Are Doctors Rich?

(Part of an ongoing series Should I Become A Doctor?)

People rarely ask about income directly, but Doctor D gets a lot of wink-wink nudge-nudge questions about his finances such as,

“So what you drive, doc, a BMW?”

or

“It’s hard making ends meet sometimes, but you wouldn’t know about that, would you doc?”

So to answer your questions Doctor D will throw open the doors to the secret realm of physician personal finance:

"Where'd I get the money? Med School, Bitches!"

Last year Dr. D made about 150,000 dollars, which is a lot of money. (The Medical Mafia makes sure MD's get paid well in exchange for our souls!) Uncle Sam and student loans took a pretty large chunk of that, but still Doctor D has more than every non-medical person he knows, and he is a Primary Care Doctor, which is one of the lowest paying specialties!

Now before you start filling out medical school applications dreaming of big money let me warn you about the downside: You spend about a decade of your life working for free and amass a mountain of debt to get here.

Dropping Out and Adding Up

Everyone considering the financial benefits of medical school should calculate their drop-out sibling equation:

Doctor D has a brother about his age. Brother D was a smart dude, but he never liked school so he dropped out in high school. Brother D immediately started making money working at low-skilled but steady jobs while Dr. D was toiling away at medical education.

Brother D’s lifetime earning was very gradually rising while Dr. D’s debt was increasing, until one day Dr. D started making big bucks. Dr. D and Brother D sat down and did the math problem.

The answer: 41

Doctor D will be 41 years old before his MD catches up with his drop-out brother's GED in lifetime income!

Our paths diverged at about 17 years old. Doctor D is 32 now so he has another 9 years till he’s made as much money in his life as Brother D.

Medical School isn’t exactly the quick way to riches.

But in this economy who can complain about making six figures? Doctors do it all the time, but nobody is listening.

Doctors work hard and we get rewarded. It just isn’t as rewarding as some pre-med students and patients think.

"You know you laidies can't resist!"

By the way, Dr. D drives the cheapest car Toyota makes—it’s the first new car he ever owned.

What do you think?

Pre-meds and Med Students: Did the financial rewards of affect your career choice?

Patients: Do you think income differences between you and your doctor harms your doctor-patient relationship?

Doctors: Are you satisfied with your income? Do you feel you deserve more or less?

Doctor D always loves to read your thoughts in the comments.

Saved With A Dodge

Part 4 of Straight Answers From Doctors

Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient's side of things.

How the $#@% can a doctor dodging a question help the patient?

Let me tell you a story:

Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As a parent I can tell you that this sucks. Lady D and I did a lot of worrying about our baby.

"Daddy, I don't feel good!"

Medical people are often the worst patients. We know just enough to be really difficult. Or we just know too much, and it gets in the way of our common sense.

Doctor D had never even heard of his son's super rare disease so he read everything he could find. Unfortunately the mutation was so rare that research was almost non-existent. Doctor D read every published study on the disease an found more questions than answers.

The poor Expertologist got way too many questions from Doctor D. Some he answered. Others he totally dodged. Near the end of the appointment Doctor D asked a very specific question about a potential complication.

The Expertologist smiled and said, “Oh, I think he’ll grow up and play sports and have kids of his own some day.”

Doctor D was totally frustrated. “I’m a f*#@ing MD! Of course, I know that this mutation doesn’t affect the reproductive system or the muscles. You didn’t answer my specific question!” Yeah, I considered yelling that, but instead I smiled and left the office.

I still don’t know why the Expertologist gave me a non-answer. Maybe no one knew the answer? Maybe a full answer would have taken a long discussion of probabilities and complex research he didn’t have time for? Maybe he was just sick of this non-expert doctor who asked so many questions?

Doctor D was pissed. But on the way home Doctor D looked in the rearview mirror at his sleeping baby and realized that vague answer had been just what he needed to hear: “Chill out, Doctor D. Your kid is doing fine. He’ll be okay.”

And you know what? Little D is doing just fine.Little D:
Growing perfectly as long as his parents can refrain from killing him during his Terrible 2's

Sometimes patients don’t need factual answers. Doctor D had hundreds of questions tumbling around in his over-educated head. Expertologist could have taken all day answering every question, but the real question was “Is my kid alright?”

This brilliant Expertologist totally dodged even trying to answer my question and told me what I needed to hear, “You kid is okay.”

What do you think?

Have you ever been glad an MD dodged your question?

Do you think there is any place for this in medicine?

Doctor D always loves hearing your thoughts in the comments!

How To Get A Straight Answer From A Doctor

(Part III of Straight Answers From Doctors)

The answer is really very simple:

Don’t accept a non-answer answer from a doctor on a question that really matters to you!

If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.

