoons.

As far as applied science goes, yes you do use the biology, chemistry, and physics you learn but you don’t always consciously do so. It sort of becomes ingrained in medicine and you don’t need the details as much as the basic principles. For example, flow-volume physics is most important in understanding how blood pressure medications work to lower blood pressure and why one medication might be better or worse for a particular patient, but I don’t actually do calculations. It’s not pure science since it is always applied to unique patients. I do think that an interest in biology is important because it is the ultimate basis of medicine.

My best advice is to hang out with doctors as much as you can. Go to their offices and spend the day. See what their day is really like. Make sure you try to see different specialists, but absolutely don’t worry if you like all or only some. You have many years to decide what to do.

(Note: you may not want to emulate the author who is currently typing this at 2 AM instead of sleeping when she has patients starting at 9AM. I would also not suggest working through lunch, staying at the office doing paperwork until 9 then ordering Chinese to eat while you surf the net. This leads to burn-out and crazy ranting posts which may devolve into anti-medicine screeds. They tell me it is possible to be a doctor and have a life. Ignore the lady in the white coat behind the curtain…)

17

3rd year medical student here.

  1. I would say that much of medicine is applied anatomy, physiology, biochemistry, pathology, etc. As psychobunny said you don’t always apply it consciously when practicing medicine - but it underlies the principles of diagnosing and treating disease. Don’t forget that medicine has a humanistic side as well which is equally important.

  2. Nurses generally follow doctors’ orders in treating patients, but I would definitely not call them “minions” - as I understand it, for example, they are supposed to question doctors about unusual doses or seemingly dangerous medications which have been ordered for a patient. They have a certain amount of autonomy within their scope of practice, and they spend a lot more time with the patients than doctors do.

  3. A lot of people go into medical school thinking they are interested in a certain kind of medicine but then change their minds after being exposed to other specialties during their clinical rotations.

I second lavenderviolet’s suggestion that you check out studentdoctor.net. They even have a specific forum for high school studentsinterested in medicine or other health care careers.

18

And take chemistry. As much as you can.

Like I said, my dad gives this advice to all the high schoolers that come to him interested in Medicine. Of the two high schoolers that actually did go to med school after and become doctors, one of them has thanked Dad for that advice, saying it made all the difference in the world. Biology is important, but there’s more chemistry involved than you might think. (His advice may also have something to do with the fact that the higher chemistry courses also require a good deal of mathematics as pre- or co-requisites, which gets into much of the calculations that psychobunny alludes to.)

19

As you may figure out on your own, these are two bits of advice that may conflict with each other unless you have a passion for chemistry. Go with the first bit. Ignore Snickers dad.

Chemistry per se is really completely unimportant in the practice of medicine. There is not a single doctor who is a better clinician because (s)he aced analytical chem or p-chem. Organic I’ll grant you, but not because of the information, but because it fosters a certain approach to problem solving, just like those proofs in geometry did.

As a practical matter reductionism is not useful. Managing clinical uncertainties, matching the clinical presentation patterns and recognizing the mismatches, getting patients to maintain or adopt healthy behaviors, is not actually helped much by understanding how mitochondria work. We don’t actually calculate drug half lifes and clearance rates when we dose a med. No more than you need to understand quantum physics in order to balance a chemical equation.

OTOH, understanding how to critically evaluate information of all sorts, how to induce and to deduce and how those are different, knowing how to access the information you do not know and to recognize that you do not know it, knowing what Bayes Theorem is and why it matters so much in medicine, matter. Being able to communicate effectively, being able to articulate well, being able to do so at a variety of levels of understanding, being able to connect to people, matters.

Take chemistry, as much as you can, if that is you passion, otherwise take what you need to in order to apply to med school and no more; save the credit hours for things that interest you.

20

I love General Practice.

Yes, I have 10minute appointments, but repeatedly, with the same patient, over weeks, months or years. Which means meaningful relationships can be forged.
Which you can’t do in an ER, and rarely get the chance to do in acute hospital care.

I see typically 14 patients in a morning and another 14 in the afternoon, with 1 or 2 housecalls over lunch.

The issues in a 2 hour clinic session can range from marital breakdown due to a spouse’s pathological gambling, to a routine antenatal appointment, to seeing child with an ear infection, to telling someone their chest xray result is suspicious for lung cancer, to an annual well-woman check up and a chat about contraception.

Quite often I get people complaining of weird, vague, seemingly unrelated and not particularly serious symptoms, and I have to make that into a diagnosis and formulate a treatment plan from scratch. I like being able to say"try this and come back next week and tell me how you get on, and if it didn’t work, we’ll figure something else out together".

How could anyone not love that type of variety and the chance to make positive differences in people’s lives?

Sure, I don’t “save lives” in a flashy way (apart from very occasionally calling an ambulance if someone looks very, very unwell) , but I can initiate medications that will improve quality of life, get investigations which give answers, and arrange to refer to specialists when things look serious.