Even though I’ve mentioned several different methods to increase profitability in clinical medicine, the bottom line is that clinical medicine is — for the most part — a bad choice. Here are four really simple reasons why.

1. You’ll put in long hours for way too long.
Ask yourself this simple question: Do I want to be 55 years old and still coming into the hospital at 3 a.m.? If you pick specialties such as surgery, internal medicine, or even family medicine — chances are pretty good that you’ll experience this. Trust me, you’re not going to want to work like this 30 years down the road.

This reminds me of a junior rotation back in medical school. An attending said to me after coming in at 2 am the night before: “It’s just not natural for a man my age to work all night and then to work the whole next day. It’s just not right.”

It won’t be right for you, either.

2. You’ll still be on call.
If you’re in a group practice, you’ll split call with the group. Unless you utilize hospitalists to manage your inpatients, you’ll need to cover call. This goes for just about any clinical specialty (save maybe Dermatology) that you can think of. Do you want to be 55 and still taking call? I didn’t think so.

3. Your best years are “worked up.”
Who wants to work their ass off for thirty years with little “life time?” I don’t see any hands. I don’t blame you, either.

These are your prime years. Think long and hard before you sign your life to the medical devil and wake up one morning overworked, undersexed, and slightly-above-average payed. He’s waiting with that red-hot pitchfork of medical status. Is it worth your best 30 years?

4. More clinicians turn bitter than turn sweet.
No, this isn’t based on some study. This is based on the real deal life experiences of being around these people for too long. I’ve never met a more unhappy bunch than clinical medicine attendings. Do you want to end up like them? I sure as hell didn’t and the door didn’t come close to my ass on the way out.

So, What Now?

• If you’re dead-set on clinical medicine, go into Emergency Medicine. You’ll appreciate a regular schedule.
• If you’re dead-set on clinical medicine, are AOA, and sleep with your attendings so you can honor rotations (dermatology ho’s, you know who you are), go into Dermatology. You’ll have normal hours.
• If you don’t give a shit about clinical medicine, look into Radiology or Pathology. They’re solid choices with nice pay and regular hours (generally speaking).
• If you’re a slacker, never show up to class, skip at least one day a week on rotations, stay hidden, play any type of MMORPG (World of Warcraft, anyone?) or the XBox 360 on a regular basis, hate gunners, and get laid regularly, just keep on doing what you’re doing. You’ll find a way to make it.

www.wikipedia.org: Rather than a generic focus of education, Nurse Practitioners are able to specialize in an area of study they desire (e.g. Pediatrics, Family Practice, Adult, Geriatric, etc.), and provide care within the scope of their expertise. As well, Nurse practitioners in certain states can be “psychiatric clinicians” and perform similar practice (though at a different level) as a psychiatrist would.

Salary.com: Nurse Practitioner salary (25th-75th percentile) is $67,166 – $78,497. Generalist physician salary (25th-75th%) is $115,260 – $152,715.

Wikipedia: According to numerous salary reports throughout the years, CRNAs remain the highest compensated of all nursing specialties. Their average reported annual salary range in 2006, reported by the AMGA Medical Group Compensation and Financial Survey, was $140,396. The mean annual salary for an anesthesiologist in the United States in 2006 was $184,340. [1]

What’s my point? Fair question. First, NP’s have the same scope of practice as any physician. This is clear from my first statement about NP’s specializing. Whatever specialty you want as a physician, there’s an NP that can do the same thing. “But surely not for surgery?!” is the cry of retort. Well I promise you that within the next 10 years, some politician is going to realize that “Hey! PA’s and Surgical Tech’s can pop out gallbladders just as well as a surgeon can!”

Also note the salary differences. Now I can’t find information regarding the various NP specialties, but compare the lowest specialty to the most basic NP, the salaries are comparable, and the highest NP position to the highest (according to MSN.com) paid physician. When you do, you’ll note that physicians do, in fact, win. And NP’s must do 2 years of post bachelors work and one year of work experience (for a total of 3 years) compared to the 4 years post-undergrad for a physician. Big whoop. One year.

Well please note, the average med student graduates with around $200K in debt, while, according to Barry.edu (a school in FL that has both NP and PA programs) the PA program (the more expensive of the two) is $24,810.00 per year. This is roughly equivalent to medical school. However, you’re paying twice as much in med school because you go to school for twice as long. Also, one of the 3 requisite years for NP school is clinical experience. This is a paid job. RN’s make (again, 25th-75th%) $49,479 – $59,114. That means that if a med student and an NP were compared at the same time, 4 years post undergrad, the med student would be out $200,000 (roughly) and the NP would be out $521 (rounding to $25K/yr for both programs, and using the 25th percentile for RN’s). Add the interest on a med school loan, and that puts you at about $600,000 paid back (bc you pay back about 3x what you borrow, esp the financial geniuses that make up our MD population).

Now lets say that no matter what you do, you make $30,000/year more than your equivalent NP. You figure that after 30 years of practice (putting you at the nice comfortable retirement age of 66 for those of us that took the direct route) and you’re up $900K. Worth it, right? Well we haven’t incorporated malpractice insurance. Have you ever heard of anyone suing their NP? I sure as shit haven’t. Factor in 30 years of malpractice insurance bills, and I’ll promise you it brings you right back to even (not to mention that physicians’ salaries are trending down relative to inflation while all nursing salaries are trending up). Couple that with the hours worked by an NP relative to an M.D. and the paperwork/legal hassles handled by an MD that aren’t worried about by NP’s, and the conclusion is obvious.

Do the same thing for the same amount of money, and have a better quality of life. Become an NP.

Time is valuable, and there’s only so much of it in a day. The amount of reading you have to do during medical school won’t change, so in order to salvage more free time to enjoy life, you’ll need to create that time on your own.

One of the ways to create more time and still get the same amount of reading done is to increase your reading speed and comprehension. This is easier said than done, but it is possible. Here’s a tutorial on Overclocking Your Reading Speed. Now that summer is upon us and if you’re not on rotations or studying for Step I, this is the perfect time to get these methods under your belt and start reading more efficiently.

1. Realize that reading is not from beginning to end, but rather point to point.
2. Try using a pacing tool.
3. Get rid of all distractions and possible interruptions.
4. Try to read more than one word at a time.
5. Never move backwards.
6. Think visually.

Check it out.

Hey guys, to all of the bloggers that have dropped links to MSH, I just wanted to say that I really appreciate it. I’ve got some upcoming “Top Links” posts to catch up on and I’m going to make sure you guys get some link love back.

Thanks again.

Currently listening to: DI Vocal Trance
Currently Drinking: Sam Adams Honey Porter

I thought it was time to resurrect some old posts from the early MSH days. Here ya go:

• I’m Your Entourage – A look into the the “round train” and how residents always walk behind attendings medical students walk behind residents. It was the little things like this that really pissed me off about medical school.

• Not On My Time – So much of your time as a medical student is blown. This post outlines just one common example of massive time wastage.

• Medical School Hierarchy – A quick and dirty look into the dreaded hierarchy of medical school from a ward perspective.

And the post that really started it all:

• OB/GYN – I wrote this post while hanging out at a friends house one night and drinking beer. At the time, this post generated a lot of controversy and the link to it was posted across forums and shared via email among students.