We doctors are totally scary, but if you have to have the guts to ask the question a second or even third time most docs will do their best to insure you get an answer that makes sense to you. Force the issue!

"Okay doc, now I need you to explain that again in plain English."

Sometimes the doctor will have to look something up and get back to you. Sometimes the doc will have to work to explain something complicated in a way that you can understand. Sometimes if there is no definite answer available your doctor can help you understand the nature of the uncertainly.

Most doctors will work hard to get you an answer, but if your doc blatantly dodges your question after multiple direct inquiries you might just be stuck with a god-complex prick. This is good to know so that you can find another physician ASAP who works well with you.

A few tips for truth-seekers:

Be Ready: Medical decisions and predictions can be really complicated. Add the amount of uncertainly that we work with and the straight answers can get really difficult to grasp. Most of the questions we dodge have difficult answers that might leave you with a headache. Don’t assume that the full answer is always going to make things more clear.

Be Reasonable: You shouldn't use the nuclear I-won’t-leave-till-I-get-an-answer option for every question that pops into your head. Doctors don’t mind giving the full answer from time to time, but if you have an insatiable curiosity you may want to do your own research with Dr. Google. You don’t want to be that patient your doctor groans to see because he knows he’s going to end up running an hour behind every time he sees you.

"Doc, suppose my pancreas was a sentient being trying to assassinate me.
How would that change your treatment plan?"

Accept Disappointment: Some patients confuse "a straight answer" with "the answer I wanted." Sorry! You can ask till you're blue in the face but your doctor still has to say, "Your runny nose doesn't need antibiotics" and "90 year-old Aunt Ethyl probably won't recover" every time. Persistence won't change facts, but it may force exasperated docs to tell you a white lie just to make you quit badgering them. You don't really want to force doctors to be dishonest with you.

Consider yourself warned! Use the "nuclear option" with caution. Now go forth and find out what your doc is really thinking!

What do you think? Have you every forced the issue till you got the answer? Tell your experience in the comments!

Doctor D has typically been on the doctor side of this interaction, and can say a patient dedicated to answers always gets them from me.

But do you as patients think this approach works?

Why Do Doctors Dodge Your Questions?

Part II of How To Get A Straight Answer From A Doctor

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why Would A Good Doctor Give Useless Answers?

1) There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend they do. Trust me, they're faking it. While it may not help you "I don't know" is a refreshing answer to get from a doctor. MDs don't often admit this.

2) Your doctor knows the answer, but it is too complicated to explain. A lot of the physical processes doctors think about are pretty complex. Translating all the technomedical concepts into layman’s terms to sensibly explaining it would just take a lot of time and bore you to tears, so the doc just gives you a vague answer instead.

3) The answer depends on a lot of variables. Predicting the course of an illness or recovery can be tricky. A lot of things that are in our control and out of our control can make a straightforward “here’s what to expect” answer impossible. Doctors are busy. It would take a lot of time to explain all the variables. So they often dodge any answer that asks they explain the future.

4) There is no answer. You’d be surprised how many of your questions just don’t have have answers. Doctors have no idea of the answer and no good way of finding out. Sorry! Most patients (and quite a few doctors) get unnerved at the amount of real uncertainty in the world of medicine. We often cover the uncertainty with total bullshit. We make up things that sound intelligent. For example: “Probably a virus...” is secret doctor code for “I have no idea why you feel this way, but it probably isn’t serious.”

"If I tell you it's a virus will you stop bugging me?"

5) The answer went right over your head. The doctor did answer your question. Doc just said the answer in technomedical jargon that made no sense to you. While you may have technically gotten a "straight answer", the doc replying in a foreign language you don’t speak really doesn’t count.

6) The answer doesn’t matter. "Look, you silly patient, I give out info on a need-to-know basis, and you don’t need this answer!" This is probably the root of all vague, dodgy answers given by doctors. We don’t think the answer is important for you to know. It won’t make a difference. Answers take time and energy that might be spent on something productive. "Trust me, if you needed to know the answer I would have told you already!"

All doctors dodge questions!

Doctor D does it too. Some questions really aren’t as important as others. We are busy and if we took all the time to answer every question we wouldn’t be able to actually help many people with with what’s wrong.

And not everyone wants the full answer:

As a young physician, Doctor D actually tried to fully answer every patient’s question. He looked up answers. He explained complex medical processes and variables. He educated people on uncertainty. And you know what... nobody liked it! Patient’s eyes would glaze over. Doctor D was constantly running late. His patients didn’t always want to get the full answer.

When he switched to need-to-know answering his efficiency improved and his patients were happier. Yes, a lot of people are very satisfied with vague meaningless answers. Not everyone needs the full truth. Some people just needed to know I heard their concerns.

"You want my real answer, or the answer you want?"

