Thursday, September 19, 2013

Is medical school worth it?

A woman writes
I came across your blog as I was looking for "doctors with good hours." Here's my situation:

I'm a female currently applying to medical school. Besides the question of "Can I get in?" (which is haunting me right now since my MCAT score of 31 is scaring me...all my friends have gotten interviews but I still haven't heard a thing), I'm wondering if it's even worth it to go to med school.
The biggest things concerning me:
1) The money. I have no idea how I'm going to pay that all back. If I get into my state med school, my estimated cost for tuition is $120,000. If I get into an out of state school, I'm looking at minimum $200,000 for tuition alone. I didn't calculate school fees, test fees, books, transportation, or car payment (I'll probably have to buy a car) into either my state or out of state costs.
2) The inflexibility. I have a boyfriend, we're planning on getting married, and he has his career too. It seems like the next four years + 3 years + ? = uncertainty since I don't know where I'm going to med school, where I'd match, etc, and where he'd work in that meantime.
3) The time. I'd also like a family. I don't know how fair it is to get through med school and residency and then do a part time physician thing. Doesn't seem very smart to me.
My question is, Is there light at the end of the tunnel? Am I just imagining trouble, or is medical life as a physician not worth it? My alternate career is to become a nurse--get my master's in about two years (through an accelerated program), work, and advance upward, maybe to a Nurse Practitioner level.

Thanks for writing.

You have nicely listed some of the major challenges facing most women who are considering medicine as a career.

You are the only person who can decide if medical school is worth it for you, but let's see if we can think it through.

My first instinct is to tell you to carefully reread your email as if it had been written by someone else. After doing so, what is your reaction? After you do that, resume reading my reply.

Not being a woman, I decided to outsource this. One of my daughters who is not a doctor, but has a master's degree in a science, is married and has two children said,

"It sounds like she doesn't really want to be a doctor..."

My wife, who is a nurse, agreed and said nursing is a career that allows you to do the things you wrote about.

Here are three posts I have written about this subject.

I will also ask my Twitter followers to read this and comment. I hope they do.


  1. Nursing is a career that offers many different challenges and opportunities. Let's look at several aspects: the education cost is no where near what a physician's cost (even a doctorate in nursing, while expensive, it is still low compared to the cost of becoming a doctor) and, with some accommodation, a nurse can start her career and then continue pursuing a masters and doctorate. The nursing field is wide open and by that I mean if you start out in OB-GY and discover you don't fit/like it, you can easily change to any specialty you find interesting. As a nurse, you will spend much more time with the patient (if you decide you want bedside or patient contact)than the physician. The choice is yours; you need to take some time to figure out what you really want. Good luck! Retired CCRN

  2. I broadly agree with your response to this but be warned: becoming a nurse isn't 'doctoring without the bother or expense of medical school' and comes with its own very distinct challenges. You need to consider positively what you want from your life and then study for a career that fits with your desires. If you 'settle' for nursing, then you will not make a good nurse and that is no good for you, or for the patients you will be caring for.

  3. One option is Physician Assistant. I am practicing PA and I teach at a PA program and we get more and more personal statements just as yours. It is 2.5 years of school and clinical rotations and you can practice in any sub-specialty you like without having to obtain additional certifications and training. You function as an extension of a physician with as much autonomy as you and your MD agree on. It is a fantastic choice for people that want to practice with some degree of autonomy, but have a better lifestyle than a physician

  4. Thanks for the above three excellent comments. My wife also cautioned that the nursing shortage may be abating somewhat. Some new graduates of nursing schools are not readily finding jobs.

  5. A Twitter follower recommended reading the Mothers in Medicine blog. Here's the link:

  6. I agree that for this applicant, PA school may make more sense: less schooling (and thus less debt), no residency (or match), and it offers more flexibility (and more part-time job opportunities) than would be available to a physician. A PA's practice is similar to a Nurse Practitioner's, but NP school requires at least 1-2 years of experience as an RN (often in an ICU), so it takes a lot longer (and more money) to get through NP school.

    There are trade-offs to being a mid-level provider instead of an MD/DO: PAs are subordinate to a physician, and cannot practice independently. PAs may be first assist in surgery, but will never be the top dog. PA pay is very good, but almost always less than what MDs make.

    I agree that this applicant's letter does not sound like it comes from someone who feels compelled/driven to be a physician. I suspect that anyone who has that many doubts and second-guesses BEFORE starting med school is likely to become overwhelmed with them DURING med school

  7. I think you should ask her what she wants to get out of a medical degree - what she's looking to accomplish in life. If she is getting pushed towards an MD by her parents or by otherwise external motivation such as career prestige, then maybe that is the reason she is focusing on all these drawbacks. The loans are certainly a concern, but if she plans to have a career she'll pay them off in time. The inflexibility is a perception - if she and her boyfriend are flexible, creative and communicate well with their superiors, they'll be able to work out a way to stay together and pursue their respective careers. The time is definitely an issue for childbearing. If you are in a fulfilling and happiness-providing career, you'll be able to be much more present with your children and provide them with an inspiring role model. It's much better than being an unhappy stay-at-home parent or work in a field that doesn't inspire you.