But, obviously not everyone is happy with non-answers from doctors. Doctor D’s email is full of desperate patients complaining that their doctors really aren’t answering their burning questions.

So we have a problem:

Full, straight answers to every question would take so much time and energy that the medical system would grind to a halt, but some of your questions need full answers.

Doctor try their best to help filter what answers you need most, but in the end it is only you who can say what you really need to know.

Next Week: Doctor D will teach you how to extract real honest-to-goodness straight answers from an MD!

What do you think?

Are you okay with an MD giving you vague answers or dodging your questions?

Medical People: Do you think it is possible to honestly and thoroughly answer every patient question?

Doctor D always loves to hear your opinions!

Vague Answers

A reader asks Doctor D:

“What should I do when my doctor’s answers are vague and useless?”

This patient was frustrated that every time she asked her doctor what to expect she got useless answers like “Maybe” or “That’s a great question!” or “I wish I knew” or other replies so vague as to offer no real answer at all.

So D the ever-helpful wrote her back:

“Dear reader,

Great Question! I wish I knew. Maybe that’s just how doctors are?

Love always,
Doctor D.”

"Admit it, bullshit answers feel so much better coming from a professional like me!"

You know, it's the prerogative to be a heartless bastard that really makes all those years of medical school worth it!

Okay, so Doctor D isn't really that much of a jerk.

In fact, he's starting a series on How To Get A Straight Answer From A Doctor.

Tune in tomorrow for the real answer!

I Hate Medicine!

Last week Ella the Med Student wrote brilliant and thoughtful advice on how to be happy in medical school: You need to love medicine.

Now Doctor D has a confession to make:

I hate medicine! Medical school was the worst 4 years of my life.

There, I said it! It felt good to let it out.

But before all of Dr. D’s medstudent fans rush to unfriend him on facebook they should know this: Doctor D not just a good doctor. He is a frickin’ amazing doctor!

How is this possible?

They look so pleased just to be in a hospital!
Doctor D isn't in any photos like this.

How I Learned to Stop Worrying and Hate Medicine:

Ella classified medical students based on their love for medicine with the “miserablites” at the bottom. They are the ones in medicine with ulterior motives. Therefore they hate school from the first cut on the cadaver. They don’t fit in with other medical folks. They don’t like studying diseases or treatments. They can’t wait for medical school to be over.

Yup, that pretty much describes D in medical school!

Young D took one of those aptitude tests administered by the college career counselor. It said that his personality was an awful fit for doctoring. He was warned.

So why did he do it?

Medical School With Ulterior Motives

Doctor D’s ulterior motive for studying medicine was that pesky humanitarian impulse. D loves people. As a student young D worked in homeless shelters and volunteered in 3rd World countries—not to pad a resume for med school, but because he actually liked doing those things. Young D asked himself, “Self, what work should you choose that allows you to help suffering people?” Since D had the book smarts everybody suggested medicine.

On day one of medical school D realized he wasn’t in Kansas anymore. He was surrounded by highly driven people who absolutely loved spending 18 hours a day studying pathophysiology and pharmacokinetics. Ella enjoys kicking back with Robbins Pathology while sipping her coffee in the morning. God bless her crazy ass! Doctor D’s trudge through Robbins was about as enjoyable as the Bataan Death March.

D’s secret fantasy in medical school was that one day he’d go in and give everyone the middle finger and drop out. This thought was the only real pleasure he had for most of med school. It kept him going when times got rough. Every miserable day D told himself, “I’ll quit tomorrow.” He came close to doing this about a hundred times, but never pulled the trigger.

Doctoring with Love and Hate

So D became Doctor D, and lo and behold he was right: All this dull medical science he forced himself to learn is useful—it helps sick people get well, and D really enjoys his job!

The actual practice of medicine allows for amazing connection with other human beings. A caring doctor during the worst and most painful day of your life is really useful. Doctor D always gets along well with patients. One reason Dr. D connects so well with patients is that he never really did connect with other medical folks.

Some doctors love studying diseases and reading the latest medical trials—quite a few retired docs do this years after they’ve seen their last patient. That’s cool and all, but it ain’t me. If Doctor D lost his medical license tomorrow you can bet he wouldn’t read another sentence of medical literature again!

"Yeah, I don't like school either, but some things are worth the misery."

But Doctor D does keep up with all the info on the escalating arms race between diseases and medicine and he'll treat you with just as much skill as the next doctor. In some ways D sees himself as the purest form of doctor:

Some doctors battle illness because they are fascinated with the weapons or with the battle strategy. Doctor D fights because he believes in the cause.

So take courage you med school miserablites—you sad souls who don’t like biochemistry or fit in with your anal classmates—here is hope for you yet! You may yet become a fine MD who loves this crazy job in a way those medical types could never imagine.

PS: If any of you med students do decide to go out in a blaze of glory by telling "the man" to stick it up his rectum and burning your student ID please email Dr. D your story because he would love to live that moment vicariously!

An informal AskAnMD poll:

How many of you medical people actually like medicine vs. those who use medicine for ulterior motives like Dr. D?

How many of you patients would care if you doctor wasn’t actually fascinated with your disease and your medicines?

Will Medical School Make Me Miserable?

Part II of ongoing series: Should I Become A Doctor?

Great question from a potential medical student:

"I got accepted to med school for 2011, but I am scared to commit to this decision. Will medical school suck all life out of me, leaving me passionless, tired and with no ambitions?"

For this question Doctor D called in a consult! Doctor D recruited a real live medical student! Ella the Med Student is a brilliant blogger and a winner of the coveted Big D Award!

Ella's Advice:

Medical school is difficult. It takes tons of time. It's stressful. It is a huge commitment. It's competitive. It is also a million other wonderful things.

Everyone in medical school has essentially the same experience, the same course load, the same time schedule, etc. Yet, you will hear very different opinion from students about their medical school experience... ranging from "it was the worst time in my life" to "this is so much fun!"

The MAJOR factor that contributes to the differences in student's experiences in medical school is why they are there.

"Why am I here?"

Let me describe a pattern I have noticed among medical student. I think there are three main groups of student attitudes about medical school. I'll describe them here...

Ella’s Taxonomy of Medical Students:

The Good

The happiest students are those who are enjoying the journey. They actually love medicine, love the material they are studying, love the lifestyle of continued learning and a high-paced academic environment. Of course, many have other interests and families, but to them medical school is not an obstacle in the way of those things. Med school is an awesome part of their life.

"I'm happier than a pig in mud! Medical school is Awesome!"

Personally, I love reading my huge Robbins pathology book with a cup of coffee in the early morning. I love going to lecture and participating in clinical problem solving. I feel a rush every time I am in the hospital, I talk to my patients for too long, and my brain is always coming up with ideas for projects and research. I look forward to residency and my future career, but I am in no way miserable in school. I absolutely could NOT imagine being anything other than a physician... it took me so much work to get here that I am actually in bliss all the time. I know this sounds weird... but I know a lot of other people like this. If you ask them about medical school, they will describe it just like I have.

The (sort of) Bad

The second group of people are those that like medicine just fine, and it came to it as a reasonable choice. They worked hard in undergrad, and are all around strong academic students. To them, medicine is more of "a good field to be in" but not "the most amazing and only possible career on the planet." They could have been attorneys or engineers or business entrepreneurs or stock brokers and would have been just as happy. They do well academically, but are a bit blase about medicine... often eager to get home, eager to skip extra discussion about a disease or patient, and tend to be a bit frustrated with the rigmarole that comes with medicine. This doesn't make them less of a physician, but they do not enjoy the ride of med school as much as the first group. They are "putting up" with med school... and looking forward to getting out so they can have a family, a paycheck and a steady schedule.

The Ugly

The third group are the Miserablites. They hate medical school. They are barely hanging on by a thread academically, and they are socially and academically absent. They are caught up in the idea that that are in the wrong spot. They've realized that medicine is a lifestyle that doesn't end after medical school... and they expect that stress and academic/hospital nonsense will be a theme in their lives forever.

Some miserablites ended up in medical school because of outside influences. They felt pressured to do something "worthwhile.” Their heart wasn't in it... but they either didn't have another readily identifiable passion, or they felt their other passion didn't hold enough weight.

Other miserablites came to medical school for the money or lifestyle, and quickly figured out that those reasons are not sufficient to motivate you through the insanity of medical school. And they also figured out too late that being a doctor usually doesn't make you rich. 90% of doctors are not free of financial obligations. Student loans, malpractice insurance, etc. make the life less than glamorous.

The miserablites are those who, as you say regard medical school as "sucking all life out of me, leaving me absolutely passionless, tired and with no ambitions." I can tell you I have NEVER even one day felt this way about medical school.

Search Your Soul!

So, you have a lot of thinking to do. I would really consider what this commitment means, and how it will effect your goals. You have already identified some gut feelings about whether this career is a good match for you. I really think you owe yourself, your wallet, your future family, your happiness and your overall sanity some real hard soul-searching.

If you decide not to go into medicine, there is NO SHAME in that!

There are a million other things you can do which are just as rewarding. And if you do choose medicine as a career, choose it because it is best for you. It is indeed a wonderful life, but only if it is the life you really want.

Good luck!

What do you think? Doctor D always loves hearing your thoughts in the comments.

Patients: Would you care if your doctor enjoyed learning medicine?

Medical Students: Where do you fit in Ella's Taxonomy? Any of your Miserablites want to explain themselves?

Go on over to Ella's blog and admire how awesome she is!