    1. Asya, thanks for commenting. I am hoping the woman who asked the questions will comment on the post and the comments of others. Your last point is a good one.

  8. Mike, thanks for the very pertinent comments. That is sound advice.

  9. Hi!
    I am a part-time pediatrician. There are a few things in your letter that I would like to address.

    1. You were searching for “doctors with good hours.”
    Most people think of good hours as working 8 hours or less at a time, during daylight on weekdays. This is rare in medicine. People get sick at all hours of the night and on weekends. This does not mean that you cannot have a schedule that you find satisfying. I work in an Emergency Department. Despite being awake at night and at work when my husband is home, I have found that the shift schedule means that time with my family is fairly well protected. A hospitalist I know just switched from 12 hour shifts to 24 hour shifts because it works better for her and her family. (The 24/7 nature of medicine impacts the schedules of nurses and midlevel providers as well.)

    2. The investment.
    I financed medical school with loans and I hope to break even on my investment. My husband is also a physician, still in training, and with his own loans. The majority of our monthly income goes towards paying off debt. I have often wondered if we would be better off if I had pursued the midlevel provider route. I mentioned this to a nurse practitioner I work with. “Don’t ever say that,” she reproached me. “I can’t tell you how much I envy the years you spent in residency.” The time spent in medical school and residency is hard but it is not wasted. People often cite the opportunities available to midlevel providers. They can start their careers in pediatrics but move on to adult medicine or surgery if they want to. I may practice in pediatrics only, but the opportunities available to me as a physician are different. Working part time for a few years will not prevent me from going full time, pursuing fellowship or positions of leadership that are only available to physicians.

    3. I don’t know that inflexibility is the right word. Uncertainty, maybe?
    I was nervous about where we would match for residency but it worked out very well. I stressed over the fellowship my husband wanted in a new city but my new job is better for my career than the one I left. My fellow residents were married to navy seals, air force pilots, international business travelers, nurses, physicians, and photographers, to name a few. They all made it work.

    4. There is nothing wrong with working fewer hours than the average doctor if you are doing something awesome with the rest of your time.
    I do not like how much criticism is targeted at young physicians who choose to work fewer hours than others. I do not remember signing on for a specific set of patient care hours when I was accepted into medical school. Further, this criticism spares those who cut back on clinical time to move into the business side of medicine, run for political office, write novels, chat on TV, consult with EMR companies or build a social media presence. I am building a career that I love. It happens to involve spending time with two amazing kids while they are young and it is fantastic.

    If I were you, I would make certain that your career has to be in health care. If it does, spend as much time as you can getting a real sense of what different health care careers are available. If it has to be medical school, pursue it and build a career that suits you.

  10. Dr. Katie, thanks for the perspective from someone who has been there. It's interesting that you "hope to break even" on your investment but still think it's worth it for the other reasons you cited. I guess it depends on how one defines "worth."

    1. I sort of glossed over it since my comment was already long but, since you mentioned it, I have more to say about the financial side of things.

      1. If I work the same number of hours with the same compensation and cost of living that I currently do for 35 years and my alternative career was nursing, which would have required additional training and student loans after college as my school did not have a nursing program, and I consider residency compensation for hours worked (and generously credit myself with exactly 80 hours per week for 3 years) I will end up netting slightly more financially.
      2. If I increase my hours and involvement as my kids get older, I will see more return on investment. This is my plan but plans do change.
      3. If I listen to those who preach doom and gloom for physician compensation in the age of Obamacare, I get really depressed.

      You are also correct in that I do place quite a bit of value on the non-financial aspects of being a physician.

    2. Dr. Katie, thank you again. I agree with your third point. Regarding the woman who asked the questions, her tone suggests that she might not be as committed as you are. If that is so, the financial implications plus the work-life issues might equal a bad outcome if she chooses med school.

  11. I'm a OMS1 and I can tell you that if you are wavering, don't do it. The workload is too high to throw in a case of the "woulda coulda shouldas".

    Also, if you measure "worth" in dollars, don't do it. You will never feel that you get paid what your worth (and that applies to most careers).

    I have an engineering degree, spent time in the army, taught high school and a couple of other things before I took the plunge. There is nothing wrong with doing something else first. I think my non-traditional classmates would agree with me. There is a certain peace that comes with knowing what color the grass is in all the other pastures.

  12. Ryan, thanks for the very useful comments. I hope the woman who wrote in is keeping up with what has been added.